What I have learned from working with a QUAD

Penelope_Pitstop, BSN, RN · Mar 7, 2010

it is often best to listen to the judgement of your quad (within reason) because they know their body better than you do

"Your quad." Do you call the patient that, "hey, quad, what's up?" "Hey, now, she's MY quad!"

elizabeth8503RN, MSN, EMT-B, NP · Mar 7, 2010

"Your quad." Do you call the patient that, "hey, quad, what's up?" "Hey, now, she's MY quad!"

no....i dont call them my quad...but i can't and won't call them by their name here on the site...

and he's the only quad i take care of....when i take care of him...i call him by his name....

Virgo_RN, BSN, RN · Mar 7, 2010

I learned "quad coughing" from a man who had been paralyzed as a young adult, who had been in our unit frequently toward the end of his life. I'll be forever grateful to him for that.

allnurses Guide · Mar 7, 2010

You learn a different set of new things with each "quad" or immobile patient, too, Elizabeth! I'm going to assume that you, like most people may have thought a patient's limbs were completely immobile due to severed or damaged nerves, but obviously that is not the case! Your patient has spasms and contractures. Very challenging as you've discovered!

I have a patient that many people say is "paralyzed". He can't move his extremities, but he can feel heat, cold, pain and pressure. If you have a patient like that, you learn the most effective yet gentle way of moving them without hurting yourself. This teaches you the safest way to move people who can't feel sensation.

If you spend a lot of time with a person who can't move, you'll see the frustration of their day to day life up close and personal. I remember this one lady who had been in bed for years with a wasting neuromuscular disease, one day for some reason I saw her struggle and struggle to reach her remote control when I was helping another nurse turn her. All that effort I could see in her face. She tried to "will" her hand to move, despite I am sure knowing that was not going to happen. Made me a more sensitive person, for sure.

Then there are lighter moments, and sometimes even humorous ones. Once when my very strong co-nurse and I pulled a lady up a leeetle too far, her head hit the headboard (not too hard) she treated us to a string of unladylike swear words which ended with all of us laughing. :)

Thanks for contributing your story!

**Elektra6, ASN, BSN, RN** · Mar 7, 2010

My patient appears completely normal in his wheelchair (despite a sip n puff) so people will often try to shake hands when meeting him!

scoutsmom · Mar 7, 2010

Gee , I thiink that was kind of a shallow comentary on quadriplegics, I always think of a "Quad" as a cane, not a person .

KaroSnowQueen, RN · Mar 7, 2010

Oh get a grip! The OP already said she used the word "Quad" rather than violate the all important HIPAA and call the patient by name or type in the equally awkwardly long "my patient who happens to be a quadriplegic", and somebody would certainly get on their soapbox about that as well. The OP ALREADY explained herself, which most of who have been nurses for any length of time already understood. Can a nurse not post here without the Politically Correct Run Amuk going crazy and criticizing over and over over again???!!!!????

Sorry for the rant. I just can't stand it sometimes. Let the OP make their statement. One gripe, fine, but don't be posting the holier-than-thou sentiments a second (or more) times!!!!!!!:oornt::hdvwl: :twocents:

Otessa, BSN, RN · Mar 7, 2010

To the OP, I learned many things from the patients I took care of in our trauma ICU.

The best memory was of a patient that was learning how to talk and eat again while on a vent-what a process!!

I remember baking that patient chocolate-chip cookies (took care of this patient for half a year and then as a frequent flier when they went home) and the look of absolute delight on their face while eating that cookie-made me feel like Julia Child!!!!

I also would go home after taking care of my para and quad patients and cranking up my favorite music and just dancing!(mind you this was after a 13-14-15 hour shift)-because *I* could-don't want to take that for granted. My husband was a bit dumbfounded though.....

otessa

Penelope_Pitstop, BSN, RN · Mar 7, 2010

Oh get a grip! The OP already said she used the word "Quad" rather than violate the all important HIPAA and call the patient by name or type in the equally awkwardly long "my patient who happens to be a quadriplegic", and somebody would certainly get on their soapbox about that as well. The OP ALREADY explained herself, which most of who have been nurses for any length of time already understood. Can a nurse not post here without the Politically Correct Run Amuk going crazy and criticizing over and over over again???!!!!????
Sorry for the rant. I just can't stand it sometimes. Let the OP make their statement. One gripe, fine, but don't be posting the holier-than-thou sentiments a second (or more) times!!!!!!!:oornt::hdvwl:

Jawohl, Herr Kommandant. Or, I suppose Frau or Fraulein Kommandanten.

With apologies to the OP, since I've hijacked her thread YET AGAIN! (I should be on the no-fly list!) I'm actually going to answer the question! I haven't had the pleasure of working with many paralyzed patients. Most of them come to me with wound issues...so although I've always known skin care is very important, these patients have taught me that an ounce of prevention truly is a pound of cure! I know even the most diligent turning and whatnot can still result in wounds, but a great deal of these patients who end up with stage IV decubs were receiving poor care.

thehipcrip · Mar 7, 2010

Great post, elizabeth8503RN!

it is often best to listen to the judgement of your quad (within reason) because they know their body better than you do.

Bravo and amen. What's normal for your able-bodied patients is not necessarily normal for people with spinal cord injuries/damage (SCI/D). For example, like many people with SCI/D, I have difficulty regulating my body temperature. A fever of 99.8 degrees for me is not low grade because my normal body temp runs between 96.5 and 97. Yet despite my best efforts to educate them, 9/10 nurses -- especially triage nurses -- dismiss this information.

My brief list of things I wish more nurses and other medical professionals understood about people with SCI/D:

**We have pain -- often severe -- below our level of injury. Spinal cord damage causes central pain, the most difficult type of pain to manage. It manifests in multiple forms below the level of injury, including a metallic icy-burning, stabbing, pins and needles, and broken/ground glass rubbed into the skin, to mention a few. While some people are able to manage this pain using medications like Cymbalta and gabapentin, others require high doses of narcotics to bring the pain to manageable levels.

**Autonomic dysreflexia (AD) is a life-threatening condition. People with SCI/D above T6 are highly susceptible to AD, which can occur when there is a pain stimulus below the level of injury. The most common triggers are full bladder/bowels, but AD can be triggered by anything that causes discomfort -- clothing seams, an ingrown toe nail, pressure sores/skin wounds, etc. AD triggers a rise in blood pressure which, if not checked and treated, can cause the individual to stroke out. Symptoms include a pounding headache, profuse sweating, congestion, and goose bumps. So if a para or quad calls you during report because they need to be straight-cathed, asking them to wait 45 minutes until report is over puts them at serious risk for AD. (I speak from experience.)

**There is NOTHING sexual about digital stimulation. Quads with upper motor neuron (UMN) neurogenic bowels suffer from severe spasticity of the orifice. Digital stimulation is often a necessary and integral part of a bowel program because it fatigues the anal sphincter and allows stool to leave the rectum. Dig stim is typically performed for at least five minutes at a time, followed by a 15 minute break -- this can be repeated three additional times during bowel care. Specific instructions given by people with SCI/D about dig stim are based on an individual's experience with what works best for his/her body. Those of us who must rely on others to help us perform this task derive no sexual pleasure from this act. It's inexcusable that I have often heard nurses refer to a person with SCI/D who require dig stim as perverts or sexual deviants because the quad has specific requirements as to how dig stim is performed.

Gee , I thiink that was kind of a shallow comentary on quadriplegics, I always think of a "Quad" as a cane, not a person

As a quad, I don't find this thread shallow at all -- in fact, I love it! The more information that's shared about the issues people with spinal cord injuries/damage (SCI/D) and other disabilities face every day, the better.

And while the preferred language is "people first" -- person with quadriplegia/paraplegia -- I doubt there are many people with SCI/D who'd become angry about being referred to as my para/quad patient/friend/family member, especially when it's not appropriate to use their name.

phoenixrn · Mar 7, 2010

What I learned from the quadriplegic patient I worked with in nursing school:

- Gentle massage may calm spasms... or it may not, but it does seem to affect the body in a positive way. (Not EBP, just something that I observed. Anyone else find this?)

- People can endure the loss of their function and still have a tremendously positive attitude, which is unbelievably inspiring.

- Never underestimate the power of a mother's love and care.