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NUR 315 Milestone Two: Nursing Care Plan for Amyotrophic Lateral Sclerosis
	Amyotrophic Lateral Sclerosis is a progressive neurodegenerative disorder that has a life-altering effect on the motor neurons of the body, resulting in muscle atrophy and the inability to move. The world-famous theoretical physicist Stephen Hawking was diagnosed with ALS at the age of 21 and managed to live more than five decades with the illness. This care plan will focus on managing Hawking's ALS through the PIE (planning, intervention, and evaluation) format. The plan will include setting actionable short—and long-term objectives, defining crucial nursing issues, evaluating an intervention, and assessing overall care plan efficacy in terms of the set standards.
Planning for Care
Short-Term and Long-Term Goals  
	In Stephen Hawking's situation, the immediate objectives concentrate on preserving his quality of life and successfully mitigating the advancement of ALS-related symptoms. The first short-term objective is to enhance respiratory function using a non-invasive mechanical ventilator, such as a BiPAP machine, to attain an oxygen saturation level above 90% during two weeks (Fournier, 2022). This will provide sufficient breathing support and avert hypoxia. The objective is to instruct him in using assistive communication technologies such as it is the case of a speech generating (for example Tobii Dynavox) in order to improve his capacity to engage in at least three significant daily discussions during the next month. 
For long-term goals, the first aim is to prevent complications associated with immobility, such as pressure ulcers, by maintaining skin integrity through a rigorous repositioning schedule every two hours and using specialized pressure-relief mattresses over the next six months. This approach will enhance Stephen's comfort while preventing the development of pressure ulcers (Boddy et al., 2021). The second objective is to control feeding through a Percutaneous Endoscopic Gastrostomy feeding tube (Vudayagiri et al., 2024). This will guarantee that the patient can maintain an acceptable body weight by receiving sufficient caloric intake customized to his metabolic requirements within six months.  
Nursing Concerns and Prioritization  
The critical nursing concerns associated with ALS include respiratory failure, communication barriers, nutritional deficiencies, and risk for skin breakdown due to immobility. Respiratory failure tops the list because the disease progressively affects the muscles used in breathing, which may cause hypoxia and possible respiratory arrest. Other important concerns include communication since it influences Hawking’s interactions with his caregivers and his research (Newell et al., 2022). The next are nutritional deficiencies and skin integrity problems, which are results of immobility and dysphagia. To improve Hawking's quality of life and also to prevent potentially fatal consequences, nursing care should prioritize resolving the previously mentioned issues.
Patient Care Technologies  
	Several technologies have been proven essential in treating Stephen Hawking's ALS symptoms and have been effectively incorporated into his comprehensive treatment plan. Mechanical ventilators (for example BiPAP devices) facilitate respiration as the illness advances, guaranteeing that Stephen's oxygen saturation remains over 90% and averts hypoxia. Speech-generating technologies, such as the Tobii Dynavox, facilitate Stephen's effective communication, enabling his engagement in everyday discussions and ongoing work in physics, thus improving his emotional well-being and social relationships. It is also worth noting that enteral feeding tubes guarantee that Stephen has sufficient nourishment when swallowing is impaired, preserving his body weight and averting malnutrition, which is essential for his general health stability.
Modern monitoring systems should constantly monitor the patient's vital signs and health status. This real-time data enables care providers to intervene and customize their treatment plans accordingly. Telehealth services enable consistent meetings with his multidisciplinary healthcare team, guaranteeing coordinated and thorough treatment (Areia et al., 2022). These solutions facilitate the immediate treatment of ALS symptoms while advancing the long-term objectives of reducing complications. It is expected that integrating these technologies into Stephen's care could successfully extend his life and improve his overall functionality,
Intervention
Nursing Interventions  
	Nursing care for the case of Hawking should involve the management of respiratory function, nutrition, skin integrity maintenance, and communication support. First, there should be a constant assessment of the patient regarding respiratory status to monitor the oxygen level and mechanical ventilation. Nurses are critical in preventing pressure ulcers, so frequent skin assessments and repositioning every two hours are essential. Research proves that repositioning can be very effective for patients, comfort-wise, and overall improvement if done at substantial intervals. Enteral feeding to regain nutritional status is another aspect of nursing care provided to the patients. Research has shown that meeting nutritional needs, especially calorie needs, can strengthen healing and amplify overall health (Trojsi et al., 2020). These nursing interventions are vital in enhancing patient care and preventing complications. Regarding communication, the nurses should help Hawking use his speech-generating device, check whether it is working correctly, and ensure he has access to the equipment all the time. These interventions are closely associated with his goals and objectives and are primarily focused on his quality of life.
Medication Management  
	While several classes of medications are used to manage ALS, and most of them focus on symptom control, only a few of them are actually approved by governmental institutions. Riluzole is the only medication that is approved by the FDA for ALS and is typically administered orally at a dosage of 50 mg twice a day. Regular liver function tests monitor its effectiveness in slowing motor neuron damage to detect potential hepatotoxicity (Masrori & Van Damme, 2020). Antispasmodic drugs, including baclofen (starting at 5 mg three times daily, which may be titrated up based on patient response) and tizanidine (starting at 2 mg three times daily), are used to manage muscle stiffness and spasticity (Cui et al., 2022). These medications require close monitoring for side effects such as drowsiness, hypotension, and even muscle weakness. Usually, dose adjustments are required to balance efficacy and tolerability.
Respiratory drugs such as it is the case of bronchodilators (as it is the case of albuterol) are administered thought inhalation with the purpose of alleviating breathing difficulties. For the proper management of pain, non-opioid analgesics (paracetamol or NSAIDs) are frequently included in the pharmacological plan. Strategies for mitigating expected adverse effects include conducting regular patient assessments, instructing Stephen on identifying negative reactions, and executing prompt interventions like dosage modifications or changes in prescriptions if adverse effects worsen (de Campos et al., 2023). Adhering to the prescribed dosages and also timelines, together with proactive management of adverse effects, will allow these pharmacological agents to effectively alleviate symptoms and reduce additional health complications.
Patient Care Technologies in Health Promotion  
	Patient care technologies play a crucial role in health promotion for ALS patients by enhancing their ability to perform daily activities and manage symptoms. In Hawking's case, using a mechanical ventilator also improved the patient's overall breathing ability, thereby reducing the risk of respiratory complications such as the development of respiratory failure. It was the primary tool for communicating with the rest of the world, crucial for enhancing psychological well-being. Studies indicate that communication technologies can significantly improve well-being by reducing loneliness and enabling affective expression (Smith et al., 2020). The ability to speak helps one to liberate oneself and contribute to an individual's general well-being, particularly within social networks. In addition, technologies were incorporated to manage pressure ulcers, protect skin integrity, and enhance comfort using specialized mattresses and wheelchair cushions. Hence, these technologies do more than build physical strength; they also foster mental and emotional strength by improving overall quality of life.
Patient Care Technologies and Safety  
Patient care technologies are considered to be important when it comes to reducing the number of pharmaceutical mistakes that occur. This is in addition to the fact that they play a part in improving health outcomes. Mechanical ventilation systems provide early alerts for urgent matters such as it is the case of malfunctioning ventilators or insufficient oxygen levels. A study by Haribhai & Mahboobi (2024) found that the implementation of alarm systems in ventilators significantly decreased the incidence of complications related to hypoxia in patients with severe respiratory conditions. Proactive alarm systems provide timely interventions and, in this way, they allow for the prevention of unfavorable outcomes. 
Speech generation technologies are also recognized for their ability to improve patient safety. This is achieved by reducing the probability of miscommunications as Mehta et al. (2022) were able to provide in their research paper. More exactly, their findings support the fact that ALS patients who are able to use SGDs experienced a lower incidence of miscommunication. Consequently, this led to improved precision in the planning of care and the administration of drugs. It is also essential to mention that enteral feeding devices are designed to reduce the likelihood of aspiration and provide precision nutritional delivery, which are critical factors for patients diagnosed with ALS. According to a study conducted by Lin et al. (2022), the incidence of aspiration pneumonia in individuals with digestive difficulties was substantially reduced by the use of enteral feeding tubes.  All the previously mentioned technologies work by being able to identify potential hazards. In turn, this will result in lowered number of adverse events and better outcome for the patients. 
Evaluation
Measures of Success  
	The success of the care plan for the patient will be closely monitored by gathering data on critical aspects of his health, focusing on respiratory function, skin condition, nutrition, and communication abilities. Respiratory function will be assessed through oxygen saturation, which is frequently documented, to target 90% or more. This will be beneficial in confirming whether his type of mechanical ventilation is helpful or not. Daily checks on skin integrity will be conducted to detect pressure ulcers in immobile patients at an early stage. Early detection is crucial in preventing these ulcers, significantly affecting a patient's quality of life. Addressing these issues promptly can avoid complications and help patients lead healthier lives.
           The patient's body weight will also be regularly monitored to ensure proper nutrition. This monitoring will help confirm that they receive enough calories through their feeding tube, ensuring their nutritional needs are being effectively met. This ensures that they do not develop malnutrition and that they are strong enough to go through different activities. Another way that the series' success will be measured is through Hawking's interactions using the specialized communication device (Mehta et al., 2022). This is because analyzing his interactions throughout the day will show whether the device is working appropriately and if modifications are required. The specifics, which encompass aspects such as respiratory health, skin condition, nutrition, and communication, will be used to determine the plan's success in improving Hawking's quality of life.
Evaluation of Plan and Interventions  
	The care plan proposed for Stephen Hawking will lead to positive outcomes based on the identified measures. The services provided, which include respiratory care, nutrition, skin wellness, and communication, are all backed by extensive research. Mechanical ventilation has been proven to increase the life expectancy of ALS patients referring to respiratory support. Likewise, enteral feeding systems are vital in delivering the appropriate nutrients, especially when swallowing is compromised. Such interventions, provided selectively to Hawking, should avert standard troubles connected with ALS, ensuring that he stays stable.
           In addition, communication technologies such as speech-generating devices allow Hawking to stay connected with his environment, reducing isolation. Skin checks and repositioning schedules are also effective ways to avoid pressure ulcers, leading to other complications. Reviewing these factors continuously allows the formulation of corrective measures as early as possible (Boddy et al., 2021). It advocates for adherence to well-researched and generally accepted standards of practice in nursing. Among the key areas where the quality of life or possible health outcomes for Hawking will be significantly improved include respiratory health, nutrition, skincare, and communication interventions. 
Conclusion
	The care plan for Stephen Hawking's amyotrophic lateral sclerosis diagnosis is intended to address important nursing problems, such as it is the case of respiratory failure together with communication obstacles, dietary inadequacies and skin integrity. This strategy aims to assure Hawking's comfort and longevity using evidence- based therapies and advanced patient care technology. It is also worth noting that the mentioned evaluation measures will assist in reviewing the strategy while making sure that the proposed techniques adequately manage his symptomatology and enhance the quality of his life.