The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). What is the nurse's primary focus of care?
1. Respiratory support as the muscles of breathing fail, and managing secretions due to the inability to swallow and communicate
2. Providing gastrostomy feedings as soon as possible to build up muscle mass when motor functions return
3. Pain management and active range-of-motion (ROM) exercises
4. Administering immunosuppressants
1
Rationale 1: Manifestations of ALS include loss of both upper and lower motor neurons, resulting in loss of the muscles of respiration and swallowing. Atrophy of the tongue and facial muscles results in difficulty swallowing and the inability to communicate.
Rationale 2: Gastrostomy feedings may be needed as the disorder progresses and muscle function is permanently lost.
Rationale 3: Pain management is not part of the treatment of ALS. Active ROM exercises are instituted only if the patient is able; then passive ROM is initiated to stimulate circulation.
Rationale 4: Immunosuppressants are not part of the treatment of ALS.
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