"Old" Neuro assessmet of Nipple Twisting of Pinching - page 4
Can anyone give a little history regarding nursing's involvement with nipple twisting or pinching in order to elicit a neurologic response? Approx. how long was it a part of our nursing assessment?... Read More
Dec 23, '09ThrowEdNurse; I work in a major hospital in a large city. The day after a catastrophic natural disaster, when we were innondated with more pts than we could safely manage. . .
Dec 25, '09I would like to weigh in on the debate: I side w/Morte....the nipple is a highly erogenous area of the body, and recognized as such by our society mores, and researched and defined as such by physiology experts. Twisting other erogenous zones on the body 'to provoke a pain response' is not considered a standard of care, so why would the nipple? Most ED nurses I have worked with do not do this anymore, if ever. It was recognized as inappropriate at least 10 years ago, if not more, and yes, it could easily be construed as assault and battery. Excuses as "we were busy", "we needed the bed for someone sicker", "we had a disaster" does not stand up as an effective defense should the point be adjudicated in court. I have not heard anyone objecting to the nailbed procedure or the trapezius muscle pinch procedure (yet). Having witnessed this procedure in the past, on pts. that had a high index of suspicion of playing possum and refusing to cooperate with a medical screening, the behavior almost always screams SHORTCUT in context. May I also add, just because an MD does it, does not mean it is appropriate nursing care.
In my past experience, (at a large urban hospital), we would assess for fine motor muscle movement of the eyelids. This finding is present in the conscious pt., is very rapid and fine in the awake pt., and is involuntary....the pt. will tell you by his eyelids that he is conscious. Also, gently lifting a pt.'s uninjured hand and holding it 4-6 in. over his nose, then letting it drop, is a procedure that delivers a lot of information: the conscious pt. will usually divert his hand so it does not hit his nose. And thirdly, if you gently lift open the upper eyelid to assess the pupil of a conscious pt who is trying to keep his eyes closed, you will encounter muscle tension in the eyelid resistance) that is not present in the unconscious pt., and they almost always deviate their eyeballs/pupils away from your light. Try these procedures first, before you inflict pain on a pt. you suspect of malingering and having major drama issues. As sick and injured as the disaster victims are, the nonresponsive drama queen must be assumed to be suicidal until a thorough assessment proves otherwise. They deserve an appropriate triage priority asignment like everyone else. If you assume too much, you run the risk of missing the abused or raped victim, or the soldier with pstd exacerbation, so the standard of care will only help. If treatment can be delayed (therapeautic talk, etc.), they at least need a sitter.Last edit by trixie333 on Dec 25, '09 : Reason: correction
Dec 25, '09The last drama queen I had about 2 wks. ago, wouldn't talk for 30 min. Finally learned from a late arriving friend she had taken a bottle of Tylenol....that queen went to the ICU....
Dec 25, '09When did my pt become suicidal?
I do use all of your suggested recommendations during the secondary, lengthy assessment, they however don't wake the pt.
I didn't say I do it because the mds do. The original question was "have you seen this?" My response was, "yes today."
Thanks for all the suggestions. You made some great points. I also appreciate the suggestions for new techniques. Hopefully everyone learned something. I also appreciate your tone. Thanks for not recommending a pt assault me as well. But I probably will use this as needed. I don't do this every day, heck not even every week! But that's okay because those of you who disagree with it don't have to do it, it's just that simple.
Dec 25, '09Oh, and SI doesn't excuse overly dramatic behavior. I won't tolerate disruption of proper triage processes because of drama, regardless of the medical complaint in ANY situation. Across the board, it's safer for everyone that way. Don't conclude that because this is how I operate that I don't do a thorough or proper triage or that I miss a thing, I don't!
Dec 11, '11way out dated. i worked neuro-trama icu for 8 years and would find old fart doctors using it on occ. we had a 85 year old woman who lost her nipple using this approach. you are looking for a response to noxious stim. nailbed pressure with a pen is quite sufficient , even with this people leave the icu with bruises on nailbeds. try it on yourself, it hurts.
Jan 5, '12In my opinion, it just seems pervy when there are other methods that could be used. God help the guy who tries to pinch my nipple if I'm a patient.