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Check bony prominences and areas under the brace or jacket for skin breakdown. Aggressive physical and occupational therapy early in the acute phase may be beneficial to the patient's overall rehabilitation. Joint range-of-motion exercises prevent contractures and severe muscle wasting. Some patients may require splints for the upper and lower extremities to prevent flexion contractures and footdrop.

Prevent urinary tract infections by instituting an intermittent catheterization protocol early. Protocols vary, but most begin with catheterizing every 4 hours. Monitor the residual urine volume; when it is less than 400 mL, catheterization can be done every 6 hours. Record the amount of urine voided and the postvoid residuals. As the amount of residual volume decreases, increase the time intervals between catheterizations. Before catheterization, assist the patient in emptying the bladder by Crede's method or by gently tapping or percussing the bladder. Establish bowel continence early in the acute phase.

When the patient is eating by mouth or is being tube fed, administer stool softeners as ordered. If the patient has not had a bowel movement, administer bisocodyl (Dulcolax) suppository. If the patient is NPO (nothing by mouth), administer bisocodyl every other night. Digital stimulation is used in conjunction with the bowel program. Adequate fluid volume status is important for a successful bowel and bladder program.

Provide diversionary activities to help pass the time. Arrange for the patient or family to consult with a clinical nurse specialist, chaplain, or social worker to assist in coping with anxiety and stress, if it is deemed necessary. If the patient has little hope for recovery, consider speaking with the family about donating the patient's organs, if appropriate.

If the patient is scheduled for discharge, teach the patient and family about the recommended activity level and rehabilitative exercises. Explain how to recognize the signs and symptoms of infection or a deteriorating level of consciousness. Instruct the patient and family in the name, dosage, action, and potential adverse effects of all prescribed medications. Show them the proper care for wounds and lacerations. Make sure the patient and family are aware of the schedule for follow-up medical care.

• Physical findings: Vital signs, hemodynamic parameters, urinary output, tidal volumes, vital capacity, level of consciousness

• Presence of complications: Pulmonary infections, urinary tract infection, deep vein thrombosis, alterations in skin integrity, autonomic dysreflexia

• Presence of bowel and bladder continence

Encourage the patient to participate in therapies. Instruct the patient to communicate any abnormalities that are recognized. Explain the use of compression stockings as prescribed, with correct application. Teach the patient to maintain the bowel and bladder program. Verify that the patient and family understand the causes and symptoms of autonomic dysreflexia. Be sure the patient understands any medication prescribed. Verify that the patient and family have demonstrated safe use of all assistive devices: wheelchair, transfers, adaptive feeding equipment, and toileting practices. Review with the patient and family all follow-up appointments that are arranged. Verify that all at-home arrangements have been completed.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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