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Restless Leg Syndrome Nursing Guide

This course is intended as a Quick Reference for Restless Leg Syndrome and will cover an overview as well as nursing considerations utilizing the nursing process.

Content reviewed by Ann Dietrich, MD, FAAP, FACEP. 

Restless Leg Syndrome ICD-10 Code 

  • G25.81 - Restless legs syndrome 

Restless Leg Syndrome Etiology and Epidemiology 

Primary restless leg syndrome is idiopathic in nature, though it often presents with a genetic predisposition. Secondary restless leg syndrome can occur secondary to several medical conditions including: 

Certain medications can exacerbate symptoms, such as: 

  • Antinausea drugs 
  • Antipsychotic drugs 
  • Antidepressants that increase serotonin 
  • Antihistamines 

Lifestyle factors like alcohol, nicotine, and caffeine can also trigger symptoms in some individuals. 

Epidemiology of RLS

RLS affects both men and women of all ages, with a higher prevalence in women. The disorder tends to have a familial link, with symptoms often appearing before age 45 in individuals with a genetic predisposition. The likelihood of developing RLS increases with age.  

Restless Leg Syndrome Diagnosis 

The diagnosis of RLS is primarily clinical, based on patient history and symptomatology. A complete physical examination is performed to exclude secondary causes. Key diagnostic criteria include: 

  1. Urge to move the legs, usually accompanied by uncomfortable sensations. 
  2. Symptom onset or worsening during periods of rest or inactivity. 
  3. Partial or complete relief of symptoms with movement. 
  4. Symptoms are worse or only occur in the evening or night. 
  5. Symptoms cannot be attributed to another medical or behavioral condition. 

In patients with a normal physical examination where primary restless leg syndrome is suspected, diagnostic tests may include: 

  • Anemia profile 
  • Complete blood count (CBC) 
  • Complete metabolic panel (CMP) to rule out other causes 

If secondary restless leg syndrome is suspected the diagnostic evaluation will be directed by the suspected condition. 

Management 

Management strategies for RLS focus on symptom relief and improving quality of life. Treatments may include: 

  • Medications: 
    • Iron supplements (if deficient) 
    • Benzodiazepines for sleep 
    • Opioids for severe pain 
    • Anti-seizure drugs and dopaminergic agents 
  • Lifestyle Modifications: 
    • Regular exercise 
    • Avoiding caffeine, nicotine, and alcohol 
    • Good sleep hygiene 
  • Non-Pharmacological Interventions: 
    • Aromatherapy 
    • Sleep sounds 
    • Progressive relaxation techniques 

Secondary restless leg syndrome treatment additionally targets the underlying condition. In pregnant patients the symptoms typically subside a few weeks after delivery. In patients with end-stage renal disease the symptoms are usually worse during hemodialysis. In addition to the lifestyle modifications and non-pharmacologic interventions listed above, management of anxiety and hyperphosphatemia may help. RLS may resolve following renal transplantation. 

Restless Leg Syndrome Nursing Care Plan 

Assessment 

  • Assess signs and symptoms: Pain, anxiety, fatigue, depression, leg sensations, sleep patterns, and lifestyle behaviors. 
  • Evaluate current medications. 

Nursing Diagnoses/Risk For 

  • Disturbed sleep pattern related to leg discomfort during sleep, evidenced by fatigue, lethargy, impaired sleep verbalization, and irritability. 
  • Chronic pain related to leg discomfort, evidenced by verbalization of pain, irritability, and facial grimacing. 
  • Anxiety related to worsening leg discomfort, evidenced by verbalization of anxiety, restlessness, irritability, moodiness, and impaired decision-making. 
  • Risk of constipation related to iron supplementation, evidenced by infrequent or difficult defecation, abdominal pain, and hypoactive bowel sounds. 

Interventions 

  • Provide psychosocial support to the individual and family. 
  • Monitor pain levels and manage as ordered. 
  • Encourage and teach good sleep habits. 
  • Create a calm and restful environment. 
  • Encourage lifestyle behaviors that reduce leg discomfort, such as regular exercise and reducing intake of alcohol and caffeine. 
  • Administer medications as ordered and provide non-pharmacological pain relief measures. 
  • Administer bowel medications and encourage fluid intake. 

Expected Outcomes 

  • The individual will verbalize effective pain management strategies. 
  • The individual will express reduced fears and anxieties. 
  • The individual will report improved sleep quality and duration. 
  • The individual will maintain a regular bowel pattern. 

Individual/Caregiver Education 

  • Explain the condition, treatment options, and expected outcomes. 
  • Discuss side effects of prescribed medications. 
  • Teach non-pharmacological treatments, including good sleep hygiene, physical exercise, and avoiding stimulants. 
  • Advise when to seek medical attention, such as worsening sleep, increased depression or anxiety, concentration difficulties, or lack of bowel movements for four to five days. 
  • Emphasize the importance of regular follow-up with healthcare providers. 

FAQs

Additional Information

Content Release Date 

3/31/2022

References

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