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Difficulty: MediumCollaboration with Interdisciplinary Team

A client with advanced amyotrophic lateral sclerosis (ALS) is preparing for discharge to home hospice care. The client has developed progressive difficulty swallowing thin liquids and recently started coughing frequently during meals, which is causing significant anxiety for the client and family. Which action is the most appropriate for the nurse to take to address these concerns?

  1. A
    Delegate the administration of all oral meals to the unlicensed assistive personnel to ensure the client is fed slowly and carefully.
  2. B
    Prioritize initiating a referral to a registered dietitian to increase the client's daily caloric intake to prevent weight loss.
  3. Request a consultation with a speech-language pathologist to evaluate swallowing function and recommend safe dietary consistencies.Answer
  4. D
    Tell the client and family, "Do not worry, coughing during meals is a normal and expected part of this disease process."

Answer

Request a consultation with a speech-language pathologist to evaluate swallowing function and recommend safe dietary consistencies.
The client is exhibiting clear signs of dysphagia and potential aspiration (coughing during meals). A speech-language pathologist is the appropriate interdisciplinary team member whose scope of practice involves evaluating the mechanics of swallowing and recommending the safest diet consistencies (e.g., thickened liquids, pureed foods) to prevent life-threatening aspiration pneumonia before discharge.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client has advanced ALS and is experiencing new-onset coughing during meals alongside difficulty swallowing thin liquids.
Identifying acute changes in condition is the foundational step in clinical judgment.
2
Evaluate the immediate risks associated with these symptoms.
Coughing while drinking thin liquids indicates a high risk for aspiration and a compromised airway.
Airway and breathing are always the highest priorities in nursing care based on the ABCs framework.
3
Determine the appropriate interdisciplinary team member to address the primary risk.
A speech-language pathologist (SLP) must be consulted to perform a comprehensive swallow evaluation.
SLPs are the allied health experts specifically trained to assess dysphagia and recommend safe dietary consistencies to prevent aspiration pneumonia.

Key Concept

Interdisciplinary Collaboration: Scope of Practice and Airway Prioritization
Estimated Time:1m 0s
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Topics

Collaboration with Interdisciplinary Team

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