carpal tunnel syndrome

nursing assessment for CTS

-complaint of burning or aching pain -numbness, tingling that wakes the pt at night -if the disorder progress it can move into the arm pt may report dropping things e.g. may resolve after wake and shake of the hand

Carpal Tunnel Syndrome

A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.

diagnostic tests for CTS

EMG/NCS (electromyography conduction studies)

Of the following common problems of the upper extremities, which results from entrapment of the median nerve at the wrist? a. Carpal tunnel syndrome b. Impingement syndrome c. Dupuytren's contracture d. Ganglion

a

The patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What key point will you be sure to teach the patient? a. Pain and numbness will be experienced for several days to weeks. b. After surgery, the pain and paresthesia will no longer be present. c. Immediately after surgery, the patient will no longer need assistance. d. After surgery, the dressing will be large with dots of drainage

a

You are providing nursing care for a patient with carpal tunnel syndrome (CTS) who is preparing for surgery. Which intervention should you delegate to the nursing assistant? a. Assist the patient with daily self-care measures such as bathing and eating. b. Initiate placement of a splint for immobilization during the day. c. Test the patient for painful tingling in the four digits of the hand. d. Assess the patient's wrist and hand for discoloration and brittle nails.

a

You are preparing the post-operative CTS patient for discharge. Which information is important to provide to this patient? A. The surgical procedure is a cure for CTS. B. Hand movements will be restricted for 4 - 6 weeks after surgery. C. Frequent pain medication dosages will no longer be necessary. D. Notify the physician immediately for any pain or discomfort.

b

As charge nurse you assign the nursing care of a patient who has just returned form open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which of the following instructions will you provide for the LPN/LVN? (Choose all that apply.) a. The patient will no longer need pain medication. b. Elevate the patient's hand above the heart. c. Check the patient's vital signs every 15 minutes in the first hour. d. Check the neurovascular status of the fingers every hour. e. Check the dressing for drainage and tightness.

b,c,d,e

early symptoms of CTS can usually be relieved

by stopping the aggravating movement and by resting the hand and wrist by immobilzation in a splint.

You deserve the nursing assistant performing all of these interventions for the patient with CTS. Which action requires that you intervene immediately? A. Arrange the patient's lunch tray and cut the meat. B. Provide warm water and assist the patient with a bath. C. Replace the patient's splint in hyperextension position. D. Remind the patient not to lift very heavy objects.

c

Mrs. Moore, 62-year-old, with diabetes is in the emergency department. She stepped on a sharp sea shells while walking barefoot along the beach. Mrs. Moore did not notice that the object pierced the skin until later that evening. What problem does the client most probably have? A. Nephropathy B. Macroangiopathy C. Carpal tunnel syndrome D. Peripheral neuropathy

d

The nurse is conducting a discharge teaching regarding the prevention of further problems to a client who undergone surgery for carpal tunnel syndrome of the right hand. Which of the following instruction will the nurse includes? A. Learn to type using your left hand only. B. Avoid typing in a long period of time. C. Avoid carrying heavy things using the right hand. D. Do manual stretching exercise during breaks.

d

caring for pt with CTS

is directed towards relieving the underlying cause of nerve compression.

Nerve conduction studies NCS

measure how well and how fast the nerves can send electrical signals.

EMG

measures the electrical activity of muscles at rest and during contraction.

expected outcomes of CTS

mild cause usually respond to conservative measures (splints and meds to help) pt may require surgical relieve nerve if burning,numbness, tingling persists; loss of grip/pinch

complications of CTS

muscle atrophy which is irreversible nerve damage, and surgery will not help.

what causes CTS

process that involve peripheral nerves Rheumatoid arthritis repeated computer (hand) overuse metabolic disorder (DM) tumors Connective Tissue disorder nurses using IV bags ppl that ice cakes carpeters ppl who wash floors

how can we prevent CTS

proper ergonomics (correct hold of hand when using keyboard) adaptive device such as wrist splints, special keyboards, special mice. treatment of underlying problems

risk factor for CTS

repetitive wrist flexion/ extension

if symptoms last for more than 6 months pt should consider

surgery, which is performed in out patient setting using local anestheia. very painful but always successful.

what population does CTS affect

women more so than men women age 30-50 y/o affects 2 million americans per year