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purplekath

purplekath

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I'm a 34 yo first year nursing student.

purplekath's Latest Activity

  1. purplekath

    A big mess!!!

    Cogentin is not routinely given with benzos. I don't even routinely give it unless I'm dealing with someone with a known hx of ESP, or if I am giving something like Clopixol Accuphase where it is a big dose of anti-psych mx which makes ESP more probable. You say you are giving this to small children? How young? It is a little like atropine in its action, so really little children (3 and under) it is not a good idea. In any case - I wouldn't call it "a big mess"... just keep learning! You will be fine :-)
  2. purplekath

    Anyone ever try working 60 hours a week?

    60 is routine...80 is common...more than that, quite often. Mandatory overtime....sigh.... Honestly, a 40 hour week seems quite cruisy these days. lol... sad but true
  3. purplekath

    Do you ever get gifts from patients?

    Our facility is ok for us to keep gifts - I work in a state psych hospital, and most of these folks don't have a bunch of money, so it is not really a big problem. I have an area in my study with boxes of little gifts from patients. The most precious ones are artworks, poetry, songs, crafts etc. When I've had a rotten day I'll go in there and just look at them all. One of my patients wrote me this poem...made me cry... btw, the guy was still a lil crazy I should point out...he thought he had died and was living his afterlife. He gave this to me with a drawing called "bird losing its scream". Kath the Golden Gentle friend An expert in love such kindness a gentle soul who shows no force and shares her smiles freely Today, much like yesterday, more like tomorrow So female and easy to be around My gentle friend has shown me no force And has allowed me kindness There is no time like a single moment frozen Which is a smile from silver love This much I grant you This sun is yours Stay close to those you love For always you are in my heart And forever you have a home In this, my afterlife
  4. purplekath

    Question for Psych RN's about pt on cardiac unit

    Hi Amy, Tricky situation for you! I'm in Australia and have no idea how the system works over there. With regard to managing this guy on the ward, you need to know that he is not doing what he's doing deliberately or to be manipulative. He is manic. This means he only has limited ability to control his behaviour. His thoughts are running very fast and loud in his mind right now, so you need to keep things clear and firm. If possible, have the same nurses looking after him from shift to shift. Gather your meds in oral and IM/IV form where possible. Zyprexa comes in IM form. Grab hospital security and several other nurses/orderlies...whatever. You shouldn't have to restrain him..just a show of presence will usually work. I'm assuming at this point, he is under some kind of treatment order and can be "forced" to take his meds. If not, this should be organised before you proceed. Approach him confidently, offer him the choice of taking his medication orally. At the first refusal, be firm, give him his medication IM, then retreat. After a few minutes, go and reassure him that while he doesn't see it now, he is unwell and needs medication to get well again. Remind him that he has been unwell before and that he is a wonderful man who doesn't behave this way when he is well. Anti-psych meds can take a few weeks to work for some, but they are quite sedating. You might also want to get him written up for something like Diazepam or Clonazepam, which can both be given IM. These will slow him down a little while the other meds work. Sleeping medication for night is a very good idea as he will have missed a lot of sleep while in this manic phase. As he begins to settle, he will then be more willing to take the Lithium, which is what he really needs to get well. Sexually inappropriate or aggressive behaviour you must be really firm about. Be clear and firm, "No (name)! This is not acceptable". Don't be afraid to call security. The other crappy manic behaviour like pulling out IV lines etc you just have to manage by the seat of your pants, using the principle of positve/negative reinforcements eg: - re-cannulate/re-tube him every time you need to if you have to...he will soon get tired of that program I can assure you! Figure out what he likes, and have it on hand as a kind of "reward" when things are going well...I know it sounds bad, but sometimes it works and when it comes to psych, there is no "right way". I have a particular very aggressive patient who LOVES gummi bears...the minute I hear he has been admitted, I buy some, and let me tell you...those little squisy bears have defused many a "situation" before it starts. Best of luck Amy - and keep us posted on what ends up happening with this poor guy.
  5. purplekath

    Day in the life?

    lol...go on...I dare ya!
  6. Actually, I'm going thru this right now. A very close friend of mine was admitted tonight and is a forensic case. Management has been really strict about it with me, and I'm actually very thankful. I'm not to nurse him, have been told I must stay in a different area for the duration of his admission and of course cannot access his file at all. I am SOOOOOOOO glad! It is a very difficult position to be in I have to say.
  7. purplekath

    community mental health

    It is both less hectic but has much more responsibility than hospital based mental health. Not sure what Canada is like but here it involved having a "case load" of mental health clients. Up to about 20. Your job is to try and keep them well in the community. It is very holistic; you help with every area of their lives - jobs, living skills, medication, counselling, housing, financial planning, coping with their children, relationships etc. You go out in the car and visit them, or they come into the office for sessions with you. How often depends on you and what you think. You need to make sure they are travelling ok, taking medication, monitoring drug and alcohol issues, working out if they need intervention or support. You teach skills for living with mental illness or other issues, set goals, monitor progress, work out plans. I find it very challenging but incredibly rewarding. You work with ppl over years sometimes. Those with psychotic illness, drug and alcohol problems, anxiety disorders, depression, borderlines. Each have their own challenges. The borderlines who call you suicidal every friday night when they know you are going home for the weekend; the schizophrenic who goes missing and only you have any clue about where to find him as you know him so well; the depressed mother who is not getting out of bed and not handling her children well...and you need to make the decision about whether she needs more support or if her children need to be removed from her care for a time. It can be dangerous at times. You don't have duress alarms and you are generally in someone's home where there are weapons and unpredictability. You often have "his word against mine" type scenarios. You have to document so carefully. On the plus side, you get to know your patients really well...and most of the healing that is done happens in the community. But the responsibility is huge. I'm not sure I would recommend it to a new grad, but not sure if it works the same way over there.
  8. I think most of us working in the area would agree that it is a disorder that can always use more ideas in its treatment. I think it is totally necessary to try and get a handle on the worldview of the patient, both as a person with a diagnosis and as an individual. This itself is a difficult enough thing to try to piece together ... let alone to try and find ways to help that person make changes. My theory is that most of us grow up with a pretty decent foundation - a strong floor beneath our feet. Our parents and others give us that. Sure, all parents muck things up and all of us come out with the occasional hole in our foundation, but we can still stand up most of the time and live our lives. Borderlines on the other hands have foundations that have TOO MANY holes... the floor beneath their feet resembles swiss cheese and they find it impossible to use this foundation to support them. That is why the world is a chaotic and terrifying place. ANY stressor threatens to throw them into one of the many holes in their foundation. They didn't have the luxury of a firm foundation from their parents...they must learn to build their own. Most "treatments" for bpd involve trying to fix those holes, however if we as professionals attempt to do that for the person, we are doomed to fail. There are too many, and besides, we can't even SEE them, let alone fix them. Therefore, the key has to lie in helping that person to mend the holes in their own foundations. We give them the tools to do it. But of course, they are terrified. They want to cling to anyone and anything in their world that will stop them falling in. They do not want to venture to the edge of these chasms. They will do almost anything to avoid it -- get angry, avoid, self destruct, manipulate....we've all seen the behaviours. In order to get well (and yes...some DO get well), EVERY person in their world must stand back and insist that the borderline use their tools and get to work on one hole at a time. Getting to that stage is a long and difficult process, but one of the biggest joys in my life is when I see that person stand with pride and say in effect, "look what I did! I fixed that one! And I did it by myself!" As practictioners it is our job to: * give the tools and teach how to use them. DBT, life skills, how to cope with stress, how to cope with trama, how to learn to love yourself, to love and care for others. * to REFUSE to allow that person to "manipulate" to avoid doing this scary thing.... and I use the term "manipulate" in an understanding way. It is a coping mechanism, just like most of the behaviours we see with BPD. * Understand the behaviours for what they are - hole avoidance :-) And explain that to the person in a calm and appropriate way, eg: "you smashed your room up because you we afraid to do the work we talked about. I know you're scared, and I understand why you did it. But you still need to do the work. Clean up the mess you made - I am going on a lunch break, and will come and talk to you when you are ready to use your tools. I know you can do it" (smile, squeeze hand, leave room etc) * be a cheer squad from the sideline - give messages, "I know you are terrified, but I have seen others do it, and I have seen (insert individual strengths) you be strong even though you are scared". * Reinforce as each "hole" is fixed the achievement they have made and how much easier it is to walk around without fear with each new piece of foundation. * Don't give up your patient and let them know that. It may take years and many admissions and setbacks while they learn to build their own foundation. With each new admission, remind them of the progress they made last time and remind them that they are here to work some more.... let them know you are looking forward to watching their achievements this time. Then get to work yourself. Anticipate and cut off the behaviours that avoid the work. Instruct your collegues that your patient is to be directed to you for everything that shift, and make sure she knows that will always be the case. Make regular "appointments" with her (approx 10 mins an hour or two) - snippets of your time and support. Find a system of positive and negative reinforcement that works for that particular person to encourage her to keep working. Eg: a guarantee of safety means some leave to the coffee shop with you. Breaking the fire alarm and absconding into traffic and laying on the road = her time with you is delayed for one hour. Threatening to kill self or harm you = appointment ends immediately. Talking about the feelings surrounding her suicidal ideation or rage = verbal reinforcement and appointment continues. A few ideas :-)
  9. purplekath

    Dropping in from ER forum to ask a question ...

    ummm..noooo...this not normal at all. wow, I am floored too! These drugs are powerful and certainly not suitable for a child. I suggest you do a little detective work and find out how this kid ended up on these meds. Did you get what the dosage was? I would be curious. The side effects in adults are bad enough...I shudder to think what they would do to a child. Major psychiatric disorders are not diagnosable at this age, certainly not bipolar disorder. Wow...still floored. So, what ended up happening with this kid?
  10. It is so important to build rapport with your patients. It humanises what can be a dehumanising experience for them. And it really helps when it comes time to ask the probing and other difficult questions, as well as in laying boundaries. Rapport building starts from the moment they are admitted. So does the assessment process. When someone is admitted, smile, introduce yourself and offer a handshake. Whether they shake your hand back is the first tip about how they are feeling. Offer a little sympathy and offer of help, "sounds like you've had a tough day huh? Let's grab a cup of coffee and I'll give you the grand tour". Be aware of how your face and body language is affecting your patient. They are in a scary place. Eye contact, smiles, nodding, relaxed posture...these are all so important to convey messages that the patient needs to "hear" when they get ready to share what they are going through. Probing questions: These are questions you need to ask, and they are easier to ask if you have taken the time to build a rapport. You don't have to fire them off like a machine gun - it can be done over a coffee, sandwiched between small-talk, little jokes...just general stuff too. The process is intimidating to the patient, so it is ok to break it up with small talk. Don't be afraid to share bits of yourself as you are comfortable. Eg: If someone expresses a delusion that they are the lead singer of a famous band, you can share the kind of music you like, the last concert you attended etc...then ask a relevant question, "sounds like you have been pretty busy, how have you been sleeping?". Limit setting: Again the rapport will help. You can share what you are comfortable to share - there is nothing wrong with that. But where you are not comfortable, just say so and move along quickly. If you don't want to share your age, just say something with a smile, "oh, old enough!". Flirtation. Depends how bad it is. If it is just flirtation, just remind them that what they said or did is not appropriate. If it is someone who is delusional about you, believes they are in love etc, it is at this time a genuine feeling to them. I say something like, "I know you feel this way now, but that is a part of being unwell. Feelings like this are quite common, and they don't last ...you'll see." If they are trying to touch or grab you, you need to be quite firm, raise your voice a little, be very clear about what will happen if they persist. With concerns, just mirror what they say, "so you feel like the doctor doesn't care? What makes you feel that way?". You don't have to agree or disagree...you just want to know how they feel.
  11. purplekath

    Need help from psych nurses! Severe depression...

    Wow, what a great nurse you are! He is very fortunate to have someone who cares for him as holistically as you obviously do. It could well be that his anxiety is increased by the Seroquel - if he feels that he is "crawling out of his skin", can't sit still etc. This feeling of restlessness is fairly common with antipsychotics and can be alleiviated by either reducing the dose or by adding a medication like Benztropine (Cogentin). He would certainly benefit from regular anti-anxiety medication. There are lots of benzo and non-benzo meds to choose from - you probably want to avoid ones that have a cumulative effect in the system as this can add to sedation, spending a lot of time in bed and therefore the accumulation of melatonin (the body's own depressant) in the brain. One to be wary of is Clonazepam. And encourage your pt to spend regular periods outdoors, sitting in the sun. Regular rising times and spending 15 mins every few hours in the sun can be an enormous help. When we sleep, we produce melatonin -- which is great for inducing sleep, but also makes us feel depressed. Melatonin requires sunlight to "burn off", which is why some of us feel so lousy early in the morning before we get out and about. I have literally dragged depressed patients out of bed and into the sun, swearing that they can't face it..only to have to come to me an hour later and say, "you know what? I feel a bit better!" He will also need to explore the issues surrounding his condition and the grief associated with his dx. Since you say he has a history of depression over years, you know that at least part of the problem is organic. However there is also going to be a reactive element given his circumstances. He needs: 1. A regular counsellor, encourage him to use these sessions as a place to "let loose" with all of his negative emotions, to talk, to unload. The rest of the time, practicing cbt principles will be useful to him. He has had many years to develop this negative thought process, and it will take time of course. And it will require the assistance of everyone in his world to be brave enough to do the tough parts of this. 2. HOPE. He needs some level of hope in his life. Depression feeds off hopelessness (if he is saying things to the effect that "nobody can help him", then he is feeling pretty hopeless). This man cannot be allowed to believe he has no hope, and perhaps his doctor has unwittingly contributed. Hope comes from a variety of places, but those that love him must help him find some of it. 3. Something outside of himself that he can devote himself to. Depression causes a tunnel vision rendering a person unable to contemplate much besides their own pain. So something that he can DO to make the world a better place for someone else. Whether it be fostering a special relationship with a grandchild, writing to prisoners, developing interest in a charity...whatever...but he needs to spend a period of time each day thinking about someone outside his own sphere of pain. Sounds like you have done a lot for this man already -- you are doing a great job! Give us an update soon ok?
  12. purplekath

    Paraphilias

    Oh trust me...I have strong feelings too. I think most of us do. But guess that a big part of wanting to help these ppl are because ultimately it helps society, including potential victims of crime. I'd still be interested in hearing your point of view. Are you in psych nursing BTW? Do you ever nurse these patients?
  13. purplekath

    Paraphilias

    I work in an acute unit which deals with the forensic mental health cases for our city. Lately I seem to have had a lot of ppl with paraphilias of an illegal nature -- namely pedophiles, voyeurs, rapists etc. Often we get these patients because they become suicidal and are deeply remorseful for their thoughts/behaviour. Mostly they come from the prison system. I long since got over the emotional aspect of nursing someone whose actions repel me. I feel that it is important to HELP these ppl... for themselves and to prevent them victimising others in the future. There is precious little information out there on treating/couselling these types of ppl.... even the DSM-IV has no real advice for clinicians. So, thought I'd throw it open to my fellow psych nurses - how do you approach a paraphiliac wanting help? Apart from the basics (administering Depoprovera or Androcur and keeping them locked into the unit)...what can we do to help? What kind of therapies are useful for these kinds of patients?
  14. purplekath

    Day in the life?

    Well best of luck as you study! We always need new nurses in mental health ... it is not for everyone, but if it is for you, you know it :-)
  15. purplekath

    Assessment/Question Tool

    Oops, I also include a section for medication....any PRN I have given and why, and any medication changes I have requested or have been made, any adverse reactions observed.
  16. purplekath

    Assessment/Question Tool

    I use this template: Risk factors: (risk self-harm/suicide, absconding, physical/verbal aggression, reputation etc) Mental State: (Mood, affect, speech, thought content, cognition etc, as well as any details you want to add about delusional content etc) Physical: Include vitals, tests taken, results, complaints of pain and what you did etc. Psychosocial: Any drug and alcohol issues, issues with children, relationships, visits that took place and how they went, upcoming court cases etc. Leave status/CRA/discharge planning etc.