Peripheral Neuropathy

Peripheral Neuropathy for Nurses

1. Peripheral Neuropathy Nurses' Manual

2. CONTENTS Introduction Types Causes Sign and symptoms Diagnosis Treatment/management Nurses' Manual

3. Introduction The peripheral nervous system refers to the parts of the nervous system that are outside the central nervous system i.e . those outside the brain and spinal cord. Nurses' Manual

4. Thus, the peripheral nervous system includes: The nerves that connect the head, face, eyes, nose, muscles, and ears to the brain – 12 pairs of Cranial Nerves The nerves that connect the spinal cord to the rest of the body, including the 31 pairs of Spinal Nerves More than 100 billion nerve cells that run throughout the body Nurses' Manual

5. Peripheral nerves, by connecting the spinal cord and brain to all other body organs, transmit motor impulses outward and rely back sensory impulses to encode sensation in the brain. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain. Nurses' Manual

6. Peripheral neuropathy is a disorder affecting motor, sensory or autonomic nerves . Nurses' Manual

7. Types Neuropathies are classified according to the problems they cause. They are: a)Mono neuropathy b)Poly neuropathies Nurses' Manual

8. a. Mononeuropathy Damage to a single peripheral nerve is known to as mononeuropathy . Mononeuropathy occurs when myelin sheath or part of the nerve cell is damaged. The damage prevents nerves from spreading signals. Nurses' Manual

9. The most common cause is physical injury or trauma from an accident. Common complains are: -loss of feeling in the affected area -weakness in the affected area -pain or burning -feeling of “ pins and needles ” etc Nurses' Manual

10. Types of mononeuropathies Carpel tunnel syndrome Ulnar nerve palsy Radial nerve palsy Tarsal tunnel syndrome Peroneal nerve palsy Nurses' Manual

11. 1. Carpel tunnel syndrome AKA overuse strain injury Common type of mononeuropathy Occurs due to compression of median nerve at wrist . Risk: people whose work requires repeated motions with the wrist   Nurses' Manual

12. 2. Ulnar nerve palsy Occurs when ulnar nerve is damaged. Numbness is noted in the 4th and 5th digit of the hand. Nurses' Manual

13. 3. Radial nerve palsy Caused by injury to the radial nerve Occcurs when humerus bone is fractured. Nurses' Manual

14. 4. Tarsal tunnel syndrome Caused when the posterior tibial nerve is trapped Posterior nerve travels along tarsal tunnel.   Nurses' Manual

15. 5. Peroneal nerve palsy Occurs when peroneal nerve is compressed. This leads to a condition called “ foot drop”. Nurses' Manual

16. b. Polyneuropathy Accounts for the greatest number of peripheral neuropathy cases. It occurs when multiple peripheral nerves throughout the body malfunctioned at the same time causing weakness ,numbness and burning pain in roughly the same side of the body. One of the most common forms of chronic polyneuropathy is diabetic neuropathy. Nurses' Manual

17. Causes Idiopathic causes Age: over 40 Acquired causes: environmental factors such as illness,trauma,toxins etc. Other causes are diabetes,alcoholism , under nutrition(especially vitamin B), cancer and chemotherapy, different medications, etc Hereditary : are not so common. most common of these is Charcot-Marie tooth disease type 1. Nurses' Manual

18. Sign And Symptoms Depends upon the type of nerve is affected. When sensory nerve is affected: -Gradual onset of numbness -Prickling or tingling in feet or hands, which can spread upward into legs and arms . -Sharp, throbbing or burning pain -Extreme sensitivity to touch -Pain during activities that shouldn't cause pain. Nurses' Manual

19. S/S Cont’d… When motor nerve is affected : lack of coordination, falling, muscle atrophy, diminished reflex ,etc. When autonomic nerve is affected : heat intolerance, excessive sweating or no sweating, changes in blood pressure causing dizziness, etc Nurses' Manual

20. Diagnosis History taking Physical examination Blood test CT/MRI Nerve biopsy Electromyography Nurses' Manual

21. Treatment 1.Medical Management 2. Nursing management Nurses' Manual

22. 1.Medical Management a. Pharmacological treatment Treatment of peripheral neuropathy depends upon the cause. Eg if diabetes is the cause, then it is important to control blood sugar level. Analgesics: acetaminophen and other NSAIDS like ibuprofen,aspirin Other medications: cyclo oxygenase 2 inhibitor, serotonin nor epinephrine reuptake inhibitor- cymbalta , etc Nurses' Manual

23. b. Plasmapheresis can be done in case of polyneuritis. AKA plasma exchange . Works by ridding plasma off certain antibodies that contributes immune system to attack on peripheral nerves Nurses' Manual

24. c.Transcutaneous nerve stimulation: The goal of is to disrupt nerves from transmitting pain signals to the brain. It uses low voltage electrical current to provide pain relief A battery-powered device delivers electrical impulses through electrodes placed on the surface of skin at or near nerves where the pain is located or at trigger points. Nurses' Manual

25. d. Use of splints: casts provide support for the part of body that is uncomfortable. This can relieve pain. For example, a cast or splint that holds wrists in a proper position while sleeping can relieve the discomfort of carpal tunnel syndrome. Nurses' Manual

26. e . Self care: Acupuncture Massage, Yoga, meditations, exercises etc Avoiding alcohol and smoking Controlling blood sugar level Nurses' Manual

27. f.Precaution at home: Always wear shoes Keep floor clean Check temperature before bathing with elbow Don’t stay in one position for long period, etc Nurses' Manual

28. 2.Nursing management: History taking Complete physical assessment. Assess level of patients understanding. Provide prescribed medications on time ,assess side effects and ,manage them efficiently. Instruct about good foot care including proper use of good shoes. If overweight, advise to reduce weight. Nurses' Manual

29. Assist in choosing walking aids for those with severe leg weakness Maintain safe environment, assist with ambulation. Explain the effectiveness of using braces/splints in case of foot drops. Physiotherapy is very effective, so provide and teach the patient and family members. Counseling is must and focus on the underlying causes, self care and precautions to be taken at home. Also focus for immediate follow up when the symptoms got worsen. Nurses' Manual