What Nurses Need to Know About Cutting

Chronic consitions anf acute care crises are not the only area in which nurses serve their patients. Nurses must be vigilant to observe compulsive and dissociative disorders beginning among their patients in care. When a patient is at risk for harming themselves, the situation becomes a health care crisis.

Patients under monitoring will exhibit patterns of normal behavior. Then changes in a patient’s habits will stand out.  One aberrant behavior that signals the need for attention is cutting. Cutting may sound odd, even absurd to most people when first encountering the medical disorder. But cutting is no laughing matter. It can affect housewives, adolescents, students, and profession people of all ethnicities  and at every education level.

Yet the  problem of cutting is more widespread than thought at first, although experts cite early underreporting as a major factor. Many caregivers may not wish to risk their position on an intervention. Irregular nursing staffing can result in turnover that prevents consisted reliability between caregivers with an opportunity to see cutting symptoms.

Cutting is a problem that has become a recognized part of the vocabulary of disorders and psychological signs of emotional distress in people. Striking mainly juveniles and adolescents, cutting is a practice where the physical mutilation of the skin serves no purpose but abuse. Cutting flourishes in environments where body checks and inconsistent observation is the norm.

Both women and men suffer from cutting. The inclination will start small, and the disorder will build as the victim of cutting behavior learns to harm themselves routinely. Cutting may be hidden by hobbies such as carpentry, fishing, sports, and crafts where cuts and abrasions can be shrugged off as casual. Where cold weather can conceal skin condition, nurses should urge patients to change into a gown for evaluation. Many doctors who skip the full-body evaluation can miss the signs and symptoms of cutting right under their nose.

Cutters are trying to treat their emotional pain. The individual will start to experiment and transfer feelings of emotional pain to a physically concrete manifestation of cuts, bruises, lesions, in areas not regularly seen by others. This is regularly in the lower arms and forearms, which can be hidden by long sleeved clothing. The individual will withdraw from normal social activity if it reveals their cutting scars or lesions.

Therapy for cutting involves multiple disciplines. Treatment involves  confronting the cutter in a safe space and  from their caregivong usually takes the form of two tiers of treatment. Skin cuts are treated for infection and bandaged, and mild painkiller is prescribed. Psychiatric examination and counseling make up the other part of treating cutters.

It would seem that those in metaphorical pain would avoid seeking actual pain. Yet for many this is bringing their pain into the open. Wound care nurses should be wary of patients who pick at scabs or worsen wounds and lesions between dressings.   Yet the exhilaration and catharsis of the cutting ritual allows the individual to achieve emotional release from psychological pressure. Cutters can form bonds with website friends online part of the cutting world.

Cutting is usually done by persons who feel helpless to control important aspects of their lives. Cutting is generally a shameful secret they hide. Cutters should not be condemned, but take in recommending the case for treatment. Friends should report this to a doctor or physician for further investigation.

Signs and symptoms of self-injury may include dermal scars that can be seen in those who have been practicing the self-abuse of cutting for some time. Referrals to the appropriate speciaist are encouraged.

Cutters may distinguish themselves by having sharp objects like pins, knives, switchblades, or razors on hand. They may be seen to wear long sleeves on their arms  and long pants unseasonably in hot weather. Cutters often exhibit difficulties in having close friends near, or holding long-term friendships or have difficulties in interpersonal relationships. The intimacy and familiarity required in these relationships make it difficult for the cutter to hide the cutting habit.

The habit of cutting may become a compulsion for some , one they wish to hide. Conditions in the cutter’s life may lead them to question their existence and voice thoughts of hopelessness or confusion. Stressful life events such as loss of a loved one, decline in social contacts,and new changes in negative life experience may signal a potential for cutting.

The patient or individual will mull over questions about his or her personal identity, such as “Who am I?”, “Where am I going?,  “What am I doing here?” They may exhibit panic and confusion when confronted with obstacles.  Nurses should be alerted to patients with pronounced skin conditions and the above mentioned problems.

Patients involved in cutting behaviors will experience behavioral and emotional instability, such as uncontrolled crying or mood extremes.  Cuters may ecperience problems with impulse control, and be subject to violence aggressiveness or other taboo behaviors. Cutters form a new routine, replacing the chaotic unpredictability of their problems with the “control” of the cutting instigation.

There may be a detectable change in patients, from an external viewpoint. . A patient who usually goes out for a walk or shops with friends and suddenly elects to stay in or avoid phone calls may be a patient considering cutting or performing the cutting practice as a way of coping. The cutter’s disorder is marked acute when the individual finds solace or relief in cutting.

Nurses should discuss with the charge nurse, roommate, staff nurses and social if they have overheard the patient make statements of helplessness, hopelessness or worthlessness. Futility and despair are the emotional hallmarks of a cutter. Intervention is only possible if the caregiver or nurse steps in and speak up.

Spinal Cord Nursing Notes-Treatment

The contusion condition of the spinal cord requires careful nursing and treatment advice. Nursing of this type of patient and providing health care must allow for direct spinal cord adjustment within the spinal cord nerve housings as well as delicate avoidance of the nerves controlling respiratory action and organ failure.

The spine is one of the most challenging nursing assignments on record. The unconscious nervous system is only treated in cases of shock and failure by contact with technological machines which preserve their action. However, the physician will estimate in what cases this will bring about total recovery or dependence ultimately on machines for any wellness caliber at all.

The variety of symptoms will surprise nonmedical personnel, but to trained nurses they will signify a serious underlying condition or set of underlying spinal injuries. Lack of voluntary muscle control, and appearance of having no spinal reflexes, perception of light and perspiration as well as obvious bladder failure and bowel dysfunction will make nurses remind the physician to assess the patient using the neurological scale. The basis of total paralysis to active movement should be universally objective.

Nurses should practice making observations to test their independent ability to rate active movement  and the continuum to total paralysis. These assessments will not be purely physical symptoms.  Bowel dysfunction is indicative of central nerve failure the ability to control motor actions should indicate a lapse in spinal activity control overall. If the physician is so informed of any lack of active ovement, a new appraoc to patient care that involves the patient’s immobility should be udnertaken. Cervical collars, stretchers, and backboards must be used as soon as any of th attending staff observe lack of motor senrry volition.

If the EMT staff, the nurses, the physicians, and the participants in a surgery do not observe the signs of spinal cord injury, then the symptoms may be occluded by injuries and traumatic accident recoveryside effects. When the field officer makes the necessary report, a protocol spinal cord recovery program should be observed. in this way, every patient admitted to critical care for any medical trauma will be checked for lack of motor control and other spinal cord related functions.

When the SCI paralysis test is failed, this does not mean there will never be any spinal cord injury. It means that the patient as it stands currently does not show signs of spinal cord injury. However any damage suffered from lacerations, contusions, concussions, dislocations, compressions, and transections may show up later. The consequent discovery of the symptoms of central spinal cord, anterior cord, Brown-sequard, and conus medullus as well as causa equina should be immediately communicated to the physician.

Nurses for this reason must examine their patients after traumatic injury admission and not allow them to go to sleep. Nurses must check the medications for drowsiness or effect on motor neuron areas. Testing for asymmetric pain and radicular pain, however severe, should be noted on the chart. Loss of bladder control and bowel control may be common in shock and bedridden patients. Examination of natural sensory and motor reflex activity will better indicate the presence of paralysis than mere incontinence.

Nurses and attendants must review all patient symptoms for each motor deficit, sensory loss, (e.g. Pain, texture, taste, sound) or pressure or vibration that fails to register. Assessment must recur with every repositioning and 48 hour check. The spinal cord injury, or SCI, is a life changing experience for any patient and often will change a patient’s personality and challenge the patient’s family and support network.

An SCI injury will present as a sensory “deafness” that observant nurses will notice. Keep an entire rotation of CNA and mobiilty support persons on notice for these characteristics is a valid endorsement. Herniated discs and a cut cord (laterally) will evince itself in Brown-Sequard index responses such as a flinch that only includes the right maxillofacial muscles and right shoulders. Possibly there will be an attempt to stand that will display balance using muscles on the left side, left legs and left arms only.

SCI patients will orient toward close contact with the physical therapy nursing staff. Sleeping patients cannot be tested for involuntary motor control action lapses and/or paralysis. And the ability to measure the extent to which a patient has changed their SC injury status and the direction in which the change has occurred is not detectable when the patient is asleep.

Furthermore, is the patient does not awaken naturally the conditions of blood pressure, spinal cord injury, and cardiopulmonary arrest may overtake treatment of spinal cord shock episodes. Careful charting must accompany every station’s monitoring of this patient.

The spinal cord conditions must be addressed in concert with other more dramatic organ failures, skin wounds and possible bone breakage. An evaluation by the therapist must occur every so often.

The respiratory system may survey the initial incident but they may become during the recovery phase. The nursing attendants must take careful notes about the extent of the patients recovery if any during the rest stages. Patients will also exhibit great stress and reactions to great pain when they awaken or recover from surgical intervention. Nurses should calm the patient and only allow them to be informed of as much information as the physician believes is feasible.

The nature of what information to tell patients in dramatic situations of spinal cord injury is debatable. Some schools of thought hold that nurses are bound by patient wishes and should be told of the extent to brain and spine and recovery processes at once. But some physicians believe this information can cause a stress episode to the patient that can irreversibly negate a positive outcome.

 

Nurses should indicate the family or spouse the seriousness of the condition and ask them how they think the patient will want to deal with the decisions regarding mechanical stabilization beyond spinal cord natural involuntary muscle and nerve control. Some patients will have a living will prepared in which they treat their plans for these situations.

 

However, many patients do not realize the full extent of the damage and what partial or total spinal cord injury can mean. The nerve system within the spinal cord may never fully recover from shock. Furthermore, any additional trauma to the spinal cord nerves may trigger recurrences of nerve damage or activate old contusions, lacerations, hyperinflexions, and other conditions of the SC index.

If the nurse feels that the patient does not have enough information to make an informed decision and no living will is present the physician must dictate what information they are told to get the necessary qualifying advice for further treatment. Some individual health plans will stipulate the decision to not activate artificial recovery if the patient lapses voluntary respiratory control or nervous control governing neural systems, cardiac nerves and other functions. Some patients will want every last measure taken to prevent loss of life and loss of nerve activity.

 

Nurse Treatment of Back Pain

The nurse with a patient complaining of back pain should screen the individual or treatment and therapeutic approach. Back pain, especially in the elderly or the very young, can be a red flag for more extreme disorders or more involved and complicated medical problems. Nurses studying the symptoms of back pain disorders and related conditions should review the list of symptoms and therapies. There is a tendency to medicate back pain, which can shield the patient from being diagnosed with more complex attention to the patient’s more overall health. Smoking and depression, for example, have been linked with diagnosis of back pain.

A nurse’s advice is the first line of defense when back pain strikes or rears up. A nurse should be fiercely protective of any patient complaining of unusual amounts of back pain, especially when they seem to have no basis in normal causes. Backaches after pregnancy and fibromyalgia, for example, would be considered expected. But a nurse will be able to single out over time that a patient has experienced serve back pain during some phases of their condition, and less or none in other stages of their admission. Nurses should be careful to fit the bed positioning to suit the best rest position for that particular patient‘s size and height.

A patient will rely (consciously or unconsciously) on the nurse’s ability to relate this occurrence of symptoms with the physician or other nurses. The nursing staff can plot from the chart when and under what stress the patient reports the most pain. The nurse can review notes from other nurses concerning the most serious incidents of back pain in a patient and analyze the cause. Does the pain result from exercise or inaction? Too much bed rest or not enough in the right position? Too many hours straining over a hot laptop, and not enough restful sleep in a bed meant for the purpose?

A change in bathing habits or a change in the weather could activate arthritis nerves, escalating back pain for a patient who previously only generally complained of it. Turning a mattress or finding a different sort of pillow may be ease the neck tension that cause the surprise of back pain for a patient. The patient may be so used to their particular daily habits in sitting or standing, sleeping and resting, that they have not noticed that these may have damaged best posture or their sleep rhythm. Even temporary daily adjustment to a poorly formed car seat could cause problems over time.

The usual amounts of back pain every adult processes can be due to stress, weight gain in the abdomen, rare syndromes, and poor sitting postures. But unusual pain experienced when the patient is sitting down or lying down can be cause for concern. The spinal cord and related nerves, and the pelvic bones and the sternum area, all come into play. Neck tension and postural neck pain can become the cause of tensed nerve in the lower back, often related to motion in the bed during sleep hours. Nurses should survey the patient upon waking about how their neck and back feels.

Patients with back pain should embrace alternate technologies as well as a consult with e specialty physician. Some habits can be cured, such as reading in bed and poor posture. Homeopathic alternatives for pain treatment have enjoyed a resurgence lately. Such patients should be monitored and the intervention be written for nursing prompts for better posture or “lights out” for less reading in bed, for example. Movement and grooming should be evaluated for best posture and less strain on lower back positioning for long periods of time. Nurses should be particularly attentive to fall/injury risks for back pain sufferers, such as dressing, transitioning from bed to standing without support, and in-bed movement without a rail.

Reflexology, meditation, and acupuncture can give significant relief for back pain sufferers, and many HMOs and insurance types cover these regimens. And massage can often do wonder for back pain victims. Thoracic exercise, lumbar spine exercise, Pilates, and Yoga can contribute to better overall back health. But the conventional medical approach still matters. Surgery and injections may be necessary, depending on the level of the condition. A hybrid approach can work well.

A general physician or custodial doctor may refer the back pain patient for an X-ray, MRI or CT scan. A bone scan or discography may be necessary to evaluate the cause of the back pain. The general physician may refer the patient to a specialty physician. Several physicians may need to be seen before the right one grasps the needs of a specific patient. The pain doctor or chiropractor may direct the patient to multiple modalities, such as stress management, physical therapy, holistic directions, as well as improved posture while sleeping, a better mattress and better neck rest from incorrect arrangement of pillows. And an evaluation of the patient’s coverage can allow for further options.

A nurse should be concerned with an over-reliance on medications to solve these pain problems. Chronic pain can be a condition too often medicated for, and not analyzed enough. Too often, many patients are impressed with commercialized depictions of pain-free lives in pharmaceutical advertisements. A nurse may have to parse these ideals down to simple English for a patient eager to accept the pill path of pain treatment. The dispute over NSAID therapy, more widely advertised drugs, and clinical trial results marches on.

Persons with back pain should be encouraged to try non-pharmaceutical approaches like yoga for strengthening the back, stretching, environment, or focused breathing. The level of attachment a patient has to their back pain can affect their willingness to employ various methods to lessen it or get rid of it entirely. Lifting the tent flap of back pain can reveal unpleasant truths a patient may be unwilling or unable to deal with. Bridging the gap between current pain symptoms and a pattern of anti-pain practices should be the care plan goal of many patient dealing with such issues.

Back pain is also a symptom of tense nerves, chronic stress, and harmful relationships. A watchful nurse can plot a record of just when the patient complains of back pain symptoms and analyze what occurred that might have prompted spasms or a cramped lower back. During times of medical issues and their tendency to create unrelated crises, the relatives and friends of a patient can create havoc with their emotions and concerns “dumped” on the patient. A nurse should observe when a certain phone caller or visitor makes the patient distraught.

Of course, energy vampires suck the energy from an empathic patient who does not have a filter to stop the onslaught of verbal disputes and arguments that occur when medical planning and family conflicts persist. Too often, a nurse will see the patient giving attention to a person who will deflate the and overload them with complaints and problems.

A person suffering from back pain must have a strategy to eliminate harmful inputs that worsen their symptoms. The intervention in the care plan will indicate to a nurse what steps they are authorized to take, such as moving abusive family members on and providing hints for coping.

Student nurses should know that duodenum ulcers, kidney problems, osteoporosis, and inappropriate headrests can cause back pain. Lifestyle choices such as a heavy shoulder bag or handbag, heavy lifting or stooping, or overstuffed pillows can disturb delicate rhythms in spinal function and rest. The causes of back pain and the conditions resulting in untreated back pain should be a regular course of study and a basis for materials review.