Medical Surgical Nursing

(Tina Sui) #1
 If these measures do not relieve the hypertension and excruciating headache, a
ganglionic blocking agent (hydralazine hydrochloride [Apresoline]) is
prescribed and administered slowly by the IV route.
 The medical record or chart is labeled with a clearly visible note about the risk
for autonomic dysreflexia.
 The patient is instructed about prevention and management measures.
 Any patient with a lesion above the T6 segment is informed that such an
episode is possible and may occur even many years after the initial injury.

Promoting Home and Community-Based Care
Teaching Patients Self-Care
In most cases, patients with SCI (ie, patients with tetraplegia or paraplegia) need long-
term rehabilitation. The process begins during hospitalization, as acute symptoms begin
to subside or come under better control and the overall deficits and long-term effects of
the injury become clear. The goals begin to shift from merely surviving the injury to
learning strategies necessary to cope with the alterations that the injury imposes on
activities of daily living (ADLs). The emphasis shifts from ensuring that the patient is
stable and free of complications to specific assessment and planning designed to meet
the patient's rehabilitation needs. Patient teaching may initially focus on the injury and
its effects on mobility, dressing, and bowel, bladder, and sexual function. As the patient
and family acknowledge the consequences of the injury and the resulting disability, the
focus of teaching broadens to address issues necessary for carrying out the tasks of
daily living and taking charge of their lives (Kinder, 2005). Teaching begins in the
acute phase and continues throughout rehabilitation and throughout the patient's life as
changes occur, the patient ages, and problems arise (Capoor & Stein, 2005).
Caring for the patient with SCI at home may at first seem a daunting task to the family.
They will require dedicated nursing support to gradually assume full care of the patient.
Although maintaining function and preventing complications will remain important,
goals regarding self-care and preparation for discharge will assist in a smooth transition
to rehabilitation and eventually to the community.


Continuing Care
The ultimate goal of the rehabilitation process is independence. The nurse becomes a
support to both the patient and the family, assisting them to assume responsibility for
increasing aspects of patient care and management. Care for the patient with SCI
involves members of all the health care disciplines, which may include nursing,
medicine, rehabilitation, respiratory therapy, physical and occupational therapy, case
management, and social services. The nurse often serves as coordinator of the
management team and as a liaison with rehabilitation centers and home care agencies.
The patient and family often require assistance in dealing with the psychological
impact of the injury and its consequences; referral to a psychiatric clinical nurse
specialist or other mental health care professional often is helpful.
The nurse should reassure female patients with SCI that pregnancy is not
contraindicated, but that pregnant women with acute or chronic SCI pose unique
management challenges (Jackson, Lindsey, Klebine, et al., 2004). The normal
physiologic changes of pregnancy may predispose women with SCI to many potentially
life-threatening complications, including autonomic dysreflexia, pyelonephritis,
respiratory insufficiency, thrombophlebitis, PE, and unattended delivery. Preconception
assessment and counseling are strongly recommended to ensure that the woman is in
optimal health and to increase the likelihood of an uneventful pregnancy and healthy
outcomes.

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