The nurse is providing care for a client with a diagnosis of otosclerosis due to previous ear surgeries. Which type of pathological hearing loss supports the client's clinical history?

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord. Understanding the pathophysiological process of ALS is crucial for providing accurate information about the disease prognosis to the client. Here's why option B is the correct choice:

A) It occurs as a complication of a spinal cord injury:

This statement is incorrect. ALS is not a complication of a spinal cord injury. While both conditions involve motor neuron dysfunction, they have different etiologies and pathophysiological processes. ALS is characterized by the degeneration of motor neurons in the brain and spinal cord, leading to muscle weakness and atrophy, whereas spinal cord injury results from trauma to the spinal cord.

B) Muscle weakness is progressive, degenerative, and fatal:

Correct. ALS is characterized by progressive degeneration of motor neurons, leading to muscle weakness, atrophy, and eventual paralysis. The disease is relentless and fatal, typically within 2 to 5 years of diagnosis, although survival can vary widely among individuals. As motor neurons degenerate, voluntary muscle control is lost, eventually affecting the ability to speak, swallow, breathe, and move. Respiratory failure is the most common cause of death in ALS patients.

C) Mental status changes occur late in the disease:

While cognitive and behavioral changes can occur in some individuals with ALS, particularly in the later stages of the disease, they are not universal. ALS primarily affects motor neurons, leading to progressive muscle weakness and paralysis. However, some individuals may experience frontotemporal dementia (FTD), a type of cognitive impairment characterized by changes in behavior, personality, and language.

D) Autonomic nervous system and sensory changes occur:

ALS primarily affects motor neurons rather than sensory neurons or the autonomic nervous system. Sensory symptoms such as numbness, tingling, or loss of sensation are not typical features of ALS. Autonomic dysfunction, including changes in heart rate, blood pressure, or bowel and bladder function, is not a prominent feature of ALS.

A. Severely decreased GFR:

In stage 4 chronic kidney disease (CKD), the glomerular filtration rate (GFR) is indeed severely decreased. Stage 4 CKD is characterized by a GFR between 15 and 29 mL/min/1.73 m² according to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. At this stage, there is significant kidney damage, resulting in a substantial reduction in kidney function and GFR. Clients with stage 4 CKD require close monitoring and management to prevent further progression of kidney disease and associated complications.

B. Mildly decreased GFR:

This choice is incorrect. Stage 4 CKD is not associated with a mildly decreased GFR. A mildly decreased GFR would typically be indicative of earlier stages of CKD. In stage 4 CKD, the reduction in GFR is severe, falling below 30 mL/min/1.73 m².

C. Kidney damage with increased GFR:

This interpretation is inaccurate. In stage 4 CKD, kidney damage leads to a progressive decline in GFR, rather than an increase. An increased GFR is not typical of advanced CKD stages; instead, it may occur in conditions such as hyperfiltration in early stages of diabetic nephropathy.

D. Moderately decreased GFR:

This option is also incorrect. Stage 4 CKD is not associated with a moderately decreased GFR. A moderately decreased GFR would typically be indicative of stage 3 CKD, where the GFR ranges from 30 to 59 mL/min/1.73 m². In stage 4 CKD, the reduction in GFR is more severe, falling below 30 mL/min/1.73 m².