Module1_ALS and MS GRID.pdf

AMYOTROPHIC LATERAL SCLEROSIS (ALS) & MULTIPLE SCLEROSIS (MS) Patho Cause Disease Course & Expected Findings Amyotrophic Lateral Sclerosis (ALS) • Chronic, Progressive, Neurodegenerative • NO CURE • Autoimmune disease? NO • Fatal? YES • Targets the CNS & Brain • Loss of voluntary movement control,...

AMYOTROPHIC LATERAL SCLEROSIS (ALS) & MULTIPLE SCLEROSIS (MS) Patho Cause Disease Course & Expected Findings Amyotrophic Lateral Sclerosis (ALS) • Chronic, Progressive, Neurodegenerative • NO CURE • Autoimmune disease? NO • Fatal? YES • Targets the CNS & Brain • Loss of voluntary movement control, weakness, (spasticity & flacidity) • Patients suffer from lack of physical ability • Also called Lou Gehrig’s Disease Multiple Sclerosis • Chronic, progressive, neurodegenerative • NO CURE • Autoimmune inflammatory disease? YES • Fatal? NO • Targets the brain & spinal cord (myelin sheath) • Demyelination of white matter leads to decreased flow of nerve impulses. • Patients suffer with more cognitive dysfunction than with ALS • Sx worse in extreme heat & cold, stress, infection fatigue, pregnancy • Remissions & Exacerbations Unknown (genetic, environmental?) Uncommon disease. Most die within 3-5 years when symptoms first start. Only about 10% of people with ALS survive for 10 or more years. Causes progressive muscle weakness and wasting. Clients lose the ability to speak, eat, move, and eventually breathe (paralysis of respiratory muscles). • Fatigue • Muscle atrophy (wasting away, including tongue) & Muscle weakness followed by spasticity and hyperactive reflexes • Twitching (fasciculations) of face and tongue • Dysarthria (uncoordinated or slurred speech) • Dysphagia (difficulty swallowing) • Stiff and clumsy gait Unknown No cure, progressive in severity. Over time, may progress to tetraplegia. Normal life expectancy. • Fatigue • Muscle spasticity • Blurred or double vision (diplopia) • Scotomas (patches of blindness in peripheral vision) • Uhthoff’s sign (temp bad vision commonly seen just after exertion or when they are exposed to heat) • Nystagmus, tinnitus • Pain or Paresthesia • Hypoalgesia ( sensitivity to pain) • Areflexic (flaccid) or spastic bladder •  sexual function • Intention tremors (when performing activity) • Gait changes NUR3225 Module 1: Neurological Updated 12/27/2021 MR 1 Risk Factors Labs & Diagnostics Meds Amyotrophic Lateral Sclerosis (ALS) • Abnormal reflexes More common in men, 40-60yo. Multiple Sclerosis No definitive test to confirm presence Diagnosis based on Medical history Neurological examination Symptoms Lab test to rule out other metabolic conditions ONLY FDA Approved Meds for ALS: • riluzole (Rilutek) – decreases glutamate, less death of brain cells. • Woman x2 greater risk, 20-50yo, often whites of Northern European ancestry • • • • • • • Complications & Nursing Care edaravone (Radicava) – Antioxidant, decreases free radicals & oxidative stress. • Death Anxiety r/t impending progressive loss of function leading to death • • NUR3225 Module 1: Neurological Updated 12/27/2021 MR CSF reveals elevated protein level, slight increase in WBC’s,  IgG MRI →plaques of the brain & spine Evoke potential testing (give stimulation & see if sense is decreased) Interferon beta-1a & beta 1b – Injectables, side effects: Flu-like sx Muscle relaxants – baclofen (avoid stopping abruptly d/t risk for seizure, hallucination, rhabdomyolysis), dantrolene (monitor liver values, AST/ALT), diazepam (Valium) benzodiazepine Medical Marijuana- decreases pain, stiffness, spasticity. (May cause increased cognitive decline & dizziness) Dalfampridine (Ampyra) Improves gait/walking Steroids - Dexamethasone (Decadron) used for relapses, must taper off, increased risk for infection. Assess for sensory & mobility issues Psychosocial support for: apathy, emotional lability, depression 2 Amyotrophic Lateral Sclerosis (ALS) Palliative care for symptom management at end of life – home health, EOL planning Psychosocial support/ Supportive care to promote optimal function Ineffective breathing pattern r/t compromised muscles of respiration Multiple Sclerosis • Encourage fluid intake to prevent UTI • Promote cognitive function • Eye patches for diplopia • Group care & treatments to promote energy conservation. • Exercise & stretching of involved muscles (Avoid fatigue & overheating) • SLP for swallow issues • Safety: assistive devices, skin precautions, rehab support PT/OT • Bowel & Bladder Training o Track voiding schedule o Gradually lengthen voiding schedule o Schedule toileting o Assist with restroom visits o Changes in diet o Medication modification o Pelvic floor exercises Did your patient? • Remain free of infection • Maintain optimal mobility & function • Maintain adequate visual acuity & cognition to function independently. Long, R., Havics, B., Zembillas, M., Kelly, J. & Amundson, M. (2019). Elucidating the end-of-life experience of persons With Amyotrophic Lateral Sclerosis. Holistic Nursing Practice, 33, 3-8. https://doi.org/10.1097/HNP.0000000000000301 Jeffery, D. & Fish, A. (2018). A journey with Amyotrophic Lateral Sclerosis. Journal of Christian Nursing, 35, 152-159. https://doi.org/10.1097/CNJ.0000000000000502 NUR3225 Module 1: Neurological Updated 12/27/2021 MR 3