kidluvinRN

Thanks for your replies.

Hello! It's me, wondering if anyone can give me some insight. I have not worked in psych and feel overwhelmed with this situation. My community based training (person centered) would respond to this using 2 person holds, transports. Techniques like sitting against a wall using arms and legs to hold the center person still until they calm. This works well, but I have concerns with safety d/t this child with a trach, respiratory, and seizure disorder. What do you all think?

Hi all, I could really use some advice. I am a community-based nurse who is working closely with a 13 yo with medical needs, developmental delay, and what I suspect maybe emerging bipolar (strong family hx). Child takes Zyprexa and is under psych care. I have been a caregiver with this child for a number of years, which has required that I be very skilled in behavior management and aviodance of power struggles (this child has been known to remove trach as an attention getting ploy) Not easy but I have managed to establish a good rapport with this child and am able to provide the medical care needed. Here is where this story begins: Over the last several weeks behavior has been severely escalated; self-abusive to the point of leaving bruises and marks; and yesterday erupted into a crisis where the immediate environment was trashed and restraint was needed. While attempting this I was hit, bitten and scratched until another person helped me with a two-person hold. This continued for close to one hour while we were transported home. Once there the child suddenly calmed and walked directly to the foster-mom and said "(name of child) hit and bit" It was eerie, like the child was talking about someone else. There was very little association with all that had just happened. Is this dissociation common with Bipolar or are we looking at something else here?! During these periods of escalation it is like I do not know this child; nothing I have done in the past helps; all of my good rapport is for naught!!!! Ultimately I am afraid that the escalated behavior with precipitate a medical crisis. I am working closely with her home but no one seems to know what to do. Any advice?

I thought it was the policy of this site to not engage in speculation about medical diagnosis!!!! Sorry for your daughters troubles, sounds like she needs are more compassionate primary care provider, perhaps a Nurse Practitioner.

In my experience LTC had an E-box; for antibiotics and frequently needed meds. Our Drs knew what we had, and would order what we could give right away!!! Me, I would have given the med 30 min late, write it in my note, and inform the next shift. I'd feel funny sitting in report saying that I had received but not yet started the med. .

Alcohol wash is fine as long as your hands aren't visibly soiled per CDC guidelines.

Last week was the longest short week I have ever had! Something must have been "in the air". So, is the cath something that you do regularly with this student? If so it would seem appropriate to use the private bathroom facility and close your office briefly at that time. What emergency procedures do they use when you aren't there?!? This student needs privacy; that must be accomodated.

Last week was the longest short week I have ever had! Something must have been "in the air". So, is the cath something that you do regularly with this student? If so it would seem appropriate to use the private bathroom facility and close your office briefly at that time. What emergency procedures do they use when you aren't there?!? This student needs privacy; that must be accomodated.

You go! You'll be a great nurse someday. I always heard "don't be a nurse be a doctor" when I was growing up. I knew I didn't want to be a doctor!! So I just gave up the whole thing, or let it go for awhile. . .until I had kids and encounters with nurses who inspired me! It is ashame that our society values caring and caregiving so little that this attitude continues.

Poor kid, it sounds like this family fell between the cracks, so to speak, as far as anyone following up with them. This family needs an advocate. Perhaps the insurance co. has case managers, school nurse, even a friend to go with them to the pediatricians so that they can express their needs. ...Personally, this type of thing drives me crazy, why wouldn't this family need to know how to keep their child safe and healthy, and especially since there is a history of aspiration!!!!! I would want a consult to GI, social work, a dr. order for thickener (so that insurance will pay), and ((((Hug)))) for this poor family.

I am not in your area; but I have held two positions with the MR/DD population as an RN. One in pediatric long-term care and the other for a school district as a 1:1 RN for a medically fragile child with MR/DD. Both experiences have been great.

I am not in your area; but I have held two positions with the MR/DD population as an RN. One in pediatric long-term care and the other for a school district as a 1:1 RN for a medically fragile child with MR/DD. Both experiences have been great.

Sounds like this child needs further medical attention; obviously colace,etc. not working. Could be something neurological; tethered cord syndrome can cause impaction in children although typically not that young. Definately dietary counseling and a better bowel routine are needed in the least.

Try venting the tube for air; that or some tape but that can get messy!

Try venting the tube for air; that or some tape but that can get messy!