Peripheral neuropathy is a condition affecting the peripheral nervous system or the network of nerves beyond the central nervous system (brain and spinal cord). These nerves are damaged or destroyed disrupting communications affecting the sensory, motor, or autonomic response.
Neuropathy can affect one nerve (mononeuropathy), or two or more nerves (polyneuropathies, which is the most common type).
It can also be acute or chronic and may cause reversible changes if detected early but can result in permanent damage if left untreated. Peripheral neuropathy is commonly misdiagnosed and overlooked, affecting more than 20 million people in the U.S.
Signs and Symptoms of Peripheral Neuropathy
The signs and symptoms of neuropathy depend on which type of peripheral nerves are damaged. It can also be a combination of the following symptoms if more than one nerve is affected:
- Motor neuropathy. Muscle weakness, wasting, twitching, tremors, cramps, or even paralysis may happen.
- Sensory neuropathy. Symptoms are numbness, tingling, burning or loss of sensation, inability to detect temperature changes, difficulty with balance or coordination, and shooting or stabbing pain.
- Autonomic neuropathy. Problems with heat tolerance, sweating, digestion, bowel or bladder control, swallowing, erection, breathing, and blood pressure may be experienced.
Causes of Peripheral Neuropathy
Peripheral neuropathy is either acquired or genetic and can also be idiopathic. The following are some of the known conditions that can cause nerve damage:
- Autoimmune diseases. The immune system attacks its tissue causing nerve damage. This includes: Guillain-Barre syndrome, Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, vasculitis, and chronic inflammatory demyelinating polyneuropathy.
- Diabetes. High blood sugar levels cause damage to the skin and blood vessels causing neuropathy. This is the leading cause of polyneuropathy in the U.S.
- Infections. Certain viruses and bacteria that can attack nerve tissues and cause neuropathy are Lyme disease, Epstein-Barr, West Nile, herpes, syphilis, shingles, chicken pox, leprosy, hepatitis C, and HIV infection.
- Hereditary diseases. Charcot-Marie-Tooth disease causes degeneration of nerves around the muscles. Familial amyloidosis, Fabry disease, and metachromatic leukodystrophy can cause neuropathy.
- Other medical conditions. Kidney or liver disorders, hypothyroidism, metabolic disorder, vascular diseases, bone marrow disorder, hormonal imbalances, degenerative disorders, and tumors can indirectly cause widespread nerve damage.
- Chronic alcoholism and smoking. Alcohol is toxic to nerves because it robs the thiamine essential for nerve function. Smoking can cause vascular problems leading to neuropathy.
- Medications and chemicals. Some antibiotics, anti-seizure, chemotherapeutics, and radiation can damage peripheral nerves. Exposure to lead, mercury, and industrial chemical can also affect nerve function.
- Injury or surgery. Falls, car accidents, or fractures can cause neuropathy. Some surgery can cause temporary or permanent nerve damage.
- Vitamin Deficiencies. Vitamin B, vitamin E, folate, and niacin are crucial to nerve health.
Risk Factors to Peripheral Neuropathy
There are over 100 kinds of peripheral neuropathies, and they usually develop because of certain factors such as:
- Diabetes. It is estimated that 60-70% of people with diabetes have diabetic peripheral neuropathy. This causes 54,000 amputations each year and is highly preventable if detected and treated early.
- Chronic alcoholism. More than half of alcohol abusers develop nerve pain due to poor nutrition and poisoning of the nerve tissues.
- Vitamin deficiencies. Lack of vitamin B12 can cause pernicious anemia leading to peripheral neuropathy. Vitamin B1 or thiamine deficiency can also be seen in chronic alcoholism. Vitamin B1 is essential for nerve function.
- Infections. Viruses and bacteria often damage sensory nerves causing pain and peripheral neuropathy. HIV or AIDS are often accompanied by neuropathy with a 33% prevalence among all cases.
- Autoimmune diseases. The immune system attacking its tissues can cause chronic inflammation and damage to the body leading to temporary or permanent peripheral neuropathy.
- Kidney, liver, or thyroid disorders. Minimize the body’s ability to process nutrients and remove toxins affecting the entire body process.
- Toxins. This represents drug ingestion, chemical abuse, or exposure to heavy metals in the environment. Chemotherapeutic drugs account for 30-40% of induced peripheral neuropathy.
- Repetitive motion. Some professionals or athletes are commonly affected by these neuropathies from continuous trauma or compression of the nerves.
- Family history. Some disorders and conditions are hereditary increasing the risk for peripheral neuropathy.
- Age. Middle-aged and elderly are commonly diagnosed with idiopathic peripheral neuropathy with a 23% prevalence rate.
Complications of Peripheral Neuropathy
Treatment of the underlying cause can help prevent permanent nerve damage and reverse neuropathy. However, if this is left untreated the following complications may arise:
- Burns and skin injury. Loss of sensation and temperature changes increase the risk of getting burns without being aware of it.
- Falls. Impaired balance and coordination increase the risk of falls and injury.
- Infection. A small cut can be left unnoticed due to the loss of sensation and can be infected if left untreated. Always check and treat any breaks in the skin to prevent an infection. Severe infection may lead to skin breakdown or gangrene and amputation.
- Heart and circulatory system problems. Autonomic neuropathy can damage peripheral nerves that control blood circulation and heart rate which can result in cardiovascular autonomic neuropathy (CAN) causing arrhythmias and low blood pressure. This is a serious and life-threatening complication that is common in people with diabetes.
- Diabetic foot ulcer. Blood contains infection-fighting cells essential for healing and perfusion. High blood sugar damages blood vessels causing limited blood supply, numbness, and a longer healing process which may lead to gangrene if left untreated. 1 out of 4 diabetic patients develops foot ulcers over time.
- Gangrene. Reduced blood flow prevents the wound or ulcer from healing causing skin breakdown which requires debridement or even amputation to prevent further damage to the adjacent tissue. Foot ulcers are the leading cause of amputation in diabetic patients.
- Charcot’s foot. It is a diabetic-related rare condition in which the bones and tissue are damaged causing changes in the shape of the feet and toes.
Diagnosis of Peripheral Neuropathy
Peripheral neuropathy is usually diagnosed during a routine check-up due to the variability of the symptoms. The following diagnostic tests that can be done are:
- Medical history. This can initially detect possible underlying causes of neuropathy. A complete medical history includes symptoms, medications, exposure to toxic substances, history of trauma, lifestyle, alcohol use, diet, family history, and medical conditions.
- Physical exam. Thorough physical exam such as checking of vital signs and skin breakdown. Neurological exam to test the sensory and motor function which includes reflexes, muscle strength, muscle tone, sensations, balance, and coordination.
- Blood test. This test should be done to detect vitamin and mineral deficiencies, blood glucose levels, electrolyte imbalance, thyroid function tests, or antibody levels to identify the underlying cause of the neuropathy.
- Imaging test. CT scan or MRI can help detect abnormalities in the blood vessel or bones, tumors, or disc herniation which can cause pinched or compressed nerves.
- Nerve function test. This test is used to determine the extent and nature of the neuropathy. This includes:
- Electromyography (EMG). Records the electrical activity of muscles during rest and contractions. This will determine the responsiveness, and abnormal electrical activity, and differentiate if the disorder is from muscle or nerve.
- Nerve conduction velocity (NCV). It measures the signal strength and speed of the motor and sensory nerves. A slow transmission rate indicates damage to the myelin sheath. Reduced strength impulse indicates axonal degeneration and the inability to elicit signals indicates a severe problem.
- Biopsy. Skin and nerve biopsy can be done to detect abnormalities in the nerve endings.
Treatment for Peripheral Neuropathy
Treatment of peripheral neuropathy is focused on the correction of the present condition and control of symptoms associated which includes:
- Medications. This is used to relieve peripheral neuropathy signs and symptoms.
- Analgesics. NSAIDs are used as a primary choice for mild to moderate pain.
- Anti-seizure. Drugs used for epilepsy have shown effective in relieving pain associated with diabetic neuropathy.
- Antidepressants. Inhibit incoming pain signals relieving neuropathic pain.
- Topical treatments. Lidocaine patch and Capsaicin cream are used for localized pain with fewer side effects.
- Procedures. The following may help ease signs and symptoms of peripheral neuropathy:
- Transcutaneous Electrical Nerve Stimulation (TENS). This procedure delivers a low-level electrical current delivered through the electrodes to your skin disrupting pain signals to the brain.
- Plasmapheresis. Blood transfusion removes antibodies and other proteins which are potentially irritating to your bloodstream.
- Intravenous immune globulin. Receiving high levels of antibodies is beneficial to certain inflammatory conditions.
- Therapeutic ultrasound. It uses high-frequency sound waves to stimulate the tissue regaining sensitivity.
- Therapy. This help improves the quality of life with permanent damage to peripheral neuropathy.
- Physical Therapy. Physical re-education such as gait training and specific exercises helps develop muscle strength and improve movements. Assistive devices may also be used such as braces, a cane, a walker, or a wheelchair to prevent falls and injury. Massage or manual therapy relieves muscle spasms and inhibits atrophy.
- Occupational Therapy. Teaching coping strategies with pain and skills to make up for the loss of function.
- Behavioural therapy and Psychotherapy. May help relieve neuropathic pain.
- Surgery. Nerve decompression surgery caused by a herniated disc, tumors, or nerve entrapment disorders provides effective pain relief and protection from foot ulceration.
- Lifestyle modifications. Eating a healthy balanced diet, maintaining ideal body weight, smoking cessation, and limiting alcohol intake may help in the recovery and improvement of the present condition.
Nursing Diagnosis Peripheral Neuropathy
Nursing Care Plan for Neuropathy 1
Disturbed Sensory Perception (Touch)
Nursing Diagnosis: Disturbed Sensory Perception related to peripheral neuropathy secondary to ongoing chemotherapy as evidenced by tingling sensation and numbness.
Desired Outcomes:
- The patient will be able to adapt skills to cope with sensory disturbances while the treatment is ongoing.
- The patient will be able to perform activities of daily living with minimal assistance and supervision.
Nursing Care Plan for Neuropathy 2
Nursing Diagnosis: Deficient Knowledge related to a new health diagnosis secondary to diabetic neuropathy as evidenced by frequent questioning.
Desired Outcomes:
- The patient will verbalize understanding of the disease process.
- The patient will participate and comply with the treatment plan.
| Nursing Care Plan for Neuropathy | Rationale |
| Assess the patient’s current knowledge and understanding of his/her condition. | This will help the nurse plan an appropriate approach and treatment plan based on the patient’s level of understanding without being overwhelmed with information. |
| Educate the patient about his/her condition and treatment plans in a language that the patient can easily understand. | Information about the condition will help the patient understand the treatment plan. Avoid using medical jargon as this may cause confusion and further questions from the patient and significant others. |
| Educate the patient and significant others using visualization materials such as structural models, images, or videos about the use of an assistive device. | This will provide a clear and detailed picture of the patient’s condition without confusing the patient. Proper use of these devices prevents injury to the patient. |
| Educate the patient about self-care management. | Diabetic neuropathy can be a prolonged debilitating disease, the patient must be able to develop routine self-care to prevent further damage and self-injury. |
| Instruct the patient to repeat the given information about his/her condition. | This will determine the patient’s comprehension of the information given. |
| Encourage verbalization of feelings and difficulties that the patient experience during the treatment. | Restrictions in activities can result in frustration and depression. Promoting a trusting environment can help the patient focus on the treatment goal with expected support from the nurse and caregiver. |
Nursing Care Plan for Neuropathy 3
Nursing Diagnosis: Impaired Physical Mobility related to burn injury secondary to peripheral neuropathy as evidenced by contractures on both extremities.
Desired Outcomes:
- The patient will be able to move both feet and toes without difficulties and absence of contractures.
- The patient will verbalize sensations on both feet and toes with an active range of motion.
| Nursing Care Plan for Neuropathy | Rationale |
| Assess the patient’s skin integrity noting adequate perfusion, motion, and sensation including the digits. | Contractures may cause a limited range of motion and less sensation. Secure adequate skin perfusion to prevent permanent nerve damage. |
| Administer analgesics as ordered before performing exercises or activities. | This encourages the patient’s active participation and reduces muscle stiffness and tension. |
| Provide support or splint to the affected area. | Proper positioning prevents contractures while promoting a functional movement of the extremities and joints. |
| Schedule activities and treatments with rest periods in between. | Help the patient develop a routine without being tired and exhausted. |
| Keep the side rails up, lower the bed, and important items within reach. | Promote a safe environment and reduce the risk of falls. |
| Encourage passive ROM exercises to active ROM. | Gradually increase the patient’s activities as tolerated to enhance muscle function and prevent contractures. |
| Educate significant others about proper support and assistance such as proper use of assistive devices and ROM exercises. | Active participation of family members promotes consistency and compliance with the treatment plan. This can also prevent accidental injury. |
| Encourage activities of daily living with physical therapy. | This can improve muscle strength and functional movements. |
| Consider referral to a physical therapist. | A trained physical therapist can provide safe and proper training with the progression of activities as tolerated. |
| Educate the patient and significant others about warning signs and symptoms to report. | This facilitates prompt intervention and prevents further complications. |
Nursing Care Plan for Neuropathy 4
Nursing Diagnosis: Risk for Falls related to impaired balance secondary to peripheral neuropathy.
Desired Outcomes:
- The patient will be able to maintain balance upon standing and walking.
- The patient will perform activities of daily living safely.
Nursing Care Plan for Neuropathy 5
Nursing Diagnosis: Acute Pain related to burn injury secondary to peripheral neuropathy as evidenced by verbalization of pain on a pain scale of 5/10.
Desired Outcomes:
- The patient will verbalize pain relief within 2 hours of nursing intervention.
- The patient will be able to verbalize awareness of the risk for injury with an impaired ability to detect temperature changes due to peripheral neuropathy.
| Nursing Care Plan for Neuropathy | Rationale |
| 1. Assess the patient’s level of pain using a pain scale every hour. Note the characteristic, duration, or relieving factor associated. | This will determine the effectiveness of the treatment or progression of symptoms. |
| 2. Assist the patient to submerge the affected part in cold or running water. | This relieves the inflammation and pain. |
| 3. Apply a cold compress. | This reduces pain and inflammation when applied within the first 24 hours. |
| 4. Disinfect the wound and place a dressing. | This prevents infection to the affected part. Make sure to change the dressing frequently and check for contractures. |
| Elevate the affected part. | Elevation prevents edema formation, make sure to change positions frequently. |
| 7. Administer pain medication as ordered. | Give pain medications as needed only. |
| 8. Assess the patient’s sensory functions including sensations of pain, touch, temperature, balance, and coordination. | Sensory neuropathy affects sensation and causes burn injury. This will help the nurse plan an appropriate approach and treatment plan based on the degree of injury to the affected part. |
| Provide diversional activities such as guided imagery. | This technique is used to distract the patient from the pain. |
| Encourage range of motion exercises. | This prevents contractures and peripheral nerve damage. |
| Continue activities of daily living observing precautionary measures. | Gradually increase the activity of the affected part as tolerated to enhance muscle function and prevent contractures. |
| Consider referral to an occupational therapist or physical therapist. | Trained OT and PT can provide skills to adapt and improve functions while performing activities of daily living. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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