What I have learned from working with a QUAD

Nurses General Nursing

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This is what I have learned from working with a quad over the past couple of months....(do not take completely literally)

* you can lose an arm wrestling fight with them (arm spasms are stronger than you would think)

* no matter how long a patient has been a quad....the first place the hands will go is to check to see that their personal equiptment is still intact....

* watch out for flying limbs...they can and do hurt...and are faster than the speed of sound

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

* just because something is supposed to happen doesn't mean it will happen....in fact...that's when you should expect the exact opposite to occur

These are just a few things that I can think of right now....

Anyone else care to add on to this?

lizzy

I recall a quad at the VA. He had been hurt while in the Army, serving in war.

I could not believe that the staff were making fun of him and complaining that he wanted too much help, took too much of their time.

How do you determine what is "too much" when someone can't even scratch his own itch or bat away a determined fly? I tried getting staff to feel his pain and his frustration, tried talking with them about how frightening and frustrating it must be to totally dependent, totally helpless, totally totally in fear of the moods and temperaments of other people who were supposedly taking care of him. All to no avail.

I pray to God that all those who made fun of him and complained about him and ignored him get to experience being quads themselves. Yes, I do. Then maybe they will comprehend.

Yes, I know it can get tiresome, I know it can be overwhelming to care for someone who is totally helpless, but this was in the hospital, it was their job, not in a private home being cared for by family.

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I work with paras and quads on an SCI unit. Here are a few things I've learned:

The pt is your best guide when transferring to the wheelchair - he knows what he can and can't do and what you need to do

Take the time to let the pt do what he can for himself (lift the pill cup to his mouth, for example) - try not to rush him

One pt (a para) told me that he always wears white underwear and socks so that, at the end of the day, he can check for any blood from skin breakdown

A common cause of AD when in the chair is squashed testicles

A quad's BP is normally very low (87/45, for example) and this is OK

This group of pts has the most AMAZING attitude! They have to fight for things that the rest of us take for granted, but they still keep smiling. I just love them!

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.

I've found pretty this to be true for some people and not others-- just as hipcrip and elizabeth mentioned, best to be just keenly aware of that person's completely unique situation. Something that- pretty much every patient like this has said to me "nurses, don't rush ahead of yourselves" "Listen to me, and I will tell you, step by step, what you need to do, because I know. I'm not sure if it's an element of hurry-hurry to get to the next task, or an element of "I'm the nurse, and I know better." This drives my patients crazy!

Another complaint is that people who aren't paralyzed basically invade the personal space of an immobile person. I know most of the time it is intended in an affectionate manner, but one of my female patients especially does not like it when someone picks up her hand and starts to caress it or pat or squeeze an arm or shoulder. I'm sure many people don't mind it, but it's best to be sensitive to the paralyzed person, if you don't know them well. This lady gives the best "dagger eyes" I've ever seen,(her voice is quite weak) but yet, many people are still oblivious. I've noticed subtle things like this that often aren't in a textbook!!

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Another complaint is that people who aren't paralyzed basically invade the personal space of an immobile person.

Absolutely. My wheelchair is an extension of my body -- leaning on it, hanging off it, etc. is a huge invasion of my personal space and considered to be extremely rude.

The worst possible offense able-bodied people commit is grabbing the push handles and pushing me without my express permission -- it is equivalent to grabbing the arm of an able-bodied person and forcefully dragging them along with you. Unfortunately, health care professionals, who are accustomed to transporting patients by wheelchair, are among the worst offenders. Proper etiquette when you need to have a para or quad chair user accompany you from place to place is to ask them if they would prefer to walk with you or have you push them to your destination.

On a similar note, if you have a para or quad patient who can transfer to and from their chair independently, do not move the chair away from the spot where they left it. I can't tell you how frustrating it is to have someone come in and move my chair away from where I can reach it! I understand hospital rooms are cramped and that you need room to do your job, but moving my chair away from my bed without putting it back traps me in my bed as effectively as putting me in restraints. If you must move my chair in order to do your job, please put it back where you found it when you are done.

Other etiquette tips about interacting with people who use wheelchairs

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Specializes in Psychiatrics.

Thank you all for your posts....

The client I have been working with has been a quad for 25 yrs...he was in a car accident and has been paralized since the age of 3....T3 I believe, he is also on a vent.

He has an amazing attitude despite everything he has gone through. He does have autonomic dysreflexia, and needs is cathed 4 times a day, and needs digital stimulation.

Despite all the help he needs, he is able to do so much by himself. He is able to use a computer with a mouth peice, has a job via the computer, has a wheelchair that he is able to operate himself.

When he goes to the doctor, most of the time, the doctor asks him.... "so...what is it that you need today?" because his doctors know that my client knows his body better than any doctor does.

He knows when he needs to be cathed, knows when his muscles need to be streched more, and occasionally when his wounds are deep (tho called pressure sores are not pressure sores...are from a skin issue that I can't remember the name of right now) he can feel pain. He knows his body, and after 25 years of being in it, its best to trust his judgement.

I have some very amazing stories from working with him, and when I get to feeling down, I always remember, that my life could be sooo much worse off...

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Specializes in Med Surg, Ortho.

I've recently encountered working with these type of pts for the first time in my nursing career, one was para and one was a quad. New onset for both due to trauma. It's so hard sometimes to know what to say as their nurse. I try to remain as positive as I can and just lend a listening ear, but I find that these pts seem angry and do not always want to talk. What is the right thing to say? I know each case if different. I had good report with my last patient so he was able to discuss some of the feelings he was experiencing. One question he asked me was, "will I be able to have kids?" I didn't know what to say at the time, I just encouraged him to get involved with a group of other's with his condition for outside support. I just hope and pray that some day there will be a cure for this disease.

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I've recently encountered working with these type of pts for the first time in my nursing career, one was para and one was a quad. New onset for both due to trauma. It's so hard sometimes to know what to say as their nurse. I try to remain as positive as I can and just lend a listening ear, but I find that these pts seem angry and do not always want to talk. What is the right thing to say? I know each case if different. I had good report with my last patient so he was able to discuss some of the feelings he was experiencing. One question he asked me was, "will I be able to have kids?" I didn't know what to say at the time, I just encouraged him to get involved with a group of other's with his condition for outside support. I just hope and pray that some day there will be a cure for this disease.

being of new onset, this has to be incredibly overwhelming to them.

i would suggest a referral to therapists in their area...

and as you stated, a support group...maybe if you could find a referral, or the licsw?

and, antidepressants should be considered, but that should happen w/a psych consult.

as to having kids, i would refer that question to the dr...

but have known a few quads who became dads s/p trauma.

leslie

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Specializes in Geriatrics.

My uncle was a quad for over 20 yrs before his death and one thing I learned was, simply treat them as normal people. Because they are. They simply need more assistance. One other thing- when feeding them, ask their preference of food order, size of bites, timing of bites and PAY ATTENTION to THEM! I remember my aunt would start talking and hold the food near my uncle's mouth (not teasing, just inattentive) until he would get irritated and say- " Dang Sue, give me that bite!" She would apologize, but it wouldn't be long before she would do it again.

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An excellent online resource and source of support for people with SCI/D, whether they're newly disabled or have been living with SCI/D for decades (as well as their spouses, families, and caregivers), is the CareCure Community.

CareCure offers peer-to-peer advice and support on every topic imaginable related to living with spinal cord injury/damage -- we talk about it all: health and care, independent living, relationships and sexuality, work and benefits, exercise, research on and progress toward a cure, and the issues we face in every day life.

In addition to being able to talk to others with para- and quadriplegia, there's a team of experienced rehab nurses on hand who answer questions, provide referrals to resources, and share their experiences.

The site is run by Dr. Wise Young, one of the world's leading neuroscientists and a pioneer in spinal cord injury research. Dr. Young, who actively participates in the discussions on CareCure, was part of the team that discovered and established high-dose methylprednisolone (MP) as the first effective therapy for spinal cord injuries. He is also chair and professor of the Department of Cell Biology and Neuroscience at Rutgers University.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

There is a lot more to feeding people than I ever thought, also. For instance, if someone eats a regular diet, (cut in pieces) doesn't mean to bring in a mangled pile of goo that used to be a piece of pie. .:uhoh21: Once I was feeding spaghetti that I had overzealously cut, pt said to me, "Ummm. . I don't know about you. . but I'd really prefer not to have mush for dinner, o-kay?" :lol2:

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Specializes in Med Surg, Ortho.
An excellent online resource and source of support for people with SCI/D, whether they're newly disabled or have been living with SCI/D for decades (as well as their spouses, families, and caregivers), is the CareCure Community.

CareCure offers peer-to-peer advice and support on every topic imaginable related to living with spinal cord injury/damage -- we talk about it all: health and care, independent living, relationships and sexuality, work and benefits, exercise, research on and progress toward a cure, and the issues we face in every day life.

In addition to being able to talk to others with para- and quadriplegia, there's a team of experienced rehab nurses on hand who answer questions, provide referrals to resources, and share their experiences.

The site is run by Dr. Wise Young, one of the world's leading neuroscientists and a pioneer in spinal cord injury research. Dr. Young, who actively participates in the discussions on CareCure, was part of the team that discovered and established high-dose methylprednisolone (MP) as the first effective therapy for spinal cord injuries. He is also chair and professor of the Department of Cell Biology and Neuroscience at Rutgers University.

Man, this is a great site. Thank you so much. I wish I would have known about this earlier, but hopefully, my former pts will find this site. I will always keep this in mind if ever I get another SCI patient. Thanks again.

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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:

:yeah: Thank you.

And thank you all who helped put this thread meant to provide insight into a significant population of our patients back on track. Some excellent info provided here.

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