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A nurse is caring for a client who has amyotrophic lateral sclerosis (ALS) and is being admitted to the hospital with pneumonia. Which of the following assessment findings is the nurse’s priority
Increased respiratory secretion
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A client with amyotrophic lateral sclerosis (ALS) tells the nurse, “Sometimes I feel so frustrated. I can’t do anything without help!” This comment best supports which nursing diagnosis?
An SLP is providing services to adults with neurogenic disorders of communication. Of the following clients, which will likely have the most favorable management prognosis? (A) John, who has a brain injury resulting in a slight concussion (B) Jim, who has a traumatic brain injury resulting in paralysis (C) Juan, who has amyotrophic lateral sclerosis (D) Helen, who has Huntington’s chorea
(A) is correct. The disorder is most limited in scope among those mentioned and, therefore, most likely to be amenable to therapy or treatment. (B) is incorrect because the problem described is diffused or dispersed throughout the head with major impairments to the nerves. (C) and (D) are incorrect because the disorders mentioned are progressive in nature.
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ALS: Amyotrophic Lateral Sclerosis
Lou Gehrig’s disease The brain is smart and active, the body cannot move Too much glutamate causes motor neurons to die
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amyotrophic lateral sclerosis (ALS)
a degenerative disease in which patients become progressively weaker until they are completely paralyzed; also known as Lou Gehrig’s disease
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Lou Gehrig’s Disease(Amyotrophic Lateral Sclerosis)
-Neurologically degenerative, rapidly progressive and fatal -Weakness and wasting of muscles that are under voluntary control -No accompanying sensory or cognitive changes -Muscle atrophy results from motor neuron degeneration and sclerosis of the corticospinal tract in the lateral column of the spinal cord Amyotrophy = without muscle nutrition or progressive muscle wasting/atrophy
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ALS – amyotrophic lateral sclerosis (LMN and UMN)
Definition – neurodegenerative disease, rapid progressive muscle wasting eventually resulting in difficulty speaking swallowing and breathing Classification – UMN and LMN disease S&S – starts at hands and cranial nerves and atrophy of the thumb webbing, 75% start in arms or legs Investigations – EMG fibrillations and sharp +ve waves, El Escorial criteria = more than 3 regions of body affected Treatment – riluzole (glutamate receptor antagonist) adds 3/12, BiPAP, gastic tube, multidisciplinary PT and OT Notable – PLS (primary lateral sclerosis) is UMN form and PMA (progressive muscular atrophy) is LMN form of ALS
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The nurse is giving change-of-shift report for four clients in the emergency center and reports the client with the terminal disease has a living will and a “Do not resuscitate” (DNR) order on file. Which client fits the criteria for a terminal illness? A. 2-year-old child with esophageal burns from drinking drain cleaner who now has a gastrostomy tube. B. 76-year-old female client with Alzheimer’s disease who is pacing the halls and trying to “go home”. C. 52-year-old male client who had a partial lobectomy and on a ventilator on the 2 postoperative day. D. 43-year-old male with amyotrophic lateral sclerosis who is refusing artificial nutrition or hydration.
Amyotrophic Lateral Sclerosis (ALS)-
-Describes a group of progressive, degenerative neuromuscular diseases, no remission -Destruction of motor neurons within the spinal cord, brainstem & motor cortex -Rapidly progressive disease with life expectancy of 3-5 years after symptom onset -20-25% of people with ALS experience cognitive changes
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A 51-year-old client with amyotrophic lateral sclerosis (Lou Gehrig’s disease) is admitted to the hospital because his condition is deteriorating. The client tells the nurse that he wants a do-not-resuscitate (DNR) order. The nurse should tell the client that:
The DNR request should be discussed with the physician, who will write the order Rationale: A client may request a DNR order after being given the appropriate information by the physician. Therefore, if a client requests a DNR order the nurse should contact the physician so that the physician may discuss the request with the client. A DNR order should be written, not verbal. The pertinent agency and state guidelines must be followed with regard to when a verbal DNR order is acceptable. Therefore the other options are incorrect.
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