Neurological Disorders Q 82

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A female 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?

  

     A. Anxiety

     B. Powerlessness

     C. Ineffective denial

     D. Risk for disuse syndrome

    

    

Correct Answer: B. Powerlessness

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This comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can’t perform even simple daily tasks. Discuss with the patient concerning his or her care (e.g., treatment options, convenience of visits, or time of ADLs). Allowing the patient to participate in discussions will increase his or her sense of independence or autonomy.

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Option A: Depression has a significant effect on the quality of life in patients with ALS, and studies have shown that treatment can improve quality of life. While no controlled trials have evaluated the treatment of depression in patients with ALS, Amitriptyline is commonly used as it can also treat other symptoms such as insomnia, sialorrhea, and pseudobulbar affect.

Option D: Although Risk for disuse syndrome may be the nursing diagnosis associated with ALS, the client’s comment specifically refers to an inability to act autonomously. Limb onset ALS (LO) is the predominant type, presenting in 70% of patients. LO ALS can be further classified as flail arm syndrome or brachial amyotrophic diplegia, which is characterized by LMN weakness and wasting. It usually starts proximally and often symmetrically, then progresses distally to a point where upper extremity function is severely impaired.

Option C: A diagnosis of Ineffective denial would be indicated if the client didn’t seem to perceive the personal relevance of symptoms or danger. Patients need to know that this disease causes the muscles to weaken, eventually to the point of paralysis. Patients should also be aware that the disease will get worse and ultimately lead to death. Unfortunately, there is no cure; however, numerous medications can help lessen the associated symptoms. Patients may begin to notice difficulty with fine motor skills, from speaking to writing, as well as with walking, and eventually breathing.

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