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TerpGal02 ASN

Psych

Content by TerpGal02

  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. 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.
  3. I am an INFJ. Psych so far has been a pretty good fit [discounting the trauma I suffered after being assaulted my a pt in his home). The job requires a lot of supportive listening, therapeutic support, motivational interviewing, psycho ed which are all forms of "counselling". I think the operative word is that you cannot provide psychotherapy, if that makes sense. Now I know you will have to go through nursing school to become a psych nurse. I dont know if it's TRUE for INFJs but I felt like a deer in headlights during med surgery clinicals. Also keep in mind that if you work on an input unit, often there is not much time in the day to chat with patients for any extended period. You are more there to keep the pts and the milieu safe. It's a bit different if you work in output. This is a very sort of taxing for an introvert. INFJs are supposed to be the most extroverted appearing out of all the I configurations but the job takes a lot out of you. I know when I get home from work, I have had more than enough social interaction for the day and I need at least an hour to decompress and just be away from people.
  4. TerpGal02

    Visually impaired nurses

    I was diagnosed with Stargardt Disease a year ago at age 37. It affects my central vision and is a progressive genetic condition. I have 20/80 corrected in the right eye and 20/60 in the left. So far I can still drive and practice safely with adaptation. I need direct lighting to read most things and my progressive glasses do help quite a bit. I use the magnifier on the computer and use the camera on my phone to zoom in on written materials as needed. I am a psych nurse.
  5. TerpGal02

    Not so sure about psych anymore

    I have been working in psych for 6 1/2 years now, my entire nursing career. I knew I wanted to work in psych my first day of psych clinical in nursing school. I have seen it all as far as psych goes. Children, adolescents, adults, geri patients, psychosis, mania, depression anxiety, personality disorders, self injury, acute detox.......seen it all. I am currently working with adults on an ACT (Assertive Community Treatment) team. We provide services to clients wherever they are, be it a homeless shelter, their home, etc. In February, I was assaulted by a male client while I was in his home. He was intoxicated at the time. He grabbed me repeatedly and kissed me. Thank God it didn't go any further than that, but on its own was pretty traumatic. I filed charged against him and we went to court. He been in jail for a little over 2 months and got time served. He ended up spending more time in jail for other reasons and just got out recently. My team is continuing to serve this person. I thought I was doing ok as far as coping, until he got out. I am not expected to complete visits with him at all but he is in the office frequently, I have to see him, at times I have had to speak with him (briefly) on the phone. I am having a really hard time with all of this. I am terrified half the time to go in to the office for hear he will be there. If I see him or even really hear his voice, I am immediately in panic mode. My co workers do their best to run interference but it is still hard. Based on this and my many other experiences working in our very broken mental health system, I don't really feel good about what I'm doing anymore and am thinking about changing specialties. Has anyone on here ever done this? I am worried I have pigeonholed myself.
  6. TerpGal02

    Not so sure about psych anymore

    Thanks all! Yes, I have been in therapy for this incident and am now going through EMDR. This individual basically has to come to the office as we will no longer see him in his home if 2 people can't go. He has a long history of violence when intoxicated. The reason I keep hearing that we have to keep him is that the county mental health authority will not allow us to drop him. I was never given a debriefing. A co worker came to court but she was primarily there to support him and give info on our program to the judge. In fact, she didnt know that it was my case she was showing up for until she saw me at court. She was pretty upset that no one told her beforehand. One of the directors at my agency was trying to find me another position in the agency but she resigned. Our agency as a whole is great, it's the leadership of our team that is the problem. The directors did not know about this until almostn2 months later and supervisors are expected to notify them immediately in incidents like this. This has all been handled pretty horribly IMO. I just worry that this level of anxiety and frankly I am worried that I am experiencing some symptoms of dissociation is really negatively impacting my work in general. I dont know what else to say. I was never really offered any time off and I had no idea that my therapy could or should be covered under workers comp. My insurance has no copay for therapy so I haven't even thought about it. But thanks for the well wishes all.
  7. TerpGal02

    Holding voluntary patients - illegally?

    Really I think it boils down to what the law is in your state regarding psych admissions. I don't know of any state, although I am sure they are out there which says voluntary psych patients can just AMA whenever they want. In my state, patients are required to give a written 72 hour notice. As with elk, the clock starts at the time they sign the paper. That doesnt mean the doctor has to keep them 72 hours, it just means they CAN. They can also be certified involuntarily at the end of 72 hours if t2 docs sign off that the pt is a danger to self or others. We usually would ask patients to wait while we did DC paperwork too but if they were demanding to go after the order was given, we would let them leave. Straight detox is another animal. In my state it is treated like any other medical admission and the pt can walk out pretty much whenever, although we would try to keep them until morning if they wanted to leave in the middle of the night. Most of them just needed a bit of TLC and convincing that it would be in their best interest to stay until morning.
  8. TerpGal02

    Trans Patient

    One facility Inworked in had all private rooms so problem solved there. Another facility had double rooms and the policy was that trans patients got a private room. The unit eventually moved to all private rooms so again, problem solved. That trans patient is not a Male, she is a woman and should be seen and treated as such, period. The second unit I worked on had a lot of older, conservative nurses who would cisgender trans patients all the time. Us more open minded nurses would cringe and shake our heads.
  9. TerpGal02

    Pediatric Psych - HELP

    I found that activities that got the kids up and moving were great to burn of excessive energy. Kids that age need to be active and for the ADHD kids this is especially true. Obviously you have to keep rough housing in check though. I dont know if your unit utilizes a "token encomony" approach but when I worked with kids that young, earning rewards for positive behavior really reinforced that behavior. I worked evenings and I frequentlynbribed kids with offers of bed time stories if they were good lol. I think working with kids that age is the most physically demanding as far as psych. Holds and seclusions (although giving time outs works too) is inevitable. Kids just dont have the impulse control yet and it's especially bad if you are dealing with a lot of ADHD kids. I have worked with all ages in my 6 year career. I have been hit, kicked, bitten, scratched, so it on, and pee'd on. 99% of those were kids under 12 soooo.........
  10. I would review psychotropic meds, their indications for child/adolescent patients. I would also review your therapeutic communication techniques. I would also suggest that you take another look at your Human Growth and Development and your Erikson's Developmental Tasks to review what is developmentally "normal" for the age group you are working with. I think it depends on the culture/patient population as far as what to expect. For example, I worked at a free standing psych hospital that took all ages and as far as child and adolescent went, all behavioral issues-think high impulsivity/aggression. I then worked on a unit in a general hospital that took adolescents and adults. They were more "picky" there on what kids they would take, just because of the mixed nature of the unit. We typically would not take kids with aggression issues. Always on a behavioral health unit, safety is your #1 priority. You will learn to have your head on a swivel, especially when it comes to teenagers. They don't yet have a fully developed pre frontal cortex so they can be impulsive and can also be incredibly sneaky. You will likely see a lot of patients who self harm as as far as the teens go, they can be VERY creative in what implements they use to self harm. I have seen kids burn themselves with pencil erasers, crayons, etc. Yu will need to learn to develop VERY strong boundaries and to stick to them, but also know when its ok to be flexible too. Good luck! I love adolsecents, they are my favorite population by far1 !
  11. TerpGal02

    Imminent danger

    I would agree that alternate methods should be tried first just like previous posters have said. If the docs are on the floor, I would let them make the call but the psychiatrists IMO spend on about an hour or 2 on the unit seeing pts then they bugger off. "Imminent danger" is so vague. I will tell you what an old nurse manager of mine said. If you feel threatened by a pt, or you feel a pt is threatening to others, that would qualify as "Imminent danger". IE they are screaming with balled up fists and cant ge redirected, verbal threats (technically, that is assault), lunging, posturing ,etc. It all boils down to your documentation on the incident. Things if TJC pulled the chart, is your documentation sufficient to support your intervention.
  12. 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!
  13. 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.
  14. TerpGal02

    Psych NPs and COPD/CHF/CKD/etc clinics

    We have this at the agency I work for. We habe the outpatienf mental jealth clinic and our agency has partnered with another agency that pdovides primary care so that they have a clinic in the same building. They do this at 2 of our locations. Its pretty great.
  15. 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.
  16. 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.
  17. I have a very high arch to my foot. I have tried all varieties of sneakers and no matter what after a long day of clinicals my feet, knees, and back are just ACHING. I can't seem to find a shoe that has the arch support I need. Anyone here with the same issue? If so could you recommend an insole/shoe with good arch support?
  18. TerpGal02

    power struggles

    I just do not get how so many of our adult staff cannot grasp the concept of not getting involved in power struggles. Urgh. Case in point. We have 2 pts on the unit veeeery Axis II, antisocial PD males that just rub you the wrong way. Well every time staff has to redirect them, they get into arguements with them about what actually happened and then want to argue some more after the fact. We had one guy got from his room to Tue bathroom shirtless. The staff wanted to make a big deal about it. I just went down and said, "Hey I can't have you in the hallway without a shirt on". He apologized I started to walk away biut staff still wanted to have a go with him. I just had to tell them "let's go". If he did it again, he was warned and we'd step up to losing privileges. I don't understand what is SO HARD about this. The C&A staff is pretty great at being firm but fair with the kids.
  19. 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.
  20. TerpGal02

    Psych nurses all have a mental illness

    I have heard this a number of times, too. I tend to agree with some other posters where nurses often end up in specialties they feel a personal connection with, thus there are a certain number of psych nurses that have struggled with mental illness themselves or watched a family member struggle with one. On my unit, we have both. One of my closest friends at work (who is an awesome psych nurse too, btw) doesnt have any history herself of mental illness and she does amazing with the patients. I myself do have a history of a mood disorder and PTSD and I work very hard to take care of myself and keep myself stable. I think as a nurse with a mental illness, you wouldnt last very long in psych if you did not have VERY keen insight into your own illness and had it under very good control because psych nursing, if one is doing it right, is very difficult. Its not as hysically demanding as other specialties and not as task oriented but it is mentally, emotionally, and spiritfually (if you let it) draining. We have had a few techs that I am quite sure had an unstable mental illness and they did not last long. If you are unstable working on a psych unit, you bring the whole unit down and then you start having safety issues. But really, its nurses that make comments like "all psych nurses must be crazy" that could never handle this job. I think people say things like this out of fear really. There is still a large amount of fear out there surrounding mental illness. Its sad really. Its funny watching ancillary hospital staff come onto our unit sometimes.......they act like they are walking into a war zone. Our unit is probably the most calm in the whole hospital LOL. It does make me sad for the patients that have to witness those attitudes though. They're not stupid and totally pick up on stuff like that. They are human beings, too.
  21. 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.
  22. 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.
  23. Yes, I have seen this done in the past for catatonia. It was pretty effective the times I have seen it used. Mind you, this was for severe cataonia where the patient was unresponsive and just laying in bed starinv at the ceiling. I would assess respiratory status, sedation, and vital signs before giving though. The patients I have done this for however have been so sick we had to gibe IM because they were again, essentially unresponsivs. ECT also works brilliantly in these cases, I dont know if your facility performs it.
  24. TerpGal02

    When does staff rights start

    I often wonder on this too, especially after the week I just had. We had a batch of particularly verbally abusive patients.
  25. TerpGal02

    I Hate Psych

    Sorry gotta disagree there. Sometimes there is MORE secondary gain with adolescents. Sooooooo much attention seeking behavior. Whats a better way to get attention from a distant, hninvolved parent than to keep yourself in hospital after hospital? Anyway, not to jack this thread.........yep, psych is like that. There is a very high burnout rate. Tis the season for frequent flyers on my unit and I just tell myself, "Terp, obviously there is a major problem with this persons functioning if they would rather be stuck in a psych ward rather than out in the world". Yes even the homeless person with hot urine. I think sooooo many hospitalizations could be avoided if a lot of these pts had stable housing but who am I lol. Maybe those state hospitals werent such a bad thing after all.
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