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Symptom: Hands, Difficulty Using

Initial Grading Reminder

CTCAE grading of difficulty using hands:

Grade 1: Asymptomatic; clinical or diagnostic observations only; intervention not indicated
Grade 2: Moderate symptoms; limiting instrumental ADLs
Grade 3: Severe symptoms; limiting self-care ADLs; mechanical assistance indicated

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? Have you had any difficulty using your hands in the past? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How much difficulty do you have using your hands? Have you been dropping or having difficulty gripping objects? What tasks can you or can’t you do?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you also having any difficulty breathing? Are you having trouble with any other joints in your body? If so, are you worried about falling?

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) symptoms should be seen.

    Patients with difficulty breathing or who are at a fall risk because of arthritis/arthralgia should be seen immediately.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the patient’s flatulence?

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