Amyotrophic Lateral Sclerosis ALS NCLEX Review Care Plans
Nursing Study Guide: Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a disease that involves the nervous system and primarily manifests as loss of control of the muscles.
This progressive disease usually starts with slurred speech, weak extremities, and/or muscle twitching. ALS can severely affect the quality of life of patients, especially when it begins to affect the muscular control for eating, speaking, moving, or even breathing.
The cause is unknown, although some medicine experts believe that it is a genetic disorder.
Currently there is no cure for ALS, so treatment is focused on the control of its symptoms in order to maintain the optimal quality of life for patients.
The average life span of an ALS patient in 3-5 years after the symptoms begins, although some patients live for 10 years or more.
Signs and Symptoms of ALS
- Muscle twitching, an/or cramping, usually found in the shoulders, arms, and tongue
- Slurred speech
- Trouble swallowing
- Muscular weakness of the extremities
- Recurrent falls
- Progressive difficulty doing normal daily activities
- Mood, cognitive, and behavioral changes
Causes and Risk Factors of ALS
The root cause of ALS is still unknown. It involves the gradual deterioration of the neurons that control the voluntary muscles. Eventually, these nerve cells die, causing severe loss of muscle control as the messages from these damaged neurons are unable to reach the muscles.
One of the biggest risk factors for ALS is heredity, as 5 to 10% of the people who have ALS have inherited it. The risk also increased with age, particularly above 40 years old. Genetic variations might also put a person at higher risk for developing ALS. Smoking, lead exposure, and military service seemed to have some effect in the development of ALS.
Complications of ALS
- Respiratory Failure. ALS eventually causes paralysis of the muscles that are used for breathing. Assistive breathing devices such as bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP) may be given to enable the patient to breathe as normal while sleeping. Advanced stages of ALS may require a tracheostomy to breathe better. Respiratory failure is the most common cause of death for ALS patients.
- Malnutrition and dehydration. Difficulty of swallowing can affect the nourishment and hydration of an ALS patient. They are also at higher risk for aspiration pneumonia because of swallowing problems. Feeding tube devices may be needed to provide nutrition and hydration to an advanced ALS patient.
- Dementia. Memory problems and decision-making difficulties may be present in patients with ALS. This can eventually progress to frontotemporal dementia.
- Trouble speaking. Slurred speech is one of the symptoms of ALS. This begins as a mild and occasional trouble speaking, but gradually becomes more apparent and frequent. Communication devices are helpful to understand ALS patients better.
Diagnosis of ALS
- Electromyogram (EMG) – to compare for the electrical activity of muscles at rest versus during muscular contraction by inserting a needle electrode into the skin
- Nerve conduction study – to measure the ability of the nerves in sending impulses to the muscles of the extremities and other parts of the body
- Blood and urine tests – to rule out other possible causes of the signs and symptoms
- MRI – to visualize the brain and the spinal cord
- Lumbar puncture also called a spinal tap – to analyze a sample of the spinal fluids
- Muscle biopsy – to rule out any muscular disease that may have similar symptoms of ALS
Treatment of ALS
- Medications. Riluzole (Rilutek) is an FDA-approved oral medication that can increase the life expectancy of an ALS patient by 3 to 6 months. The main side effects of this drug involve liver function and gastrointestinal conditions. The other drug is Edravone (Radicava), which helps the ALS patient slow down the decline in daily functioning. The patient takes this medication on a daily basis for two weeks and lasts for one month. Other medications can be prescribed to relieve the symptoms of ALS, such as constipation, depression, sleeping problems, and muscle cramps and pain.
- Therapies. Patients with ALS will benefit from respiratory therapy to manage difficulty of breathing, physical therapy for optimal mobility, speech therapy to have improved communication, and occupational therapy to teach them how to manage their activities of daily living. Nutritional, social, and psychological support are also extremely important in the holistic care of ALS.
Nursing Care Plans for ALS
- Nursing Diagnosis: Deficient Knowledge related to new diagnosis of ALS as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of ALS and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)||To address the patient’s cognition and mental status towards the new diagnosis of ALS and to help the patient overcome blocks to learning.|
|Explain what ALS is, and how it affects the body. Avoid using medical jargons and explain in layman’s terms.||To provide information on ALS and its pathophysiology in the simplest way possible.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to promote sodium and water resorption, to reduce potassium levels, and to manage symptoms of ALS, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. The two known ALS medications are Riluzole and Evradone, while the physician may prescribe several supportive medications for symptom relief.|
|Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can help in the management of ALS.||To assist the patient managing nutrition, diet, and exercise as related to the care and management of ALS.|
- Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake secondary to ALS, as evidenced by weight loss, poor muscle tone, swallowing difficulty, and lack of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices that are easy to swallow.||ALS patients often require nutritional support because the nerve cells that control the muscles for swallowing are progressively getting damaged. Foods that are easy to swallow are recommended for ALS patients.|
|Prepare the patient for feeding tube insertion as prescribed.||To provide nutritional support if swallowing is too difficult for the patient.|
|Refer the patient to the dietitian and the speech and language therapist.||Dietitian: To provide a more specialized care for the patient in terms of nutrition and diet. Speech and Language Therapist (SALT): To accurately assess the swallowing and communication difficulties of the ALS patient.|
Other Nursing Diagnoses:
- Ineffective Airway Clearance
- Risk for Impaired Physical Mobility
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Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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