A 75-year-old patient with emphysema states "Every year I end up getting admitted to the ICU because of bad breathing problems. I'm really trying to stay out of there this year. Which points are appropriate for the nurse to include in a teaching session? (SELECT ALL THAT APPLY)

A. Encourage the patient to write questions on a white erase board: While writing on a whiteboard can be a helpful method of communication for some patients with ALS, it may not be effective as the disease progresses. In the later stages of ALS, patients often lose the ability to use their hands or arms, making writing impossible.

B. Use pre-arranged eye signals because eye muscles remain intact: In the later stages of ALS, most voluntary muscle function is lost, except for eye muscles. Using eye movements or pre-arranged eye signals (e.g., blinking or moving eyes up or down) is an effective way to communicate with patients who can no longer speak or write. The nurse can establish a system of eye signals to communicate with the patient.

C. Speak slow and repeat phrases due to cognitive decline: ALS typically does not cause cognitive decline. It primarily affects motor function. Speaking slowly and repeating phrases may be helpful if the patient is struggling with speech, but cognitive impairment is not a common symptom in ALS.

D. Have the patient squeeze the nurse's hand when intubated and on the ventilator: When a patient is intubated and on a ventilator, they may not be able to effectively squeeze the nurse's hand due to the presence of a tube in their airway. Additionally, the ability to use hand movements may be lost in advanced ALS, making this method of communication unreliable.

A. Make sure you are rinsing & drying your inhaler holders daily – Proper cleaning of inhaler devices is essential to prevent bacterial contamination, which can lead to respiratory infections and exacerbations of emphysema. This is an important point in client education.

B. Have you contacted social work about long-term care placement? This is not appropriate unless the patient has expressed interest in or a need for long-term care. The patient is seeking ways to stay out of the ICU, not leave home for institutional care, so this response is not supportive or relevant to the patient's current goal.

C. Are you currently getting the influenza vaccine yearly? Annual influenza vaccination is strongly recommended for patients with chronic respiratory diseases such as emphysema. It helps reduce the risk of flu-related complications and hospitalizations.

D. Do you have access to nutritious meals each day?. Good nutrition supports immune function and overall health. Malnutrition can weaken respiratory muscles and the immune system, increasing the risk of exacerbations.

E. Limit your daytime fluid intake if you're using the bathroom too much. Fluid restriction is not routinely recommended for patients with emphysema unless there’s another condition like heart failure requiring it. In fact, adequate hydration can help thin secretions, making them easier to clear from the lungs. Restricting fluids without cause could be harmful.