ALS

How to diagnose ALS

NO definitive test diagnosis based on med history, neuro exam, symptoms, rule out

Tim was diagnosed with amyotrophic lateral sclerosis (ALS). You are a home health nurse who is going to visit him for the first time. As part of this initial visit, you will begin to coordinate care with speech, occupational, respiratory, and physical therapists, as well as a dietitian and a psychologist. Describe the role that each of these professionals will play in Tim's treatment.

Physical and Occupational Therapists • Assess what he can do and his need for specific devices, such as splints or braces. • Assess his safety while standing, walking, or transferring. • Develop a program of exercise to maintain range of motion of his limbs. Speech Therapist • Assess T.H.'s swallowing and cognitive abilities. • Speech therapy will initially focus on teaching techniques to maximize speech clarity. • Later, the focus will be on assisting with alternative communication devices (e.g., note pad, communication board, and computer-based voice synthesizer). Dietitian • The registered dietitian (RD) would perform a complete nutritional assessment and recommend appropriate diet to maintain body weight. • Teach chewing and swallowing strategies to improve swallowing function. Respiratory Therapist • As the ability to breathe declines, the respiratory therapist will focus on ways to help the patient get O2 into the lungs through supplemental O2 and ventilator support. Psychologist • The psychologist can recommend or prescribe antidepressants. • The psychologist or counselor can address concerns that T.H. is a burden to his family, both emotionally and financially. The professional can help him come to grips with the condition and develop solution-oriented strategies for coping.

Tim with ALS asks you, "How will the end probably come for me?" What should you tell him?

The immediate cause of death in most patients with ALS is usually respiratory failure because the respiratory muscles are too weak to breathe. Some patients aspirate and develop pneumonia secondary to the inability to chew and swallow food or fluids.

ALS is a ____ and ____ term fatal disease

chronic, short

Patients with ALS lose ability to

eat, speak, move and eventually breathe

Nursing diagnosis for ALS

ineffective breathing pattern r/t compromised muscles of respiration

ALS leads to the

loss of voluntary muscle movement control and weakness

ALS is more common in

men, 40-60 yr old

ALS patients should receive

palliative care for symptom management at EOL and psychosocial support

ALS patients may have anxiety related to

progressive loss of function leading to death

ALS medications include

riluzole (Rilutek) edaravone (Radicava)

ALS meds slow disease progression to increase

survival time 2-3 months

Cause of ALS

unknown, possibly genetic

ALS destroys

upper neurons in cerebral cortex lower neurons in CNS and PNS that innervate skeletal muscle

Most with ALS will die within

3-5 years after symptoms start 10% live 10+ years

Which of the following actions will support communication among Tim's care providers? Select all that apply. A) Maintaining one central medical record B)Designating the physician as the team leader C)Having open communication among team members D)Holding periodic team conferences to communicate goals E)Inviting Tim and his caregiver to participate in team conferences

A) Maintaining one central medical record C)Having open communication among team members D)Holding periodic team conferences to communicate goals E)Inviting Tim and his caregiver to participate in team conferences

riluzole (Rilutek)

ALS treatment decreases glutamate transport messages between neurons "Calm the cheerleader in the brain" less death of brain cells

Expected findings of ALS

Fatigue muscle atrophy including tongue muscle weakness followed by spasticity and hyperactive reflexes twitching (fasciculations) of face and tongue dysarthria (uncoordinated/slurred speech) dysphagia (difficulty swallowing) stiff & clumsy gait abnormal refexes

edaravone (Radicava)

IV therapy for ALS, antioxidant calms, and protects nerves

ALS is also called

Lou Gehrig's disease