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
[tab category='Neuropathy' header="Neuropathy - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']Differential Diagnosis
What do you suspect is the cause of the numbness?
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