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| No. 20 | 
Jul 01, 2008, 01:56 AM
 Re: digital stimulation!!!
RE Autonomic dysreflexia:
December 1, 2006
Applied Neurology. Rehabilitative Management of Complications of Spinal Cord Injury The most common symptoms of AD are significant hypertension, pounding headache, bradycardia, profuse sweating and flushing of the skin above the level of the injury, blurred vision, nasal congestion, and anxiety and apprehension. Hypertension, in particular, can lead to intracranial hemorrhage, seizures, myocardial infarction, and death. AD therefore should be treated as a medical emergency. The patient who is in a supine position must be immediately seated upright and all constrictive clothing must be removed or loosened. Cause of noxious stimuli should be identified, beginning with the urinary system.
If the patient requires bladder catheterization, an instillation of 2% lidocaine should be introduced through the urethra before catheterization to avoid additional stimuli caused by advancement of the catheter. If the patient has an indwelling catheter, it needs to be checked for kinking and blockage. If it is not draining, it is best to remove the catheter and catheterize the bladder.
In management of fecal impaction, the rectal wall should be lubricated with lidocaine gel, allowing up to 5 minutes before performing a gentle rectal examination. If stool is present, it needs to be gently removed.
If symptoms of AD continue and blood pressure remains elevated, pharmacologic management should be considered. Antihypertensive therapy using agents with rapid onset and short duration is useful while additional causes of AD are being identified. Topical and sublingual nitrates and nifedipine are the initial drugs of choice. In using a topical nitrate, apply an inch of 2% nitroglycerin paste to the chest above the level of injury. Topical application of nitroglycerin has the advantage of easy removal if blood pressure falls precipitously. When using nifedipine, administer as a bite-and-swallow 10-mg dose. If needed, the dose can be repeated in 15-minute increments until blood pressure is controlled. Other agents, such as phenoxybenzamine (Dybenzyline), diazoxide, mecamylamine (Inversine), and hydralazine also can be used. For severe episodes of AD, intravenous drip of sodium nitroprusside under close monitoring is effective.12 http://www.psychiatrictimes.com/disp...1?pageNumber=2 Since this thread was started four months ago, first poster has not been back to respond/update us. I am hoping these resources will be helpful to others in similar circumstances.  | | Advertisement Sponsored Links | | | | No. 21 |
Jul 01, 2008, 07:27 AM
Re: digital stimulation!!!
Establishing the importance of routine bowel care was one my main goals. I still feel that many healthcare providers fail to realize the importance of this in patients with SCI. It is obvious by this thread and that is a problem in itself. It seems like many on here almost immediately assumed the problem was that the patient was controlling or doing this for sexual stimulation, when in reality this is rare. I think it is extremely concerning as a nurse to see rehabilitation nurses and a moderator seemingly confirm these opinions.
What further adds insult to injury is when bogus terms such as "quad personality" are used. There is no such thing and it is horribly insulting and demeaning. As Karen alluded to, anyone suffering a loss will display a wide range of emotions.
I read all of KLD's posts and did not see her directly attack anyone. She is outraged, as are many people with SCI. KLD is an expert on SCI, one of the top SCI nurses in the country. She is part of the carecure.org community which is led by Dr. Wise Young. (I hope the link will be kept, it is such an important site to gain knowledge on SCI).
I still feel that a lot of good will come from this post. I think this is one example of how allnurses.com allows for professional and personal growth.
| | No. 22 |
Jul 02, 2008, 04:45 PM
Updated
Jul 02, 2008 at 04:52 PM by Tweety
Re: digital stimulation!!! Originally Posted by Noryn  I read all of KLD's posts and did not see her directly attack anyone..
Most of the time those posts aren't allowed to remain out of respect to the one being attacked. So just because you didn't read it doesn't mean it didn't happen. Originally Posted by Noryn I still feel that a lot of good will come from this post. I think this is one example of how allnurses.com allows for professional and personal growth.
I certainly agree with you.
We are a moderated site, unlike other forums, including the one you posted. Unfortunately the profanity posted by some of the members there is very off putting to me. That's o.k. I have this site and accept the moderation (of course now I'm a mod myself, so that's a moot point). Others who want a more free-speaking forum can have that site, or other sites too.
This certainly is a good thread with plenty of education, our plan for now is to let it stand. Unfortunately there might be others from others sites that are trying to sabbatoge things here. My post is off topic and made to clarify a few points. Please stick to the main topic if you don't mind. Thanks | | No. 23 |
Jul 02, 2008, 08:44 PM
Re: digital stimulation!!!
I did read the posts before they were edited. Again I did not see any personal attacks. I did see views that were challenged. I guess what is so frustrating is that few are seeing how offensive some of these posts are to patients with SCI.
The other site is moderated and also highly respected among the SCI community. Again it is run by nationwide experts in SCI care. Wise Young along with the SCI nurses are among the best in the country. Actually I will go further and state that Dr. Young is known and respected around the world. If you have ever taken care of a patient with acute SCI injury in the ER chances are you have given high dose steroids which was due in part to his research.
But again a very important question was raised and perhaps this is actually somewhat on topic. Why arent terms like "quad personality" edited out?
My intent for this thread was to inform healthcare providers who I think were making a rush to judgement. By explaining how important bowel care was I think it allowed me to also to challenge the views that "there are control issues" and that they somehow get enjoyment out of this. As someone who has taken care of patients with SCI injury those views are really off base.
| | No. 24 |
Jul 02, 2008, 09:09 PM
Re: digital stimulation!!! Originally Posted by Noryn Why arent terms like "quad personality" edited out?
Because you have to name the concept in order to discuss it.
As Karen pointed out, what is being called "quad personality" could easily apply to other kinds of patients. The common denominators are people who are (or can be) medically fragile, those who are dependent on others for even basic survival needs, and those who have had too many run-ins with medical or other caregivers who do not listen and therefore place the patients at great risk.
I have a grandson with spina bifida (L 4-5, S 1-2) who is now eleven years old. The only reason that he has made it this far is that his mother is extremely vigilant and does not back down when she knows his needs are not being met. She and I are considering writing a book about their experiences, including a chapter on how to be the squeaky wheel and how to get past some of the communication barriers that sidetrack proper care. Our little guy has come close to dying more than once and his mom has saved his life by getting the necessary medfolk to understand that she wasn't just being difficult (SB personality?) for the fun of it, but had legitimate concerns that absolutely had to be addressed for him to be okay.
To her credit, she has used these opportunities to kindly but firmly instruct the residents (he goes to a teaching hospital) and even the attendings that they need to listen to their patients and the patients' families. She has been apologized to and thanked many times after the fact, but she takes greatest satisfaction in thinking that maybe the practitioners will take future patients more seriously because they finally made the connection with her and her son.
| | No. 25 |
Jul 02, 2008, 09:26 PM
Re: digital stimulation!!!
I am not trying to be difficult but I am having a hard time understanding why no one else sees that there is a problem with this.
That concept is bogus. It is a false generalization. That is a derogatory term used for patients with SCI. It could apply to other patients but it doesnt because of the term "quad."
On the CRRN examination how much attention is dedicated to "quad personality?"
| | No. 26 |
Jul 02, 2008, 11:32 PM
Re: digital stimulation!!!
I would like to, once again, apologize to everyone that I may have offended by using the term "quad personality." This is certainly not a term or a condition that I made up. Nor does it apply to all persons with SCI. Rather, it is a set of behaviors that I have seen in some patients with SCI. I have also seen the same behaviors in others that have a long history of hospitalization. Once again I apologize and if the moderators feel it is necessary to regain the calm I am more than happy to have all of my posts deleted.
| | No. 28 |
Jul 03, 2008, 12:09 AM
Updated
Jul 03, 2008 at 12:17 AM by canoehead
Re: digital stimulation!!! Originally Posted by Noryn By explaining how important bowel care was I think it allowed me to also to challenge the views that "there are control issues" and that they somehow get enjoyment out of this. As someone who has taken care of patients with SCI injury those views are really off base.
For every patient, not just SCI patients, there are control issues, I don't think anyone would be offbase in assuming that someone dependant on other for care has control issues. I would go so far as to say I'd be concerned about the patient if we didn't have to chat frankly about their needs vrs nursing care needs at some point, and find a balance.
Patients getting sexual enjoyment from nursing care isn't an issue we deal with every day, but when I worked MS certainly it came up every few months, and in the ER it's every few days, especially when alcohol is involved.
When the term "quad personality" was used I knew what was being talked about, but sure don't think it has a thing to do with SCI. Some people have been exposed to the deaf ear of healthcare so long that they feel they need to shout. I think the same syndrome afflicts docs and nurses who suddenly have to take on a patient role. We've seen the mistakes, and get much more controlling and mouthy because we know what can go wrong. Bringing up those points and discussing them makes the thread helpful for me, and I hope we continue to discuss them. | | No. 29 |
Jul 03, 2008, 04:46 AM
Updated
Jul 03, 2008 at 11:48 AM by Tweety
Re: digital stimulation!!! Originally Posted by Noryn I am not trying to be difficult but I am having a hard time understanding why no one else sees that there is a problem with this.
That concept is bogus. It is a false generalization. That is a derogatory term used for patients with SCI. It could apply to other patients but it doesnt because of the term "quad."
On the CRRN examination how much attention is dedicated to "quad personality?"
You are not being difficult at all. You're stating an opinion and educating us about it. We have no problem with that at all.
As far as allowing the term, if someone said to you personally...you're being so difficult...oh yeah because you have a quad personality that's why. We'd be all over them as moderators.
Also however, if someone talked about a patient with a quad personality and you came back with "you're such an idiot for thinking that, don't you know there isn't such as thing as a quad personality", then you have just committed a TOS violation.
It gets tricky. Yes, sometimes we catch one's violation and not another. There have been a few times I've dinged someone for a TOS violation and they said "what about so and so" and I've said "yes, you're right about that...I missed it."
About that other site, I probably shouldn't judge it so quickly, a 2nd look and it seems very informative, but I was really turned off by some of the language in the first thread I read, with the f-bombs flowing freely. Just not me and that's definitely not us. Often people who are used to such freespeaking have difficulty here, and it's understandable.
By the way, I totally agree with you about the "quad personality". For nurses to judge an entire group of people like that is wrong.
Carrry on.
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