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Difficulty: MediumCollaboration with Interdisciplinary Team

A registered nurse is managing the care of a client newly diagnosed with amyotrophic lateral sclerosis (ALS). The client has begun to cough frequently while drinking liquids and exhibits progressive dysarthria. The client's spouse expresses significant distress about how to safely feed the client at home. Which intervention demonstrates the most appropriate interprofessional care coordination?

  1. Initiate a referral to the speech therapy department for a comprehensive swallowing evaluation and texture modification guidelines.Answer
  2. B
    Delegate the initial mealtime feeding and aspiration risk assessment to an unlicensed assistive personnel (UAP).
  3. C
    Postpone addressing the nutritional concerns until the client has been evaluated by physical therapy for mobility deficits.
  4. D
    Inform the spouse that coughing is an expected complication of the disease and there is no need to worry prematurely.

Answer

The most appropriate action is to initiate a referral to the speech therapy department for a comprehensive swallowing evaluation and texture modification guidelines.
Speech-language pathologists (speech therapy) are the specialized members of the interdisciplinary team trained to evaluate swallowing disorders (dysphagia) and recommend specific interventions, such as thickened liquids or modified food textures, to prevent aspiration in clients with progressive neuromuscular diseases like ALS.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client with ALS is exhibiting frequent coughing with liquids and dysarthria, indicating a high risk for aspiration and compromised airway safety.
Identifying the primary physiological risk (dysphagia/aspiration) is required before determining the appropriate intervention or interdisciplinary team member to involve.
2
Identify the appropriate interprofessional team member for the specific deficit.
A speech-language pathologist specializes in the evaluation of swallowing mechanics (dysphagia) and can recommend safe dietary alterations.
Collaborating with the correct specialist ensures the client receives an expert assessment, which mitigates the risk of aspiration pneumonia.
3
Evaluate the remaining options against safety protocols and scope of practice.
Delegating the assessment to a UAP is unsafe; delaying the intervention ignores an airway priority; and telling the spouse not to worry is non-therapeutic.
The registered nurse must coordinate care safely while adhering to delegation laws, prioritization frameworks (ABCs), and therapeutic communication principles.

Key Concept

Interprofessional Care Coordination and Scope of Practice
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Topics

Collaboration with Interdisciplinary Team

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