nailbed pressure - page 3

Ok, here's a pet peeve of mine. Once again, today, I walked into the unit (I'm a neurosurgical program coordinator, many years CC, CNRN) that I supervise and found a nurse using nailbed pressure to... Read More

  1. by   BBFRN
    Quote from neurogeek
    Trap is good, periorbital is fantastic. Especially for pseudo-seizure pt's.
    Thank you for pointing this out. I had another nurse act like I was being mean for doing this when I was a charge nurse, and pt had a pseudo-seizure every time her nurse tried to d/c her home. The pt had already learned how to withstand everything else (arm drop, etc). She didn't expect a periorbital, and I got a definite response from it. Of course, several weeks later, and after many trips to the ICU for "seizures," everyone was in consensus that she was having pseudo-seizures.
  2. by   NotReady4PrimeTime
    When determining what type of posture a person is exhibiting, the LE movements are the same, extension, but there is movement. The UE flexion/extension and internal rotation is the definitive. Extensor posture is always BAD!
  3. by   all4schwa
    When is it that you are applying the orbital pressure during the psuedo seizure, during or after?
  4. by   LadyNASDAQ
    We do a hand clap loudly to each ear. It isn't painful but will give you the startle response you need. After, check if patient is moving their eyes and pupillary response.

    I was taught no nailbed pressure or nipple twists ever. Light sternal rub but what works better is cold fingers to the neck. If that doesn't give a response, stop right there.
  5. by   gasmaster
    When checking gag on my intubated patients I usually just move the ETT tube a bit if they don't cough with suction. The other day I saw a nurse shoving the ETT down so far I thought I'd lose sight of it! I also saw her later trying to illicit gag by using the yankeur and it too was halfway down the patients throat! When I approached her she got really defensive about it. I tried to tell her nicely that it only takes minimal stim to determine gag, and boy was she mad. I guess if you shove it far enough down and tickle their anus they'll eventually respond, huh? :smackingf
  6. by   GrnHonu99
    Quote from neurogeek
    When checking gag on my intubated patients I usually just move the ETT tube a bit if they don't cough with suction. The other day I saw a nurse shoving the ETT down so far I thought I'd lose sight of it! I also saw her later trying to illicit gag by using the yankeur and it too was halfway down the patients throat! When I approached her she got really defensive about it. I tried to tell her nicely that it only takes minimal stim to determine gag, and boy was she mad. I guess if you shove it far enough down and tickle their anus they'll eventually respond, huh? :smackingf
    lol. needed a good laugh this morning:0)

    I usually use the yanker if I can.
  7. by   auzzieneuronurse
    Our GCS criteria must be slightly different as if the pt does not obey commands or localise to central pain (sternal rub) we apply nailbed pressure bilaterally to elicit a withdrawl/abnormal flexion/extension response.
  8. by   gasmaster
    Quote from auzzieneuronurse
    Our GCS criteria must be slightly different as if the pt does not obey commands or localise to central pain (sternal rub) we apply nailbed pressure bilaterally to elicit a withdrawl/abnormal flexion/extension response.
    When performing the sternal rub the patient should exhibit flexion or extension then if it's present. There is no need to do nailbed pressure. You're looking for brain reaction, not peripheral. So checking for central stimulus with nailbed pressure isn't going to give you the most accurate results. If you think about it, flexion means that there is still some function in the cerebral cortex (although VERY abnormal) and extension means that function is now in the brainstem. So you really want to assess these movements using central stimuli. Does that make any sense?
  9. by   all4schwa
    Yes, it does make sense. I knew that extension was 'worse,' but didn't really know why..thanks!
  10. by   Cissi Oloomi
    The neuro assessment is the most misunderstood assessment.
    You use the central stimulus to check level of consciousness- have you tried the pinching of the ear- it is good if you can't do the others. However, you must still check movement of each extremity and if they can't voluntariy move each extremity and /or they are unable to follow verbal commands, you might need the painful stimulus.
    In addition, when checking if they can squeeze your hands, if you put your two fingers on top of their fingers and not in the palm, then you won't potentially get the palmar or grasp reflex. And tell them to let go.If it is a refex, it is triggered by palmar stimulation and they won't let go.


    Neuro CNS
  11. by   castens
    Quote from ELKMNin06
    yep. I usually use: show me two fingers (however im not even picky on which two)...I
    ...and when you get the "double bird" you know that they are definitely following commands (and probably ready to extubate, for that matter).
  12. by   Keepstanding
    Quote from emernurse
    anyone point to a website that shows these different techniques (trap squeeze, periorbital,etc)? i do very little severe neuro so i'm not familiar.

    thanks!
    yes, i am quite interested in how these techniques are done too. please share !
    thanks ~ praiser :spin:

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