Nursing Diagnoses for ALS

5 Nursing Diagnoses for ALS:

1. Potential for injury related to impaired physical mobility
• Pt. has decreased muscle use and therefore they are at more risk for pressure ulcers and also injury from falling.
2. Impaired urinary elimination related to progressive loss of mobility and dehydration
• Pt. has decreased swallowing and loss of mobility which leads to them being unable to drink a lot of fluids to produce enough urine, and also the loss of mobility prevents them from walking to the bathroom and being able to urinate by themselves properly. They may need help going to the bathroom as the disease progresses.
3. Impaired nutritional status related to inability to swallow.
• Pt. has impaired muscle use of throat muscles, therefore they have decreasing ability to swallow and eat food properly, putting them at risk for impaired nutritional status as they are not getting enough of different types of foods as the disease progresses.
4. Ineffective airway clearance related to impaired swallowing, gag reflex, and cough.
• Impaired muscles - abdominal, throat - lead to inability to cough and clear secretions in their throat.
5. Impaired verbal communications related to altered volume of speech, altered clarity of speech and loss of speech.
• Muscles of speech (tongue muscles, mouth muscles, throat muscles) are affected by the degenerative disease, which decrease ability of the patient to use those muscles, which causes garbled speech.

Nursing Diagnoses	Goal	Intervention	Outcome
Potential for injured related to impaired physical mobility.	Promotion of activity and exercise. Promotion of proper positioning to prevent decubitus ulcers.	ROM exercises to prevent contracture & pain in joints. Change positions every 2 hours; after each change of position, check for redness over bony prominences.	Patient will be active for as long as they can, and can remain more comfortable so their joints and muscles die slower. Patient will not get pressure ulcers, since they are immobile, by turning them often you prevent skin breakdown.

If you would like more information on the nursing care and management of patient’s with ALS. I would highly suggest going to this website, as it has a lot of useful information on how to care for these patients safely. It not only provides information on what to assess in these patients, but also how to manage these problems that pop up.

Source: 

Association, A. (2014). Nursing Management in ALS. Retrieved from ALS Association: http://www.alsa.org/als-care/resources/publications-videos/factsheets/nursing-management-in-als.html

Nursing Care of Individuals with ALS

There are multiple steps to the nursing care of patients with ALS.

You want to be very receptive when assessing these patients. Below I’ve created a table on what nurses should assess consistently when their patient has ALS.

Nursing Assessment with ALS
What you Assess	Reasoning
Motor strength	Assessing the motor strength consistently can give the patient and physician a good idea of how fast their disease is progressing and to what degree the disease has progressed to. Assess for presence of spasticity or flaccidity also.
Presence of Contracture	This is a disease of the motor neurons. As the motor neurons are unable to send messages down to the muscle cells. You get contractures, from the muscle being unable to relax, especially when the disease has really progressed and you’re in the end stages.
Skin	You want to especially assess areas that are susceptible to breakdown. These patients’ muscles cells are slowly dying (atrophy) and so they will not be moving as much as the disease progresses. It is very important to assess their skin daily, to prevent ulcers from getting worse or showing up.
Urinary Function	You want to assess their urination pattern and patterns of fluid intake. You also want to assess their ability to transfer to the toilet or stand (for males). This will ensure that the patient is safe when walking. If the patient is unable to walk or transfer safely, it can be dangerous, or we could potentially help them with transfer devices that support them (walker, wheelchair).
Bowel Function	You want to assess their bowel pattern for constipation, diarrhea and impaction. The intestines use muscles to push stool through the body and out. Since ALS is a disease of the muscles, and of them not functioning as well as they are supposed to, then the bowel function will also be altered. The patient can experience some diarrhea and mostly constipation (because they have difficulty pushing the stool out of the body).
Swallowing	As ALS progresses, patients have a hard time swallowing, and experience dysphagia (which is difficulty swallowing). This is because swallowing, much like the intestines, is also moved by muscles in the throat/neck. When the muscles progressively die and start deteriorating, they don’t work as well, therefore the patient has more trouble swallowing. It is very important to assess this frequently as this is a progressive disease, and even though the pt. can swallow currently, they may not be able to in a few weeks or so.

If you would like more information on the nursing care and management of patient’s with ALS. I would highly suggest going to this website, as it has a lot of useful information on how to care for these patients safely. It not only provides information on what to assess in these patients, but also how to manage these problems that pop up.

Source: 

Association, A. (2014). Nursing Management in ALS. Retrieved from ALS Association: http://www.alsa.org/als-care/resources/publications-videos/factsheets/nursing-management-in-als.html

Treatment for ALS

Although there is NO CURE for ALS, there is indeed treatment, to slow the progression of the disease and increase mortality/morbidity. I will now go on the list the different kinds of treatment options there are for someone with ALS.

• There is a medication, one medication, for ALS. Rilutek slows down the progression by decreasing amounts of glutamate in the body. Excess levels of Glutamate are a supposed cause for ALS. 
• Other Medications can relieve symptoms of ALS including:
• Muscle cramps & spasms
• Spasticity
• Constipation
• Fatigue
• Excessive Salivation
• Excessive Phlegm
• Pain
• Depression
• Sleep Problems
• Uncontrollable bursts of crying and laughing
• There have been many advances in respiratory treatment now that increase the morbidity of patients diagnosed with ALS. In the past, patients with ALS have had a hard time surviving for long, due to the weakening of their chest muscles, that make it hard for them to breath as time goes on. In fact, the cause of death in patient's with ALS is usually due to a respiratory problem. Now that ventilation, drugs, and treatment have improved, patients can survive for even longer and live better, more comfortable lifestyles, until their time comes.
• There have also been significant improvements in nutritional care. Very aggressive nutritional supplementation and feeding tubes are used to help patients overcome deficiencies, due to their inability to swallow, chew and eat their food. 

All of these treatments do not cure ALS, but they do increase the quality of life for patients living with the disease. I've included a video I found on Youtube of a Physician discussing tips for the treatment of ALS. What I like about this video is the holistic approach that the Physician decides to take with the treatment of ALS. Most physicians just concentrate on a few of the symptoms and the progression of the disease, but this Physician talks about the life of the patient as a whole, and how the disease affects them.

Sources:

Video Source

Clinic, M. (2014). Amyotrophic Lateral Sclerosis. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/basics/treatment/con-20024397

Foundation, A. H. (2012). Treating ALS. Retrieved from ALS Hope Foundation: https://www.alshopefoundation.org/understanding-als/treatment-als.php

Symptoms of ALS

People with ALS are often aware of the signs and symptoms to look out for because most likely someone in their family had experienced the same signs, and it is genetically passed down.

First it starts with muscle weakness in either their arms or legs, or maybe both. For people who don’t realize it’s happening, they think nothing of it, and just think they are being more clumsy than usual.

Picture Source

 The symptoms progress to some twitching or cramping of their muscles, especially those of the hands and feet, leading to impairment of the use of their limbs. They’ll start having symptoms of their respiratory system as the disease starts affecting the motor neurons in their chest muscles. They’ll have difficulty projecting their voice and maybe stumble over their words.

In the advance stages of the disease, the person with ALS will have shortness of breath, which is when the person has difficulty catching a full breath and feels like they aren’t getting enough air. The disease progresses and they eventually have difficulty breathing and swallowing, most people in the end stages of the disease will need a ventilator to help them breathe and maybe a feeding tube or a change in their diet to prevent them from choking on their food.

On the bright side, since ALS only attacks the motor neurons, you still have your sensory skills. You can still feel touch, see, hear, smell, and taste the world just the same as before you had the disease. The only thing that’s changed is your ability to move, breathe, and swallow.

The mean survival time with ALS (or how long it takes the disease to kill you) is about three to five years, but a lot of people survive more than 10 years. The sooner you know the symptoms, the better. There is one drug that slows the progression of ALS, so the sooner you can get on the drug, the more time it can give you with the world. 

Sources:

Association, A. (2010). Symptoms of ALS. Retrieved from ALS Association.

Association, M. D. (2015). Amyotrophic Lateral Sclerosis. Retrieved from Muscular Dystrophy Association: http://mda.org/disease/amyotrophic-lateral-sclerosis/signs-and-symptoms

Picture Source: http://mda.org/sites/default/files/body_motor-neurons.jpg