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TerpGal02 ASN

Psych
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TerpGal02 has 6 years experience as a ASN and specializes in Psych.

37, married, graduate of University of MD College Park with a degree in Political Science and a Dec '11 grad of a local CC ADN program

TerpGal02's Latest Activity

  1. No I've not seen routine accuchecks for Pts on atypicals unless of course they are diabetic. Usually what I have seen in tje settings I have worked in is that the prescribers will get an A1C on initiation and then regularly thereafter. I have seen Pts being prescribed Metformin alongside the atypical a couple times before. The rationale prescribers have given me is to help curtail weight gain.
  2. TerpGal02

    Nursing with vision loss/low vision

    It's good to "meet" someone else with Stargardts. No one else in my family has it. I am 37 now, did not start noticing something was wrong until I was 36. No one else in my "real life" has Stargardts either. Being a rare disease, it's hard to connect with people who understand what it's like. A very lonely feeling. Anyway, I'm glad to hear someone else with vision loss successfully able to navigate a clinical setting. Good luck in your adventure as a new nurse and keep us posted on how things go!
  3. TerpGal02

    IM Injections

    You're talking long acting injections right? I work on an ACT Team and I give lots of long acting IM's. Usually when I'm in a clients home I will casually ask them where we did the injection last time (and I do look it up before I get there) then I casually suggest we use the other arm or glutes if we've been doing a lot of delts. To be fair, I have a couple of very paranoid pets who refuse to rotate site. I have one who's been on Haldol Dec for YEARS, has a huge knot but absolutely refuses to let us inject him elsewhere. IMO in that situation with the pts being as sick as they are, they are better off getting the meds in their body.
  4. Hi all! I have been an RN working in mental health nursing for 6 years now. I currently work in a community based mental health agency on a mobile treatment team. In April, I was diagnosed with Stargardt Disease which for all intents and purposes is an early onset version of macular degeneration caused by an autosomal recessive mutation of the ABCA4 gene. All my life up until the last year or so I have had perfect vision. In nursing school I had perfect vision. Now I am corrected with glasses to 20/60 in the left eye and 20/80 in the right eye. It has progressed within the last 6 months but I don't know how much farther it will progress and in what time frame. Luckily, I have NIH in my backyard and am participating in a Natural History study there. As far as functional vision, I mostly have problems with close tasks like reading fine print, working on the computer (without magnification) and reading handwriting. I can barely read my own handwriting anymore. Thankfully everything at my workplace is digital so I dont have to decipher chicken scratch orders or anything. I was wondering if there are other low vision nurses out there still successfully working in the field. How do you manage day to day work tasks and what accommodations do you use to make work easier? I am really new to all of this and quite frightened that I may no longer be able to work as a nurse one day.
  5. TerpGal02

    Physical demands?

    If you work on inpatient child/adolescent, things can get quite physical. You will find, especially with kids under 12 that they are in the hospital for behavior problems/aggression along with ADHD. Pediatric patienfs simply do not have the impulse control an adult has.......that whole prefrontal cortex thing. If they want to act out, they will. You are more likely to see aggressive acting out from a 9 year old with ADHD than you ever will from an adult expereincing psychosis. Most psychotic patients tend to be more isolative than anything in my experience.
  6. I work on an inpatient unit in a general hospital and we use haldol regularly on the m3dical floors. If a patient has delerium during their stay, haldol is the treatment of choice.
  7. TerpGal02

    Artane (Trihexyphenidyl) vs Cogentin (Benztropine)

    This. There is a potential for abuse with Artane. Its also a lot more dangerous in the case of an overdose. I rarely see it used. Really I have only seen it in pts that are real chronics, been on antipsychotics for a long time and have Parkinsonism or TD from them.
  8. TerpGal02

    Adults vs kids

    I have worked with all ages but I like adolescents best. The biggest difference I see is the influence of family on the patients. 9 times out of 10 its some kind of family conflict that will be the root cause of why the kiddo is in the hospital, especially with the teens. Physical altercations/self injury/suicide attempts after a disagreement with mom and/or dad are soooooooooooooo common. Most pediatic psych patients come from pretty dyfunctional families. The parents need a long of education and support if the child is to get better. With under 12s you will see a lot more physical acting out. Common diagnoses with children are ADHD, Oppositional Defiant Disorder, and Disruptive Mood Dysregulation Disorder. A lot more hands on. I think you have a greater chance of being hit or having something thrown at you with children because they dont have that higher executive functioning yet thus lack impulse control. If they want to hit you, tjey will hit you. The same can be true of teens at times as well. You will need to learn to employ more behavior modification techniques for this population and will have to have a strong ability to set limits. I think most child and adolescent units operate on a priviledge based system. You earn whatever privledges the unit jas to offer and lose them if your behavior is out of line. Another thing to remeber, especially with little ones is that their capabilities for abstract thinking are not that of an adult. You have to be very plain and straightforward in yoir interactions with them. Not to mention a teen will spot someone who is disingenuous a mile away. Hope that helps.
  9. TerpGal02

    Night Shift Survival

    I did noghts for a year. Loved my night shift crew, loved the shift itself. I just couldnt deal with the hours. I tried all the suggestions above and I just could not sleep during the day. Plus I ended up having no social life because flip flopping my schedule around on days off was so hard. My blood pressure became difficult to control, I got sick a lot more often. It wasnt good for me. As soon as that sun hit my face leaving the hospital in the AM, my brain was like, "ok its time to be awake!' And when I did sleep it was not restful at all. Not to say you will have the same experience, that was just mine. The biggest things that helped me slightly were the use of an eye mask, blackout curtains and ear plugs. Also trying to keep your bedroom as cool as possible. I have a heck of a time sleeping if Im hot. I also cant sleep on an empty stomach. I would eat something small like a bagel or cereal before turning in usually. Good luck, I hope it works out for y.
  10. TerpGal02

    Just can't do nights and I am finally accepting it.

    Count me in as well. Just started on days this week after a year of working nights. At my last job, I worked 2nd shift and loved those hours as I havent always exactly been a morning person. I picked up a few nocs there and thought that night shift would be just fine when I applied for my current job. It was not. I loved my night shift crew for the most part. I loved the laid back feel. Yep we got super busy, but no doctors or management or case managers breathing down your neck. My body just couldnt take it. And it drove me crazy when I jeard people sau, "well of you really have to do it, you will force yourself", as if there was something wrong with me. I DID force myself. The problem was that every morning when I walked to my car and that sun hit my face, my brain would say "wooohooo time to be awake" and no matter the dark curtains or eye masks or fans or sleep aids either I simply could not get to sleep or if I did Id wake up feeling like I never slept at all. I constantly felt like I had the flu and my mental jealth suffered so much. I became depressed and anxious. I had no social life. Sure Im tired after a 12 hour shift now on days. But when my jead hits the pillow at night, I sleep, and stay asleep. And feel rested when I wake up. With that said though, I think there is a HUGE difference between 12 hour nights and 8 hour nights. Not tjat I would really want to work 8 hour shifts again, but if I had been on 8 hour nights I reckon I could have held off the move a little while longer.
  11. TerpGal02

    Code blue on psych floor

    Well I had my first code today after 3 years of nursing. Elderly patient started choking about half an hour after evening snack. Thank God I was in his room. I Heimlich'ed him but he went unresponsive and started slithering to the floor in my arms (big guy too, I am a pretty petite gal). Started compressions called a code. He made it to ICU but family decided to withdraw care. Despite every doctor and nirse that came up telling me I did exactly the right thing and everything I could have........cant help but questioing myself. Anyone here ever had a code blue on the psych floor? I dont think I could ever get used to that. One of the many reasons I work in psych.
  12. TerpGal02

    For New Grads -YES you can do psych.

    Sorry, gotta disagree with ya on this one. I went into psych straight out of nursing school. In my experience, I never STOPPED looking at and understanding lab values, doing physical assessments, inserting catheters (mostly just straight cath though). My first job in a community mental health agency was more medical than psych. We had social workers and therapists to deal with much of the psych stuff. We were in charge of keeping the clients healthy. I learned more about health promotion and prevention at that job than any other jib I have ever head. Psych patients get sick too. On average, the severely mentally ill die 25 years sooner than non-mentally ill folk. When I worked at the free standing psych hospital, we had no medical floor to send patients to, no ICU, no IMC. We had to be able to assess to a pretty good degree whether that chest pain or SOB was because of anxiety or because there was some cardiac problem going on. If it was the latter, we were SOL until EMS showed up. I work on a psych unit in a general hospital now. We take pretty medically sick patients as well. We also take alcohol detox. Those patients get VERY sick quickly. I manage IV fluids, hang IV meds, do wound care, etc. About the only med-sug tasks I don't do are IV starts or NG tubes. Its actually nice we have respiratory to do neb treatments. I did them myself at the free standing. I think your physical assessment skills have to be pretty on point in psych because to get a doc to take you seriously you 1) have to prove to the doctor you know what you are talking about because most doctors think psych nurses dont know what we're talking about 2) Be able to have real, solid evidence something is going on because most doctors dont take the patients seriously either. Its always "just in their head". Did I mention we do TONS of IM's? In my first job I ran an injection clinic where all the Pts on long term antipsychotics came to get their IM's every other week or every month depending on the med. You learn confidence in psych, at least I have. I have learned how to keep my cool in a crisis. I have learned how to be confident in my assessments. I have learned to manage my time. Having an assignment of 5 actively detoxing alcoholics can be pretty time consuming :) Ive learned a lot of skills I wouldnt have learned in med surg. In my facility, 2 members of our team are required to respond to any code greens (combative person) in the hospital. I have foiund it very interesting how a lot of med surg nurses (we have a LOT of code greens on the medical floors) are just not able to de-escalate patients or even calm them down. From dementia patients climbing OOB to schizophrenics admitted for medical reasons. Half the time I show up and they are standing there like a deer in headlights. For example. we just went to a code last week wherein an actively hallucinating high fall risk schizophrenic was trying to get OOB and swinging at the air. We were able to get the situation under control quite quickly, and the house supervisor at night relies pretty heavily on us during any behavior in the hospital. Dont get me wrong, I have much respect for med surg nurses. Their work is often thankless, and unsafe due to high ratios, but really if what you want is psych, I say go for it. When I went into school, I was pretty surprised that I immediately felt "home" during psych clinical LOL. I too felt like I needed a year of med surg, and believe you me, I tried. This was 2011 though and it was quite difficult for new grads to land that first job. It just so happens the position I was offered after umpteem interviews and resumes sent was with a community agency. And if you really feel like you might want to branch out someday, I would advise anyone to work on a psych unit in a general hospital. Units are much more likely to put in the time to train internal transfers :)
  13. TerpGal02

    Nursing School Scrubs Nostalgia

    We had these awful white bottoms and white tunic tops that zipped in the back with our school patch on the sleeve. They were made of this awful polyester/rayon synthetic blend and they were SOOOOOO itchy, They switched to navy scrub pants for the incoming first semester students the semester I graduated. We were so jealous.
  14. TerpGal02

    hydroxyzine HCl vs hydroxyzine pamoate

    They're given interchangeably everywhere I've ever worked. At my last hospital, the docs could order Atarax (hcl) or Vistaril (pamoate) and they were getting hcl, no matter what. Hcl was the only formulation we carried. Where I work now, if a doc goes to order hydroxyzine, the order reads like This: hydroxyzine (Atarax/Vistaril) and the pt would get the pamoate because that's what we stock.
  15. TerpGal02

    Eliminating Seclusion/Restraint? Um, NO.

    I agree. I don't think it will be possible to ever totally eliminate it. Sometimes people are so sick that no amount of verbal Dr-escalation or PO PRNs (if the of even agrees to take) will keep them safe. I have worked places where it seems like there was a rush to restrain someone but where I work now I have yet to see one and it's been 6 months. Now granted I work on a voluntary unit. Involuntary and forensic, those are some really sick pts. And I feel like they are getting sicker.
  16. TerpGal02

    Avoiding counter transferrence

    I just started a new job in a community hospital psych/detox unit. I have almost 3 years in psych caring for all ages and love it. The addictions part not as much. We have had addicts and drug seekers but never straight detox. We do straight detox for EtOH. We will detox opiates but they have to be on the floor for a co occurring psych problem. Sometimes I have a really hard time having empathy for the alcoholics. I give them good care but some of them trigger me a lot. My father is an alcoholic and my husband is a recovering alcholic (and still in early recovery). So having lived with all the chaos and he'll that is being close to addiction sometimes I feel for their families more than them. Anyone else in a similar situation? How do you avoid being triggered? I went to Al Anon for a while but found the 12 step model does not work for me so well.
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