Symptom: Numbness

Initial Grading Reminder

CTCAE grading of numbness:

Grade 1: Mild symptoms
Grade 2: Moderate symptoms; limiting instrumental ADLs
Grade 3: Severe symptoms; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Do you normally have some degree of numbness? Has the symptom developed gradually or suddenly?

Grade the symptom

Ask the patient:

Where are you numb? If it’s fingertips/hands: Can you button your pants or shirt? Can you put the backs on your earrings without help? If it’s toes/feet: Can you walk without stumbling or looking at your feet? Is it affecting your ability to take care of yourself? Do you typically have any numbness/tingling in that area?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any difficulty breathing?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new-onset or greatly exacerbated numbness should be seen.

    Patients with numbness plus shortness of breath need to be seen immediately, with an ED referral as necessary.

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    Nursing Assessment of Potential Causes

    Neuropathy - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear weak?
    • Does the patient appear uncomfortable?
    • Altered ambulation or general movement?
    • If muscular weakness is present, any respiratory difficulties apparent?
    • Does the patient report weakness (unilateral or bilateral)?
    • Does the patient report new or worsened pain, numbness, or tingling?
    • Does the patient report difficulty walking or holding items?
    • Motor deficits
    • Sensory deficits
    • Mental status changes
    • Paresthesias
    • Laboratory values
    • Does the patient have diabetes mellitus?
    • Are there neurologic signs and symptoms?
    • Results of prior imaging
      • Metastases to spinal cord
      • Other metastases that may cause symptoms

    Differential Diagnosis

    What do you suspect is the cause of the numbness?