Which assessment findings would the nurse expect to find in a client diagnosed with amyotrophic lateral sclerosis (ALS)? Select all that apply.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons, leading to gradual loss of voluntary muscle control. It results in muscle weakness, atrophy, and eventual respiratory failure while sensory function is typically preserved. As the disease advances, bulbar involvement affects speech and swallowing, and some patients may develop cognitive or behavioral changes. Nursing care focuses on symptom management, safety, and maintaining quality of life. A. Progressive muscle weakness is a hallmark feature of ALS due to degeneration of both upper and lower motor neurons. This leads to worsening motor dysfunction, starting in the limbs and eventually affecting respiratory muscles. The weakness is typically asymmetric and steadily progressive without periods of remission. B. Loss of central vision is not associated with ALS because the disease does not affect the visual pathways or ocular structures. ALS is primarily a motor neuron disorder, and sensory functions, including vision, hearing, and sensation, remain intact. Visual disturbances would suggest an alternative neurological condition. C. Mask-like face is a classic finding of Parkinson’s Disease, caused by a lack of dopamine. While ALS affects facial muscles eventually, the "mask-like" description is specific to Parkinson’s. D. Cognitive decline may occur in a subset of ALS patients due to overlap with frontotemporal dysfunction. This can manifest as impaired judgment, personality changes, or executive dysfunction. While not present in all cases, cognitive and behavioral changes are increasingly recognized as part of the ALS disease spectrum. E. Dysphagia is a common finding in ALS due to progressive weakness of bulbar muscles controlling swallowing. This increases the risk of aspiration, malnutrition, and dehydration. It is a significant clinical concern that often requires dietary modification and eventually alternative feeding methods. F. Fatigue is commonly experienced in ALS as a result of progressive muscle weakness and increased energy expenditure required for basic movements. Respiratory muscle involvement further contributes to reduced endurance and generalized exhaustion. This symptom significantly impacts functional ability and quality of life as the disease progresses.