I must be an idiot.

[eriksoln, BSN, RN]

OK. I used to be a travel nurse and I settled down into a wonderful hospital recently that I really enjoy. One of the things that made me want to become a staff member was the fact that my unit was a Pulmonary unit. It has tele beds, people on vents and all sorts of things I wasnt seeing much on on a basic M/S unit. I was ready to move out of M/S and this was a good step into a specialty, in my eyes at the time.

One thing I know about myself is (every nurse has their one patient population they would rather not care for) I'm not a fan of taking care of people with anxiety disorder. They come to the hospital, their stressed because they are sick, their meds are arranged differently and...........BAM, there you have it, anxiety disorder not being addressed and the pt. is showing it. People with anxiety disorder GO RIGHT THROUGH ME. Cant help them. Just cant.

So, why didnt it dawn on me that on a Pulmonary unit, with steroids being handed out like candy, I would see much more of this? I have 8 patients at night and, oh my, the panic attacks I've witnessed are................wow.

So, what do you guys do to help them. I'm not a new nurse, so I already know about checking if their breathing is OK and that part. But, when it is simply a matter of anxiety disorder and there is no ativan to give, what do you do to make the pt. more comfortable?

I posted this here cause I guess psych. nurses see it most.

[inthesky]

You are definitely not an idiot =P Nurses get very little psych training and it's great that you are interested in learning! Everyone is different, but for my anxious patients..

*Let them vent.

*go over all treatments one at a time without an air of hurry

*encourage deep breaths

*discussion of flight/fight response

*encourage them not to try and solve all the world's problems in one moment

It's frustrating that nurses don't have near enough time to do this all the time. Learn to cope with anxiety is a long process, so said patient will still be anxious when you leave, but they will be better for having been given a nudge in the right direction.

=)

[Virgo_RN, BSN, RN]

I was gonna say Ativan, but then I read the rest of your post!

With pulmonary patients, it's partially the steroids, and partially the sensation of not being able to breathe.

I encourage pursed lip breathing, let them know their feelings are completely normal, and page RT to give a treatment. I offer comfort measures such as warm blankets, herbal tea, and dim lighting/low stimulus environment. I keep myself/my presence in their space calm and comforting.

You know what to do.

[Whispera, MSN, RN]

I agree with all of the above, AND...

If the patient has been taking anti-anxiety medications regularly for awhile, he or she is dependent on them and is likely to go through withdrawal symptoms if they are not given during hospitalization. It's commone to see withdrawal symptoms start by the second or third day of hospitalization without the meds. If a patient takes these at home, you should call the doc and get them ordered while the patient is hospitalized. Not only are they stressed by the surgery, but their anxiety is rebounding harder than a watermelon dropped off a skyscraper hits the street. You'll see panic, GI disturbances, rapid breathing...

[lucianne]

A lot of the teaching I do with my anxious clients involves breathing and focusing on breathing, so that might not be helpful to your population. However, teaching them to do progressive muscle relaxation might be helpful. My all-time-favorite panic attack trick is to teach them to pick a 3-digit number and subtract serial 7s. You might have to get them started on it and do a few subtractions with them until they get the hang of it. Tell them not to worry too much about right answers, just do it. Of course, if you have someone who also has OCD and lousy math skills, it might either back-fire on you or keep them occupied for a long, long time!

Oh, and the quietest, most sonorous tone of voice you can manage is good too.

[eriksoln, BSN, RN]

Hmmm, all good advice. And I learned something..........I'm not as bad as I thought. I do a little bit of this (keeping myself calm, stern but quiet voice) but can do a lot more of the things you have all mentioned. I think someone upstairs decided to make a change in me cause I've had no choice but to be better with them. Hiding is not an option anymore, ALL of my patients do it. lol I have no choice but to grow from it now. And, well, I've had a couple good days where it didnt get to me so much.

I just need to learn not to take it personal.

[Whispera, MSN, RN]

Progressive muscle relaxation is great, but watch out for using it with elders or people with hypertension. It's not recommended for them.

[iwanna]

About twenty years ago, I was a patient on high dose steroids via IV, plus the nebulizer treatments. I did not have anxiety as a primary diagnosis, however, after all of those meds, I felt like I was ready to jump out of my skin. It was absoultely horrible and the dr. wasn't much help. He asked my family, if I had an anxiety disorder, and if I was always like that. The answer was , "NO". I was given Vistaril IM which did not touch my anxiety. However, a nurse asked me if I had faith in praying, and if so, I should attempt it. There was a moment, that I felt such a feeling of "peace" after praying. I can truly empathize with any patient on high dose steroids.

[Orca, ADN, ASN, RN]

The craziest case I have seen regarding floor nurses with no mental health training involved a patient on my hospital's telemetry unit. I was the swing shift charge nurse on the adult psych/chemical dependency unit, and we had a companion geropsych unit next door. I heard the code for a psychiatric emergency called overhead, but the location was our telemetry unit. The geropsych charge nurse and I responded. When we got to the floor, we saw the tele charge nurse essentially in a fist fight with a female patient who looked to be in her late 70s. I looked at my counterpart and said "We had better take this over." We separated the two "combatants" and calmly escorted the patient to her room. The patient had fallen asleep and upon waking got the idea that someone had moved her to another hospital, and she was afraid. The charge nurse's focus was getting her back into her room, whatever that took. We talked with the patient for about 20 minutes, showing her our name tags with the name of the hospital, showing her her own belongings in the room and so forth. She calmed down and was fine. The staff on the floor were astounded that we accomplished all this without restraints or medication. After this day we got a lot more respect around the house. Our units were relatively new and the perceptions had ranged from people being afraid to come on the units to people believing we weren't really nurses.