Amyotrophic lateral sclerosis (ALS) is a progressive disease that causes the loss of motor neurons in the spinal cord and brainstem, leading to muscle weakness and atrophy. Risk factors include autoimmune, oxidative stress, smoking, and free radical damage. As motor neurons die, the muscles they control weaken and waste away. Currently, there is no cure and treatment focuses on managing symptoms to maintain function and quality of life for as long as possible. Nursing care involves managing mobility, communication, swallowing, and breathing impairments through exercise, nutrition support, respiratory treatments, and education to support patients and their families.

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Amyotrophic Lateral Sclerosis (ALS)
Nursing Care Plan and Management
Definition
Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there
is a loss of motor neurons (nerve cells controlling muscles) in the anterior horns
of the spinal cord and the motor nuclei of the lower brain stem.
It is often referred to as Lou Gehrig’s disease.
Risk Factors
Autoimmune
Free radical damage
Oxidative stress
Cigarette smoking
Pathophysiology
As motor neuron cells die, the muscle fibers that they supply undergo atrophic
changes. Neuronal degeneration 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.

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Assessment/Clinical Manifestations/Signs and Symptoms
The signs and symptoms presented depend on the location of the affected neuron.
Generally, the following presentations are evident:
Fatigue
Progressive muscle weakness
Cramps
Twitching
Incoordination
Anterior horns
Progressive weakness
Muscle atrophy (arms, trunk, legs)
Spasticity
Brisk or overreactive muscle reflexes
Cranial nerves
Muscle weakness
Difficulty talking
Difficulty swallowing
Difficulty breathing
Soft palate and upper esophageal weakness
Weakness on the posterior tongue
Bulbar muscles
Progressive difficulty in speaking
Difficulty in swallowing
Articulation and speech effects
Compromised respiratory function
Diagnostic Tests
The following tests and assessment tools are used to verify the presence of Amyotrophic
Lateral Sclerosis:
EMG studies of affected muscles indicate reduction in the number of functioning
motor units
MRI may show high signal intensity in the corticospinal tracts

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Medical Management
No specific therapy 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.
Symptomatic treatment and rehabilitative measures are employed to support the
patient and improve the quality of life.
Baclofen (Lioresal), dantrolene sodium (Dantrium), or diazepam (Valium) may be
useful for patients troubled by spasticity, which causes pain and interferes with
self-care.
A patient experiencing problems with aspiration and swallowing may require
enteral feeding.
Mechanical ventilation (using negative-pressure ventilators) is an option if
alveolar hypoventilation develops.
Patients are encouraged to complete an advance directive or “living will” to
preserve their autonomy in decision making.
Nursing Diagnosis
Impaired mobility related to muscle wasting, weakness, and spasticity
Impaired communication related to impairment of the muscles of speech
High risk for aspiration related to impaired muscles of swallowing
Ineffective breathing pattern related to impaired muscles of breathing
Nursing Management
1. Provide intellectual stimulating activities, because the client typically experiences
no 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 the poor
prognosis and the grieving process
5. Provide referrals.
6. Maximize functional abilities
o Prevent complications of immobility
o Promote self-care
o Maximize effective communication
7. Ensure adequate nutrition
8. Prevent respiratory complications
o Promote measures to maintain adequate airway

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o Promote measures to enhance gas exchange, such as oxygen therapy and
ventilator assistance.
o Promote measures to prevent respiratory infection