impaired physical mobility related to nursing diagnosis

Impaired physical mobility related to nursing diagnosis manual#
Impaired physical mobility related to nursing diagnosis skin#

Hydration status – determined by careful recording of fluid intake and output and by test of urine specific gravity. Laboratory Test – indicated if patient has lost ten percent or more of body weight in the last two months or weighs fifteen percent or more below “ideal body weight”.ģ. As mobility progresses and/or diet and fluid intake is altered, a more aggressive bowel program may be indicated, daily or every other day.ĭ) Weight gain/loss pattern since onset of diseaseĢ.Mineral oil should not be used because of the danger of aspiration. Laxatives may be used, but chronic use may be harsh on the bowel. Daily use of stool softeners and Metamucil are often recommended.Provide dietary instruction regarding the importance of fiber, use of bran cereals, prune juices, etc., unless contraindicated because of swallowing ability.Encourage patient to keep daily record of bowel movements (include consistency and amount), particularly if there has been change to a more constipated or less frequent stool.Unlike a neurogenic bowel, person with ALS have slowed bowel motility. Management – ideally focused on preventative measures.Progressive inability of the trunk muscles to support a normal posture to assist in defecation.Assess diet, fluid intake, and swallowing ability.Assess bowel pattern (for constipation, diarrhea, impaction.Consult physician if there are signs of urinary tract infection.Encourage daily fluid intake of 2,500cc’s per day unless contraindicated because of swallowing ability.

(urinary tract infections are rare in ALS). Assess for signs and symptoms of urinary tract infection frequency, urgency, painful urination, fever, etc.Assess ability to transfer to toilet or commode, or standing ability for a male.Assess urination pattern and patterns of fluid intake.Proper positioning when ambulating or in a wheelchair, i.e., use of a sling for a weak upper extremity.

Use of a wheelchair cushion to prevent skin breakdown.

Repositioning in the wheelchair based on the patient’s skin tolerance.

prominences, and provide an eggshell or circulating mattress when immobility prevents independent repositioning.After each change of position, check for redness over bone Change positions every two hours, or on skin tolerance. Use as many different positions as possible when in bed.Promotion of proper positioning to prevent decubitus ulcers.

When weakness in the extremities begins to compromise mobility, safety, or independence in ADL, refer to a physical or occupational therapist.

Refer to physical therapist for exercise program and see recommended passive range of motion description in Managing ALS (MALS) Manual II.

Range-of-Motion (ROM) exercises to prevent contracture and pain in joints first Active ROM, then passive.

Encourage continuation of daily routines and activities.

Knowledge deficit regarding prevention of injury while promoting mobility and self-care.

Potential for injury related to impaired physical mobility.

Assess skin daily, especially those areas susceptible to breakdown.

Assess motor strength presence of spasticity of flaccidity.

Impaired physical mobility related to nursing diagnosis skin#

Impaired physical mobility related to nursing diagnosis manual#