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Nursing Care Plan | NCP Restless Legs Syndrome

Restless legs syndrome is sometimes defined as a movement disorder and sometimes as a sleep disorder, because patients who suffer from it often develop insomnia. It is also known as Ekbom’s syndrome, named for Karl-Axel Ekbom, a Swedish doctor who published a paper about eight patients with RLS in 1945. The oldest description of the disorder, however, was written by Thomas Willis (1621–1675), an English doctor who is considered the father of modern neurology.

Patients with Restless legs syndromeoften find the condition difficult to describe; they may speak of it as an almost irresistible urge to move the legs, usually when they are trying to sleep. The sensations are usually only bothersome but may be painful for some patients. People with RLS may use words like “pins and needles,” “like ants crawling under my skin,” “stinging,” “tugging,” “like an electrical shock,” “burning,” or “creeping” to explain to the doctor what their sensations feel like.

The patient often tries to relieve the uncomfortable feelings by moving the legs or rubbing them. The person may change position in bed or get up and walk around for a few minutes. The unpleasant sensations are usually relieved while the patient is moving around but come back when the patient is trying to rest. Many people have a daily pattern to RLS, with the symptoms worsening at night and going away around daybreak.

It is thought that between 2 and 15 percent of the American population has RLS. Most people have only a mild form of the disorder, but others are severely affected. RLS is more common in adults and often gets worse with age; however, it can occur in children and teenagers. One study of people with severe RLS found that a third of them had their first symptoms before they were twenty; by age fifty they had their sleep disrupted almost every night by the disorder. RLS is thought to affect men and women equally, although some researchers report that it is more common in women.

Nursing Care Plan Signs and Symptoms

Restless legs syndrome has two subtypes, primary RLS, which runs in families; and secondary RLS, which may be caused by iron deficiency, pregnancy, kidney failure, or abnormalities of the nerves in the legs. Restless legs syndrome is not caused by mental disorders or by stress, but it can make them worse or be made worse by them. In some cases RLS is a side effect of certain medications—particularly cold remedies, decongestants, some types of allergy medications, and some drugs given to stop nausea and vomiting.

Several theories have been offered about the cause of RLS but none have been proven. Dr. Ekbom thought that RLS might be caused by slow circulation of the blood in the leg veins. Other suggestions include abnormal levels of neurotransmitters, which are chemicals produced by the brain that transmit impulses from one nerve cell to the next. Neurotransmitters affect muscle movement as well as moods and emotions. In 2007 a group of researchers in Iceland discovered a gene that increases a person’s risk of developing RLS.

The central symptom of Restless legs syndrome is uncomfortable sensations in the legs combined with an urge to move the legs in order to relieve the sensations. About 85 percent of patients with RLS also have periodic leg movements during sleep, and about 90 percent have trouble getting a good night’s sleep. Many of these patients have problems with daytime drowsiness and depression related to loss of sleep.

Nursing Care Plan Diagnosis

There is no laboratory test for Restless legs syndrome. Any imaging tests or other medical tests that are performed are done to rule out other disorders of the muscles or nervous system. The doctor usually bases the diagnosis on the patient’s descriptions of how his or her legs feel and what makes them feel better. There are four criteria that define RLS, listed in 1995 by an international committee:
• The person has a strong urge to move the legs that is impossible to resist. The need to move the legs is combined with uncomfortable sensations in the legs.
• The symptoms become worse when the person is resting or sitting still.
• The symptoms are relieved very quickly when the person starts moving the legs.
• The symptoms are worse at night, especially when the person is lying down.

Nursing Care Plan Treatment

Some patients can be helped without prescription medications by cutting down on beverages containing caffeine (coffee, tea, and cola drinks), limiting their use of alcohol, and getting a healthful amount of physical exercise. Other non-drug treatments include hot baths, massaging the legs, or applying hot or cold packs. Patients who are not helped by these treatments may be given one or more types of drugs to relieve their symptoms. One type of drug works by changing the levels of neurotransmitters in the brain. Other groups of drugs used to treat RLS include tranquilizers, painkillers, and drugs used to treat epilepsy. The doctor may have to try more than one type of medication before finding one that will work for the specific patient. Patients who have RLS because of an iron deficiency in their blood can be given iron supplements.

The prognosis of the disorder depends on the person’s age and whether he or she has the primary form or the secondary form of RLS. Older people are less likely to benefit from treatment. Women who develop RLS during pregnancy often feel better after the baby is born.

Nursing Care Plan Prevention

There is no known way to prevent RLS because the causes of the disorder are not fully understood.

The Future
Genetic research may help scientists to better understand the causes of RLS and then develop a treatment that will work for everyone with the disorder.
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