Which referral is the nurse's priority for a client in the advanced stage of amyotrophic lateral sclerosis (ALS)?

In the advanced stage of amyotrophic lateral sclerosis (ALS), the client experiences significant progression of muscle weakness and respiratory compromise. Referrals during this stage should focus on the most critical needs for sustaining quality of life and ensuring safety.

A speech-language pathologist is the priority referral because clients with advanced ALS often face difficulties with communication and swallowing due to muscle atrophy and weakness in the throat and mouth. As the disease progresses, maintaining effective communication becomes essential for the client to express needs, feelings, and decisions. The speech-language pathologist can provide strategies for alternative communication methods and assess swallowing to prevent aspiration, which is a common complication at this stage.

While referrals to occupational, physical, and respiratory therapists are also important, they may not address the immediate and crucial needs of communication and safe swallowing that are typically prioritized in late-stage ALS care. Thus, the referral to the speech-language pathologist is vital for these clients to support their remaining functional abilities and enhance their overall well-being.