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^ PLANNING AND IMPLEMENTATION Collaborative

The most conservative treatment prescribed by physicians is splinting of the involved wrist and administering of medications. Physical therapy may be prescribed at any point in the treatment process to decrease swelling and promote healing. After 6 weeks of physical therapy, a vocational evaluation is performed to determine the patient's ability to return to his or her previous job. Vocational retraining may be recommended. If conservative treatment is not successful, the carpal ligament is released surgically to relieve compression of the median nerve. The surgeon may also perform neurolysis, freeing of the nerve fibers, if necessary.

Pharmacologic Highlights

Medication or Drug Class Dosage Description Rationale

Nonsteroidal anti-inflammatory Varies with drug Includes a number of medications Reduce swelling medications such as indomethacin (Indocin)

or phenylbutazone

Other Medications: Steroid injections are also used to decrease the inflammation of the carpal ligament. Analgesics are administered as needed.

196 Cataract

Independent

An important focus of nursing intervention is prevention of CTS. When discussing prevention, explain to the patient that people at risk should be rotated into other jobs that do not require similar tasks. Periodic rests should also be taken, accompanied by stretching of the wrist, hand, fingers, and thumbs. If the patient is to wear a splint, teach the proper techniques for applying the splint so that it is not too tight. Teach the patient how to remove the splint in order to exercise, and teach the patient how to perform daily, gentle range-of-motion exercises. If the patient is to wear a sling, instruct her or him to remove it several times daily to perform elbow and shoulder exercises. Advise the patient that occasional exercise in warm water is therapeutic. Encourage the patient to use the hands as much as possible. For patients whose hand use is impaired, assist with bathing and eating tasks. Encourage the patient to verbalize concerns about CTS. Answer questions, and arrange for consultations with a licensed physical therapist and a vocational rehabilitation counselor.

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