Skip to main content

Carpal tunnel syndrome

 Description

§  Is an entrapment syndrome resulting from compression of the median nerve in the tendon sheath within the ventral surface of the wrist.
§  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.      Nursing Path
§  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; l


eads to pain waking the patient up at night.
§  Motor changes beginning with clumsiness and progressing to weakness; edema and thenar atrophy may be noted.
§  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.     Nursing Path
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.
2.      Procedure is release of carpal ligament and tendon to relieve pressure on median nerve.

Nursing Interventions                   Nursing Path

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.

Comments

Post a Comment

Popular posts from this blog

ROLE OF A NURSE IN EPIDEMIOLOGY

 ROLE OF A NURSE IN EPIDEMIOLOGY Role of a nurse in epidemiology can be explained in 4 aspects. These are: Preventive role Promotive role Curative role Rehabilitative role Role in Prevention Epidemiology is one of the basic sciences applicable to nursing. The nurses working in a community deal with people in various settings and help them solve their health problems. They make the nursing process. They identify and investigate the problem, formulate and test the hypothesis regarding the causal factors, formulate alternative interventions and implement to prevent and control the problem and evaluate effectiveness of intervention. They have an active role in the prevention and control of communicable diseases which include:             - Identify sources of infection and methods of spread of infection.             - Health education of people in general.             - Having an important role in...
Post a Comment
Read more

TYPES OF TOOLS USED FOR EVALUATION

 TYPES OF TOOLS USED FOR EVALUATION There are many tools or instruments used in evaluation process. Some of the tools have been briefly discussed here: Questionnaire Most commonly used method of evaluation is questionnaire in which an individual attempts answers in writing on a paper. It is generally self-administered in  which person goes through the questionnaire and responds as per the instruction. It is considered to be the most cost-effective tool of evaluation in terms of administration. While developing teacher should ensure that it is simple, concise, and clearly stated. Evaluation done with the help of questionnaire is quantitative. Interview  Interview is the second most important technique used for evaluation in which students participating in evaluation are interviewed. Interview can help in getting information both quantitatively and qualitatively. Interview can be conducted in group or individually. It is a time-consuming process; therefore it should be arra...
Post a Comment
Read more

mania ( psychiatric disorder)

  Introduction of mania  Mania  is a psychological condition that causes a person to experience unreasonable  euphoria .  Mania  is a dangerous condition in which patient may not sleep &eat while in a manic episode. It is moody disorder. Defination of mania  Mania  is a mood affective disorder , hyperactivity are present into the patient characterised by increase psychomotor activity , irritation or expensive behaviour. Causes of mania -: Stressful life events. -: Using recreational drugs or alcohol. -: Seasonal changes. -: Changes in sleep patterns & lack of sleep. Sign and symptoms of mania -: Increase psychomotor activity. -: Aggressiveness. -: Pressure speak. -: Speak are loudly. -: Flight of idea. -: Illogical thinking. -: Loss of hunger. -: Attention are distrub. -: Improper judgement. -: Loss of sleep. -: Decrease the understanding level. -: Irritability. -: Expensive behaviour. -: Increase the energy level. -: Increase goal directe...
Post a Comment
Read more