The nurse is teaching the family about amyotrophic lateral sclerosis and progression of the disease. The nurse would include which common late manifestations?

Choice A reason: ALS is a neurodegenerative disease that affects the motor neurons, which control the voluntary muscles. It does not affect the cognitive or mental functions, such as memory, reasoning, or emotions. Therefore, the person with ALS will be aware of their condition and their surroundings, even when they lose their ability to move, speak, or breathe.

Choice B reason: ALS affects the muscles of the mouth, throat, and chest, which are involved in swallowing. As the disease progresses, the person with ALS will have difficulty swallowing food, liquids, and saliva. This can lead to malnutrition, dehydration, choking, and aspiration pneumonia.

Choice C reason: ALS does not directly cause seizures, which are abnormal electrical activity in the brain. However, some medications used to treat the symptoms of ALS, such as muscle relaxants, may increase the risk of seizures. Therefore, the person with ALS should be monitored for any signs of seizures, such as loss of consciousness, convulsions, or confusion.

Choice D reason: ALS affects the muscles of the diaphragm and the intercostal muscles, which are involved in breathing. As the disease progresses, the person with ALS will have difficulty breathing, especially at night or when lying down. This can lead to respiratory failure, which is the most common cause of death in ALS. Therefore, the person with ALS may need mechanical ventilation or noninvasive positive pressure ventilation to support their breathing.

Choice A reason: Encouraging intake of favorite foods to increase weight and promote normal growth is an important nursing goal for a child with leukemia, but it is not the priority. Chemotherapy can cause nausea, vomiting, and loss of appetite, which can affect the child's nutritional status and growth. However, these effects can be managed with antiemetics, supplements, and small frequent meals.

Choice B reason: Utilizing approaches to minimize risk of infection and bleeding episodes is the priority nursing goal for a child with leukemia. Chemotherapy can cause bone marrow suppression, which reduces the production of white blood cells, red blood cells, and platelets. This increases the risk of infection, anemia, and bleeding, which can be life-threatening. Therefore, the nurse should monitor the child's blood counts, vital signs, and signs of infection or bleeding, and implement preventive measures such as hand hygiene, isolation, and transfusions.

Choice C reason: Providing age-appropriate activities to promote optimum cognitive and motor skills development is an important nursing goal for a child with leukemia, but it is not the priority. Chemotherapy can cause fatigue, weakness, and neuropathy, which can affect the child's physical and mental abilities. However, these effects can be managed with rest, pain relief, and stimulation.

Choice D reason: Providing emotional support for the child and family members that relieve stress is an important nursing goal for a child with leukemia, but it is not the priority. Chemotherapy can cause anxiety, depression, and fear, which can affect the child's psychological and emotional well-being. However, these effects can be managed with counseling, education, and coping strategies.