Nursing Care Plan | NCP Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS), first described in 1854 as a complication of trauma and again in 1947 as an idiopathic syndrome, is part of a larger group of musculoskeletal alterations called upper extremity repetitive use syndrome, or cumulative trauma disorders. Cumulative trauma disorders involve injury to the tendon, tendon sheath, and related tissues (bones, muscles, and nerves) of the upper extremity. Carpal tunnel syndrome is the most common of the nerve entanglement syndromes; it has an estimated lifetime risk of 10% in the U.S. population, and the annual incidence is 0.1% among adults.
Carpal tunnel syndromeoccurs because of a compression of the median nerve as it passes through the wrist within the carpal tunnel, resulting in a slowing of nerve conduction velocity. The median nerve carries motor, sensory, and autonomic fibers to the hand and, when injured, results in an impairment of sensory and motor function.
Rheumatoid arthritis, flexor tenosynovitis, severe sprain of the wrist, or dislocation of the
wrist are factors that predispose patients to carpal tunnel syndrome. Other factors include pregnancy, menopause, and hysterectomy. Diabetes mellitus, acromegaly, renal failure, hypothyroidism, tuberculosis, amyloidosis, and myxedema, as well as aging and obesity, are also thought to be contributory factors. Many researchers have reported an occupational link to the performance of certain jobs or ergonomic factors in the workplace. Jobs that require highly repetitive motions involving high hand force or awkward positions that deviate from normal wrist flexion, extension, or mediallateral rotation positions are thought to cause carpal tunnel syndrome.
Nursing care plan assessment and physical examination
Elicit a history of hand-related symptoms. Determine the patient’s dominant hand, and ask if she or he has experienced attacks of painful tingling in the hand(s) at night sufficient to disturb sleep. Ask the patient if she or he has experienced accompanying daytime swelling and numbness of the hands or fingers. Elicit a history of aching, stiffness, and/or burning in the hand(s), fingers, or thumb(s). Establish a history of contributing factors to carpal tunnel syndrome. Has the patient ever been diagnosed with rheumatoid arthritis, flexor tenosynovitis, diabetes mellitus, hypothyroidism, acromegaly, tuberculosis, amyloidosis, or myxedema? Ask if the patient has sprained or dislocated the wrist. Establish a history of pregnancies, menopause, and/or hysterectomy. Establish an occupational history. Does the patient’s work require use of the hands? Which hand is involved in repetitive movements or the use of tools?
Examine the patient’s hands and wrists. Check the nails for atrophy, and ask if the patient can clench the hands into fists. Note the patient’s range of motion of the fingers and wrist, and the hand strength. Examine the patient for dry, shiny skin.
Patients with carpal tunnel syndrome usually have had a progressive, long-term problem that interrupts their activities of daily living, along with their ability to perform occupational tasks. Anxiety is a common response. Assess the patient’s coping, occupational status, and familial interactions. If an occupational change is necessary, assess the consequences for patient and
family.
Nursing care plan intervention and treatment
The most conservative treatment prescribed by physicians is splinting of the involved wrist and administering of medications. Physical therapy may be prescribed at any point in the treatment process to decrease swelling and promote healing. After 6 weeks of physical therapy, a vocational evaluation is performed to determine the patient’s ability to return to his or her previous job. Vocational retraining may be recommended. If conservative treatment is not successful, the carpal ligament is released surgically to relieve compression of the median nerve. The surgeon may also perform neurolysis, freeing of the nerve fibers, if necessary.
An important focus of nursing intervention is prevention of carpal tunnel syndrome. When discussing prevention, explain to the patient that people at risk should be rotated into other jobs that do not require similar tasks. Periodic rests should also be taken, accompanied by stretching of the wrist, hand, fingers, and thumbs. If the patient is to wear a splint, teach the proper techniques for applying the splint so that it is not too tight. Teach the patient how to remove the splint in order to exercise, and teach the patient how to perform daily, gentle range-of-motion exercises. If the patient is to wear a sling, instruct her or him to remove it several times daily to perform elbow and shoulder exercises. Advise the patient that occasional exercise in warm water is therapeutic. Encourage the patient to use the hands as much as possible. For patients whose hand use is impaired, assist with bathing and eating tasks. Encourage the patient to verbalize concerns about carpal tunnel syndrome. Answer questions, and arrange for consultations with a licensed physical therapist and a vocational rehabilitation counselor.
Carpal tunnel syndromeoccurs because of a compression of the median nerve as it passes through the wrist within the carpal tunnel, resulting in a slowing of nerve conduction velocity. The median nerve carries motor, sensory, and autonomic fibers to the hand and, when injured, results in an impairment of sensory and motor function.
wrist are factors that predispose patients to carpal tunnel syndrome. Other factors include pregnancy, menopause, and hysterectomy. Diabetes mellitus, acromegaly, renal failure, hypothyroidism, tuberculosis, amyloidosis, and myxedema, as well as aging and obesity, are also thought to be contributory factors. Many researchers have reported an occupational link to the performance of certain jobs or ergonomic factors in the workplace. Jobs that require highly repetitive motions involving high hand force or awkward positions that deviate from normal wrist flexion, extension, or mediallateral rotation positions are thought to cause carpal tunnel syndrome.
Nursing care plan assessment and physical examination
Elicit a history of hand-related symptoms. Determine the patient’s dominant hand, and ask if she or he has experienced attacks of painful tingling in the hand(s) at night sufficient to disturb sleep. Ask the patient if she or he has experienced accompanying daytime swelling and numbness of the hands or fingers. Elicit a history of aching, stiffness, and/or burning in the hand(s), fingers, or thumb(s). Establish a history of contributing factors to carpal tunnel syndrome. Has the patient ever been diagnosed with rheumatoid arthritis, flexor tenosynovitis, diabetes mellitus, hypothyroidism, acromegaly, tuberculosis, amyloidosis, or myxedema? Ask if the patient has sprained or dislocated the wrist. Establish a history of pregnancies, menopause, and/or hysterectomy. Establish an occupational history. Does the patient’s work require use of the hands? Which hand is involved in repetitive movements or the use of tools?
Examine the patient’s hands and wrists. Check the nails for atrophy, and ask if the patient can clench the hands into fists. Note the patient’s range of motion of the fingers and wrist, and the hand strength. Examine the patient for dry, shiny skin.
Patients with carpal tunnel syndrome usually have had a progressive, long-term problem that interrupts their activities of daily living, along with their ability to perform occupational tasks. Anxiety is a common response. Assess the patient’s coping, occupational status, and familial interactions. If an occupational change is necessary, assess the consequences for patient and
family.
Nursing care plan intervention and treatment
The most conservative treatment prescribed by physicians is splinting of the involved wrist and administering of medications. Physical therapy may be prescribed at any point in the treatment process to decrease swelling and promote healing. After 6 weeks of physical therapy, a vocational evaluation is performed to determine the patient’s ability to return to his or her previous job. Vocational retraining may be recommended. If conservative treatment is not successful, the carpal ligament is released surgically to relieve compression of the median nerve. The surgeon may also perform neurolysis, freeing of the nerve fibers, if necessary.
An important focus of nursing intervention is prevention of carpal tunnel syndrome. When discussing prevention, explain to the patient that people at risk should be rotated into other jobs that do not require similar tasks. Periodic rests should also be taken, accompanied by stretching of the wrist, hand, fingers, and thumbs. If the patient is to wear a splint, teach the proper techniques for applying the splint so that it is not too tight. Teach the patient how to remove the splint in order to exercise, and teach the patient how to perform daily, gentle range-of-motion exercises. If the patient is to wear a sling, instruct her or him to remove it several times daily to perform elbow and shoulder exercises. Advise the patient that occasional exercise in warm water is therapeutic. Encourage the patient to use the hands as much as possible. For patients whose hand use is impaired, assist with bathing and eating tasks. Encourage the patient to verbalize concerns about carpal tunnel syndrome. Answer questions, and arrange for consultations with a licensed physical therapist and a vocational rehabilitation counselor.
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Nursing Care Plan
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