Medical Surgical ALS #4

Question

A client is in the latter stages of ALS. Which assistance is most associated with the needs of a client at this late stage?

Answers

  1. Leg braces to assist with mobility.
    • Rationale:

      This answer is not correct since leg braces in the ALS client typically are placed to help extremities remain stretched and in a good position in the early stages. In the latter stages of ALS, most voluntary muscles are paralyzed and the client will be immobile.

  2. Lift chair and rising toilet seat to help clients rise from a seated position.
    • Rationale:

      This answer is not correct because in the late stage of ALS, the client will most likely be paralyzed and become bed-bound. Transfering from lift chairs and toilet seats will pose a fall risk in the last stage.

  3. Medications to help the client cope with depression and anxiety.
    • Rationale:

      This answer is not correct because although medications to help clients cope with depression and anxiety with the ALS diagnosis are helpful, it is usually started in the beginning or middle stages of the disease process. ALS clients are at higher risk for depression and anxiety due to the fatal prognosis of the disease.

  4. A feeding tube to provide nutrition and reduce risk of choking or aspiration.
    • Rationale:

      This answer is correct because in the last stage of ALS, speech and swallowing are severely impaired or not possible. A feeding tube will provide adequate nutrition and reduce the risk of aspiration or choking. It also helps with fatigue and is a safer way to administer medications to the client.

Overview

Amyotrophic lateral sclerosis (ALS) is an accelerating neurogenic disease that negatively affects the nerve cells that control voluntary muscles. This leads to muscle atrophy and weakness which eventually causes lack of immobility and inability to speak or swallow.

Explanation

Learning Outcomes

Amyotrophic lateral sclerosis (ALS) is an accelerating neurogenic disease that negatively affects the nerve cells that control voluntary muscles. This leads to muscle atrophy and weakness which eventually causes immobility and the inability to speak or swallow and breath on their own. As this disease progresses, the voluntary muscles become paralyzed. The client will require assistance to breath by a ventilator due to the disease weakening the diaphragm. Most ALS clients die as a result of respiratory failure. The muscles of the mouth and throat are also weakened so speaking and eating become impossible. A feeding tube maintains the client’s weight and nutritional status, as well as reduces the risk of choking or aspiration.

Test Taking Tip

Time is important. Notice “late stage”. There are different needs during different stages of various diseases, especially in ALS. Note time that is indicated in each question.

Video Rationale