Medical Geripsych???

kamakasigirl · Jul 25, 2008

Anybody??????

I start next week and would like to know what I might expect/experience.

Thanks for any replys/advise etc.

Thunderwolf, MSN, RN · Jul 25, 2008

Ok...I see no one has answered you yet.

Folks, chime in any time.

Pt population

Geropsych: Alzeheimers dementia and general depression/anxieties are the forerunners. PTSD may also be witnessed. Newly placed nursing home patients are at greatest risk for depression and failure to thrive, especially within their first year of placement.

Medical Geropsych: Multi-Infarct and Parkinsonian dementias, Huntington's Chorea, and Depressions/Anxieties related to medical disorders (such as MS, Diabetes, Cancer and CVA). Lung and GI disorders have a high risk for suicide.

As a group, elderly men (especially caucasion men) are at the highest risk for suicide...especially if divorced or widowed and if substance abuse is present.

Monitor for elderly neglect and abuse...emotional, physical, financial, and yes, even sexual. In the nursing home patient, listen for clues about their nursing home environment...don't dismiss it as crazy. Nursing home Ombudsman are there to protect the elderly. Monitor how the elderly patient engages the family...abuse or neglect may also be identified from the interaction and/or by what the patient says afterward about a particular family member...again, don't assume it is crazy talk. Contact your social work department in order to have them follow up and if "Job and Family Services" in your area needs contacted in order to report it. Know the difference between a medical POA and a financial POA...they are NOT the same...and that they are null if the patient is oriented and chooses to make decisions for him/herself...the POA person has to abide by that patient's decision. POA means nothing about competence. So, any oriented elderly patient can extend a written POA to anyone in order to reduce decision making stress on him/herself in order to improve quality of life and that same elderly patient can rescind that POA any time of his/her choosing. POA does NOT mean Guardianship....totally different...a judge makes that decision (competence vs incompetence and Guardianship, which are legal terms...and has nothing to do with the medical/psychiatric field).

Also, delirium, as a syndrome, needs monitored for. In the elderly, it often can point to an undiagnosed infection....like, UTI and pneumonia...in fact, it may be the first clue. Also, medication induced delirium may account for it. That is why it is important to know a patient's medication regime and medication history...especially if delirium was present in the past or if any meds are newly added. Remember IVPB Zantac from years past?....not used any more..cause it often threw the elderly patient easily into a delirium, increasing the morbidity/mortality risk. Come to know which meds increase the risk of side effects....uh, like anxiety, insomnia, restless leg, visual disturbances, tinnitus, gait/movement disturbances, fatigue, anorexia, and yes...depression. Also, the elderly are not immune to substance abuse/dependence.....beer, hard liquor, marijuana, opiate use, herbals, or that "rheumatoid medicine I take every night." Remember, our elderly once were "the flower children" of the 60's.

Know your policies on restraint procedures and use of sitters...don't deviate one iota.

Polypharmacy is often present in the elderly...and monitoring for drug interactions is important...like orthostatic hypotension and over sedation. Monitoring patient glucose and liver and urine chemistries are also key. Low sodium levels often impair cognition....so check those lytes. Keep an eye on those Potassium levels too, which impact muscle and cardiac tissues...especially when on diuretics or when dehydration/emesis/diarrhea is present....uh, like C Diff for one thing. Antipsychotic meds may increase the risk for obesity, diabetes, and high cholesterol. Neurontin is not for the kidney impaired. EKG's...monitor for the lengthening of the QTc interval, especially with the newer generation antipsychotics. So, much to keep an eye on with the elderly and their meds. This only touches the tip of the iceberg. This is also why I am personally against medication aides passing out the meds...it's just beyond a reasonable scope of practice. I have heard the arguements...don't buy it.

Hope this helps some.

Other member input?

kamakasigirl · Jul 26, 2008

Thank you for the comprehensive reply, that is just what I was looking for!!!!

Sounds like I am in for a fun ride! :wink2:

Thunderwolf, MSN, RN · Jul 26, 2008

You have my very best, my friend.

Enjoy your new position.

:yelclap:

wonderbee, BSN, RN · Jul 27, 2008

Please let us know how it goes? Best of luck! :yeah:

RN007 · Jul 27, 2008

Thunderwolf,

The hospital where I'm working prn in the emotional health unit is talking about opening a medical psych unit. I'm working on my MSN in mental health w/plans of becoming a psych NP. Do you think a psych specialty is appropriate for such a unit? I have med/surg experience and my 'real' job is in occupational (industrial) health, but my heart belongs to psych.

TIA for your opinion.

RN007

Thunderwolf, MSN, RN · Jul 28, 2008

Absolutely.

This is where the marriage between psych and medical nursing can genuinely pull all things together. In many ways, this type of unit makes great sense. And your being able to wear both hats will make you invaluable as a nurse and as a resource person for other staff...who may have only worn one hat in their career.

Let's give some scenarios here:

1. A Schizophrenic diabetic woman coming in for ketoacidosis. If the person has been delusional about her insulin, who do you suppose would be the best person to support and guide her through her diabetic day to day regime once she is becoming psychiatrically stabilized?

2. A depressed and suicidal young man who has been diagnosed with AIDS.

3. An eating disorder middle age woman who has esophagitis and an electrolyte imbalance from her chronic binge/purging....now showing EKG changes.

The list goes on and on.

I would encourage you to do so, follow your dream, and become the best you can be in this.

You definately have my support.

RN007 · Jul 28, 2008

Thanks! I think you're awesome and value your thoughts. I like your age, too. I'm a little older, but who's counting this late in the game?

fawnsternurse · Aug 5, 2008

Hi,

I am currently on a medical unit in a State Psychiatric facility and frankly I love it!

SuesquatchRN, BSN, RN · Aug 30, 2008

Wolfie, given your list of geri-psych patient ailments, what the heck differentiates a geri-pysch unit from every LTC in which I've ever worked or visited? Almost everyone has one or more of the morbidities you mentioned.

I think that was one of the most frustrating thing about working in LTC - the resident populations had become far more fragile and mentally unstable than current practices and staffing can handle well.

RN007 · Aug 30, 2008

I'm not Wolfie, but my take is that the hospital unit is more for stabilization of psych patients' emergent medical issues. So often a typical med-surg floor doesn't have the knowledge for handling those particular patients, be they dementia patients who develop pneumonia or someone who's in for pneumonia and detoxing off alcohol.

I agree with what you say about LTC and don't know the solution except upgraded staffing, which is expensive, of course. There is a LTC facility where I live that is staffed only with RNs. Some say overkill but not considering what you've just stated.