It is the bane of my existence and perhaps the most
dangerous medical condition that affects those with spinal cord injuries – autonomic
dysreflexia. If bodily functions are monitored and maintained properly it can hardly
an issue, but as you will find out in this blog, it can be life-threatening if
not treated as the emergency that it truly can be.
Autonomic dysreflexia (AD) is a malfunction of the autonomic
nervous system brought on by a pain sensation where a person with a spinal cord
injury has no sensation. It is mainly caused by episodes in which a urinary
catheter becomes blocked causing the bladder to distend to abnormal sizes and
triggering full on AD characteristics. AD can also be brought on by bowel
obstruction or impaction, hemorrhoids, or a number of painful stimuli that
attack the body. The main characteristics of AD are an extreme pararoxsymal
hypertension (an extreme and sudden onset of abnormally high blood pressure),
profuse sweating from head to toe, low pulse rate, flushing of the skin, and
(due to high blood pressure) a headache that is indescribably intense and
overwhelming.
After years of having an indwelling Foley catheter and the
constant urinary tract infections that go along with them, I suffer from bouts
of AD on almost a weekly basis. There are rare instances where the effects of this
malady are caused by bowel obstruction or even passing kidney stones, but the
most often culprit of these attacks is from sediment produced by my kidneys
clogging my catheter and “backing up the plumbing.”
Within 20 minutes there is a risk of stroke and/or heart
attack and with each second that passes during these attacks one’s blood
pleasure continues to climb. Needless to say, the faster a resolution is found
to this situation the better. AD can be overcome by nothing more than a simple
flushing of the catheter with sterile saline to unblock the clog of sediment
or, in many cases, the changing of the Foley catheter. Unfortunately, autonomic
dysreflexia is not a common occurrence in nursing homes, so the knowledge of
how to solve this issue is not widely known by medical staff.
Just to jump out of the flow for a second, I would like to
describe my rehabilitation. After spending nearly 6 weeks in an ICU in
Montgomery, Alabama I was shipped to Lakeshore Rehabilitation Hospital near
Birmingham. There were no illusions to what I would be doing at a physical
rehab hospital, I would not be rising to my feet after a couple of weeks of
physical therapy to defy the odds and walk out of the facility on my own
volition. It was pounded into my brain over and over that I was a “complete
injury,” which meant that my spinal cord was severed at the third cervical
vertebrae and thus I would never regain sensation or use of the muscles below
my collarbones ever again. I was to spend the next 8 to 10 weeks learning how
to teach others how to take care of me. I had to learn each step in the process
of doing my range of motion every day to prevent the atrophy of the muscles
that I could not use starting at the pinky finger and covering every muscle
down to my pinky toes. I had to learn how to talk a complete novice through the
steps of bathing my body, emptying my catheter bag, transferring me from the
bed to the wheelchair, and every other minute step necessary to keep me
healthy. And yes, autonomic dysreflexia and quad coughing were most definitely
part of the curriculum I had to pore over daily. One of the main
responsibilities I face is making sure that I can not only communicate this
information to those responsible for my care, but that they understand me and
can perform the steps necessary. With this said, I continue…
Just as it is important for me to know how to describe the
intricate steps in relieving my body from the effects of AD, it is absolutely
essential that the medical staff realize with what immediacy the situation must
be dealt. That is not always reality living in a nursing facility.
A most recent occurrence that I can describe has to do with
the nursing staff completely disregarding my directions and pleas for a relief
of my distended bladder from a blocked catheter. When nurses start at the
facility they spend three days in orientation. During this period they learn
the ropes of whatever set they are placed on and the rules and regulations of
the facility as well as abiding by the rules set forth by the state of Alabama.
These orientees are extremely common due to the turnover rate in my facility.
When a nurse is on orientation I make sure to introduce myself. I also try to
find out as much information about them as possible. I am not being nosy, but
if you can remember that a certain person has two daughters, two shih tzus, or
has worked with someone familiar to you it can absolutely build a bond between
the two of you.
When the most recent nurse that works the weekend night
shifts was in orientation I made sure to cozy up to her and make conversation
as often as possible while she was going through orientation. Although she was
quite close lipped for the most part, I did find out that she had been a nurse
for more than 30 years and had worked nearly every position a nurse could face
with the exception of a nursing home. I took her standoffishness as just a
personality quirk, but I had no idea how incredibly close minded and inept she
would become until her second weekend working after orientation.
I happened to be sound asleep when I was awoken by sweat
pouring into my ears and down the sides of my face. As soon as I became awake
and lucid I struck into action. I hit my call light and within 15 minutes a CNA
had answered it. I told her that my catheter was blocked and that I was already
in the throes of autonomic dysreflexia with my blood pressure already out of
hand. I asked her to please ask the nurse to flush my catheter. After 25-30
minutes the CNA returned when I again had to hit my call light. She informed me
that the nurse said she was busy and she would get to me when she could.
“Please, please let her know what is going on (the CNA was
no stranger to this situation) and the necessity to get this unclogged as soon
as possible,” I begged.
After another 30 minutes I begged the CNA to get the other
nurse that works on my unit to come and if she was occupied to please page the
house supervisor, I was desperate for assistance. At this point my head began
pounding with every heartbeat that flow through my body. For years I suffered
from migraines, but a blood pressure headache is five times the strength of a
migraine. My left bicep was causing my arm to flail around in front of me and I
had long since sweat completely through my comforter.
Finally, after another 20 or 30 minutes the nurse came in
empty-handed. I begged her to grab a 60 cc syringe and sterile saline to blast through
the obstruction in the line. She looked at me cynically and reached down and
picked up the tube that ran from my urinary catheter to the catheter bag that
hung from the side of the bed.
“The back has urine in it, so it is not blocked,” she said
with an impatient groan.
“I am sorry, but you cannot tell if the catheter is flowing
by looking at the urine in the bag,” I responded. “That is like looking at a
puddle in the street and saying that it is raining. That may not be so, it
could have rained 15 minutes ago or three days ago. That urine could have been
in there for six hours, but there is one thing that I do know and that is that
my catheter is blocked.”
“How can you tell?”
“My blood pressure is through the roof causing me to sweat
profusely and my head is pounding unmercifully,” I responded.
At this point she told me that there is no way for one to
tell when their blood pressure is high and that she would not flush my
catheter. I swore to her that this happens all the time and that I am
accustomed to recognizing the symptoms of AD and that I was perilously close to
having a stroke or heart attack due to the height of my blood pressure. Her
solution was to have someone take my blood pressure despite my pleas for
assistance.
Of course, in a nursing home of the caliber I reside in it
took a massive hunt for another half hour before anyone found a blood pressure
cuff. They took my blood pressure again and again until I finally asked what
number they were getting. Every time they took my blood pressure the systolic
number was over 210 and diastolic was over 150. They could not believe how high
it was said they kept taking it over and over.
Finally, the other nurse from the unit (who had been
distracted in the room of another patient going through medical distress) came
into the room and simply said that I was correct and that if the new nurse
would just listen to me that I know what I am talking about and that I know my
body. Another 15 minutes or so and a syringe and saline were found. Before
flushing my catheter the CNA emptied the bed bag completely. Once the nurse
flushed saline up my catheter and dislodged the sediment a urine stream came
gushing out into the bag and over 850 mL flowed out of my bladder.
The nurse came in a few minutes later with blood pressure
medicine for me to take. I refused. Within five minutes of relieving the issue
my blood pressure was normal, the sweat stopped pouring, and my headache
disappeared. Yet when I told her this she became belligerent believing that I
was intentionally disagreeing with her to make her look bad. I told her that
taking the blood pressure medication would bottom out my pressure and cause me
to pass out. She argued and argued with me – even trying to dump the pills in
my mouth while I was speaking to her. Finally the CNA took my blood pressure
and it was a normal 110/70. The nurse left the room in disgust.
This is but a single incident with this one nurse where I
have been left in a position of extreme AD for up to and exceeding an hour.
Excuses vary from not being able to come because she was making out the
schedule for the CNAs, because she was in the middle of a medication pass and
was not allowed to leave her cart (which is not true), or simply no excuse at
all – just without empathy, scruples, or morals.
This issue is a constant one. Not only do nurses not
understand the significant danger that autonomic dysreflexia poses, when they
are reprimanded for not acting with haste they develop a grudge against the
resident and become even more dysfunctional.
I have said it numerous times to the unit supervising nurse,
Director of Nursing, and administrator of the facility that one day this would
be my demise. Somehow they do not seem so sympathetic.
Excerpts from the following Wikipedia page is being used in
this blog entry. The page on autonomic dysreflexia and can be found at the
following URL:
No comments:
Post a Comment