DSM: Peripheral Neuropathy

The nurse is discussing the use of a pain scale with a patient diagnosed with peripheral neuropathy. Which patient statement demonstrates understanding of the use of a pain scale?

"By using the scale, I can see if my medication is working." Using a pain scale will help in determining the extent of pain. Consistent measurement is essential to evaluate the degree of pain and the effectiveness of intervention and medication. The use of a pain scale is not related to fluid intake with medication. Peripheral neuropathy is a chronic condition that requires continual evaluation.

The nurse is assessing a patient who the healthcare provider suspects may have Guillain-Barré syndrome (GBS). Which question should the nurse ask during the health history?

"Have you had a respiratory infection recently?" cause of GBS is unknown, but precipitating events include a resp or GI viral or bacterial infection 1-3 wks before onset of manifestations, surgery, viral immunizations, & other viral illnesses. In 60% of cases, Campylobacter jejuni is identified as cause of the preceding infection.

The nurse is planning to discuss signs in infants who may be diagnosed with Guillain-Barré syndrome (GBS). Which information should the nurse include?

"Hypotonia should be considered as a reason to diagnose GBS in an infant." Children rarely develop GBS. GBS is leading cause of acute motor paralysis in children. average age range of children who have GBS 4-8 yrs, but as young as 3 wks old can be affected. In infants, floppy baby syndrome, which is characterized by hypotonia c no identifiable cause, should be considered along c resp distress & dif feeding. Children younger than 6 may present c a refusal to walk & pain in legs, whereas older children present c symptoms more similar to adults.

The nurse is assessing the comfort level of a patient with peripheral neuropathy. Which patient statement indicates that the patient's pain is effectively managed?

"I am comfortable enough to sleep at night." Being comfortable enough to sleep at night is a good indication that the pain has been effectively managed.

The nurse taught a patient with diabetes about additional triggers that are associated with nerve damage.Which patient statement demonstrates an understanding of this information?

"I should avoid drinking alcohol excessively." The pt stating the need to avoid excessive consumption of alcohol indicates understanding of teaching. Avoiding triggers that contribute to nerve damage, such as repetitive motions, smoking, toxic chemicals, & cramped positions, will also help in prevention of neuropathies.

The nurse is discussing vitamin supplementation with a patient diagnosed with peripheral neuropathy. Which patient statement indicates understanding of the most beneficial supplementation?

"I should look for sources of B12." Controlling medical conditions that increase risk for peripheral neuropathy is one of best prevention methods. A healthy diet of vegetables, fruits, & whole grains can help improve nerve health. Intake of vitamin B12 can be helpful. In teaching nutrition, the nurse should stress its importance and identifying sources of B12.

The nurse explains to a new colleague what to assess for a patient with peripheral neuropathy. Which statement by the new nurse is accurate

"I should observe for drop foot when ambulating." Observation of a pt c peripheral neuropathy includes watching as the pt walks to notice drop foot, shuffling steps, or lack of coordinated movement that may indicate lack of feeling in the feet. These observations are important to assess the pt's risk for falls

The nurse is caring for a pregnant woman who has been diagnosed with Guillain-Barré syndrome (GBS) during her third trimester. The patient asks, "How will this affect my delivery?" Which response by the nurse is accurate?

"It should not affect your ability to deliver vaginally." GBS also may affect pregnant women, although diagnosis is often complicated in pregnant women because symptoms of GBS mimic common complaints from women in the third trimester, when GBS is most likely to occur.

A patient asks the nurse, "What is paresthesia?" Which response by the nurse is accurate?

"Paresthesia is a numbness, tingling, or prickling sensation." Paresthesia is an abnormal condition in which person feels a sensation of burning, numbness, tingling, itching, or prickling. Paresthesia can also be described as a pins-and-needles or skin-crawling sensation. Paresthesia most often occurs in extremities, such as hands, feet, fingers, & toes, but it can occur in other parts of the body, too.

The spouse of a patient newly diagnosed with Guillain-Barré syndrome (GBS) asks the nurse why the patient is alert but cannot move. Which response by the nurse is accurate?

"Peripheral motor nerves are affected but not nerves that control the level of consciousness." GBS affects peripheral motor nerves but not nerves, neurons, or parts of brain that control the level of consciousness. Pts c this syndrome stay alert but have increasing paralysis. Complications of GBS: Weakness of the extremities. Paralysis. Amputation.Ambulation problems.

A patient asks the nurse why they are taking an antiseizure medication for peripheral neuropathy. Which response by the nurse is accurate?

"The medication is used dually to treat nerve pain." The use of antiseizure drugs to treat nerve pain has increased. The mechanism of action related to nerve pain is poorly understood, but it is thought that antiseizure drugs may block pain receptors in the central nervous system (CNS).

A patient who has been using a transcutaneous electrical nerve stimulation (TENS) unit asks the nurse what is causing their shoulder to feel better while using the unit. Which response by the nurse is accurate?

"The unit creates twitches that stop pain signals from reaching the brain." A TENS unit uses pulses of electrical current to generate nonpainful mild muscle twitches at site of the pain. This inhibits transmission of pain signals to brain, helping to decrease pain. TENS can be either conventional (low intensity, high frequency) or acupuncture-like (high intensity, low frequency). TENS was found to significantly decrease pain associated c peripheral neuropathy.

The nurse is caring for a patient with neuropathic pain. Which patient statement demonstrates an understanding of this type of pain?

"This pain is due to my diabetes."Neuropathic pain is often manifested as peripheral neuropathy in patients with diabetes mellitus. Muscle pain is somatic pain. The patient with visceral pain may experience nausea. Skeletal pain is classified as somatic pain.

A pt who works at a job requiring repetitive motions reports a "tingling and prickling" sensation in the right hand and trouble grasping smaller objects. Which condition should the nurse suspect the patient has?

Carpal tunnel syndrome. Pt is experiencing prickling & tingling in her right hand only, which is indicative of a mononeuropathy such as carpal tunnel syndrome. Hereditary, or inherited, neuropathies include Charcot-Marie-Tooth disease. DM is a cause of peripheral neuropathy. Guillain Barré syndrome is demyelinating disorder of peripheral nervous system that results from both humoral & cell-mediated immunologic response

The nurse is planning care for a patient diagnosed with diabetes mellitus and peripheral neuropathy. Which nonpharmacologic treatment should the nurse include?

Daily foot care. Daily foot care is an appropriate nonpharm tx for a pt with both diabetes mellitus and peripheral neuropathy. Neurontin is an appropriate pharmacologic therapy. Electromyography and nerve biopsy are tests used to diagnose peripheral neuropathy.

The nurse is planning care for a patient who verbalizes being distraught about the loss of feeling in their right leg due to peripheral neuropathy. Which intervention should the nurse include?

Encourage the pt to verbalize their concerns about sensory loss. An outcome relevant to plan of care for the pt c peripheral neuropathy should include pt being able to verbalize feelings & concerns related to sensory loss. plan of care for pt c peripheral neuropathy may include: pt will remain free from injury. pt will report effective pain management through use of a predetermined pain rating scale. pt will verbalize feelings & concerns related to sensory loss.

Which intervention should the nurse include when caring for a patient diagnosed with diabetes mellitus and peripheral neuropathy?

Encouraging the patient to monitor and care for the feet daily. The pt with peripheral neuropathy may have a decreased tactile sensation response. The pt with diabetes is at high risk for an infection & usually exhibits a secondary complication of gangrene or necrosis related to any opening on the foot, so monitoring & caring for the feet daily is encouraged.

Which manifestation should the nurse consider in infants who may be diagnosed with Guillain-Barré syndrome?

Floppy baby syndrome. Kids rarely develop GBS. average age range of children who have GBS is 4-8 yrs, but infants as young as 3 wks old can be affected. In infants, floppy baby syndrome, which is characterized by hypotonia c no identifiable cause, should be considered along c resp distress & dif feeding. Children younger than 6 may present c a refusal to walk & pain in legs, older children present c symptoms similar to adults.

A patient diagnosed with type 2 diabetes mellitus reports burning and tingling in their feet, not feeling well, and frequent episodes of fatigue. Which suggestion should the nurse give the patient to decrease the progression of the symptoms?

Follow up with a dietary consult. The pt might benefit from a dietary consult to reestablish a healthier diet to control weight & diabetes. A healthy diet of veg, fruits, & whole grains can help improve nerve health & may avoid future complications or secondary illnesses related to diabetes.

The nurse is reviewing medications prescribed for a patient diagnosed with peripheral neuropathy. Which medication should the nurse question for this patient?

Insulin. Although some pts C peripheral neuropathy may be DX c DM that requires insulin, insulin is not useful in the tx of peripheral neuropathy and should be questioned. Antiseizure meds are admin and are thought to block pain receptors in CNS. TCAs are thought to activate descending serotonergic (5-HT1) antinociceptive pathway, which creates an endogenous pain modulation system. SSRIs block depletion of serotonin & norepi in CNS, can help to modulate pain.

The nurse is discussing the benefit of physical therapy for a patient diagnosed with Guillian-Barré syndrome (GBS). Which benefit should the nurse discuss?

Maintain mobility. The primary goals of tx are to care for and manage the underlying cause. However, a combination of medication, lifestyle modifications, and physical therapy can be effective in treating symptoms and increasing quality of life.

Clinical manifestations for peripheral neuropathy include

Motor nerve damage: Muscle weakness; Cramps; Fasciculations; Muscle loss. Sensory nerve damage: Numbness; Pain; Burning or shooting pain; Impaired touch; temperature; & pain sensation.

Which condition should the nurse recognize that contributes to the mortality of an older adult patient with Guillain-Barré syndrome (GBS) who is placed on a ventilator?

Pneumonia. Clinical manifestations and treatment of GBS are the same for older adult patients as for other patients with GBS. However, older adults have an increased risk of developing GBS, and mortality rates are higher in this population.

The nurse is assessing a patient with Guillain-Barré syndrome (GBS) who was admitted for pain control. Which assessment should be the priority for the nurse?

Respiration. For patients with GBS, the nurse should monitor for side effects of analgesics, particularly respiratory depression; and assess respirations and lung sounds. nurse should perform routine pulmonary care measures, and monitor for aspiration. Frequent respiratory monitoring is indicated.

The nurse assessing a patient suspects a polyneuropathy. Which finding supports this suspicion?

The patient has decreased sensation and reflexes bilaterally in the lower extremities. Polyneuropathies occur bilaterally in the extremities, most commonly as a complication of a chronic illness such as alcohol abuse, which leads to malnutrition. Decreased sensation & reflexes bilaterally in the lower extremities support the dx of polyneuropathy as a result of damage to the nerves from long-term excessive use of alcohol.

The nurse is discussing with colleagues the effect Guillain-Barré syndrome (GBS) has on the pregnant woman's ability to deliver vaginally. Which information should the nurse include?

The pt is unable to bear down. GBS does not affect a pregnant pt's ability to deliver vaginally, but the pt may have a decreased ability to bear down during labor, so vacuum extraction of neonate may be required. GBS does not interfere c dilation or cause extreme contractions.

The nurse is conducting a health history for a patient who may have peripheral neuropathy. Which finding in the patient's history is considered a risk factor for this disorder?

Vitamin B deficiency. Vitamin B deficiency is a risk factor for developing peripheral neuropathy. Risk factors for acquired peripheral neuropathies: Diabetes. Alcohol use. Vit deficiencies (particularly B vits). Immune system suppression.Autoimmune diseases.Exposure to toxins. Kidney disorders.Liver disorders.Thyroid disorders.