HHC Health & Home Care Clinical Policy And

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<strong>HHC</strong> HEALTH & HOME CARE Section: 14-27 Emergency: Poisoning __RN Common Toxic Substances Household Products: Alcoholic beverages Ammonia Antifreeze Ant syrup or paste Automotive products Bathroom bowl cleaner Bleach Boric Acid Camphophenique Charcoal lighter fluid Cleaning fluid Clinitest tablets Copper and brass cleaners Corn and wart remover Detergents Dishwasher detergents Disinfectants Drain cleaners Epoxy glue kit Furniture polish Garden sprays Gasoline Gun cleaners Hair dyes Iodine Iron medications Kerosene Lighter fluid Model cement Muriatic acid Mushrooms Nail polish Nail polish remover Oven cleaner Paint Paint remover Paint thinner Perfume Permanent wave solutions Pesticides Plants Prescription and non-prescription medicines Rat killers Rubbing alcohol Shaving lotion Silver polish Snail bait Spot removers Strychnine Sulfuric acid Super glue Turpentine Veterinary products Weed killers Window wash solvent Plants Anemone Angel trumpet tree Apricot kernels Arrowhead Avocado - leaves Betel nut palm Bittersweet Buckeye Buttercups Caladium Calla lily Caster bean Cherries - wild and cultivated Crocus, Autumn Daffodil Daphne Delphinium Devil's Ivy Dieffenbachia (Dumb Cane) Elderberry Elephant Ear English Ivy Four O'Clock Holly berries Foxglove Horsetail reed Hyacinth Hydrangea Iris Ivy (Boston, English and others) Jack-in-the-pulpit Jequirity Bean Jerusalem Cherry Jessamine (Jasmine) Jimpson weed (Thorn apple) Jonquil Lantana Camara (Red sage) Larkspur Laurels Lily-of-the-Valley Lobelia Marijuana Mayapple Mistletoe Moonseed Monkshood Morning Glory Mother-in-Law plant Mushroom Narcissus Nightshade Oleander Periwinkle Peyote (mescal) Philodendron Poison Ivy Poison Oak Poppy (California Poppy excepted) Pokeweed Primrose Potato sprouts Ranunculus Rhododendron Rhubarb - blade Rosary Pea Star-of-Bethlehem Tobacco Tomato vines Tulip Water Hemlock Wisteria Yew 334
<strong>HHC</strong> HEALTH & HOME CARE Section: 14-28 Emergency: Autonomic Dysreflexia (Hyperreflexia) __RN PURPOSE: To recognize and treat this medical emergency. CONSIDERATIONS: 1. Autonomic dysreflexia is a serious medical phenomenon that occurs in patients with a spinal cord injury with lesions above the area of the 6th thoracic segment (usually, loss of sensation below the nipple line or higher). 2. Pathology: A stimulus (i.e., distended bladder), initiates a reflex action of the sympathetic and parasympathetic systems that cannot be reversed by the action of vasomotor center because of the level of spinal cord lesion. The most common stimuli are infection and irritating stimuli on the skin such as decubiti, bladder calculi, bladder infection, bladder distention, fecal impaction, and bladder, bowel or anal manipulation such as rectal exams, cystoscopy, catheterization, etc. 3. Precautionary Measures: a. Always be aware of the potential for autonomic dysreflexia in spinal cord injury, including chronic patients. b. Reduce the possibilities of irritating stimuli (decubiti, plugged catheters, fecal impaction, hard stool in the anal sphincter, pressure from shoes and braces). c. Any newly admitted spinal cord injured patient should have blood pressure and pulse taken before and after first rectal exam to recognize this condition, if it exists. d. Any patient with plugged catheter, fecal impaction, etc., should have blood pressure and pulse taken before and after treatment. e. Any patient with hyperreflexia should have this noted on the front of the chart with a note stating: "any rectal and/or urologic procedures may be accompanied by marked blood pressure rise." f. Diagnosis should always include location of spinal cord injury. g. Instruct the family in signs and symptoms and potential for occurrence. 4. Symptoms: a. Sweating of forehead. b. "Goose pimples." c. Headache. d. Flushing. e. Anxiety. f. Nasal obstruction. g. Paroxysmal hypertension as high as 300/160 with pounding headache. h. Slow pulse. EQUIPMENT: Catheter supplies (if applicable) Gloves Personal Protective Equipment PROCEDURE: 1. Adhere to Universal Precautions. 2. Explain procedure to patient. 3. Place the patient in a sitting position. 4. Drain the bladder. Do not drain more than 600cc at one time. If catheter is plugged, irrigate with no more than 30cc of solution. If no results, replace the catheter. 5. For fecal mass, insert hemorrhoidal & anesthetic ointment into the rectum. After symptoms have subsided, gently remove fecal mass. 6. If the marked elevated blood pressure does not decline within one minute, contact the physician. Note: The "average" quadriplegic will have a blood pressure of 90/60 or lower in the sitting position. 7. If the blood pressure declines after the bladder is emptied, continue to observe the patient closely, as the bladder can go into severe contractions, causing hypertension to recur. 8. Follow medical instruction and call 911 if indicated. 9. Discard soiled supplies in appropriate containers. AFTER CARE: 1 Document in patient's record: a. Incident and vital signs. b. Treatment provided. c. Patient's response to treatment. d. Identity and location of emergency facility, if indicated. e. Condition of patient at time of transportation, if indicated. 335
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