The nurse is assessing a diabetic client for pain following right total knee replacement surgery. The client reports "numbness and tingling" in the bilateral lower extremities. Pedal pulses are strong bilaterally, and capillary refill is

Question

The nurse is assessing a diabetic client for pain following right total knee replacement surgery.  The client reports "numbness and tingling" in the bilateral lower extremities.  Pedal pulses are strong bilaterally, and capillary refill is <3 seconds in the right great toe.  Which action should the nurse take?

Quizplus · Accepted Answer

11ecbb05_ca03_ccdc_b433_2153f2b5ee34_MD0009_00 Numbness and tingling in both lower extremities are classic examples of neuropathic pain. The common causes of bilateral peripheral neuropathy include the following: Diabetic neuropathy - most common; distribution is usually sock-and-glove pattern Autoimmune neuropathy - Guillain-Barré syndrome Toxic neuropathy - alcohol use Establishing that the sensations the client is experiencing were present before surgery indicates whether this is a complication of surgery. Because the sensation is bilateral and the surgery was on the right knee, the "numbness and tingling" are probably baseline diabetic neuropathy. This should be confirmed by gathering more information from the client (Option B). (Option A) Diabetic neuropathy is not usually treated with traditional post-surgical medications such as opioids. Medications for diabetic neuropathy are usually given on a fixed, timed schedule and include duloxetine, pregabalin, amitriptyline, and gabapentin. If the client uses an as-needed medication, it is important to ask for more information before administering it. The client should be asked whether the pain is baseline and what medication is taken. (Option C) The nurse should question any abnormal finding, whether expected or unexpected. Questioning the client further would allow the nurse to gather more information and confirm that the client's "numbness and tingling" do not indicate a more serious situation. (Option D) It is not necessary to notify the HCP immediately. Bilateral pedal pulses and normal capillary refill indicate sufficient blood flow to the extremities. Educational objective: The nurse should assess for causes of pain and rule out serious complications as part of a pain assessment. Sensations of "numbness and tingling" indicate diabetic neuropathy but should be confirmed as baseline for the client before continuing the assessment.

The Nurse Is Assessing a Diabetic Client for Pain Following