A. Cooksey: ALS Presentation

Hi, everyone.

My name's Alicia Cooksey, and I'm doing my presentation on

amyotrophic lateral sclerosis, also known as a less or Lou

Gehrig's disease, after the baseball player from the 19 twenties

and 19 thirties who had this disease.

Okay, right, And Ailes is a progressive and fatal muscular

disease. Um, it causes a degeneration of motor neurons to

stop sending messages to the muscles, which causes the muscles

to weaken and waste away.

And then it eventually it affects the respiratory muscles, which

causes death within 2 to 5 years.

One suspected cause is too much glutamate, which is a

chemical that's responsible for relaying messages between the motor neurons.

But researchers actually don't know the real cause.

Um, according to the Neurological Disorders Institute from 2000 and

16, it's approximated that 14 to 15,000 Americans have this

disease 5 to 10% inherited from their parents, and most

will die within 3 to 5 years.

Um, Ailes affects persons of all races.

However, white males persons older than 60 those with the

family history are more likely to develop ales.

And there's some studies from the National Institute of Neurological

Disorders that suggest that veterans are two times more likely

to develop a less.

Researchers are looking into environmental toxins.

Pesticides lead as suspects as to why the veterans are

getting a less more than the regular population.

Um, and genetics is another point of research signs and

symptoms. Um, in the beginning, signs and symptoms are pretty

subtle. Um, sometimes muscle twitches, cramps real vague.

Um, sometimes that'll bring people into their primary care, doctor.

Um, and many times it's a ruling out of all

other diseases.

Want to make a diagnosis of, um, and then eventually

the This weakness progresses into weakness, slurred speech and usually

the well, inevitably, the inability to walk, swallow or breathe.

Um, one interesting, uh, trial said that heavier people have

a longer survival rate than those who have a B

M I of less than 18.5.

So probably the only disease were a little extra weight

could benefit you.

Although the disease can strike at any age, it most

commonly strikes people ages 55 to 75.

These people are in the prime of their lives working

supporting families.

Um, sometimes they just maybe made it to retirement.

Finally have some time and money toe do some fun

things, and they're just not prepared for the complete devastation

of this disease.

Um, it's a very expensive disease process.

Um, actually, any disease that needs home health care.

But I spoke Thio unity point, um, companion care service

is and Pekin, Illinois.

And they said that for 24 hour service for one

year, it cost $197,424.

That's just toe.

Have a sienna in your home that doesn't you know,

all the other expenses, Um, that come with this?

Um, And in my 30 years of healthcare, I've had

three private duty, A less patients totally in about three

years. Care for all three of them?

I always say that I won't take another a less

patient because it, to me, is one of the hardest

diseases. Um, it's very, very draining.

It's very devastating to walk with these families through this,

um, all my patients I was with from the very

beginning to the end.

Um, they it was usually about a year and a

half or so that I was with each patient.

Um, I think one of the most difficult things for

me was that they didn't lose any of their cognitive

abilities. Some patients may, but they usually, um, stay sharp.

And they just kind of become entombed in their body.

Um, on I have seen houses mortgaged.

Um ah, lot of family burn out in a lot

of family stress because of this disease process.

Now, let's go to our nursing process.

So first, we're going to start with assessment.

Um, it's really important to get a baseline with these

patients s so we can track the progression of the

disease. We need to watch for their motor strength, skin

integrity, urinary and bowel function, swallowing lung sounds and communication

and do a safety assessment of the home.

We also need to assess their emotional mental health and

the families coping, um, skills and the support needed in

any respite needed.

We need to talk faster here.

Okay. Nursing diagnosis is risk for aspiration.

Um, this is actually while I got hired into my

first, a less patient was just to come in and

spend two hours at each meal for feeding because of

the big aspiration risk.

And it takes a very, very long time for these

guys. Thio thio eat their meals We also need thio

Watch for risk of skin breakdown is they lose weight

as they're incontinent We need Thio watch their skin and

then also be really aware of caregiver strain And I'm

calling in support staff and respite What?

They need it.

Okay, moving on to planning The nurse needs to keep

in mind who their audiences when they're planning care.

Um, it's usually going to be the patient and caregivers

And we need to remember to recognize health, literacy and

of the emotional state, um of everyone when we're teaching

them this.

Alright, interventions aspiration We need to teach about medications to

decrease section or secretions feeding and swallowing techniques Positioning food

consistency Um, communication signals are really important to talk about

before communication is lost and to make sure that everybody

knows about suctioning.

Um, we also need thio skin protection and skin breakdown.

Uh, really telling the family and caregivers how important turning

is and dry and how quickly breakdown can happen.

Um, usually, they're just not aware of that, and I

think they can leave them for a few hours.

And you really have to tell them that you know,

No turning frequently is very, very important.

Um, keeping them dry.

No wrinkles, proper nutrition and safe transfer to prevent the

friction on dhe.

Then caregiver strain.

Um, you can't completely eliminate it.

But if you can teach them about support groups, social

workers that can help with insurance home health agencies to

call in for respite meal delivery and to really let

them know it's okay to get help.

Okay, how do we evaluate this?

Teach back is always important.

Any skills that you have taught, whether it's turning suctioning

feeding, have them teach that back to you.

Make sure as a nurse you having frequent follow up

visits. And also I found really important that you have

a communication log in the home so that everyone's on

the same page.

Um, and that we can so we can give consistent

care. So, in conclusion, this is such a difficult disease

process for everyone involved.

Um, but as a nurse, by giving immaculate care, using

evidence based nursing techniques and really giving great compassion to

everyone involved, we can help, um, ease the burden of

the family and the patient through this disease process.

Uh, here's my references.

And thank you, everyone

A. Cooksey: ALS Presentation

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