Carpal Tunnel

Carpal Tunnel Text Mode – Text version of the exam 1) You deserve the nursing assistant performing all of these interventions for the patient with CTS. Which action requires that you intervene immediately? immediately? A. Arr an ang e t he he pa pat ie ien t’ t’ s l un unch tr tr ay ay an and cu cut th the me me at at . B. P rro o vi vi de de w ar ar m w at at er er a nd nd a ss ss is is t t he he p at at ie ie nt nt wi wi th th a b at at h. h. C. e pl pl ac ac e t he he pa pa ti ti en en t’ t’ s s pl pl in in t i n h yp yp er er ex ex te te ns ns io io n p os os it it io io n. n. !. e mi mi nd nd th the pa pa ti ti e en nt no no t t o li ft ft ve ve ry ry he he av av y o b" b" e ec ct s. s. ) 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. #nit #nitia iate te plac placem emen entt of of a spli splint nt for for imm immob obil ili$ i$at atio ion n dur durin ing g the the day day. B. Asse Assess ss the the pat patie ient nt’s ’s wris wristt and and hand hand for for dis disco colo lora rati tion on and and bri britt ttle le nail nails. s. C. Assi Assist st the the pati patien entt wit with h dai daily ly self self%c %car are e mea measu sure res s suc such h as as bat bathi hing ng and and eat eatin ing. g. !. Test est the the pati patien entt for for pain painfu full tin tingl glin ing g in in the the four four digi digits ts of the the han hand. d. ") #f the following common pro$lems of the upper e%tremities& which results from entrapment of the median nerve at the wrist? A. Carpal tunnel syndrome B. &anglion C. !upuytren’s contracture !. #mpingement sy syndrome ') The nurse is conducting a discharge teaching regarding the prevention of further pro$lems to a client who undergone surgery for carpal tunnel syndrome of the right hand. Which of the following instruction will the nurse includes? A. 'earn to type us in ing your left ha hand only. B. Avoid ty typing in in a long pe period of of ti time. C. Av oi oi d ca rr rry in ing he hea vy vy th thi ng ngs us us in in g t he he ri righ t h an and . !. ! o m an an ua ua l s tr tret ch chi ng ng ex exerci se se du dur in in g brea (s (s . () s charge nurse you assign the nursing care of a patient who has *ust returned form open carpal tunnel release surgery to an e%perienced +,-+/-& +,-+/-& who will perform under the supervision of an 0-. Which of the following instructions will you provide for the +,-+/-? !Choose all that apply.) A. C he he c( c( th th e p at at ie ie nt nt ’s ’s vi vi ta ta l s ig ig ns ns ev ev er er y ) * m in in ut ut es es in in th th e + rs rs t ho ho ur ur. B. C he he c( c( th the dr dre s ss s in in g f or or dr dr ai ai na na ge ge an and ti tig ht ht ne nes s. s. C. ,levate th the pa patient ’s ’s ha hand ab above th the he heart. !. Th e pa ti ti e en n t w ilil l no lo lon ge ge r ne ed ed pa pai n m ed ed ic ica ti ti on on . ,. C he he c( c( th th e n eu eu ro ro va va sc sc ul ul ar ar st st at at us us of of th th e + ng ng er er s e ve ve ry ry ho ho ur ur. ) The patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What 2ey point will you $e sure to teach the patient? A. Pa in in an an d n um um bn bn es es s w ilil l b e ex pe pe ri ri en en ce ce d f or or se se ve ve ra ra l d ay ay s t o w ee ee (s (s . B. #mme #mmedi diat atel ely y aft after er surg surger eryy- the the pat patie ient nt will will no long longer er need need assi assist stan ance ce.. C. Af te te r s ur ur ge ge ry ry - th th e d re re ss ss in in g w ilil l b e l ar ar ge ge wi wi th th do do ts ts of of dr dr ai ai na na ge ge !. Afte Afterr sur surge gery ry-- the the pain pain and and par pares esth thes esia ia will will no long longer er be pres presen ent. t. 3)  '(4yr4old auto mechanic comes to the physician5s office $ecause an e%acer$ation of his psoriasis is ma2ing it difficult to wor2. 6e tells the nurse that his finger *oints are stiff and sore in the morning. The nurse should respond $y7 A. #nuir #nuiring ing furthe furtherr abou aboutt this this probl problem em becaus because e psoria psoriatic tic arthri arthritis tis can can acc accomp ompany any psoria psoriasis sis vulgaris B. /ugg /ugges esti ting ng he he ta(e ta(e asp aspir irin in for for rel relie ieff beca becaus use e it’s it’s pro proba babl bly y earl early y rheu rheuma mato toid id art arthr hrit itis is C. 0alid alidat atin ing g his his comp compla lain intt but but assu assumi ming ng it’s it’s an an adv adver erse se e1ec e1ectt of of his his voca vocati tion on !. As(i As(ing ng him him if if he he has has been been diag diagno nose sed d or or tre treat ated ed for for car carpa pall tun tunne nell syn syndr drom ome e 8) 9rs. 9oore& 4year4old& with dia$etes is in the emergency department. She stepped on a sharp sea shells while wal2ing $arefoot along the $each. 9rs. 9oore did not notice that the o$*ect pierced the s2in until later that evening. What pro$lem does the client most pro$a$ly have? A. 2ephropathy B. 3acroangiopathy

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Carpal tunnel syndrome Peripheral neuropathy :) You are preparing the post4operative CTS patient for discharge. Which information is important to provide to this patient? The su surgical pr procedure is is a cure for CT CT/. 4 an an d m ov ov em em en en ts ts wi wi llll be be re re st st ri ri ct ct ed ed fo fo r 5 – 6 w ee ee (s (s af af te te r s ur ur ge ge ry ry. 7r e e ue ue nt nt p ai ai n m ed ed ic ic at at io io n d os os ag ag es es wi wi llll no no l on on ge ge r be be ne ne ce ce ss ss ar ar y. 2 ot ot if ify th th e p hy hy si si ci ci an an im im me me di di at at el el y f or or an an y p ai ai n o r d is is co co mf mf or or t. t.  nswers and 0ationales C. Replace the patient’s splint in hyperextension position. 8hen a patient with CT/ has a splint used for immobili$ation 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. 2ursing assistants may remind patients about elements of their care plans such as avoiding heavy lifting. 7ocus9 !elegation:supervision C. Assist the patient with daily self-care measures such as bathing and eating. Placing a splint for the +rst 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. 7ocus9 !elegation:supervision A. Carpal tunnel syndrome . Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion- a collection of gelatinous material near the tendon sheaths and "oints- appears as a round- +rm- cystic swelling- usually on the dorsum of the wrist. !upuytren’s contracture is a slowly progressive contracture of the palmar fascia. #mpingement syndrome is associated with the shoulder and may progress to a rotator cu1 tear. D. Do manual stretching exercise during breas. 3anual stretching exercises will assist in (eeping the muscles and tendons supple and pliable- reducing the traumatic conseuences of repetitive activity. A. Chec the patient’s !ital signs e!ery "# minutes in the $rst hour. hour. % &. Chec the dressing for drainage and tightness. % C. 'le!ate the patient’s hand abo!e the heart. % '. Chec the neuro!ascular status of the $ngers e!ery hour. Post%operatively- patients with =CT surgery have pain and numbness. Their discomfort may last for wee(s to months. All of the other directions are appropriate appropriate to the post%operative care for this patient. #t is important or monitor for drainage- tightness- and neurovascular changes. aising the hand:wrist above the heart reduces the swelling form surgery- and this is often done for several days. 7ocus9 Assignmentdelegation:supervision A. (ain and numbness will be experienced for se!eral days to wees. Post%operative pain and numbness occur for a longer period of time with endoscopic carpal tunnel tunnel release than with the open procedure. Patients often need assistance post%operatively- even after they are discharged.  The dressing from from the endoscopic procedure is is usually very small and there there should not be a lot of drainage. 7ocus9 Prioriti$ation A. )n*uiring further about this problem because psoriatic arthritis can accompany psoriasis !ulgaris . Anyone . Anyone with psoriasis vulgaris who reports "oint pain should be evaluated for psoriaic arthritis. Approximately )*? to ;@? of individuals with psoriasis will also develop psoriatic arthritis- which can be painful and cause deformity. deformity. #t would be incorrect to assume that his pain is caused by early rheumatoid arthritis or his vocation without as(ing more uestions or performing diagnostic studies. Carpal tunnel syndrome causes sensory and motor changes in the +ngers rather than locali$ed pain in the "oints. D. (eripheral neuropathy . Peripheral neuropathy neuropathy refers to nerve damage of the hands and feet. The client did not notice that the ob"ect pierced the s(in. &. +and mo!ements will be restricted for ,   wees after surgery. 4and movements- including heavy lifting- may be restricted for 5% 6 wee(s after surgery. surgery. Patients experience discomfort for wee(s to months after surgery. surgery. The surgery is not always a cure. #n some cases- CT/ may recur months to years after surgery. surgery. 7ocus9 Prioriti$ation