Carpal Tunnel Syndrome By Rnpedia.Com

1. Of the following common problems of the upper extremities, which results from entrapment of the median nerve at the wrist?

Carpal tunnel syndrome

Ganglion

Dupuytren’s contracture

Impingement syndrome

Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren’s contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

Explanation

Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren’s contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

2. The patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What key point will you be sure to teach the patient?

Pain and numbness will be experienced for several days to weeks.

Immediately after surgery, the patient will no longer need assistance.

After surgery, the dressing will be large with dots of drainage

After surgery, the pain and paresthesia will no longer be present.

Post-operative pain and numbness occur for a longer period of time with endoscopic carpal tunnel release than with the open procedure. Patients often need assistance post-operatively, even after they are discharged. The dressing from the endoscopic procedure is usually very small and there should not be a lot of drainage. Focus: Prioritization

Explanation

Post-operative pain and numbness occur for a longer period of time with endoscopic carpal tunnel release than with the open procedure. Patients often need assistance post-operatively, even after they are discharged. The dressing from the endoscopic procedure is usually very small and there should not be a lot of drainage. Focus: Prioritization

3. You deserve the nursing assistant performing all of these interventions for the patient with CTS. Which action requires that you intervene immediately?

Arrange the patient’s lunch tray and cut the meat.

Provide warm water and assist the patient with a bath.

Replace the patient’s splint in hyperextension position.

Remind the patient not to lift very heavy objects.

When a patient with CTS has a splint used for immobilization of the wrist, it is placed either in the neutral position or in slight extension. The other interventions are correct and are within the scope of practice for a nursing assistant. Nursing assistants may remind patients about elements of their care plans such as avoiding heavy lifting. Focus: Delegation/supervision

Explanation

When a patient with CTS has a splint used for immobilization of the wrist, it is placed either in the neutral position or in slight extension. The other interventions are correct and are within the scope of practice for a nursing assistant. Nursing assistants may remind patients about elements of their care plans such as avoiding heavy lifting. Focus: Delegation/supervision

4. You are preparing the post-operative CTS patient for discharge. Which information is important to provide to this patient?

The surgical procedure is a cure for CTS.

Hand movements will be restricted for 4 – 6 weeks after surgery.

Frequent pain medication dosages will no longer be necessary.

Notify the physician immediately for any pain or discomfort.

Hand movements, including heavy lifting, may be restricted for 4- 6 weeks after surgery. Patients experience discomfort for weeks to months after surgery. The surgery is not always a cure. In some cases, CTS may recur months to years after surgery. Focus: Prioritization

Explanation

Hand movements, including heavy lifting, may be restricted for 4- 6 weeks after surgery. Patients experience discomfort for weeks to months after surgery. The surgery is not always a cure. In some cases, CTS may recur months to years after surgery. Focus: Prioritization

5. 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?

Nephropathy

Macroangiopathy

Carpal tunnel syndrome

Peripheral neuropathy

Peripheral neuropathy refers to nerve damage of the hands and feet. The client did not notice that the object pierced the skin.

Explanation

Peripheral neuropathy refers to nerve damage of the hands and feet. The client did not notice that the object pierced the skin.

6. 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?

Initiate placement of a splint for immobilization during the day.

Assess the patient’s wrist and hand for discoloration and brittle nails.

Assist the patient with daily self-care measures such as bathing and eating.

Test the patient for painful tingling in the four digits of the hand.

Placing a splint for the first time is appropriate to the scope of practice for physical therapists. Assessing and testing for paresthesia are not within the scope of practice for nursing assistants. Assistance with activities of daily living is within the scope of practice for a nursing assistant. Focus: Delegation/supervision

Explanation

Placing a splint for the first time is appropriate to the scope of practice for physical therapists. Assessing and testing for paresthesia are not within the scope of practice for nursing assistants. Assistance with activities of daily living is within the scope of practice for a nursing assistant. Focus: Delegation/supervision

7. A 45-yr-old auto mechanic comes to the physician's office because an exacerbation of his psoriasis is making it difficult to work. He tells the nurse that his finger joints are stiff and sore in the morning. The nurse should respond by:

Inquiring further about this problem because psoriatic arthritis can accompany psoriasis vulgaris

Suggesting he take aspirin for relief because it’s probably early rheumatoid arthritis

Validating his complaint but assuming it’s an adverse effect of his vocation

Asking him if he has been diagnosed or treated for carpal tunnel syndrome

Anyone with psoriasis vulgaris who reports joint pain should be evaluated for psoriaic arthritis. Approximately 15% to 20% of individuals with psoriasis will also develop psoriatic arthritis, which can be painful and cause deformity. It would be incorrect to assume that his pain is caused by early rheumatoid arthritis or his vocation without asking more questions or performing diagnostic studies. Carpal tunnel syndrome causes sensory and motor changes in the fingers rather than localized pain in the joints.

Explanation

Anyone with psoriasis vulgaris who reports joint pain should be evaluated for psoriaic arthritis. Approximately 15% to 20% of individuals with psoriasis will also develop psoriatic arthritis, which can be painful and cause deformity. It would be incorrect to assume that his pain is caused by early rheumatoid arthritis or his vocation without asking more questions or performing diagnostic studies. Carpal tunnel syndrome causes sensory and motor changes in the fingers rather than localized pain in the joints.

8. 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?

Learn to type using your left hand only.

Avoid typing in a long period of time.

Avoid carrying heavy things using the right hand.

Do manual stretching exercise during breaks.

Manual stretching exercises will assist in keeping the muscles and tendons supple and pliable, reducing the traumatic consequences of repetitive activity.

Explanation

Manual stretching exercises will assist in keeping the muscles and tendons supple and pliable, reducing the traumatic consequences of repetitive activity.

9. 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.)

Check the patient’s vital signs every 15 minutes in the first hour.

Check the dressing for drainage and tightness.

Elevate the patient’s hand above the heart.

The patient will no longer need pain medication.

Check the neurovascular status of the fingers every hour.

Post-operatively, patients with OCTR surgery have pain and numbness. Their discomfort may last for weeks to months. All of the other directions are appropriate to the post-operative care for this patient. It is important or monitor for drainage, tightness, and neurovascular changes. Raising the hand/wrist above the heart reduces the swelling form surgery, and this is often done for several days. Focus: Assignment, delegation/supervision

Explanation

Post-operatively, patients with OCTR surgery have pain and numbness. Their discomfort may last for weeks to months. All of the other directions are appropriate to the post-operative care for this patient. It is important or monitor for drainage, tightness, and neurovascular changes. Raising the hand/wrist above the heart reduces the swelling form surgery, and this is often done for several days. Focus: Assignment, delegation/supervision

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