Carpopedal spasm

Carpopedal spasm.......

Definition

A spasm (the painful contraction of the muscles) of the hand and feet.

Supplement

This is often linked with conditions of hypocalcemia, hyperventilation, and tetany.

Synonym:

• carpopedal contraction

Carpopedal spasm: Excerpt from Nursing: Interpreting Signs and Symptoms

It's an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and sustained muscle contraction and is commonly associated withhypocalcemia.Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm.)

Carpopedal spasm requires prompt evaluation and intervention. If the primary event isn't treated promptly, the patient can also develop laryngospasm, seizures, cardiac arrhythmias, and cardiac and respiratory arrest.

Action stat!

If you detect carpopedal spasm, quickly examine the patient for signs of respiratory distress (such as laryngospasm, stridor, loud-crowing noises, and cyanosis) or cardiac arrhythmias, which indicate hypocalcemia. Obtain blood specimens for electrolyte analysis (especially calcium), and perform an electrocardiogram. Connect the patient to a cardiac monitor to watch for the appearance of arrhythmias. Administer an I.V. calcium preparation, and provide emergency respiratory and cardiac support. If calcium infusion doesn't control seizures, administer a sedative, such as chloral hydrate or phenobarbital.

History and physical examination

During the history, form a general impression of the patient's mental status and behavior. If possible, ask family members or friends if they've noticed changes in the patient's behavior.Mental confusion or even personality changes may occur with hypocalcemia.If the patient isn't in distress, obtain a detailed history. Ask about the onset and duration of the spasms and ask for a description of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.

Inspect the patient's skin and fingernails, noting dryness or scaling and ridged, brittle nails.

Medical causes

Hypocalcemia.Carpopedal spasm is an early sign of hypocalcemia. It's usually accompanied by paresthesia of the fingers, toes, and perioral area; muscle weakness, twitching, and cramping; hyperreflexia; chorea; fatigue; and palpitations. Positive Chvostek's and Trousseau's signs can be elicited. Laryngospasm, stridor, and seizures may appear in severe hypocalcemia.

Chronic hypocalcemia may be accompanied by mental status changes; cramps; dry, scaly skin; brittle nails; and thin, patchy hair and eyebrows.

Tetanus.With tetanus, the patient develops muscle spasms and painful seizures. Difficulty swallowing and a low-grade fever are also present. If the patient isn't treated or treatment is delayed, the mortality rate is very high.

Other causes

Treatments.Multiple blood transfusions and parathyroidectomy may cause hypocalcemia, resulting in carpopedal spasm. Surgical procedures that impair calcium absorption, such as ileostomy formation and gastric resection with gastrojejunostomy, may also cause hypocalcemia.

Nursing considerations

▪ If carpopedal spasm causes severe pain and anxiety, leading to hyperventilation, help the patient slow his breathing through your relaxing touch, reassuring attitude, and clear directions about what he should do.

▪ Provide a quiet, dark environment to reduce his anxiety.

▪ Prepare the patient for laboratory tests, such as complete blood count and serum calcium, phosphorus, and parathyroid hormone studies.

▪ Suspect tetanus in anyone with carpopedal spasm, difficulty swallowing, and seizures.

Patient teaching

▪ Explain the underlying disorder and treatment plan.

▪ Teach the patient the importance of receiving immunization against tetanus and of keeping a vaccination record.

▪ Explain that a tetanus toxoid booster shot should be given every 10 years prophylactically, after the patient has been properly immunized in childhood.

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