Nursing Diagnosis: Mobility Impaired Physical in Patients with Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive neurological disorder that affects the nerve cells responsible for controlling voluntary muscle movement. As the disease progresses, patients may experience impaired physical mobility, which can lead to a range of complications, including constipation, urinary tract infections, and skin breakdown.

A key aspect of managing mobility impairment in ALS patients is promoting good bowel habits. Laxatives may be used to alleviate constipation, but chronic use can be harsh on the bowel. Instead, daily use of stool softeners and fiber supplements like Metamucil are often recommended. Patients should also maintain a diet rich in fiber, including bran cereals, prune juices, and other high-fiber foods.

Monitoring bowel movements is crucial to detect any changes that may indicate constipation or diarrhea. Patients should keep a daily record of their bowel movements, including consistency and amount, particularly if they experience changes in frequency or stool consistency. Unlike patients with neurogenic bowel, those with ALS have slowed bowel motility, which can lead to constipation.

To prevent complications, it is essential to assess diet, fluid intake, and swallowing ability. Patients should aim to consume at least 2,500cc of fluids per day unless contraindicated due to swallowing difficulties. They should also monitor their urination pattern and frequency, as well as any signs or symptoms of urinary tract infection, such as burning sensation during urination, fever, or cloudy urine.

Physical therapists can play a vital role in helping ALS patients maintain mobility and independence. They can develop an exercise program that includes range-of-motion exercises to prevent contracture and pain in joints. These exercises should be performed first actively, then passively if necessary.

In addition to physical therapy, proper positioning is crucial to prevent skin breakdown and decubitus ulcers. Patients should change positions every two hours or as tolerated by their skin. They should also use a wheelchair cushion and reposition regularly to prevent pressure sores. When immobility prevents independent repositioning, an eggshell or circulating mattress may be necessary.

As patients' mobility begins to decline, it is essential to refer them to physical or occupational therapists for assistance with daily activities of living (ADL). These professionals can help patients develop strategies to maintain independence and safety while compensating for declining mobility.

By addressing the complex needs of ALS patients with mobility impairment, healthcare providers can improve their quality of life and reduce the risk of complications. A comprehensive approach that includes diet and fluid management, bowel habit promotion, physical therapy, and proper positioning can help patients maintain their independence and mobility as long as possible.

Nursing diagnosis mobility impaired physical