[rxrn]

i need help figuring HIM out!!!
i have a pt ,incomplete quad who has been started on q other hs bowel program of suppository and dig stim...some nights bowel program was not effective, so t was changed to q hs; then to our surprise the pt demanded that supp be used as prn and said that dig stim worked better for him wthout the supp; per docs approval we did it; and now this pt wanted dig stim not only q hs but twce a day when he wants it...and to our greatest surprise our nurse manager and primary physician approved it...even though hell have result w the dig stim he would want it again and agan during the day...sometimes he had like 3-4 dig stim done; he does not want to do it himself saying he is still weak on upper ext; family is visiting and he does not want them trained doing dig stim...
how frustrating can that be???...i dont know if im wrong but sometimes i would think that dig stim is giving him "another kind of satisfaction"..why else wound he want a finger up his arse that frequent????
arrghhhh!!!!

[ingelein]

I took care of a quad also who was should I say "anal" about digital stimulation.He would throw a temper tantrum if we did not do it long enough, he was bleeding rectally and still wanted it done several times a day, and the family just said to continue doing it, really disgusting. Sorry if I am being crass, but I really do wonder, if there is not some sensation there and they enjoy it. I wonder if we had the same patient?

[Noryn]

I dont know what his issue is. It may be his bowel program is not right. He may have a fear of constipation, it may cause him to go into AD I dunno. But a bowel program for a quad or para should not be done 3-4 times a day routinely. Otherwise you are defeating one of the purposes of bowel training in addition going to be causing trauma by doing it that often.

[Dolce]

Wow. I think I would really feel defiled if I was in that situation. Sounds like you need to have a care conference about this issue and set limits. It is not appropriate to be doing dig stim 3-4 times a day, prn. That is not a bowel program. A bowel program is supposed to be a scheduled type of thing anyway--that's what the suppository is for.

[TheCommuter]

Originally Posted by edyrn

i dont know if im wrong but sometimes i would think that dig stim is giving him "another kind of satisfaction"

I think you might be correct.

[1studentnurse]

Note:

Some patients with certain kinds of SCI can get stimulated, since they may only have the anal "wink" reflex intact. This is usually what gets them emptied on schedule.

If there's blood or cardiac issues, definitely tell them no, you will not do it. I have a para pt now whose routine was dig stim but twice daily and he did himself.

Sounds like this character is using dig stim as an out. If he did his own that often, he should be on the commode, etc. doing it. It also makes you wonder if he enjoys manipulating staff.

Lots and lots of control issues with SCI patients, but the doc should definitely know about this character.

[Dolce]

Originally Posted by 1studentnurse

Note:



Lots and lots of control issues with SCI patients, but the doc should definitely know about this character.

I agree. I hate to stereotype, but I have many times heard patient's referred to as having a "quad personality." Often these individuals seem to have the idea that the world revolves around them and their needs.

Just an observation.

[MS._Jen_RN]

OP: this is an old thread- how'd it turn out? What ended up happening?
~Jen

[Suesquatch]

What's SCI?

Never Mind, I digured it out. Spinal cord inuury.

[snooksmama]

Sounds like an issue for your team meeting....

Originally Posted by rxrn

i need help figuring HIM out!!!
i have a pt ,incomplete quad who has been started on q other hs bowel program of suppository and dig stim...some nights bowel program was not effective, so t was changed to q hs; then to our surprise the pt demanded that supp be used as prn and said that dig stim worked better for him wthout the supp; per docs approval we did it; and now this pt wanted dig stim not only q hs but twce a day when he wants it...and to our greatest surprise our nurse manager and primary physician approved it...even though hell have result w the dig stim he would want it again and agan during the day...sometimes he had like 3-4 dig stim done; he does not want to do it himself saying he is still weak on upper ext; family is visiting and he does not want them trained doing dig stim...
how frustrating can that be???...i dont know if im wrong but sometimes i would think that dig stim is giving him "another kind of satisfaction"..why else wound he want a finger up his arse that frequent????
arrghhhh!!!!