Acute care of the high-level quadriplegic patient.

Four months post-injury, Mark is into the ongoing rehabilitation phase of his hospitalization. He is free of continuous ventilator support with a vital capacity of 1200 cc. Neurologically, his level has descended to the C5 level, which has allowed him to function with moderate assistance from a motorized wheelchair. He is still immobilized in a Halo vest which will be removed when X-ray examination reveals that adequate fusion has occurred. Mark has not developed pulmonary embolus. After an initial problem with orthostatic hypotension, he can sit upright without symptomatology. Although he will probably continue to have difficulty with temperature regulation, Mark has learned how to control his environment in order to maintain his comfort and safety. Bowel training was difficult because of Mark's initial problem with paralytic ileus. With persistent adherence to the bowel program, however, Mark has become bowel continent. This process was facilitated once he was able to be mobilized and use a bedside commode. Mark continues on his bladder retraining program. As could be anticipated with an adolescent patient, adherence to the strict program of fluid regulation and restriction was difficult. It is anticipated that Mark will eventually be catheter-free and bladder continent in the future. Mark will require two to three months of further rehabilitation, after which he will return to his home and school. Mark faces a future centered from a wheelchair. With adequate medical, nursing, psychological, social and vocational follow-up, however, he can live a near normal life-span. With a positive support system he can build on the comprehensive care he received initially, and rebuild a life for himself.