nurses soar! training curricula series for more information and inquiries: nursessoar@georgetown.edu

Nurses SOAR!Training Curricula Series

For More Information and Inquiries: nursessoar@georgetown.edu

Peripheral Neuropathy

Abbye Solis RN, BSN, PCCN

Georgetown University

School of Nursing and Health Studies

Washington, DC USA

Peripheral Neuropathy

Also called….

“Distal Symmetrical Polyneuropathy”, or DSP

Occurs in 1/3 of all HIV+ persons

Causes

Side effect of antivirals (ddI, d4T)

Side effect of TB treatment meds (INH)

Direct attack on neurons by HIV virus

Other causes

Vitamin deficiencies (Vit B12)

Diabetes

Heavy alcohol use

Neurons

Part of one of the layers of the skin

When we touch something, neurons send a signal to our brain which forms our interpretation of what we feel: soft, cold, wet, and hot.

PN

Damage to neurons decreases sensation

Damage to neurons cause alterations to normal function

Alterations in neuronal signaling can cause pain, numbness, tingling, and/or sharp pin-like stabs

Signs and Symptoms

Most common complaint: numbness and burning

Other complaints:

Pin-like pricking, can be vibratory Shooting pains Cold sensation in extremities Leg cramps

Increased in pain at night is common

Progression

Will get worse at the same rate in both hands/arms or feet/legs

Pain can be life altering and dehabilitating

People who have PN are at risk for:

Wounds/Sores

Infections

Depression because of pain

Decreased activity

Treatment of mild pain

If no other NRTI can be used (AZT), reduce d4T by 10mg BID

Treat pain with NSAIDS, Neurontin, or amitriptyline

Treatment of severe pain

Stop all “d-drugs” (ddI, d4T, )

If AZT can be used, start AZT

If AZT cannot be used, stop all ARVs

Treat pain with opiates and Neurontin or amitriptyline

Pain will decrease significantly in 6-8

weeks after stopping medications, but will

not completely go away

Pain Treatment

Mild pain:

NSAIDS Neurontin amitriptylin

e

Severe pain:

Opiate drug

Neurontin amitriptylin

e

Other treatments

Good hygiene of feet

Don’t go out barefoot, if possible

Use walking cane for balance

Stay active

Eat foods high in vitamins

Vitamin supplement: ascorbic acid, multivitamin, vitamin B complex

Peripheral Neuropathy

John is a 47 year old male, diagnosed with HIV 5 years ago, at which time he had a CD4 count of 190 and was started on ARV’s. For the last two years, his viral load has been “undetectable”.

He complains of burning and stiffness in both left foot and toes. He also says he cannot feel most of his right foot when he is walking.

What are some more questions you need to ask him?

Do you take his shoes off to look at his feet?

What can you educate him about today?

Two months later, John complains of his feet burning all the time and he does not get out of bed because “the pain is unbearable”.

He is no longer able to move them without crying out in pain.

What medication can you give him to help with the pain?

John says he wants to stop taking his HIV medications because the pain is so bad. What is your response?