18.D Peripheral Neuropathy

The nurse is caring for a client with diabetes who reports paresthesia in the toes and feet. Place the clinical events in order of development that may have contributed to this report. 1. Neuropathy develops. 2. Peripheral nerves are damaged. 3. Diabetes causes internal tissue damage. 4. Blood is shunted away from small vessels to large vessels.

3, 4, 2, 1

The nurse is assessing a client with polyneuropathy. Which manifestation should the nurse expect to​ find? (Select all that​ apply.) A. Numbness B. Shooting pain C. Warm feet D. Aching pain E. Burning pain

A, B, D, E Rationale: The client with polyneuropathy is likely to experience numbness and pain described as​ aching, burning, or shooting. The client with polyneuropathy is most likely to feel cold feet

The nurse is creating a plan of care for the client with peripheral neuropathy. Which outcome should the nurse​ include? (Select all that​ apply.) A. The client will verbalize concerns related to sensory loss. B. The client will remain free of injury. C. The client will regain full sensation of numb areas. D. The client will perform daily repetitive exercise movements. E. The client will experience effective pain control.

A, B, E Rationale: Goals of care for the client with peripheral neuropathy include remaining free of​ injury, controlling​ pain, and expressing concerns on this progressive disease. Full sensation is not always a realistic goal. Repetitive movements can contribute to the development of neuropathy.

The nurse is planning care for a client with peripheral neuropathy of the lower extremities. Which intervention should the nurse​ include? (Select all that​ apply.) A. Reposition frequently to avoid prolonged pressure. B. Avoid massage of numb areas. C. Perform foot care. D. Discuss exercises to perform while in care and when back home. E. Review nutritional sources of vitamin​ B-12.

A, C, D, E ​Rationale: A client with peripheral neuropathy needs foot care to identify and prevent​ injury, vitamin​ B-12 to promote nerve​ health, repositioning to avoid pressure​ injury, and exercise. Massage should be performed to reduce pain and improve circulation.

The nurse is reviewing the medical history of a client with peripheral neuropathy. Which risk factor should the nurse expect to​ find? (Select all that​ apply.) A. ​Insulin-dependent diabetes B. Weekly injection of vitamin​ B-12 C. Cigarette smoking D. Height of 155 cm​ (5 ft 1​ in.) E. Daily alcohol use

A, C, E ​Rationale: Alcohol​ use, smoking, and diabetes are all risk factors associated with the development of peripheral neuropathy. A height of over​ 159 cm (5 ft 3​ in.) is associated with increased risk of peripheral neuropathy. Supplementation of vitamin​ B-12 helps to prevent peripheral neuropathy.

The nurse suspects that the client has peripheral neuropathy. Which question should the nurse ask related to the​ client's occupation?​ (Select all that​ apply.) A. ​"Are you exposed to any toxins or​ chemicals?" B. ​"Do you work evening or night​ shifts?" C. ​"Do you sit much of the​ day?" D. ​"Do you perform any repetitive​ tasks?" E. ​"Does your employer cover physical therapy​ visits?"

A, D Rationale: Repetitive tasks can lead to inflammation of a nerve and mononeuropathy. Toxin and chemical exposure increase risk of developing peripheral neuropathy.​ Sitting, working off​ shifts, and coverage of physical therapy are not associated with peripheral neuropathy.

The nurse is caring for a client with ulnar nerve compression resulting in peripheral neuropathy of the right upper extremity. Which collaborative team member referral should the nurse identify as a priority for this​ client? A. A surgeon B. A physical therapist C. A pharmacist D. An endocrinologist

A. A surgeon ​Rationale: Peripheral neuropathy caused by compression requires surgical​ intervention, making the surgeon consult a priority for this client. The pharmacist and physical therapist may see the client to help with symptom​ management, but the surgeon is the priority consult for curative intervention. An endocrinologist would support treatment of the client with a metabolic​ issue, such as​ diabetes, to help reduce the impact of the disease on the nerves.

The nurse is caring for a child having difficulty walking related to neuropathy associated with Guillain​-Barré syndrome​ (GBS). Which treatment should the nurse anticipate for this​ child? A. IV immunoglobulin B. Antiseizure medication C. Antidepressant medication D. ​Anti-inflammatory medication

A. IV immunoglobulin ​Rationale: The treatment for GBS in children is IV immunoglobulin.​ Antiseizure, antidepressant, and​ anti-inflammatory medications are used for the treatment of peripheral neuropathy in adults.

A client with motor nerve damage related to peripheral neuropathy asks the nurse why physical therapy is needed. Which is the best response from the​ nurse? A. ​"Physical therapy will help you maintain your ability to walk and prevent further​ decline." B. ​"Physical therapy is not necessary if you promise to exercise​ regularly." C. ​"Physical therapy will prevent you from needing​ surgery." D. ​"Physical therapy is covered by your health​ plan, so you should maximize your​ benefits."

A. ​"Physical therapy will help you maintain your ability to walk and prevent further​ decline." Rationale: The client with motor nerve damage related to peripheral neuropathy is at risk of injury from falls and further motor decline. Physical therapy will help the client maintain the ability to walk and prevent further decline. Physical therapy does not prevent surgery needed for​ compression-related causes of neuropathy. Regular exercise is needed but is not a substitute to physical therapy. Healthcare plan benefits are not the primary reason for physical therapy.

A client with peripheral neuropathy asks the nurse why antiseizure medication is prescribed. Which response from the nurse is best​? A. ​"This medication has proven to help with neuropathy​ pain." B. ​"I will contact the physician to see if it was a​ mistake." C. ​"This medication will also help you lose​ weight." D. ​"You are having seizures in addition to your peripheral​ neuropathy."

A. ​"This medication has proven to help with neuropathy​ pain." Rationale: Antiseizure medication has proven to treat pain well through an unknown​ mechanism, which may involve the blocking of pain receptors in the central nervous system. The medication does not affect appetite or weight loss. It is unlikely to be a mistake because it is a common prescriptive therapy with​ anti-inflammatories and antidepressants. The medication is given to treat pain in those with peripheral​ neuropathy, not seizure activity.

A client has a new onset of numbness and tingling of the extremities. Which laboratory testing should the nurse anticipate to investigate the etiology of the peripheral​ neuropathy? (Select all that​ apply.) A. Liver function tests B. Metabolic panel C. Thyroid function tests D. Complete blood count E. Serum thiamine

B, C, D, E Rationale: Serum​ thiamine, a metabolic​ panel, thyroid function​ tests, and a complete blood count are all expected diagnostic laboratory tests to investigate the etiology of peripheral neuropathy. Liver function testing is not a routine diagnostic tool for the investigation of peripheral neuropathy.

The nurse is teaching a client about a tricyclic antidepressant that has been prescribed to treat pain associated with peripheral neuropathy. Which information should the nurse​ include? (Select all that​ apply.) A. ​"Do not drink grapefruit juice while on this​ medication." B. ​"This medication may make you​ dizzy." C. ​"Take this medication in the​ morning." D. ​"This medication may decrease your​ appetite." E. ​"It will take 4 weeks or more to reach therapeutic​ levels."

B, D, E ​Rationale: Tricyclic antidepressants may cause dizziness and loss of appetite and take 4 to 6 weeks to reach therapeutic levels. The medication should be taken at night because it causes drowsiness. Grapefruit should be avoided with antiseizure medications.

The nurse is planning to assess a client who reports increasing numbness and tingling in both lower legs. Which assessment technique should the nurse use to assess the​ client's perception of​ sensation? A. Presence of peripheral pulses B. Vibration test C. Gait assessment D. Deep tendon reflexes

B. Vibration test ​Rationale: The vibration test is used to test for sensation at the joints. Gait assessment helps to determine safety with ambulation. Deep tendon reflexes test nerve response. Peripheral pulses assess blood flow to the area.

The nurse identifies that a client diagnosed with diabetes is at risk of developing peripheral neuropathy. In which area of the body should the nurse expect the client to experience symptoms first​? A. The right or left hand unilaterally B. Lower portion of the face C. Bilateral feet D. Upper legs

C. Bilateral feet ​Rationale: Peripheral neuropathy in the diabetic is a bilateral sensory disorder that starts in the lower extremities and moves upward.​ Bilaterally, toes and feet are affected first. The upper legs may be affected later in disease progression. The face is not usually affected by peripheral neuropathy in the diabetic.​ Bilaterally, hands may be affected later in disease progression.

The nurse is administering pain medication to a client with peripheral neuropathy related to Guillain​Barré syndrome. Which assessment should the nurse consider a priority​? A. Skin integrity of the feet B. Renal function C. Respiratory status D. Bowel sounds

C. Respiratory status ​Rationale: A concern with peripheral neuropathy in a client with GBS treated for pain is adequate respiratory effort. Respiratory status should be monitored closely. Renal​ function, gastrointestinal​ movement, and skin integrity are also​ important, but are not priorities over respiratory status.

At which stage of pregnancy is Guillain​Barré syndrome most likely to cause​ neuropathy? A. Second trimester B. Postpartum period C. Third trimester D. First trimester

C. Third trimester ​Rationale: GBS is likely to affect the pregnant woman in the third trimester. The nurse should assess for peripheral loss of sensation in all stages of​ pregnancy, but the third trimester is the most likely time for GBS.

A client diagnosed with Charcot-Marie-Tooth disease asks the nurse about the cause of their peripheral neuropathy. Which response by the nurse is​ accurate? A. ​"An immunologic response to a Campylobacter jejuni infection is causing your​ symptoms." B. ​"An elevated blood glucose level is damaging your blood vessels and​ nerves." C. ​"You have inherited a disease that is degenerating your​ muscles." D. ​"The cause of your peripheral neuropathy is​ unknown."

C. ​"You have inherited a disease that is degenerating your​ muscles." Rationale: Charcot-Marie-Tooth disease is an inherited disease causing peripheral neuropathy through the progressive degeneration of muscles. Idiopathic neuropathy occurs in​ 30% of cases where the cause is unknown. Guillain-​Barré syndrome​ (GBS) is often caused by an immunologic response to a Campylobacter jejuni infection.​ Diabetes-induced peripheral neuropathy is caused by damage from hyperglycemia.

The nurse is teaching a client who has poorly controlled diabetes and peripheral neuropathy about​ self-care interventions. Which action is most important for this​ client? A. Routine vision exams B. Weight loss C. Daily exercise D. Care of the feet

D. Care of the feet ​Rationale: Care of the​ feet, which includes​ inspection, is important in relation to the development of peripheral neuropathy to prevent injury and infection.​ Exercise, weight​ management, and vision exams are important in the diabetic​ client, but care of the feet is of particular importance due to peripheral neuropathy.

The nurse is caring for an older adult client with Guillain​Barré syndrome. For which factor is this client at increased risk compared to a​ middle-aged adult with​ GBS? A. Intensity of symptoms B. Amount of medication required C. Cost D. Death

D. Death ​Rationale: The older adult client with GBS is at increased risk of​ mortality, particularly if the client requires mechanical ventilation. Symptoms and treatment of a​ middle-aged adult with GBS is​ similar, with no difference in​ cost, intensity of​ symptoms, or medication requirements.

An adolescent diagnosed with CharcotMarieTooth disease asks the nurse how their ambulation will change with adulthood. Which is the best response from the​ nurse? A. ​"You will be confined to a​ wheelchair." B. ​"You will not likely live to​ adulthood." C. ​"Physical therapy will allow you to walk​ normally." D. ​"You will likely walk with a device such as a​ cane."

D. ​"You will likely walk with a device such as a​ cane." ​Rationale: The client with Charcot-Marie-Tooth disease will likely walk with a device such as a cane in adulthood. There is no indication that the adolescent will not grow into adulthood. Charcot-Marie-Tooth disease does not imply that the client will be wheelchair​ bound, but it is also not fully reversible with physical therapy.

Risk factors for peripheral neuropathies include [SATA]: a. Height b. Age c. Gender d. Vitamin B excesses e. Diabetes

a, b, e Men taller than 5'6" and women taller than 5'3" at increased risk. Older adults at increased risk Risk increases with vitamin B deficiencies.

The most common types of neuropathy associated with diabetes. Bilateral sensory disorders. Manifestations appear first in the toes and feet and progress upward. Fingers and hands may also be involved in later stages of diabetes. a. Polyneuropathies b. Mononeuropathies

a. Polyneuropathies

Isolated peripheral neuropathies that affect a single nerve. Most common cause is injury or trauma. Repetitive motions can also cause them. a. Polyneuropathies b. Mononeuropathies

b. Mononeuropathies