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Difficulty: MediumCollaboration with Interdisciplinary Team

A client with progressive amyotrophic lateral sclerosis (ALS) is being evaluated for transition to home care. The client's spouse tells the nurse, 'I cannot safely lift my partner from the bed to the wheelchair anymore, and we absolutely cannot afford a mechanical lift.' Additionally, the nurse notes the client is pocketing food in their cheeks and taking unusually long to chew during breakfast. Which of the following is the most appropriate action by the nurse?

  1. A
    Delegate the teaching of safe transfer body mechanics to the unlicensed assistive personnel (UAP) and consult a registered dietitian to manage the client's feeding difficulties.
  2. B
    Consult a registered dietitian to provide high-calorie supplements for the pocketed food, prioritizing the client's long-term nutritional needs over an immediate airway evaluation.
  3. Request consultations with a physical therapist for safe transfer training, a medical social worker for equipment funding options, and a speech-language pathologist for a swallowing assessment.Answer
  4. D
    Reassure the spouse that they should not worry about the financial costs, as the occupational therapist will automatically order and secure funding for the mechanical lift.

Answer

The most appropriate action is to request consultations with a physical therapist for safe transfer training, a medical social worker for equipment funding options, and a speech-language pathologist for a swallowing assessment.
The correct action accurately delegates each specific clinical need to the appropriate interdisciplinary specialist. The physical therapist (PT) is the expert in gross motor mobility and safe transfer mechanics. The medical social worker is responsible for navigating financial barriers and securing community resources for home equipment. The speech-language pathologist (SLP) is essential for evaluating the physiological mechanics of swallowing (indicated by chewing difficulties and pocketing food) to prevent aspiration.

Step-by-Step Solution

1
Analyze the client's presentation to identify the specific care needs.
Three distinct needs are identified: physical inability to safely transfer, financial inability to afford home equipment, and signs of dysphagia (pocketing food, prolonged chewing).
Accurately identifying all physiological, safety, and psychosocial deficits is required before making appropriate interdisciplinary referrals.
2
Match the transfer safety deficit to the correct allied health professional.
A physical therapist (PT) is required to evaluate gross motor mobility and teach safe transfer techniques.
PTs specialize in movement dysfunction, ambulation, and transfer mechanics, whereas occupational therapists (OTs) primarily focus on fine motor skills and activities of daily living (ADLs).
3
Match the financial deficit to the correct allied health professional.
A medical social worker is required to assist with funding options and navigating community resources for the mechanical lift.
Social workers and case managers specialize in care coordination, insurance navigation, and securing medical equipment post-discharge.
4
Match the swallowing deficit to the correct allied health professional and apply prioritization principles.
A speech-language pathologist (SLP) is required to evaluate the aspiration risk associated with the pocketed food.
SLPs evaluate the mechanics of speech and swallowing. This immediate airway and aspiration risk must be prioritized over general nutritional concerns handled by a dietitian.

Key Concept

Interdisciplinary Collaboration and Scope of Practice
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Topics

Collaboration with Interdisciplinary Team

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