DaisyChains

I've recently made a change from medical nursing to psych nursing. I used to document so well, I knew all the right things to chart in reference to the physical condition, but now i have no idea what to document on my clients. I'm the first LPN on this team, and don't have a clue what I need to be documenting. I don't know what words OR terms or guidelines to use, anything! For example, "lungs CTA" and "no peripheal edema" come natural to me, but what terms are used in psych documentation? The clients are outpatient and long-term, severe mental illness. I want to do a good job, and that includes my documention, but I need help in knowing what to write. I was SO comfortable in the strictly medical setting, and now I feel totally out of my element. I want to have as much confidence as I did at my old job, too. Thanks!

My grandmother had a hemorrhagic stroke a few months ago, and while she did have a headache and unilateral weakness at the time of the stroke, she has had no lasting effects. She is just as good as ever, even though she is obese at 80 years old. I've always assumed that a stroke ALWAYS causes some lasting effects, especially since the leaked blood damages brain tissue. Right? I'm puzzled because my Mother suddenly died of a hemorrhagic stroke at only 55 years old; and then her Mother has a bleed at 80 and suffers no effects what-so-ever. Don't get me wrong, I'm happy that my grandmother is doing well, but like I said, I was under the impression that a stroke ALWAYS causes injury. I'm just a bit confounded because this wasn't like a TIA, it was an actual bleed. Anyone have any experience or knowledge of why a bleed wouldn't have any lasting effects? So, it just bled a "little tiny" bit, and then sealed itself off? I'm so confused here.

i'm new to the injectable drugs that are so oily and while i've not recieved many complainers, i have a few concerns that i'd like some help with. 1: is using ztrack preferred? any reason not to use it, or to use it? today i noticed a good bit of the prolixin running right back out of the hole the needle left in the pt's glut. i've not seen that happen before. 2: push fast or slow? i was taught that slower is less painful and allows more effective absorbtion, yet today a pt told me "the other nurse" pushes fast and it doesnt hurt him. what do i say so i don't make the other nurse look bad? 3: size needle? what's the smallest you've used successfully? all i have available is 20g 1.5in needles. if i were able to get a smaller gauge needle, what would be preferred for such a thick med that is for deep im? 4: bevel up and in at a 90 degree angle? right? i really do want this to be as painless as i can make it. when i first started giving im's, i was thrown out on my own and apparently gave painful shots. (that was a terrible job, i have a wonderful job now) 5: leave a small air bubble to make sure all the drug is in? i read this somewhere, and it just scares me. how do you feel? 6: if i did hit a vein, what is the worst that would happen? this never occured to me, but someone asked and i didn't know the answer. i know it's not desirable, but what would happen, in regards to these drugs? 7: use a dry needle after drawing up? does that mean changing to a fresh needle? does that make it less painful? at my new, wonderful job, i am giving the prolixin and haldol depots on a regular basis, and if i can make the injection less uncomfortable, the pt is more likely to comply with coming in to get "shot". also, i want to build a therapeutic relationship with my clients, and if they think of me as the lady that gives bad shots, i don't think are as likely to warm up to me. thank you for everyone that helps me out here!

I've been in orientation for a new job for a few weeks now, at a job I'm "okay" with but It's a midnight shift and I'm not sure how I will do with that. Now, I have another job opportunity, and I'm really having a hard time with this. I'm afraid that if I decide to take the second new-er job, that I might regret it and really mess up the job I have now. The major differences are ...one is midnights in LTC, the other is M-F days in psych. I'm thinking the psych would be alot less demanding, and I've worked psych before as an aid. The "nursing" was cake compared to what I do and put up with in LTC. Is there any way to leave during orientation and still be on good terms with a company??? I don't have to decide until later next week. Anyone know how to handle this, or has it happened to you before?

Please take the advice of those on here who say it's not our job to try to figure that out. My Mom was in chronic pain and who knows how many people in chronic pain ARE addicted or not, but chronic pain needs to be treated. Itching is very common with pain meds, first dose, hundreth dose, addicted or not addicted. Please don't start a habit of trying to determine addiction. You will end up doing that with people who are really in pain and need your help. If she were stealing, lying, getting in legal trouble, then there might be a problem. And even at that, addicts still feel pain and deserve treatment. Everyone deserves to be taken at their word in regards to how they feel. Please, please, please don't allow yourself to become the narc police. As a child of someone who was in chronic pain for years, I can tell you, my Mom was embarrased that she took pain meds, and that in itself made her act "funny" about it. Watching the clock, it may have become a comfort measure, because the DREAD of the pain is scary and clock watching can help assuage the dread. I can't say it enough, please please don't become the police to the patient.

some of you may recognize that i've been having a hard time lately with the anniversary of losing my mom, so i've started taking generic wellbutrin. i've taken it several times in my life, and i have to say it was amazing in my smoking cessation, and my depression at times. what i have experienced that is scaring me, and i have felt it when i've taken it before, is heart paplitations, heart flip flops and occasional stabbing pain in my chest or under my arm pit by my heart. i've had an ekg and it was fine, i'm not really a risk factor for cad, so i can't figure out why i would be feeling this. it seems to be a common side effect and not a big deal to docs. what i've learned and read is that this is a common side effect, but my question is, how can i be having chest pain/heart pain and it be okay? anyone have any insight into drugs that cause chest pain, because the wellbutrin is about the only anti-depressant i've been responsive to. in the past, i took a good bit of benzos to calm me down in regards to the anxiety. how can a drug cause that feeling but with no harmful effects? i dont want to stop the wellbutrin, but i've layed off for a few days to make sure it was the drug. sure enough, the cardiac problems have stopped. i'm wondering if anyone experienced this and just kept on and the feelings went away, or what? i really need the wellbutrin right now, i've been so down...but i don't want to be walking around with sudden armpit/chest pain and palpitations! thanks and happy thanksgiving to all!

I feel silly, but "I am very, very lucky" will become my mantra at work. I know I AM lucky, and it seems petty to cry about a boring job with stuck up co-workers. See, you guys are the only nurses I ever get to really "talk" to! Thanks!

I was going to post this in the student section {LPN to RN}, but realized they are still students, and I need to ask those of you who have successfully made the transition from LPN to RN or higher. I feel so discouraged, I know I can't afford any more loans d/t when I was younger and in college. I know I can take my gen ed classes and probably afford one at a time, but I'm thinking it's going to take me 20 years to finish this!!! There's nothing wrong with me being an LPN, but at 36 I'm thinking- what am I going to do when I can't run the floors anymore? I know there has to be nurses out there who beat the odds, and even after years and lots of their own money, finally made it. They do exist don't they? This is possible right? I worry alot, I know. Thanks :hug99:

I'm so sorry about your situation, and while I haven't experienced it, I am getting ready to be in your position at my new job, and I've asked alot of the nurse there how they made it through night shift. Mostly, they all said it took a while to get used to it. Then they said, it was great after the adjustment. I've already got a sleep disorder, so I feel your pain in being weepy and physically out of whack. Some of them absolutely love nights, but still said it took alot of adjustment. I think if the benefit of working nights outweighs the other options, then try to stick it out, and go with your conscience on the 4AM rounds. Not everyone is going to like you where ever you go. I know you know that, but sometimes it helps to hear it. I don't remember reading how long you've been on the nights, but I'm going thru the same as far as the nurses in the "clicks". I just posted a thread about it, sort of, if you look for it here you might get some suggestions there too. So, if you have a list of reasons FOR working nights, and then a list of the negatives of nights, maybe actually writing that out would help you see it in a better light for the long run. Hugs.

I've just started my second nursing job, and so far, it's so boring and the nurses and staff are not friendly or welcoming at all. It's really hard to make myself go everyday, but this is a good company to work for so I really want to give it a shot. PLUS I hate job hopping!!! Besides just gritting my teeth and suffering through the 12 hour shifts, is there anything that helped you all get through really hard times on the job? I miss my old job, but the conditions were terrible. Ironic, huh? Most of the time, I just feel totally alone there because no one talks to me. I've never been so ignored, does it just take time for nurses to warm up to newbies?

After your responses, I felt encouraged to write to CORE and say exactly what was on my mind. I had such a bad experience with the CORE representitive, that they "donated" a certain amount to the funeral home to try to make it up to me. The CORE rep. was deceptive on a few points during the couple of days at the hospital. So, thanks and if anyone finds out about that dark liquid, I'm still hopint to find out.

Every single one of you helped me so much. I have new terms/words to find definition for, new ideas to help me in my search, and support because now it's just me and my children. Very lonely feeling, so thank you. I do know that her kidneys, liver and heart valve were able to be used. The heart valve, as I was notified in a letter from CORE, went to a baby boy. If I remember correctly, it seems the valve was given to the recipient a few months after her death. Her corneas were transplanted to one person each. It is a tremendous feeling to know that her corneas are still viewing the world, and allowing someone else to enjoy clear sight. Maybe that sounds weird. I don't understand the delay in the heart valve either, but I hope that little boy is doing well. :redbeathe Thank you, thank you, thank you. :redbeathe

It's been almost three years since my Mom became an organ donor. However, I have always wondered a couple of things and I've asked several nurses but no one knows. #1 Right before taking her to for removal, I am sure that the nurse poured a dark liquid into a tube that was already going into the mouth. She was on a vent, but I don't remember any more tubing. WHAT was the liquid and WHY was it used and WHERE was it going? Maybe iodine, I don't know. This has bothered me over the past three years. I guess not knowing makes me feel less involved. #2, I cannot find anything about organ removal on the net, and I would feel like a weirdo asking CORE. I really want to know if they took her off the vent and let her die , or did they remove organs while on the vent? If anyone can find out the answers for me, please tell me. The unknown is not comforting to me. I only recently found out about "how" her corneas were removed, and it bothered me at first, but I feel much better knowing. Like I said, knowledge of what happened makes me feel more involved, or in control..I'm not sure, but I need answers. Barely 55, my Mom woke up on December 26 and had a massive aneurysm, leading to her brain death. I guess with that coming up, it's really weighing on me. What is it called when the doctor performing the surgery writes down all the details of a surgery. I've read reports of common surgery, so I wonder if one of those was typed up. Thank you, to whoever helps out.

So am I right in that the initial dose by an RN is because of peak and trough? I know that LPN's can get cert. for IV, and this facility does that. And for the person in Texas (I hope I got your state right :) here in Skilled Nursing Facilities, LPN's do "almost" everything that RN's do, with the exception of what has been mentioned already. Even I'm not clear on what RN's and LPN's job descriptions are. I'm totally confused, but I do know how to asses you, how your major body systems work and I can phone in prescriptions. :) I'm a new nurse, of course I'm confused!

So, I know of a patient who was transferred to our facility from another. The debate concerned a PICC line and that only an RN can give the first dose of Vancomycin. The Vanc was started in the first facility. But should the initial dose at the new facility be given by an RN too? and what is the rationale for that anyway? I had no idea that LPN's could work with PICC lines in the first place.