Carpal Tunnel Syndrome Nursing Care Plan & Management

EXPLANATION

✔Correct answer:

Phalen's test. Phalen's test is a clinical test specifically used to diagnose carpal tunnel syndrome. During this test, the patient is asked to flex their wrists maximally and hold the position for about 60 seconds. If the patient experiences numbness, tingling, or pain in the thumb, index, middle fingers, or radial half of the ring finger, it is considered a positive Phalen's test, indicating the presence of carpal tunnel syndrome. This test helps in assessing the compression of the median nerve within the carpal tunnel.

Imagine bending a garden hose (median nerve) in half; if there is a blockage or pressure (compression in the carpal tunnel), the water flow (nerve signals) is disrupted, causing symptoms like numbness and tingling.

Nurses should perform the Phalen's test to assess for carpal tunnel syndrome and document the findings accurately. Early diagnosis and intervention can help manage symptoms and prevent further complications.

• Explain the procedure of Phalen's test to the patient and ensure they are comfortable during the test.
• Observe and document the patient's response, noting any symptoms of numbness, tingling, or pain.
• Educate the patient on other diagnostic tests and interventions that may be required for a comprehensive evaluation of carpal tunnel syndrome.
• Discuss strategies to manage and alleviate symptoms, such as wrist splinting, ergonomic modifications, and possibly referral to a specialist for further evaluation and treatment.

✘Incorrect answer options:

Straight leg raise test. The straight leg raise test is used to diagnose lumbar radiculopathy or herniated disc in the lower back, not carpal tunnel syndrome. It involves lifting the patient's leg while keeping the knee straight to check for pain that radiates down the leg.

Trendelenburg's test. Trendelenburg's test assesses the stability of the hip abductor muscles, particularly in conditions like hip dysplasia or gluteus medius weakness. It is not related to diagnosing carpal tunnel syndrome.

Barlow maneuver. The Barlow maneuver is used in pediatric assessments to diagnose hip dysplasia in infants. It involves manipulating the infant's hip to check for dislocation or instability. It is not relevant to diagnosing carpal tunnel syndrome.

EXPLANATION

✔Correct answer:

Inquire further about this issue, recognizing that psoriatic arthritis can be associated with psoriasis vulgaris. Nurse Jones should recognize that psoriatic arthritis is a potential complication of psoriasis vulgaris. Psoriatic arthritis is an inflammatory type of arthritis that can affect individuals with psoriasis, leading to joint pain, stiffness, and swelling. The symptoms described by the patient, such as morning stiffness and sore finger joints, are consistent with psoriatic arthritis. Early diagnosis and treatment are important to manage symptoms and prevent joint damage.

Think of psoriatic arthritis as rust developing in a car's engine (joints) in someone already dealing with issues in the car's paintwork (skin affected by psoriasis). Addressing the rust early can prevent more serious engine problems later.

Nurses should be vigilant in recognizing potential complications of chronic conditions such as psoriasis and provide appropriate assessments and referrals to ensure comprehensive patient care.

• Ask the patient detailed questions about the onset, duration, and severity of joint symptoms.
• Perform a physical assessment of the affected joints, noting any signs of inflammation, swelling, or deformity.
• Document the patient’s symptoms and findings and communicate them to the physician for further evaluation and potential referral to a rheumatologist.
• Educate the patient about psoriatic arthritis, including its symptoms and the importance of early treatment.
• Encourage the patient to monitor and report any changes in symptoms or new symptoms to their healthcare provider.

✘Incorrect answer options:

Ask if he has previously been diagnosed or treated for carpal tunnel syndrome. While carpal tunnel syndrome can cause finger pain and stiffness, it is not typically associated with psoriasis. This approach may overlook the underlying condition of psoriatic arthritis.

Suggest taking aspirin for relief, considering it might be early rheumatoid arthritis. Although rheumatoid arthritis can cause similar symptoms, the patient’s history of psoriasis makes psoriatic arthritis more likely. Furthermore, suggesting a specific medication without further assessment or a diagnosis is inappropriate.

Acknowledge his complaint but consider that it might be related to the physical demands of his job. While the physical demands of his job may contribute to joint pain, the presence of psoriasis and the specific symptoms described suggest a more systemic issue like psoriatic arthritis. Dismissing the symptoms as job-related could delay appropriate diagnosis and treatment.

EXPLANATION

✔Correct answer:

Positioning the patient’s splint in a hyperextended position. Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel in the wrist. Proper management includes using a splint to keep the wrist in a neutral position, which helps to reduce pressure on the median nerve. Hyperextension of the wrist can exacerbate symptoms by increasing pressure on the nerve, potentially worsening the patient's condition.

The carpal tunnel is a narrow passageway in the wrist surrounded by bones and ligaments. The median nerve runs through this tunnel and can become compressed due to swelling, inflammation, or structural issues. Splinting in a neutral position helps to alleviate this compression by keeping the wrist straight and reducing stress on the median nerve. Hyperextending the wrist can stretch and compress the nerve, leading to increased pain, numbness, and tingling.

Imagine the median nerve as a garden hose running through a narrow tunnel. If the tunnel walls (wrist structures) are squeezed or the hose (nerve) is bent excessively, water flow (nerve signals) is restricted, leading to problems. Keeping the hose straight (neutral wrist position) allows for optimal flow.

Nurses should educate nursing assistants and other healthcare staff on the proper positioning of splints for patients with Carpal Tunnel Syndrome and intervene when incorrect practices are observed.

• Ensure the wrist splint is positioned in a neutral or slightly extended position, avoiding hyperextension.
• Educate the nursing assistant on the importance of proper splint positioning to prevent exacerbation of symptoms.
• Monitor the patient’s symptoms and adjust the splint as necessary to maintain optimal wrist positioning.
• Provide training sessions for healthcare staff on the correct management of Carpal Tunnel Syndrome, including splinting techniques.

✘Incorrect answer options:

Advising the patient to avoid lifting heavy objects. This advice is appropriate for a patient with Carpal Tunnel Syndrome as lifting heavy objects can increase pressure on the wrist and exacerbate symptoms.

Assisting the patient with a bath using warm water. Using warm water for bathing is beneficial for patients with Carpal Tunnel Syndrome as it can help to relax muscles and reduce stiffness and pain.

Preparing the patient’s lunch tray and cutting the meat. Assisting with meal preparation and cutting meat is a helpful action that reduces strain on the patient’s wrist and hands, thereby minimizing symptom exacerbation.

EXPLANATION

✔Correct answer:

Hand movements will be limited for 4 – 6 weeks post-surgery. It is important for Nurse Rodriguez to inform the patient that hand movements will be limited for 4 to 6 weeks post-surgery. This period allows for proper healing of the surgical site and minimizes the risk of complications such as wound dehiscence or excessive scar tissue formation. During this time, patients should avoid activities that place undue stress on the wrist and hand to ensure optimal recovery.

Think of the wrist as a newly planted tree. Just like the tree needs time to establish its roots and grow strong before being exposed to wind and other elements, the wrist needs time to heal and regain strength before resuming normal activities.

Nurses should provide comprehensive discharge instructions that include activity restrictions, wound care, pain management, and signs of complications to ensure a smooth recovery.

• Inform the patient about the expected limitations in hand movements and the importance of adhering to these restrictions to prevent complications.
• Provide guidance on gentle hand and wrist exercises that can be started once cleared by the surgeon to aid in recovery.
• Instruct the patient on proper wound care, including keeping the surgical site clean and dry, and monitoring for signs of infection.
• Discuss pain management strategies, including the use of prescribed pain medications and non-pharmacological methods such as ice application.
• Emphasize the importance of follow-up appointments to monitor the healing process and address any concerns.

✘Incorrect answer options:

Regular doses of pain medication will no longer be needed. This statement is incorrect as patients may still require pain medication during the early postoperative period to manage discomfort. Pain management should be tailored to the individual's needs.

Contact the physician promptly if any pain or discomfort occurs. While it is important to monitor for excessive or unusual pain, some level of pain and discomfort is expected after surgery. Patients should be advised to contact their physician if they experience severe or worsening pain, signs of infection, or other complications.

The surgical intervention is a definitive cure for CTS. Although surgery can significantly alleviate the symptoms of CTS, it is not always a definitive cure. Some patients may experience residual symptoms or recurrence of CTS, and it is important to manage expectations and emphasize the importance of postoperative care and prevention strategies.

EXPLANATION

✔Correct answer:

Perform manual stretching exercises during breaks. After surgery for carpal tunnel syndrome, it is important to maintain mobility and prevent stiffness through regular stretching exercises. Performing manual stretching exercises during breaks can help improve flexibility, reduce tension in the wrist and hand, and promote healing. This practice also helps to prevent the recurrence of symptoms by keeping the tendons and muscles supple.

Think of your wrist and hand like a rubber band. If you don't stretch the rubber band regularly, it can become stiff and less flexible. Regular stretching keeps the rubber band (wrist and hand) flexible and reduces the chance of it snapping (recurrence of symptoms).

Nurses should provide comprehensive discharge instructions to ensure patients understand how to care for their hand and prevent future issues after carpal tunnel surgery.

• Instruct the patient to perform gentle stretching and strengthening exercises as recommended by their healthcare provider or physical therapist.
• Advise taking regular breaks from repetitive activities to avoid overuse of the wrist and hand.
• Educate on proper ergonomics and wrist positioning during activities like typing or using tools to reduce strain on the wrist.
• Encourage the patient to use both hands for activities and avoid putting excessive strain on the operated hand.
• Provide guidance on pain management, wound care, and signs of complications to watch for, such as increased pain, swelling, or infection.

✘Incorrect answer options:

Learn to type using only your left hand. This advice is impractical and can lead to overuse of the left hand, potentially causing strain or injury. It is better to use ergonomic techniques and take breaks to prevent overuse of either hand.

Refrain from engaging in prolonged typing activities. While it is important to avoid prolonged repetitive activities, complete avoidance of typing is unrealistic for most people. Instead, using proper ergonomics, taking breaks, and performing stretching exercises are more effective strategies.

Refrain from carrying heavy items with the right hand. While it is important to avoid excessive strain on the operated hand, encouraging the use of proper techniques and distributing weight evenly between both hands is more beneficial than completely avoiding carrying items with the right hand.

EXPLANATION

✔Correct answer:

Carpal tunnel syndrome. Carpal tunnel syndrome (CTS) is characterized by the compression of the median nerve as it passes through the carpal tunnel in the wrist. This compression leads to symptoms such as numbness, tingling, and weakness in the hand and fingers, particularly in the thumb, index, middle, and part of the ring finger. The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand, which houses the median nerve and tendons. When these structures become inflamed or swollen, they compress the median nerve, leading to CTS.

The median nerve provides sensory and motor functions to the thumb and first three fingers. Compression within the carpal tunnel restricts nerve function, leading to the characteristic symptoms of pain, numbness, and tingling. Activities that require repetitive wrist movements or positions that increase pressure on the carpal tunnel can exacerbate the condition.

Imagine the median nerve as a garden hose passing through a narrow pipe (carpal tunnel). If the pipe gets squeezed (inflammation or swelling), the water flow (nerve signals) is restricted, leading to reduced water flow (symptoms like numbness and tingling).

Nurses should educate patients on the management and prevention of CTS, including ergonomic modifications, wrist splinting, and possibly surgical interventions if conservative measures fail.

• Educate patients on the importance of ergonomic adjustments to reduce wrist strain.
• Recommend wrist splinting, especially during activities or at night, to maintain a neutral wrist position and reduce nerve compression.
• Advise on exercises and stretches that can help relieve symptoms and improve wrist function.
• Discuss potential surgical options, such as carpal tunnel release, if symptoms persist despite conservative treatment.

✘Incorrect answer options:

Dupuytren’s contracture. This condition involves the thickening and tightening of the fascia in the palm, leading to contractures of the fingers. It does not involve compression of the median nerve.

Ganglion. A ganglion is a fluid-filled cyst that typically forms along tendons or joints of the wrists or hands. It may cause discomfort or limit movement but does not specifically involve median nerve compression.

Impingement syndrome. This condition typically affects the shoulder, involving the compression of tendons or bursa in the shoulder joint. It does not relate to the median nerve or the wrist.

EXPLANATION

✔Correct answer:

Assist the patient with daily self-care activities like bathing and eating.  Assisting the patient with daily self-care activities such as bathing and eating is an appropriate task to delegate to a nursing assistant. These tasks do not require the clinical judgment or specialized skills of a registered nurse and fall within the scope of practice for a nursing assistant. This delegation allows the registered nurse to focus on more complex and specialized aspects of patient care.

Think of a nursing team as a construction crew. The nursing assistant handles tasks like handing tools and assisting with basic tasks, while the skilled construction worker (nurse) handles the more complex tasks like measuring and cutting wood precisely.

Nurses should delegate tasks appropriately based on the complexity and required skill level of each task, ensuring patient safety and efficient care delivery.

• Delegate routine and non-complex tasks to nursing assistants to free up time for nurses to perform more specialized care.
• Provide clear instructions and support to nursing assistants to ensure that delegated tasks are performed correctly and safely.
• Monitor and supervise the care provided by nursing assistants to ensure quality and continuity of patient care.

✘Incorrect answer options:

Checking the patient for painful tingling in the fingers. Assessing the patient for symptoms like painful tingling in the fingers requires clinical judgment and should be performed by a registered nurse.

Starting the use of a splint for daytime immobilization. Initiating the use of a splint involves clinical decision-making and patient education, tasks that should be performed by a registered nurse.

Evaluating the patient’s wrist and hand for changes in color and nail condition. Evaluation of the patient’s wrist and hand for changes in color and nail condition requires clinical assessment skills and should be conducted by a registered nurse.

EXPLANATION

✔Correct answer:

Be prepared for pain and numbness to persist for several days to weeks after the surgery. It is important to set realistic expectations for the patient undergoing endoscopic carpal tunnel release surgery. While the surgery aims to relieve the pressure on the median nerve and alleviate symptoms of carpal tunnel syndrome, it is common for patients to experience some degree of pain and numbness for several days to weeks postoperatively. This is part of the normal healing process as tissues recover from the surgical intervention.

Think of the surgery like repairing a road with potholes. Even after the repair is done, the road (wrist) may still have some bumps and uneven spots (pain and numbness) for a while until it fully settles and smooths out (heals completely).

Nurses should provide comprehensive preoperative education to prepare patients for what to expect during the recovery period, ensuring they understand the normal course of healing and when to seek further medical attention.

• Inform the patient that some pain and numbness are normal after surgery and can persist for several days to weeks.
• Educate the patient on pain management strategies, including prescribed medications, ice application, and elevation of the hand.
• Advise the patient to report any severe or worsening symptoms, such as increased pain, redness, swelling, or signs of infection, to their healthcare provider.
• Discuss the importance of follow-up appointments to monitor the healing process and adjust the treatment plan as needed.
• Encourage the patient to perform gentle hand and finger exercises as recommended to promote circulation and prevent stiffness.

✘Incorrect answer options:

Expect a large dressing with spots of drainage after the surgery. While some postoperative drainage is normal, a large dressing is not typically required for endoscopic carpal tunnel release surgery. The procedure is minimally invasive, usually resulting in small incisions and a smaller dressing.

Anticipate complete independence and no need for assistance immediately after the surgery. This is unrealistic as the patient will likely need some assistance with daily activities immediately after the surgery, particularly while the operated hand is healing and regaining strength and function.

Predict immediate relief from pain and paresthesia following the surgery. While some patients may experience immediate relief, it is not guaranteed, and it is important to set realistic expectations that symptoms may persist for some time as the healing process continues.

EXPLANATION

✔Correct answer:

Inform the LPN/LVN that the patient will not require pain medication anymore.  It is inappropriate to assume or inform the LPN/LVN that the patient will not require pain medication postoperatively. Pain management is a critical component of postoperative care, and patients who have undergone open carpal tunnel release surgery are likely to experience some level of discomfort or pain as part of their recovery process. The decision to discontinue pain medication should be based on the patient's pain assessment and the healthcare provider's orders, rather than an assumption.

Think of postoperative pain management like monitoring the fuel in a car. You wouldn't assume the car doesn't need fuel just because it was recently filled; you need to check the fuel gauge (pain level) regularly and refuel (provide pain medication) as needed.

Nurses should provide clear and accurate instructions when delegating tasks, ensuring that pain management is appropriately addressed and tailored to the patient's needs.

• Ensure that pain management protocols are followed and pain assessments are conducted regularly.
• Communicate the importance of monitoring and managing the patient's pain to all healthcare team members involved in postoperative care.
• Provide education on pain assessment scales and appropriate interventions to address varying levels of pain.
• Emphasize the need for flexibility in pain management plans, adapting them based on the patient's pain reports and response to treatment.

✘Incorrect answer options:

Monitor the patient's vital signs every 15 minutes during the first hour. This task is appropriate for delegation to an experienced LPN/LVN, as it involves routine monitoring and documentation of vital signs, which is within their scope of practice.

Inspect the dressing for any drainage and ensure it's not too tight. This task is also appropriate for delegation to an experienced LPN/LVN, as it involves observation and basic assessment skills to ensure proper wound care and identify any issues with the dressing.

Keep the patient's hand elevated above the level of the heart. This is an appropriate task for delegation to an experienced LPN/LVN, as it involves positioning the patient's hand to reduce swelling and promote healing, which is a standard postoperative care measure.

EXPLANATION

✔Correct answer:

Peripheral neuropathy. Peripheral neuropathy is a common complication of diabetes that affects the nerves, particularly in the extremities. This condition leads to decreased sensation, making it difficult for individuals to feel pain, temperature changes, or injuries like cuts and punctures. Mrs. Davis's inability to notice the injury immediately is most likely due to diabetic peripheral neuropathy, which results in numbness or reduced sensitivity in her feet.

Peripheral neuropathy occurs due to long-term high blood glucose levels that damage the nerves over time. The damage can result in symptoms such as tingling, numbness, burning, and pain, particularly in the hands and feet. This nerve damage impairs the normal sensory perception, which can lead to unnoticed injuries.

Think of the nerves in the feet like the electrical wiring in a house. If the wiring is damaged, the signals (sensations) don't get through properly, making it difficult to detect issues like a broken appliance (injury) until it becomes a bigger problem.

Nurses should educate patients with diabetes about the risks of peripheral neuropathy and the importance of regular foot care to prevent unnoticed injuries and subsequent complications.

• Instruct patients to inspect their feet daily for any signs of injury, redness, or swelling.
• Encourage wearing protective footwear to avoid injuries from sharp objects.
• Emphasize the importance of controlling blood glucose levels to prevent further nerve damage.
• Advise on regular visits to a healthcare provider for foot examinations and to address any concerns promptly.
• Provide information on proper foot care techniques, including keeping feet clean and moisturized, but avoiding moisture between the toes.

✘Incorrect answer options:

Macroangiopathy. Macroangiopathy refers to the large blood vessel damage that occurs with diabetes, which can lead to cardiovascular issues such as heart disease and stroke. It is not directly related to reduced sensation or the ability to detect injuries.

Nephropathy. Nephropathy refers to kidney damage resulting from diabetes. While it is a serious complication, it does not affect sensation or the ability to notice injuries in the feet.

Carpal tunnel syndrome. Carpal tunnel syndrome is a condition that affects the median nerve in the wrist, leading to symptoms such as numbness, tingling, and weakness in the hand and fingers. It does not explain the decreased sensation in the feet that would lead to unnoticed injuries.