# A nurse is assessing a 58-year-old client who was recently diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment finding would be most characteristic of early-stage ALS?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541219  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 58-year-old client who was recently diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment finding would be most characteristic of early-stage ALS?

## 보기

1. Bilateral lower extremity weakness with bowel and bladder incontinence
2. Tremors at rest with cogwheel rigidity and bradykinesia
3. Memory loss, confusion, and difficulty with executive functions
4. Asymmetric muscle weakness with fasciculations in the hands and forearms **✔ 정답**

**정답: 4**

## 해설

Early-stage ALS typically presents with asymmetric muscle weakness and fasciculations, most commonly beginning in the hands and forearms. This distinguishes it from other neurological conditions.

## 심화 해설

Clinical Judgment
This question assesses the ability to distinguish the early features of amyotrophic lateral sclerosis (ALS) from other neurological disorders. The key points are asymmetry and fasciculations. Because ALS affects both upper and lower motor neurons, early signs include a mix of lower motor neuron damage (muscle atrophy, fasciculations) and upper motor neuron damage (spasticity, hyperreflexia). The most common site of onset is the distal limbs (hands, feet), characterized by an asymmetric pattern that starts on one side and gradually spreads.

Memory Tip:
**A**LS = **A**symmetry + **L**imb onset + **S**pasms (fasciculations). Remember that "ALS starts Asymmetrically, with Limb twitching (Spasms)."

KR vs US:
In Korea, the term 'Lou Gehrig's disease' may be more familiar. While the diagnostic approach is similar, in the US, early intervention through a Multidisciplinary Clinic and respiratory management (such as non-invasive ventilation) are conducted very systematically. The nurse's role also emphasizes linking patients with an early Palliative Care team alongside symptom management.

## 임상 시나리오

Clinical Practice Guide
When assessing ALS patients, use standardized tools such as the ALSFRS-R (ALS Functional Rating Scale-Revised) to quantitatively track functional decline. Regularly monitoring respiratory function (maximum inspiratory pressure, forced vital capacity) is directly linked to life prognosis.
Caution:
A key distinguishing feature of ALS is the preservation of sensation, bladder/bowel function, and cognitive function. Therefore, if there are impairments in these areas, you should suspect other diagnoses (such as myelopathy, multiple sclerosis, etc.) rather than ALS. Be careful of traps in SATA (Select All That Apply) questions that include these 'preserved functions' as incorrect options.

## 핵심 개념

- **Amyotrophic Lateral Sclerosis** — Amyotrophic lateral sclerosis. A progressive neurodegenerative disease in which the upper and lower motor neurons of the brain and spinal cord gradually degenerate, leading to muscle weakness, atrophy, and paralysis.
- **Fasciculations** — Muscle fasciculation. Involuntary contraction of small muscle bundles, visible or palpable under the skin, caused by stimulation or degeneration of lower motor neurons (anterior horn cells). Characteristic sign of ALS.
- **Upper Motor Neuron** — Upper motor neuron. A neural pathway that originates in the cerebral motor cortex and extends to the brainstem or spinal cord. Damage results in spasticity, hyperreflexia, and pathological reflexes.
- **Lower Motor Neuron** — Lower motor neuron. A neuron that originates in the anterior horn of the spinal cord or the motor nuclei of the brainstem and extends to the muscles. When damaged, it results in muscle weakness, atrophy, fasciculations, and loss of reflexes.
- **Asymmetric Presentation** — Asymmetric onset. Symptoms start first on one side of the body (e.g., right hand) or are more severe on one side. This is an early onset pattern of ALS and serves as an important distinguishing feature from multiple sclerosis (MS) or myopathy.

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