Symptom: Tingling/Numbness, in Hands

Initial Grading Reminder

Grading of paresthesia:

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

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any issues with numbness/tingling in your hands previously? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How bad is the tingling in your hands? Are you able to get dressed independently (button pants/shirt, put backs on earrings)? Does it affect your ability to do the things you want to do? Please give examples of things you can’t do now that you could before.

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you also having 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 moderate or worse (or worsening) numbness/tingling in the hands should be seen.

    Patients with any concomitant breathing difficulties should be seen immediately.

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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 tingling fingers?