Carpal Tunnel Syndrome Nursing Care Plan & Management

Notes

Description
  • Is an entrapment syndrome resulting from compression of the median nerve in the tendon sheath within the ventral surface of the wrist.Carpal Tunnel Syndrome
  • Similarly, tarsal tunnel syndrome is a group of symptoms caused by pressure on the posterior tibial nerve in the medial aspect of the ankle and cubital tunnel syndrome is caused by pressure on the ulnar nerve at the medial epicondyle of the elbow.
  • Compression symptoms due to entrapment include paresthesias, numbness, pain, weakness, and muscle atrophy.
  • Compression results from repetitive motion of the wrist, trauma, local tenosynovitis, and mass, such as ganglion or neuroma.
  • Repetitive motion causing carpal tunnel include the use of computer, typing, and use of a jackhammer.
  • Carpal tunnel syndrome is more common in those over age 50, in women, in pregnant women in the first trimester, and in those with rheumatoid arthritis.
  • Complications include chronic pain and loss of function of the extremities.
Assessment
  • Progressive sensory changes including paresthesias and numbness of the thumb, index finger, and ring finger of the involved hand; leads to pain waking the patient up at night.
  • Motor changes beginning with clumsiness and progressing to weakness; edema and thenar atrophy may be noted.Carpal Tunnel Syndrome2
  • Positive Tinel’s sign: Increased paresthesias on tapping of tendon sheath (ventral surface of central wrist).
  • Positive Phalen test: Increased symptoms with acute palmar flexion for 1 minute.
Diagnostic Evaluation
  • Electromyogram shows weakened response to median nerve stimulation.
Primary Nursing Diagnosis
  • Risk for injury
Therapeutic and Pharmacological Interventions:
  1. Wrist splint in slight extension (cock-up splint) to relieve pressure aggravated by wrist flexion: worn at night, and during day if symptomatic.
  2. Avoidance of flexion and twisting motion of the wrist.
  3. Work or activity modification to relieve repetitive strain.
  4. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 600 to 800 mg tid to relieve inflammation and pain.
  5. Corticosteroid injection into tendon sheath to relieve inflammation.
Surgical Interventions
  1. Surgery is indicated when conservative measures fail to relieve symptoms.Carpal Tunnel Syndrome3
  2. Procedure is release of carpal ligament and tendon to relieve pressure on median nerve.
Nursing Interventions
  1. Monitor level of pain, numbness, paresthesias, and functioning.
  2. Monitor for adverse effects of NSAID therapy, especially in elderly. GI distress or bleeding, dizziness, or increased serum creatinine.
  3. After surgery, monitor neurovascular status of affected extremity: pulses, color, swelling, movement, sensation, or warmth.
  4. Apply wrist splint so wrist is in neutral position, with slight extension of wrist and slight abduction of thumb; make sure that it fits correctly without constriction.
  5. Administer NSAIDs and assist with tendon sheath injections as required.
  6. Apply ice or cold compress to relieve inflammation and pain.
  7. Teach patient the cause of condition and ways to alter activity to prevent flexion of wrists; refer to an occupational therapist as indicated.
  8. Advise patient of NSAID therapy dosage schedule and potential adverse effects; instruct patient to report GI pain and bleeding.
  9. Teach patient to gentle range-of-motion exercises; refer to a physical therapist as indicated.
Documentation Guidelines
  • Physical findings: Hand, wrist,thumb,finger pain; numbness; tingling; burning
  • Response to conservative or surgical treatment
  • Attendance and response to physical therapy
  • Ability to cope with immobility and inability to return to work
Discharge and Home Healthcare Guidelines
  • THERAPY. Be sure the patient understands and implements appropriate range-of-motion exercises. Emphasize the need to use the hands as often as possible and the value of warm water exercising.
  • EQUIPMENT. Teach the patient proper techniques for applying and removing splints and/or slings.
  • VOCATIONAL COUNSELING. Arrange for the patient to consult with a vocational rehabilitation counselor about returning to work and any modifications that must be made on the job.

 


Sources:
Nursingcrib.com
Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing
Therapeutics Manual, 2007 3rd ed

 

Exam

Welcome to your MSN Exam for Carpal Tunnel Syndrome! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Choose the task that aligns with the supportive and non-invasive nature of a nursing assistant's role, focusing on patient comfort and daily needs.

1 / 10

1. As a nurse caring for a patient with carpal tunnel syndrome (CTS) who is preparing for surgery, you need to delegate tasks appropriately. Which of the following interventions should you delegate to the nursing assistant?

💡 Hint

Consider the typical recovery process and the time it may take for nerve-related symptoms to subside after this type of surgery.

2 / 10

2. As the nurse preparing a patient for endoscopic carpal tunnel release surgery scheduled for the morning, you need to provide accurate and helpful preoperative education. Which key point should you emphasize to the patient regarding what to expect postoperatively?

💡 Hint

Think about the relationship between skin conditions and joint symptoms, particularly in the context of systemic manifestations of certain dermatological conditions.

3 / 10

3. When a 44-year-old auto mechanic visits the physician's office complaining of an exacerbation of psoriasis and mentions that his finger joints are stiff and sore in the morning, Nurse Jones should consider the possible implications of these symptoms. How should Nurse Jones respond?

💡 Hint

Consider the typical postoperative care and restrictions associated with hand surgery, particularly in terms of the timeframe for regaining full mobility.

4 / 10

4. Nurse Rodriguez is readying a patient for discharge after carpal tunnel syndrome (CTS) surgery. What crucial piece of information should Nurse Rodriguez ensure to communicate to the patient?

💡 Hint

Consider recommending an activity that promotes flexibility and circulation without exerting excessive strain on the affected hand.

5 / 10

5. As a nurse preparing a client who has undergone surgery for carpal tunnel syndrome in the right hand for discharge, you are focused on providing guidance to prevent future issues. Which piece of advice should you include in your discharge instructions?

💡 Hint

Identify the statement that contradicts standard postoperative care practices, especially concerning pain management.

6 / 10

6. Charge Nurse Williams is delegating the postoperative care of a patient who has just undergone open carpal tunnel release surgery. When providing instructions to the experienced LPN/LVN, which of the following tasks will Nurse Williams NOT assign to the LPN/LVN?

💡 Hint

Choose the test specifically designed to provoke the symptoms of carpal tunnel syndrome by flexing the wrist.

7 / 10

7. A 35-year-old client, employed as a data entry specialist, reports experiencing numbness and tingling in the thumb, index, and middle fingers. Suspecting carpal tunnel syndrome, the nurse considers which clinical test could provide additional evidence to support this diagnosis.

💡 Hint

Consider which complication of diabetes is known to affect sensation in the extremities, potentially leading to a delayed response to injuries like cuts or punctures.

8 / 10

8. Mrs. Davis, a 63-year-old patient with diabetes, is in the emergency department after stepping on a sharp sea shell and not noticing the skin penetration until later. What condition is most likely contributing to Mrs. Davis not noticing her injury immediately?

💡 Hint

Identify the condition commonly associated with symptoms like tingling, numbness, and weakness in the hand, linked to a specific nerve in the wrist area.

9 / 10

9. Among the listed conditions affecting the upper extremities, which one is characterized by the compression of the median nerve at the wrist?

💡 Hint

Consider the action that might directly contradict the therapeutic goals for a patient with Carpal Tunnel Syndrome, especially in terms of wrist positioning.

10 / 10

10. As a supervising nurse, you observe a nursing assistant attending to a patient with Carpal Tunnel Syndrome (CTS). Which of the following actions performed by the nursing assistant necessitates your immediate intervention?

Nursing Care Plan

Sample: