I work as an aide for a quadriplegic. I will be starting nursing school next fall and just need some experience.
Today I went to help him out and when I got there he was starting to poop (we do a bowel program). I tried to turn him so I could have a good view of his orifice/bowels. However, I could not adequately turn him and his right side kept falling, even with a pillow in place. He was very weak and his blood pressure was over 200. I called his wife and she said he could go in to shock and possibly die. I finally got him up high enough so I could start the bowel program, but he was in a lot of pain still the whole time. Eventually we called his wife again because he was not feeling well despite my efforts to lower his blood pressure by giving him milk and raising his head.
I just need advice for quads and how I could have prevented the spike in blood pressure, maybe advice on turning and bowel programs? I just feel really bad that that happened! I have only trained once with his wife for the bowel program, so it wasn't the best situation to be in for my first time, but I feel bad that he was in such pain and his life was endangered.
Specializes in Complex pedi to LTC/SA & now a manager.
Also, JustBeachyNurse- I also just looked it up and there are some parts of the bowel program that CNAs cannot do. I should have checked on that. However, in that situation when he was already defecating when I got there, I did not know what to do. He did try calling the nurse that sometimes visits, but she did not answer. I probably should have called 911 instead. I remember that when he first told me that he needed a bowel program done, I hesitated because I had seen it done once, but had not done it supervised. I should have just not agreed to do it. I have another question-since he was starting to poop when I first got there one of the reasons his blood pressure went so high? Or was it because of all of the turning to try to get him in the right position? His hip has had problems in the past, and that's what was hurting at the beginning.
Also, one more thing to add-his wife told me that he has AD a few times a week. That is really scary, and they don't know how to reduce it. He is on medication for it and they will talk to their doctor to increase the dosage. I just can't help but feel scared that my actions endangered his life. I feel like we do make mistakes, and I don't know the true cause of what started the AD, but this was a life-threatening thing and I felt incompetent.
You should have called 911 you were not trained for this and definitely out of scope. Life threatening = activate EMS
Yes, if he had hip pain issues, when you moved him while defecating sorry to say you may very well have been the cause or exacerbated the autonomic dysreflexia. You were not adequately trained and clearly out of scope. (Remember "you do not know what you don't know")
Autonomic dysreflexia can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.
Specializes in Complex pedi to LTC/SA & now a manager.
Also note in any link about autonomic dysreflexia there is NO mention of milk as a treatment. All are medications that are out of scope for a CNA or HHA in any state.
IMHO find another job. This is not a good. " practice case" and you are risking your future license as a nurse without proper training and routine supervision by a qualified registered nurse.
What else would I have done besides moving him if he was already defecating? Or maybe it's just that I moved him incorrectly.
As for the milk, you're right. I should've asked a nurse instead of trusting his wife. It just doesn't make sense to me how often he has autonomic dysreflexia. It must have something to do with the sensitivity of his hip.
Specializes in Complex pedi to LTC/SA & now a manager.
What else would I have done besides moving him if he was already defecating? Or maybe it's just that I moved him incorrectly.
As for the milk, you're right. I should've asked a nurse instead of trusting his wife. It just doesn't make sense to me how often he has autonomic dysreflexia. It must have something to do with the sensitivity of his hip.
I cannot comment, no one can, as we don't know the patient. Maybe you moved him incorrectly. Maybe you put too much pressure on his hip. Maybe bowel pressure caused the issue. A bowel regime implemented improperly can cause hyperreflexia. Constipation, excessive gas, full bladder, stressful movement, pain, improper positioning, pressure, diarrhea can all cause hyperreflexia.
JustBeachyNurse, LPN
13,957 Posts
You should have called 911 you were not trained for this and definitely out of scope. Life threatening = activate EMS
Yes, if he had hip pain issues, when you moved him while defecating sorry to say you may very well have been the cause or exacerbated the autonomic dysreflexia. You were not adequately trained and clearly out of scope. (Remember "you do not know what you don't know")
http://www.apparelyzed.com/autonomic.html
Autonomic dysreflexia can be fatal.
. Source: http://www.sci-info-pages.com/ad.html