The nurse receives report on 4 clients. Which client should be seen first?

Question

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Amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of motor neurons in the brainstem and spinal cord. Clients have spasticity, muscle weakness, and atrophy. Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure, and death. Care of clients with ALS focuses on maintaining respiratory function, adequate nutrition, and quality of life. There is no cure, and death usually occurs within 5 years of diagnosis. The client with ALS and worsening ability to speak (dysarthria) may also have dysphagia and respiratory distress; this client should be seen first (Option A). (Option B) The client with chronic obstructive pulmonary disease and peripheral edema may have cor pulmonale, or right-sided heart failure, from vasoconstriction of the pulmonary vessels. Cor pulmonale is treated with long-term, low-flow oxygen; bronchodilators; and diuretics. This client should be seen second. Right-sided heart failure (peripheral edema) is not as dangerous as left-sided heart failure (pulmonary edema). (Option C) Fever often occurs with strep throat and may persist for ≥24 hours after initiation of antibiotics. This client should be seen last and should receive an antipyretic. (Option D) Wavelike flank pain is characteristic of urolithiasis (urinary stones). This client needs pain medication and, possibly, further treatment (eg, lithotripsy) and should be seen third. Educational objective: Amyotrophic lateral sclerosis causes progressive loss of motor neurons, resulting in muscle weakness and spasticity. Muscles involved in respiration and swallowing are affected, leading to aspiration and, ultimately, respiratory failure. Treatment focuses on maintaining respiratory function, adequate nutrition, and quality of life.

The Nurse Receives Report on 4 Clients