Peripheral neuropathy refers to disorders involving the peripheral nerve cells. These cells work like communication networks between the central nervous system and the rest of the body by sending signals that help control movement and sensation.
Diabetes mellitus, chronic alcoholism, autoimmune diseases, nutritional deficiencies, infections, chemotherapy drugs, malignancy, hypothyroidism, and trauma, are possible causes of peripheral neuropathy.
Motor symptoms caused by peripheral neuropathy include:
- Muscle weakness
- Paralysis
- Uncontrolled movements
Sensory symptoms caused by peripheral neuropathy include:
- Tingling
- Numbness
- Pain
- Loss of balance
Autonomic symptoms caused by peripheral neuropathy include:
- Orthostatic hypotension
- Tachycardia
- Sweating
- Bowel and bladder difficulties
- Sexual dysfunction
- Blurred vision
Neurological exams, blood tests, electromyography (EMG), and imaging tests can assess and diagnose peripheral neuropathy or detect underlying causes of peripheral neuropathy.
Nursing Process
Nursing goals include alleviating the disruptive symptoms of peripheral neuropathy and keeping the patient safe. Patients are at higher risk of developing wounds or experiencing injuries due to the impairment of a protective sensation. Nurses can also assist in managing underlying causes and educating patients on treatment modalities.
Nursing Care Plans Related to Peripheral Neuropathy
Disturbed Sensory Perception (Touch)
The patient experiences alterations in nerve signaling, causing a diminished, distorted, or impaired response to stimuli.
Nursing Diagnosis: Disturbed Sensory Perception (Touch)
Related to:
- Impaired sensation
- Altered circulation
As evidenced by the following:
- Hyperesthesia
- Tingling sensation
- Numbness
- Muscle weakness
- Twitching
Expected outcomes:
- Patient will recognize and compensate for alterations in peripheral sensation.
- Patient will remain free from injury.
Assessment:
1. Assess sensory and motor functions.
To detect abnormalities, the nurse can assess the patient’s sensations, reflexes, and response to stimuli.
2. Identify factors that contribute to the development of peripheral neuropathy.
A wide range of etiologies causes peripheral neuropathy. The nurse can assess for underlying causes like diabetes, injuries, autoimmune diseases, vascular disorders, excessive alcohol use, and vitamin deficiencies.
Interventions:
1. Collaborate with an occupational or physical therapist.
Therapists provide individualized exercise and rehabilitation for patients experiencing disability or mobility problems caused by peripheral neuropathy.
2. Educate the patient and family on safety precautions to prevent injury.
The loss of protective sensation causes patients to be at higher risk of injury. Family members can keep patients safe by checking the water temperature before bathing and food or cooking temperature to prevent burns.
3. Instruct the patient about proper foot care.
Due to poor circulation to the feet, patients are at risk for injuries and impaired healing. Instruct patients to inspect their feet daily, wear proper footwear, and see a podiatrist for foot care.
4. Encourage assistive devices.
Correctly using wheelchairs, canes, crutches, and braces can prevent injuries.
Chronic Pain
The patient may experience unpleasant sensory experiences due to nerve damage.
Nursing Diagnosis: Chronic Pain
Related to:
- Impaired sensation
- Physical trauma
- Nerve injury
As evidenced by the following:
- Self-report of pain intensity and characteristics
- Guarding behaviors
- Facial grimacing
- Restlessness
Expected outcomes:
- Based on a standardized scale, the patient will report no pain or decreased pain intensity.
- Patient will appear relaxed and able to sleep and rest appropriately.
- Patient will demonstrate strategies to manage pain.
Assessment:
1. Assess reports and descriptions of pain.
Neuropathic pain can affect only one nerve or many nerves. Neuralgias are associated with sensations such as numbness, tingling, and burning. Patients may describe sharpness or throbbing sensations. They may feel pain in unusual instances, such as the weight of a blanket.
2. Note nonverbal cues of pain.
Some patients cannot express pain verbally, and nonverbal cues like crying, agitation, or restlessness may be used to assess pain. Patients with long-term conditions may have acute pain superimposed on chronic pain issues.
Interventions:
1. Instruct on topical medications.
Capsaicin cream and lidocaine patches can be purchased over-the-counter to relieve pain without systemic side effects.
2. Administer medications.
NSAIDs, opioids, anti-seizure medications, and tricyclic antidepressants all play a role in relieving neuropathic pain.
3. Instruct on a Transcutaneous Electrical Nerve Stimulator.
A TENS unit can be applied to the site of pain where an electrical current stimulates the nerves to reduce pain and muscle spasms.
4. Prepare for surgery.
Pressure from tumors, pinched nerves, or injuries can be relieved by alleviating the pressure on the nerves through surgical intervention.
Risk for Impaired Skin Integrity
The patient is at risk for epidermis and dermis injury due to numbness and impaired sensations.
Nursing Diagnosis: Risk for Impaired Skin Integrity
Related to:
- Impaired sensation
- Impaired circulation
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred, and the goal of nursing interventions is aimed at prevention.
Expected outcomes:
- Patient will exhibit intact skin.
- Patient will demonstrate behaviors and techniques to prevent skin breakdown or injury.
Assessment:
1. Inspect the skin each shift.
Changes in color, turgor, and vascularity, along with redness, excoriation, or ecchymosis, indicate poor circulation and early breakdown that may lead to decubitus formation and infection.
2. Monitor fluid intake and hydration of the skin and mucous membranes.
Poor fluid intake, as well as fluid overload and edema, can contribute to skin breakdown.
Interventions:
1. Provide gentle skin care.
Do not use abrasive soaps, scrubs, or washcloths on the skin. Lotions and ointments may be desired to relieve dry, cracked skin.
2. Implement methods to prevent unintentional injury.
Cool, moist compresses can relieve itching rather than scratching. Keep fingernails short; encourage the use of gloves during sleep to reduce the risk of dermal injury.
3. Reposition frequently.
Patients who lack the ability to feel pain in prolonged positions are at risk for pressure ulcers or poor alignment. Ensure repositioning frequently, pad bony prominences, and use elbow and heel protectors to decrease pressure on edematous, poorly perfused tissues to reduce ischemia.
4. Provide foam or pressure-relieving mattresses.
Reduces prolonged pressure on tissues, which can limit cellular perfusion, potentiating ischemia and necrosis.
References
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice. (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M. E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span. (10th ed.). F.A. Davis.
- Hammi C, Yeung B. Neuropathy. [Updated 2022 Oct 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542220/
- Jameson, L.J., et al. (2018). Harrison’s principles of internal medicine. (20th ed.). McGraw Hill.
- Marchettini, P., Lacerenza, M., Mauri, E., & Marangoni, C. (2006). Painful peripheral neuropathies. Current neuropharmacology, 4(3), 175–181. https://doi.org/10.2174/157015906778019536
