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