Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord. This nursing diagnosis focuses on identifying symptoms, managing complications, and providing comprehensive care to improve the quality of life for ALS patients.
Causes (Related to)
ALS can affect patients in various ways, with several factors contributing to its progression and severity:
- Genetic mutations (familial ALS)
- Environmental factors
- Oxidative stress
- Risk factors including:
- Age (typically 40-70 years)
- Family history
- Military service
- Smoking history
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Muscle weakness
- Muscle cramping
- Difficulty speaking or swallowing
- Shortness of breath
- Fatigue
- Depression or anxiety
- Pain in muscles and joints
Objective: (Nurse assesses)
- Progressive muscle weakness
- Muscle atrophy
- Fasciculations
- Dysarthria
- Dysphagia
- Respiratory insufficiency
- Decreased muscle strength
- Impaired mobility
- Weight loss
Expected Outcomes
- Patient will maintain optimal respiratory function
- Patient will demonstrate effective swallowing techniques
- Patient will maintain optimal nutrition status
- Patient will report adequate pain management
- Patient will demonstrate coping mechanisms
- Patient will maintain independence in ADLs as long as possible
- Patient and family will understand disease progression and management
Nursing Assessment
Monitor Respiratory Status
- Assess breathing pattern and rate
- Monitor oxygen saturation
- Evaluate cough strength
- Check for secretions
- Document dyspnea
Evaluate Swallowing Function
- Assess swallowing ability
- Monitor for aspiration risk
- Document dietary modifications
- Track weight changes
- Observe meal times
Assess Mobility Status
- Evaluate muscle strength
- Document range of motion
- Assess transfer abilities
- Monitor fall risk
- Check skin integrity
Monitor Psychological Status
- Assess coping mechanisms
- Screen for depression
- Evaluate support system
- Document communication abilities
- Monitor sleep patterns
Nursing Care Plans
Nursing Care Plan 1: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to progressive neuromuscular weakness as evidenced by decreased muscle strength and difficulty performing ADLs.
Related Factors:
- Progressive motor neuron degeneration
- Muscle weakness and atrophy
- Fatigue
- Pain
Nursing Interventions and Rationales:
- Assess mobility status daily
Rationale: Monitors disease progression and adapts care accordingly - Implement range of motion exercises
Rationale: Maintains joint flexibility and prevents contractures - Provide assistive devices
Rationale: Promotes independence and safety
Desired Outcomes:
- Patient will maintain the optimal level of mobility
- Patient will use assistive devices properly
- Patient will avoid complications of immobility
Nursing Care Plan 2: Risk for Aspiration
Nursing Diagnosis Statement:
Risk for Aspiration related to impaired swallowing mechanism as evidenced by dysphagia and weakened cough reflex.
Related Factors:
- Bulbar muscle weakness
- Impaired swallowing mechanism
- Decreased cough reflex
- Increased secretions
Nursing Interventions and Rationales:
- Position patient upright during meals
Rationale: Reduces aspiration risk - Modify food consistency as needed
Rationale: Promotes safe swallowing - Teach aspiration precautions
Rationale: Prevents complications
Desired Outcomes:
- Patient will maintain safe swallowing
- Patient will remain free from aspiration
- Patient will maintain adequate nutrition
Nursing Care Plan 3: Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to respiratory muscle weakness as evidenced by dyspnea and decreased vital capacity.
Related Factors:
- Respiratory muscle weakness
- Decreased vital capacity
- Fatigue
- Anxiety
Nursing Interventions and Rationales:
- Monitor respiratory status regularly
Rationale: Detects early signs of deterioration - Position for optimal breathing
Rationale: Maximizes respiratory function - Teach energy conservation
Rationale: Reduces respiratory demand
Desired Outcomes:
- Patient will maintain adequate oxygenation
- Patient will demonstrate effective breathing techniques
- Patient will report decreased dyspnea
Nursing Care Plan 4: Risk for Compromised Family Coping
Nursing Diagnosis Statement:
Risk for Compromised Family Coping related to progressive nature of disease as evidenced by expressed feelings of burden and stress.
Related Factors:
- Progressive disease course
- Increasing care demands
- Financial strain
- Emotional burden
Nursing Interventions and Rationales:
- Assess family support system
Rationale: Identifies resources and needs - Provide education about disease progression
Rationale: Helps family prepare for future needs - Connect with support services
Rationale: Reduces caregiver burden
Desired Outcomes:
- Family will demonstrate effective coping strategies
- Family will utilize available resources
- Family will express decreased stress levels
Nursing Care Plan 5: Impaired Verbal Communication
Nursing Diagnosis Statement:
Impaired Verbal Communication related to bulbar muscle weakness as evidenced by dysarthria and difficulty speaking.
Related Factors:
- Bulbar muscle weakness
- Progressive neurological decline
- Fatigue
- Emotional state
Nursing Interventions and Rationales:
- Implement alternative communication methods
Rationale: Maintains ability to communicate needs - Allow adequate time for communication
Rationale: Reduces frustration and anxiety - Involve speech therapy
Rationale: Maximizes communication abilities
Desired Outcomes:
- Patient will effectively communicate needs
- Patient will demonstrate use of alternative communication methods
- Patient will report satisfaction with communication methods
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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