[ACollinsRN]

Hello, I am a nurse new to the itensive care unit. This week, I had my first spinal cord injury patient. He has a C3-C5 and is a quadriplegic. As his nurse, I could see the pain and frustration in his eyes as he tried to tell me he needed to be suctioned, turned, mouth hurt, etc. He is currently intubated. I found this website while trying to find resources for him and his family.
I usually name things until I get it right and he nods, blinks etc. I try to tell him everything I am going to do, such as his bath, drawing blood. I talk to him like I talk to all my patients. I can not begin to understand how he must feel now, as a 27 year old man, to suddenly be paralyzed and unable to talk.
What advise can you give me to help me help him at this stage? He will eventually get a trach and be vent dependent.
Thank you,
Angela

[Joed]

I don't know what methods there are out there, but I know someone will soon come along with first-hand experience with this.

I did, however, want to make a suggestion. Perhaps make a numbered list of the common things he may ask for, like turning, etc. Hold it up so he can refer to it, and he could blink whichever number is associated with what he's trying to convey.

Very lo-tech, but it might lessen some of the anxiety until a better way of communicating is available to him.

My injury isn't as severe as your patient's, but I know I drew a lot of strength and hope from those nurses who spoke in positive terms about my condition. It would hearten me to hear one of them say, "When you're strong enough to sit up", not 'If'. Their words conveyed hope, and although I knew very well that they couldn't predict my outcome, it was still encouraging to hear someone else say what I so badly wanted too.

Of course, the realities of an severe injury must be taken into consideration too...no need to give unreasonable hope...but I'm confident in saying that he will experience some improvements over time.

Thank you for being one of the 'good ones', who take the extra effort to be the highest quality nurse you can be to your patients. That is priceless.

[lynne]

Hi, I am the mother of a new quad. c3/C4. car accident. He is 17 years old. Very frustrating times we had at the beginning but we eventually sorted it out. The ICU had a picture card with smilies i.e cold, pain, thirsty etc. He actually amazed me with what he knew had to be done suctioning, turning. He learned very early on. He absolutely hated the turning over bit. I had to sit on the floor underneath and talk to him. Then there was the card with all the letters of the alphabet A-Z. At times it was funny and other times very hard - we used to get some things really wrong! Start off by asking how many words are in what he is trying to say and then go from there through the card. You will be surprised how quickly you get it all together.

All of the nurses in ICU treated him like a pop star. They are a very dedicated bunch of men and women. 8 months on he is in Rehab and doing very well and very positive about his condition. I am very pround of what he has achieved so far. Hope this has been of some help. I

Let me know how you get on

[Joed]

Well, as fate would have it, shortly after I had originally replied to this post, my little sister was in hospital on a vent for 14 days (asthma--->pneumonia). When she wasn't in an induced coma (she kept fighting the vent, leading to panic attacks), we used my own suggestion above, and it seemed to work well. If what she was trying to say wasn't on the list, we had the alphabet written out, and she could just point to the letters. She was restrained, so her movements were limited...we made the letters compact, enabling her to access each one with just a point of her finger.

Before we tried these things, she would get quite frustrated, causing her oxygen need to rise, leading to panic, then they'd have to knock her out again.

She was scheduled for a trach, as she had already been on the vent longer than they recommend, but thankfully she began turning the corner that same morning, and so avoided the procedure.

I sure didn't dream that this particular communication issue would manifest itself in my life, but I'm glad this thread gave me an early opportunity to consider how to overcome the communication obstacles.

[hillarymcarter]

I'm so sorry to hear about your sister. I will add her to my prayer list at night! Keep us informed. My hubby had a trach and after they took it out he healed quite nicely.