Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

Speak slow and loud so that the client can understand speech

Encourage the client to write questions on a white erase board

Use pre-arranged eye signais because eye muscles remain intact

Have the client squeeze the nurse's hand when intubated and on the ventilator

Answer and Explanation

The Correct Answer is C

A. Speak slow and loud so that the client can understand speech:

While speaking slowly and clearly may help with communication in some patients with ALS, this approach is less effective as the disease progresses. As ALS advances, speech muscles become affected, and the client may be unable to speak at all, making this method inappropriate for end-stage ALS. Simply speaking louder does not address the communication needs of a client who can no longer use their voice.

B. Encourage the client to write questions on a white erase board:

While writing on a whiteboard may be an effective communication strategy in the early stages of ALS when the client still has adequate hand function, this becomes increasingly difficult as muscle weakness progresses. By the end-stage, clients may lose the ability to hold a pen or write legibly, making this method less viable as the disease advances. It is not the best option for clients with significant motor impairment.

C. Use pre-arranged eye signals because eye muscles remain intact: In clients with end-stage amyotrophic lateral sclerosis (ALS), muscle weakness and loss of voluntary control progressively affect motor functions, including the ability to speak, write, and move. However, the eye muscles are typically preserved until the later stages of the disease, allowing patients to communicate through eye movements. Pre-arranged eye signals, such as blinking for "yes" or "no" or using a system of eye movements to select letters or words, are effective ways to facilitate communication with clients who can no longer speak or write. This method respects the client's remaining abilities and allows for more effective communication, especially as the disease progresses to its final stages.

D. Have the client squeeze the nurse's hand when intubated and on the ventilator:

When a client is intubated and on a ventilator, their ability to squeeze the nurse's hand may be limited due to the sedation and ventilator settings, and they may not have sufficient motor control to respond consistently. Additionally, when intubated, respiratory effort is controlled by the ventilator, so relying on hand squeezing would not be an effective or reliable method of communication. Furthermore, ALS patients in the later stages may not have enough muscle control for this method to be practical.

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Correct Answer is B

Explanation

Explanation of each option:

A. Respiratory rate of 10 breaths per minute:
A respiratory rate of 10 breaths per minute would be too slow in a patient with ARDS and hypoxemia. In response to hypoxemia, the body typically increases the respiratory rate to improve oxygenation. A respiratory rate of 10 breaths per minute would not be expected in this situation.

B. Respiratory rate of 32 breaths per minute: The arterial blood gas (ABG) results indicate respiratory alkalosis with hypoxemia, which is a common finding in patients with acute respiratory distress syndrome (ARDS). pH 7.59: This is alkalotic, meaning the body is experiencing respiratory alkalosis.

PaCO2 29 mmHg: The PaCO2 is low, indicating hyperventilation, which is a compensatory response to the alkalosis in an attempt to reduce carbon dioxide levels.

PaO2 55 mmHg: This is severely low, indicating hypoxemia (low oxygen levels in the blood), a hallmark of ARDS. HCO3 22 mEq/L: The bicarbonate is normal, suggesting that the metabolic component has not yet compensated for the respiratory alkalosis, or that it is in the early stages of compensation. Given these ABG results, the body is attempting to compensate for hypoxemia by increasing respiratory rate (tachypnea), which leads to hyperventilation and further reduction in PaCO2. Therefore, an expected assessment finding in this scenario would be a high respiratory rate (such as 32 breaths per minute), which is a compensatory response to hypoxemia.

C. Blood pressure 86/42 mmHg:
While hypotension can occur in severe cases of ARDS due to impaired oxygenation and circulation, it is not directly reflected by the ABG results provided. Hypoxemia and alkalosis would more likely lead to tachypnea and compensatory mechanisms like tachycardia, rather than significant hypotension unless there is another contributing factor, such as shock or sepsis. Therefore, hypotension is not the most expected finding based on these ABGs.

D. Heart rate of 45 beats per minute:
A heart rate of 45 beats per minute is bradycardic, which would be unusual in a patient with hypoxemia and respiratory alkalosis. Tachycardia is a more common compensatory response to hypoxia, as the heart works harder to improve oxygen delivery to tissues. A heart rate of 45 beats per minute would be more suggestive of a different underlying condition, such as vagal stimulation or cardiac conduction issues, but it is not the expected response in this case.

A. reports taking an extra dose each day of their anticholinesterase medication. B. is experiencing a respiratory infection and is short of breath. C. has a family history of autoimmune disorders. D. has a past medical history of type 2 diabetes mellitus.

Correct Answer is A

Explanation

A. "Reports taking an extra dose each day of their anticholinesterase medication."
This client is at highest risk for developing a cholinergic crisis. A cholinergic crisis occurs when there is overdose or excessive stimulation of acetylcholine receptors due to too much anticholinesterase medication. Symptoms include muscle weakness, respiratory distress, salivation, sweating, and bradycardia. Taking an extra dose of the medication can result in an overdose of acetylcholine, triggering these symptoms. Therefore, this client is at the greatest risk for a cholinergic crisis.

B. "Is experiencing a respiratory infection and is short of breath."
While respiratory infections can worsen symptoms of myasthenia gravis due to increased muscle weakness, this client is not directly at risk for a cholinergic crisis. Respiratory infections can increase the risk of myasthenic crisis, which is a different complication where muscle weakness worsens to the point of respiratory failure. A myasthenic crisis is caused by insufficient anticholinesterase medication or a disease exacerbation, not an overdose.

C. "Has a family history of autoimmune disorders."
A family history of autoimmune disorders may suggest a genetic predisposition to autoimmune diseases, but it does not increase the risk of a cholinergic crisis specifically. The risk of a cholinergic crisis is more directly related to medication management, not family history.

D. "Has a past medical history of type 2 diabetes mellitus."
Type 2 diabetes mellitus does not directly increase the risk of a cholinergic crisis. While diabetes may influence overall health and immune function, it does not have a direct impact on anticholinesterase therapy or the risk of cholinergic crisis in myasthenia gravis.

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Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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