Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons in the brain and spinal cord, leading to gradual muscle weakness, loss of the ability to control movement, and eventually complete immobility. Patients with ALS face inevitable progressive deterioration of respiratory function, as muscle weakness also involves the respiratory muscles. As the disease progresses, many patients develop respiratory failure, necessitating intervention in the form of long-term mechanical ventilation. Long-term mechanical ventilation can be invasive or non – invasive. Non – invasive ventilation (NIV) uses a mask that covers the nose and/or mouth, allowing the patient breathing support without the need for invasive procedures. Invasive ventilation, on the other hand, involves a tracheotomy and the insertion of a tracheal cannula, providing complete ventilatory support in this way. The decision on the type of mechanical ventilation depends on the stage of the disease, patient preferences, and treatment goals. The aim of this paper is to provide an overview of ALS and the basics of mechanical ventilation. Through the presentation of an advanced case of the disease, the most common nursing diagnoses for patients on long-term mechanical ventilation are described, along with the challenges faced by nurses and healthcare professionals in caring for such patients.