bigsurgirl

Psych nurse here!!! This is a great article that has helped me deal with newly diagnosed pts. sorry its long. The 5 stages of Bipolar grief •Denial •Many people when first diagnosed are downright relived to finally have a name for what ails them. However , that relief soon turns to denial once the full implications of the illness are evident. What this means is that they come to understand how much of their core personality is driven by the illness, and once they settle into the routine of drug-taking and doctor’s visits, the realization that life will never be the same as it used to be begins to haunt and torment them into denying some, or all of, reality. This is a dangerous but necessary time for them to pass through. They must accept it for what it is, an essential stage of coming to terms with being bipolar. Just be aware that the next step is the time when clients are most inclined to do something they may regret later on. They may drink heavily, quit taking their medication, quit seeing their psychiatrist and /or therapist and if possible there should be a safety net of some sort of in place in terms of support. If they crash hard, let there be someone who cares and can help them hold on till stability returns. Anger: They will be furious with life, themselves, the past, missed chances ,screw-ups their friends, their significant others and their physician. No one will escape totally unscathered from the sphere of the bipolar person who has yet to come to terms with his/her circumstances THEY SHOULD BE ALLOWED TO BE ANGRY! They have the reason and right to be. Anger in it's self is not a bad thing so long as it is used to empower rather than disempowering or harm other or self. The crucial point is that the client understand and acknowledge there anger. They must own it, accept it, and make it theirs to the extent necessary to get though it. Does this mean permission to wallow in it indefinitely? No way! Client can not move onward unless they dealt with this critical aspect of learning to survive with a brain chemistry that will betray them at the first opportunity. They may be angry; it’s ok, and they need no ones permissions to be so. Guilt: • Of all the many things felted as clients attempt to adjust to being officially bipolar, guilt is perhaps the most burdensome and difficult to get a grip on. There’s guilt over past obnoxious behaviors and over sexual indiscretions, the way they treated family and friends, the lack of attention or care they have given their children, the inability to maintain jobs or relationships and the nagging self-doubt about their own sense of worth. But despite all the foregoing, remember that, and in fact teach clients to make a personnel motto: GUILT IS A WASTED EMOTION! Explain to them it comes from an exaggerated sense of reasonability aimed at the wrong kinds of things and for there wrong reasons. Explain it comes from all the times of do’s and don’ts that have been drilled into them from /by mom, dad school and the church. They need to let go and forget them, unless they are principles they personally chose, after careful thought, they do not matter now and they never did. What matters now is the future they choose to follow. From this point on, the choice and responability is all their’s.That’s a little intimidating, but it’s also a freeing kind of thought as well. Encourage them to try it on for size; they might come to appreciate it. If nothing else, it unities that old guilt knot in one’s stomach. Resignation: Probably the most difficult and depressing aspect of this disorder is encountered after passing though the tussle with denial and guilt—it’s the point when mere resignation settles on their shoulders like Poe's black raven quoting its dirge of “nevermore”. Nevermore the euphoric high’s of hypomania. Nevermore the super bursts of creative energy. Nevermore the ability do the work of ten others, stay up at the local club all night, and still write or paint until time for work the next morn .Nevermore the quick running and life-of-the party charisma. Nevermore….yes, for this they must (and will) mourn, for the drugs that stabilize them will exact a price in return and this is part of it. So they should be allowed to morn for the parts of their personality that may be muted or disappear entirely; its ok to lay black roses at the feet of the drugs they must take. But then they must move on by accepting that :1 they will experience a sense of resignation regarding there situation. 2) They will morn and suffer severe depression at feeling forced into resignation. 3) They will occasionally (or often) entertain the notion of dumping there drugs down the toilet (and they may, but ask them to please think it through first). 4. They will expect life to get immediately better and they will be disappointed at the fact that it doesn’t. As a nurses we can only urge, with all our heart to ride out the tough times. This coming to grips with a new you takes a very long time Some things will improve very quickly, but others won’t and new things will pop up to grieve the client. As a nurse we must understand bipolar’s are not usually patient sorts, but for there life and well-being you explain that they must be patient with this process of adaptation. Reconciliation: •So they have been very brave and they have made it through the 4 previous stages; now they will think they can breath a bit easier for the worst is definitely over. Hopefully, as they reconciled there past with the rather scary present, they will learn a bit about themselves and discover a well of strength within that will carry them through the ups and downs to most certainly come there way in the future. During this last phase they will continue the process of adjusting their medication, setting in with a good doctor and developing a strong support network. This is also the period during which they will spend a great deal of time thinking about where they end and the drugs begin. Mixed in with these considerations will be an ongoing quest to find the real person underneath and /or cohabiting with the bipolar inside of them. …Sound peculiar? It should, but ask a bipolar of some standing and you will find out that all have spent a good bit of time trying to figure out which of their cherished personality traits are due to their being bipolar and which are due to some unique, core “self. They wonder whether it wasn’t their bipolar self protecting them from a world that was always just a bit too much. All of this questioning is an essential part of the process of acceptance. When they have accepted that there is no magic cure for what they have, and that they will have it forever, they can move on to making their life as fulfilling and stable as it can be. When they reach a point where they are both reconciled to the illness and accepting of the treatment it mandates they will really begin to grow and live a full life. The road is fraught with peril, but the destination is certainly worth the risk.

mental health can be challenging. It is so different from the med/surg philosophies. Where are you struggling and what are your weaknesses in the test? Do you understand the structure of the DSM and how to categorize disorders? I have a psych nursing care plan book that seems to help alot. I hope this helps.

Jobs are in very short supply/non existant in the south bay area also.

The bay area is in the same condition. No jobs around here either. Even snf jobs are hard to find. Good luck everyone.

One day at a time.......breath.....one day at a time. That is what I keep telling myself. I have 88 days to graduation. So I am focusing on studying for the nclex and looking for a job which are in short supply here. Good luck.

uhhhhhh.............this student wants to be a nurse? This is very disturbing. Obviously, there are no critical skills being employed to figure out the pump. And to leave a pt in a mess...yuck!!!! She should have at least delegated the mess to the nurse assistant if there was one on the floor. YOU really need to say something to your instructor. I know it seems mean to the student but think of the patients. What would you do if this was an RN? You would go to the nurse supervisor. And as a student, that would be your instructor.

I would definitely talk with your instructor. Make sure your are able to keep things confidential. I don't mind helping out my fellow students, but the ones who have no clue what to do and just seem below par SHOULD be redirected to your instructor. This is an excellent ethical issue. Remember your steps to solve them and your goal of nonmalficence as a nurse.

Every school has one. And it sucks. We had an instructor that would dismiss you from the floor if you did not have all facts down for your meds. Then you could not get your hours in, could not pass the semester...what a nightmare. She would also argue with the RN that I would work with and tell the RN her care was incorrect for the patient. Yeah, that is the way to work with staff.

RELAX!!! I am in the same boat as you. 46 yo. Hard to remember stuff right now. I have tried to learn conceptually throughout nursing school to really understand what is going on in patho because i don't memorize anything. I feel the same way because school is almost over and there is alot to balance now. I am doing the same thing you are and I am trying to relaz and have confidence in my skills. I have my clipboard to take notes so i don't have to memorize stuff, its all right there. I try to delegate effectively, prioritize my care, and count on my clipboard for my info. Good luck.

Depends on the philosophy of the instructor on the floor. Some instructors have a "learn. do, teach," attitude, some are very controlling and want to do all of the instructing themselves. I am very concerned also that this student could not easily figure out this dosage.

I am 45. I have 177 days until I graduate from nursing school. there are advantages to being older. you have life experiences on your side. you can think more critically and conceptually. can't memorize as much but that is not as important as truly understanding nursing concepts. go for it.

YOU ARE NOT too old. I am 44 in my first semester nursing school. My life experience and confidence in myself has been a tremendous gift. The younger students look to me to answer questions and I have no more experience than they do. You can do it.

Hi, this is my first post. I was just accepted to Ohlone College for their ASN program. They are in the bay area. First time in the lottery and I got in. Guess I am blessed. Hope you all get in soon.