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Aerolizing

Aerolizing

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Aerolizing's Latest Activity

  1. Aerolizing

    Electric Shock Therapy

    Where I work, ECT is done quite often especially to those patients who have complicated medical histories who may not be good candidates for the usual antidepressants or who have had no sucess with antidepressants. The patient is NPO after midnight and for the first few treatments, stays on the inpatient ward. Our ECT procedure is done under general anesthesia and only takes a few minutes to complete. Once they get down to PACU where the procedure is done, the IV is inserted, caffeine given through IV and the patient is fitted with the rubber strap with electrodes around the head and gel to conduct the shock. A BP cuff is inflated on one upper arm to 200 and clamped to prevent meds from getting through to the hand where the seizure is observed as a clenching fist. They are given meds (we usually use brevitol and succ) to paralyze and sedate. Once the shock is applied and the seizure is measured by sight and by EEG, ( trying not to forget to deflate the BP cuff) the patient quickly regains consciousness and returns to the unit for a few hours of recoop time then normal activity can resume. Generally, patients need 12-16 treatments (three a week) and some respond very quickly, others take the whole 16 treatments to respond. Once they have had a full course of ECT, we often see them once a month for maintenace ECT. I have seen it work very well. I know people think it is barbaric but for those who don't respond to any other treatment, it is a welcome last resort. We always have quite a crowd during our ECT. There is the psych attending, psych resident, med students, anesthesia attending, anesthesia resident, psych nurse as well the whole PACU staff if we should ever need them (so far that has not happened). The worst incident that ever happened is that a patient received a small burn on her scalp from an arcing ECT machine. All in all, pretty boring. Lots of fuss for a clenching fist. First time observers always ask, "Is that it?" As for where to get training, any teaching hospital around should have plenty of opportunity to do ECT. Any teaching hospital with a psych residency program and an inpatient psych ward. Where I work, there are a couple attendings who supervise it and a few resident who take a liking to it and always volunteer to take ECT cases.
  2. Aerolizing

    pain control

    I work in a long term facility. We call in hospice for our folks with end of life pain control issues and they do a wonderful job getting pain meds ordered. We also tend to use a lot of transdermal patches (fentanyl)sp?. They last for three days and seem to help with pain control without having to give prns every four or so hours. We also have some of our folks on straight orders for tylenol. We too, evaluate pain control for our folks who are falling. When we medicate for agitation, we assess for last bowel movements, hunger, and pain. A protocol for pain assessment would be wonderful. We give a lot of prn pain meds and I hope we are doing an adequate job to control pain. I have found that encouraging our folks family members to be advocates when we have failed helps also. We are lucky, our residents do not have to use our facility's contracted docs if they don't want to and I never forget to mention that to family members if they are unhappy with their loved one's pain control.
  3. Aerolizing

    LTC charge nurses

    I am new to ltc and man oh man, I could fill up all available space to talk of my concerns. I am getting ripped from family members every day. I am getting no support from administration when I have serious concerns for my patients from the care the stna's give to the lack of concern from the docs. I would love to stay to make a difference but I am already tired. I came from 10 years of acute care to what I thought would be a much more relaxing job. I was wrong. It is very hard to keep positive for my residents when I am getting hit from all sides.
  4. Aerolizing

    Nurses vs. psych techs

    I work with mental health specialists and have worked with behavioral health techs and psych assistants. The best ones have been college educated as a requirement of the position. I have worked with many CNAs who had zero psych training working as BHTs. It would be easier for me to tell you what is not a part of MHS job descriptions. They do not do physical assessments, take off orders, administer meds. That is about it. They have had psych training so they can admit patients, call the doctor with report, vs, draw blood and do ekgs with training, chart, tape report etc. I have worked with an all RN staff and that was by far the best.
  5. Aerolizing

    What is professionalism?

    competence respecting your patient and family punctuality honesty ability to listen patient advocacy
  6. Aerolizing

    I read an online article about the former

    I have worked with a few post partum psychotic women. With each and everyone of them, we had family meetings. In those family meetings we could not stress enough that the patient was never to be alone with the baby. There was always to be a family member present. We often arranged for the baby to stay with a family member and let the patient visit so she could bond. These instructions were also written on discharge instruction sheets which the patients sign. I think her husband should be legally responsible. He should be at the very least facing five counts of child endangering. He was aware of the risk and choose to go to work leaving his sick wife to take care of five children. It is a very sad case.
  7. Aerolizing

    any tips or ideas welcome

    For some of my tougher classes, I would read the whole chapter into my little tape recorder and then play it at all available chances like in the car on the way to and from school, when I went to bed, I played it until I fell asleep. I also got really nice supplies for taking notes like a great pen, an off color pad of legal paper, I liked pink or purple. I would get certain highlighters for vocab words, certain other colors for concepts. I know, a little quirky but it helped me to retain volumes of info quickly.
  8. Aerolizing

    Relative drug costs--eye opener!

    We had a young nurse who came to our hospital to request that her spinal cord be severed. (That is how she ended up on the psych unit.) She knew that meant paralysis and life in a wheelchair. She had pain that was not controlled by multiple surgeries, PT, or meds. She had gotten hurt at work, ambulating a patient who fell, jerking her back and she was never able to work again. Forgot what her actual injury was. Anyway, she was brought in unable to get out of bed for a ccouple years on multiple pain meds and left using a walker and on methadone. She never thought she would be able to function upright again. She wrote us a letter from a road trip she was able to take. Still using her walker but at least not bed ridden and her pain was controlled. I was recently without prescription insurance for a couple months. I had no idea birth control pills were $43.50 a month and my allergy nasal spray was $70.00 for a one month supply. Makes you wonder how our older folks afford all of the newer meds without prescription coverage.
  9. Aerolizing

    specialized "Deaf/Hard of Hearing" acute care unit

    Not in Cleveland. We have plenty of people who sign so communication is not really a problem. We have even had a deaf, mute, and blind patient. So if you specialize, do deaf people ever "hear" voices or do they just have obsessive bad thoughts/paranoia?
  10. Aerolizing

    Need web site for latest restraint regs

    Hi PattyJo, I have some distant relatives in Lone Pine and one of my second or third cousins was going to be a psych nurse. Been there a few times and everyone there knows everyone else. Pretty neat. Anyway.. In my experience as a nurse, those seclusion/restraint regs were memorized by all staff members, even the secretary. They were posted in the bathroom on the walls and I am not kidding. There were no mistakes. My assistant unit manager reviewed those daily. If we missed one piece of documentation, we were written up. No questions asked. As the charge nurse, we were also responsible for overseeing that the charting was done correctly. At my new job, no one even looks at the appropriateness of the seclusion/restraint episode. No one is clear on how to reorder S/R. No one knows how to chart on a person in S/R. I am telling you, this is not good. It is not my job as a staff nurse to do administration's work. They don't seem worried about any of this. I looked up the regs on my own time to make sure I was doing it correctly. No, they are not available anywhere on my unit. When I have told the other staff members about the right way, they looked at me like who the heck are you? You are in orientation, what could you possibly know? They are resistant or stupid. No one in administration has taken the time to explain any of this to them. I walk around shaking my head. I ranted and raved the first couple of times to competent staff about how insane this is and that this place is going to be closed down. They just sit quietly and listen. I have made many complaints to the administration. Not sure what they are going to do. I am the new girl. Each complaint I have though, I also give a solution. If they want my help, they will pay me well for it. I may be a staff nurse, but I am a darn good staff nurse and if I were sick, I would want me taking care of me. My boyfriend tells me it is not my problem and that I should not be looking up all this stuff on my own time and telling the other nurses how to do it correctly. He is telling me to get out before it gets ugly there. Too late, it is way ugly there. There are some really good staffers there. I have bonded with them. They are probably a little scared of me as I have gone off on many long tirades about how absurd this whole place is. They quietly tell me it is nothing they haven't said a hundred times before. I was just offered a couple of jobs as a matter of fact. I am seriously thinking about taking one of them. I do want to hear from two other places though before I make my final decision. No job is worth this much stress.
  11. Aerolizing

    Need web site for latest restraint regs

    Hey PattyJo, Do you have people in Lone Pine????
  12. Aerolizing

    nurse externships

    Hi Brown Suga, I was a nurse tech, not sure if that is the same thing as an extern but probably close. I was based on an ortho floor and got to have my elective floor (since no one in their right mind would ever want psych) sometimes. I floated from floor to floor. I got to see everything but peds and ob which I requested not to have. I think it was what got me through nursing school. I got more experience and gained more knowledge and confidence by doing real nursing. They never mention how much urine you see in one day in nursing school. That always used to be the majority of my day. Pee cleanup, poop cleanup. I was a longstanding member of the poop patrol. I got to see a softball poop. Go-litely poop all over the bathroom wall, toilet, floor and patient. I got to see poop fill up a large metal bedpan and I mean fill. I saw bright red colostomy stool from a GI bleed who went into shock. I saw floaties that looked like worms in a catheter I emtied. All dinner table talk I know. Those days were fun. But I did get to learn time management which they don't teach you in nursing school. Try applying the same time management for two patients you have in school to the 65billion you have in real life. I got to observe anything I wanted to. I saw how nurses dealt with families when patients died. I got to learn neat little tricks like gingerale always goes with feeding tubes before meds, after meds and before and after feedings. I got to learn how to fill in patient acquity sheets. I learned when a 92 year old lady says she is giving birth, she is probably constipated. More poop talk. I learned to be floated in the middle of the shift with dignity. I even learned how to be assertive when a nurse tried to give me 14 patients when 7 was my limit. I learned when to admit I am wrong like when a hospital employee asked me about the lady in 405 and I told her she has been on the call bell every five minutes since I walked in the door and she is driving me crazy and then learned that the employee was here to see her gramma in room 405. You learn so much from actually doing it and where else will you have the resources of the other nurses. I tried to do as much as I could as a tech because I figured soon enough it would be my license I would be practicing under. That was a scary thought. Take the job. Even if you can only work once a week. I can't recommend it enough. I don't understand why more nursing students don't do it. Good luck
  13. Aerolizing

    dilema

    As for the breaking of sterile technique, I would simply say, ooops, you touched this or that. Then I would offer to open up or go get sterile supplies if I was there doing the assisting. As far as iv sticks, some patients are so hard, even the expert iv starters have trouble. I think that the inexperienced people should get two tries and then let someone else try. Experienced iv stickers, I would let them keep trying cuz if they can't get it, we have to call in the docs who are brutal.
  14. Aerolizing

    new nurse blues

    I had been hired as a new grad on my first unit with 6 weeks of orientation. After that, I still had my preceptor. She still worked with me and was my resource person whenever I had any questions. Everyone on my unit reported my every move to my preceptor (who missed her calling as a drill sgt.) For example, if I missed a question on an admission assessment, I got a written note to complete my work. I also had weekly meetings with a nurse CNS to answer any questions and to process interactions with psych patients. The other staff and I processed (gently criticised) events like acting out patients and if we ever had to put anyone in seclusion or restraints. I was not the only new grad my unit ever hired. I think there may have been one other. Five years into my job, my coworkers still thought that I needed to handle the challenging patients so I could gain more experience. I always had their support though. I never felt like I was alone. Sometimes I felt dumped on but I never felt abandoned. Here is my dilemma. After 10 years, I started a new job doing the same thing. There is a new grad who has been there for a short while who is unsafe. This new nurse left me with a tech and a very assaultive patient when this nurse was coming in just behind us or so I thought. When we got back from fighting to get this patient back to her room, the new nurse gave a really stupid reply. Mind you, I wanted to do unkind things to the new nurse. I told my administrator of my very serious concerns for this new nurse. They want to fire the new nurse. They want me to give them the ammo. I have been thinking about this. When I started, I was given a whole lot of support and my coworkers had many years of experience. This new nurse did not have the same support as I did. This new nurse also has a much poorer attitude than I do though and I am not sure having a prolonged orientation would change anything. I don't believe I would have ever done things like this new nurse does. I was shown many unsafe practices and even what I would term abusive behavior. I was still being oriented (by the new nurse) to my job when this all happened. Sorry, but I do know a lot and I would love to share this info with everyone if they want to learn it. I will not be party to this type of nursing though. I have even thought of quitting. Administration has a very long way to go. The new nurse did not violate any policy or procedure because there are none. New ownership, new policies whenever they get around to it. I don't like this position they have put me in and I will voice that to them Friday. Sorry, I know lengthy post. I just want to make sure that every new nurse feels the support and guidance I did. I don't want to be one of those nurses who eat their young.
  15. Aerolizing

    Cleveland Clinic destroys wages

    I think one of the reasons that fav nurses did not cave in was that they pay their nurses approx $10.00 less per hour than the other area agencies. Passing on the savings to the CCF. To lower that by another 35% as requested would have made them lose most if not all of their nurses. That is why every agency nurse I have ever spoken to says they belong to more than one agency. I have called about working agency after finding out that for hospital prn wages, I would have made exactly half of what they pay agency nurses. Both offered no benefits. The Cleveland Clinic is by no means hurting for money. If they tell you they are, ask them what they paid for their new eye center building. Still a doctor's hospital.
  16. Coach Cathy, My thoughts exactly. Is this a baby? Sounds like one. Makes me want to go check on my little one to make sure he is all covered up. It is cold up here in Cleveland.