Question

Nursing Concept Map on Amyotrophic lateral sclerosis

1. nursing Diagnosis

2. pathophysuology

3. Subjective data

4. Objective data invluding diagnostic test, and labs

5. Smart Goal within 8 hours of nursing interventions

6. Brief History of the patient, what brought them to the hospital

7. 3 Interventions with Rational

8. 2 Drugs used for ALS with rationals

Answer 1

Amyotrophic Lateral Sclerosis (ALS)

Definition : Amyotrophic Lateral Sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons (nerve cells controlling musles) in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. It is often reffered to as Lou Gehrig's disease.

Risk Factors : Autoimmune, Free radical damage, Oxidative stress and Cigarette smoking.

Pathophysiology : As motor neuron cells die, the muscle fibers that they supply udergo atrophic changes. Neuronal degradation may occur in both the upper and lower motor neuron systems. The leading theory held by researchers is that over excitation of nerve cells by the neurotransmitter glutamate leads to cell injury and neuronal degeneration.

Clinical Manifestations : The signs and symptoms presented depend on the location of the affected neuron. Generally, the followings are evident:

1. Fatigue

2. Progressive muscle weakness

3. Cramps

4. Twitching

5. Incoordination

Anterior horns : Progressive weakness, Muscle atrophy (arms, trunk, legs), Spasticity and Brisk or overreactive muscle reflexes.

Bulbar muscles : Progressive difficulty in speaking, Difficulty in swallowing, Articulation and speech effects and Compromised respiratory function.

Diagnostic Tests : The following tests and assessment tools are used to verify the presence of Amytrophic Lateral Sclerosis:

1. EMG studies of affected muscles indicate reduction in the number of functioning.

2. MRI may show high intensity in the corticospinal tracts.

Medical Management : No specific exists for ALS. The main focus of medical and nursing management is on interventions to maintain or improve function, well-being and quality of life.

1. Symptomatic treatment and rehabilitative measures are employed to support the patient and improve the quality of life.

2. Baclofen (Loresal)), dantrolene sodium (Dantrium), or diazepam (Vallam) may be useful for patients troubled by spasticity, which causes pain and interferes with self-care.

3. A patient experiencing problems with aspiration and swallowing may require enteral feeding.

4. Mechanical ventilation (using negative-pressure ventilation) is an option if alveolar hypoventilation develops.

5. Patients are encouraged to complete an advance directive or "living will" to preserve their autonomy in decision making.

Nursing Diagnosis :

1. Impaired mobility related to muscle wasting, weakness, and spasticity.

2. Impaired communicatioo related to impairment of the muscles of speech.

3. High risk for aspiration related to impaired muscles of swallowing.

4. Ineffectie breathing pattern related to impaired muscles of breathing.

Nursing Management :

1. Provide intellectual stimulating activities, because the client typically experiences noo cognitive deficits and retains mental abilities.

2. Provide client and family teaching.

3. Promote measures to enhance body image.

4. Promote client and family coping as the client and his family deal with poor prognosis and the grieving process.

5. Provide referrals.

6. Ensure adequate nutrition.

7. Promote measures to enhance gas exchange, such as oxygen therapy and ventilator assistance.

8. Promote measures to prevent respiratory infection.

Subjective Data :

The ALS Patient Care Database was created to improve the quality of care for patients with ALS by :

1. Providing neurologists with data to evaluate and improve their practices.

2. Publishing data on temporal trends in the care of patients with ALS, and

3. Developing hypotheses to be tested during formal clinical trials.

Brief History of ALS Patient what brought them to Hospital:

ALS tends to strike in mid-life between the ages of 40 and 60, but others can developthe disease. Men are about one-and-a-half times more likely to have the disease than women. In most cases, it occurs at random with no family history of the disease.

ALS attacks nerve cells and pathways in the brain and spinal cord, causing the body's motor neurons to waste away. The resut is progressive muscle wealness and in coordination, causing difficulty with mobility, speaking, swallowing and breathing.

Proper medication and physical therapy, however, can help control symptoms and allow patients to lead more independent lives.

Potential Therapeutic Drugs :

Riluzole is currently the only FDA-approved drug for the treatment of ALS. Further emphasized potential therapyinvolving the uses of neurotrophic factors such as IGF-I, GDNF, VEGF, ADNF-9, colivelin and angiogenin in the treatment of ALS. Several existing drugs such as talampanel, ceftriaxone, pramipexole, dexpramipexole and arimoclomol potential compounds for the treatment of ALS.