Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide • (CK Level) Creatnine Kinase: Elevated in muscle atrophy o EMG: Nerve conduction study shows slowed nerve impulses to muscles o Serial muscle testing and muscle biopsy: Shows signs of atrophy to muscle fibers Nursing diagnosis for amyotrophic lateral sclerosis (ALS): • Impaired spontaneous ventilation related to respiratory muscle weakness/paralysis • Ineffective airway clearance related to impaired swallowing and coughing • Risk for aspiration related to impaired swallowing • Impaired verbal communication related to impaired speech muscles • Impaired physical activity related to muscle fatigue or paralysis of extremities • Risk for falls related to immobility, secondary to muscle weakness/paralysis • Risk for skin breakdown related to immobility • Knowledge deficit related to disease process and progression of disease Nursing interventions for amyotrophic lateral sclerosis (ALS): • Monitor respiratory status frequently and closely: breath sounds, effort, and 02 saturations • Be prepared to assist with intubation if necessary; have rescue equipment close by • Assist with chest physiotherapy, suction as needed, and encourage coughing • Turn patient every two hours to facilitate drainage of secretions • Check arterial blood gases • Elevate head of bed • Monitor ability to swallow • Give supportive medications per MD order: o Antispasmodics (Valium, Dantrium): Keeps muscles relaxed to reduce muscle fatigue o Riluzole (Rilutek): Slows the progression of the disease; side effect of liver failure • Refer to speech therapy and dietary therapy for appropriate diet; patient may need TPN as disease progresses • Teach alternate methods of communication, such as eye blinks or finger taps • Encourage frequent rest and pace activities to conserve energy • May need referral to hospice if disease is in advanced stages • Patient and family teaching regarding disease process, comfort measures, assistance with ADLs, legal matters, and home safety Review laboratory reports: o

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