Nursing Care for Individuals with ALS

Nursing Care	Details	Nursing diagnoses	Reasoning
1. Assessing muscle weakness	- Assess motor strength; presence of flaccidity or spasticity - Assess presence of contracture	- Potential for injury related to impaired physical mobility - Knowledge deficit regarding prevention of injury while promoting mobility and self-care	A nurse wants to promote daily activity and exercise as tolerated for the individual. This hopes to strengthen unaffected muscle groups without fatiguing affected muscles. ROM exercises can help prevent contracture and pain in joints.
2. Assessing skin status	- Assess skin daily, especially areas susceptible to breakdown - Change patient’s body position every two hours	- Alteration in comfort - Risk for skin integrity	As the patient’s mobility becomes limited, nurses want to maintain skin integrity by changing body position as much as needed, in order to prevent decubitis ulcers.
3. Assessing Urinary function	- Assess urination pattern and patterns of fluid intake - Assess ability to transfer to toilet or commode, or standing ability of a male - Assess for signs and symptoms of UTI	- Impaired urinary function related to progressive loss of mobility	Nurses need to encourage daily fluid intake of 2500 cc’s per day unless contraindicated because of swallowing ability. Staying on top of UTI’s is important to the patient’s comfort and health.
4. Assessing altered bowel function	- Assess bowel pattern (for constipation, diarrhea, impaction) - Assess diet, fluid intake, and swallowing ability - Assess activity level	- Impaired bowel elimination - Progressive loss of mobility - Progressive decline of dietary fiber - Often mild/moderate dehydration - Progressive inability of the trunk muscles to support a normal posture to assist in defaction	Nursing care is focused on preventative measures for bowel dysfunction, like administering stool softeners and promoting fluid intake. Having a daily record of bowel movements is important to identify regular patterns. Providing dietary regarding the importance of fiber, unless contraindicated because of swallowing ability.
5. Assessing nutritional needs	- Measuring height, pre-morbid “usual weight”, current weight, weight gain/loss pattern since onset of disease, and “ideal body weight” - Lab test indicated if patienthas lost 10% or more of body weight in last two months - Assess hydration status by carefully recording intake and output and by test of urine specific gravity	- Risk of inadequate nutritional intake	Being aware of the patient’s previous nutritional status and weight is important in comparing it to their current or progressing states of nutrition, in order to maintain adequate nutritional intake and have goals to put in place for the patient.
6. Assessing dysphagia and management of nutrition	- Assess gag, cough and swallowing reflexes, and chewing - Assess patient’s ability to swallow liquids and solids - Assess weight serially	- Potential for injury - Impaired nutritional status - Knowledge deficit regarding alternatives for diet, food preparation, and alternative procedures for supplemental feeding	Discussing techniques of protecting airway, i.e. sitting up straight, putting chin on chest while swallowing, concentrating while eating,are good preventative measures to keep patient involved and aware of their risk of dysphagia.
7. Assessing respiratory function	- Gather history of subjective symptoms, like SOB in relation to positional changes, fatigue - Assess changes from baseline respiratory rate, depth, pattern, chest expansion - Auscultate decreased breath sounds, presence of extra or adventitious sounds	- Ineffective airway clearances related to impaired/ absence gag reflex, swallowing reflex, or cough/sneeze reflex - Impaired gas exchange related to aspiration secondary to impaired/ absent gag, swallowing, or coughing reflex - Knowledge deficit regarding airway clearance and gas exchange; considerations regarding mechanical life supports	Nurse’s primary goals are maintaining airway patency by using an aspirator to suction secretions and prevent choking, and use of medications. Also maintaining adequate ventilation by cough and deep breathing exercises with an incentive spirometer to encourage lung expansion, using oxygen when ordered.
8. Assessing ability to communicate	- Assess volume and clarity of speech - Assess ability to communicate needs to family/significant others	- Impaired verbal communication related to altered volume of speech, altered clarity of speech, or loss of speech.	Nurses can refer to a speech pathologist for evaluation and intervention.
9. Assessing the patient’s psychological adaptations	- Evaluate the patient and family’s support systems and coping patterns with awareness that with ongoing loss of independence, there will be ongoing grieving by patient and family.	- Ineffective coping strategies - Knowledge deficit regarding alternatives for mobility and comfort - Impaired support system	Nurses need to provide an accepting environment in which the patient and family can share concerns and fears with each other and members of the health care team. Nurses need to help the patient and family anticipate care needs and implications.

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