Saf1

Hey! Urgent care nurse practitioner here. Ran into some road blocks tonight and thought y'all might have some thoughts. Patient came in tonight with severe panic attack. Not a ton we can do about this in urgent care but I can talk to them. Turns out patient's husband had gone to jail a few years ago for...well, trying to murder her. A couple of weeks ago one of his friends started coming around harassing her at all hours. She looked and realized the husband is getting out of jail early and she figures that why the friend started coming around. This realization causes the panic attack. She presents to me just apoplectic, shaking, crying. Vitals OK obviously just completely freaked out. I called our town DV shelter and they can't help because they can only help with intimate partner violence and because the spouse was in jail they couldn't risk their funding. They advised we call the police for an emergency protective order. We try the non-emergency police line and get an "unusually high call volume" message for 20 minutes. Tried 911 (like I'm worried someone is going to kill this woman) but am told this is not life or death and we need to call the non-emergency line. We explain that we were just stuck on hold with that but no other option. So we call non-emergency back. My MA is holding the line and I go talk to the patient. She manages to find a friend that she can stay with until the courthouse opens Tuesday so she can file a protective order. The friend calls off the last 2 hours of her work shift to come meet up with the patient. Meanwhile we closed the clinic 40 minutes ago and I was seriously starting to wonder if I was going to have to discharge this patient just to get murdered. I think we got her to a safe place but good grief! No help anywhere! Just she's on her own! Y'all deal in this sort of thing (probably?) more than I do. Any resources you know of? Or some way to work the system to get more help? It's the 3rd time I've had a patient come in with imminent DV situations that I've felt very helpless about (3 months in this job). Suggestions? Thoughts?

I don't *think* so I've only seen one Tylenol od, in an adult, and that seems to be more of an hours to days sort of thing as the liver is damaged. This was very acute. The altered mental status makes me think either opiates, or something metabolic like ZenLover described. But yeah, one of the things I'm learning in urgent care is to know not just my limitations, but the limitations of my setting. It's humbling indeed.

I've been stunned at the misinformation my patients have parroted to me, especially around the vaccine. Really appreciate the resource...I'll be on the alert for symptoms of these home "treatments."

Honestly metabolic acidosis would make a ton of sense with the presentation (compensatory breathing pattern maybe). He'd been sick...it does make me wonder. Ivermectin never even crossed my mind but I do wonder how it might affect a little guy. Or even if it was just run of the mill diarrhea. His lips were super chapped and the mom kept putting chapstick on him. I'm in Southern Colorado it's *dry* here so I didn't think much of it. They came in holding a glass of ice water for him as well...so maybe it was electrolytes or dehydration. Hopefully if it's something along those lines his young kidneys will bounce back. Hmmmm...more things to think about.

I mean it's worth a shot. My dad used to be a medic with the same company maybe he knows someone.

Yes afebrile. In fact he felt cold. I think that's why I was having such a hard time getting a pulse ox to pick up. Would be curious what his abg looked like. We're frustratingly limited in urgent care! I may try to call but I don't even have a full name on the kiddo. We never even got him checked in. Not sure they'll tell me anything but I may give it a shot. Admit I've sort of been obsessing.

Newish FNP working in urgent care. Last night one of the MAs pulled me out of an exam room for an emergency (I'm the only provider on site). Kiddo maybe 6-8 years old slumped over being carried by dad...we got him into an exam room and kiddo's breathing is super distressed. His fingers and toes are cold so we're struggling to get vitals (we don't have a lot of fancy monitoring stuff) but he's clearly altered, eyes wide open rolling all over the place, not focusing on anyone and only minimally responding to his mother's voice. His lungs are completely clear, no stridor, no apparent obstruction. Just very disorganized breathing pattern. Couldn't get a pulse ox to read so put 2L simple mask on just since he was so distressed. Sent the MA to call an ambulance. Finally pulse ox pops up 100% so I took the mask off to see if he'd maintain but he started to desat right as EMS walked in. They also said his airways weren't obstructed and his lungs were clear. They didn't seem to know either. Scooped the kid up and took him to Children's up the road from us. No *clue* what was wrong with the kiddo. Maybe toxin or medication that he got into? Something neurogical? No fevers but kiddo had been home sick with a cold but his symptoms were very sudden onset (they live near the urgent care and parents had dashed straight to us when he got sick). Anyhow, I'm hoping he did OK...we never even got him registered and I don't think there's any way to follow up. Super scary but also super curious.

I was in almost your exact same situation...my husband wasn't deployed but was sent state-side TDY for 6 months. 5 weeks after he got back from that he PCS'd...while I still had a semester left of nursing school. I spent the entire last year of school caring for our daughter alone. We didn't have family nearby and the military denied any requests for delays in his move. The biggest thing that helped me was having a good friend, also a military spouse, who was a stay-at-home mom and who helped me take care of my daughter during the odd hours of clinicals when the daycare wasn't open. I also appealed to the daycare center and one of the teachers there volunteered to take my daughter home with her in the evenings when I had day shift clinicals that ended after the daycare closed. Of course I paid her, but it wasn't much and it was what we had to do. My school friends were also great. I brought my daughter to meetings for group projects if I couldn't arrange other care and everyone loved to play with her. I'd bring a small DVD player and she'd watch in the student lounge while we worked. Is it hard? Yes. Can it be done? Yes, but it does take a lot of extra planning and coordinating, especially if you're kind of having to make a lot of different childcare scenarios work. I can't speak for the job market in Hawaii, but I can say it did take me a while to find a job where we moved to. It did happen eventually though, and I'm coming up on my one year anniversary at my first nursing job this week. Very best of luck...it can be done. :yelclap:

We have a full-time daycare/preschool for my daughter. When I work nights my husband drops her off in the morning while I'm still at work (he has to be in before I get home), then I come home, sleep, then pick her up when I wake up. I rotate, so it works well because she can also go when I work days. Paying for a daycare center is expensive though, so you have to look at the costs and the benefits. For us it was the only option that really worked.

I've been thinking about this a lot lately too. I'm older than the OP...married, one kid. My husband works a regular M-F and my daughter is in preschool. Between the night shifts (I rotate) and weekends I feel like I spend my days off alone in an empty house and leave for work just as my family is coming home. I feel very out of sync with them. In nursing school I had a lot of friends that I could socialize with, but at work everyone is too busy to talk about anything but work. When the shift is over everyone is just so exhausted that we head straight home. This is a second career for me and I'm used to at least having lunches out with coworkers, but since in nursing we obviously can't all leave the floor at once for an hour, lunch breaks (if they happen at all) are quick and solo. I assumed when I started working as a nurse I'd make a lot of nurse friends, but that just hasn't been the case. It's very frustrating.

In the Air Force nurses are officers. If you want to enter the Air Force to be a nurse you would need to attend nursing school and go through some sort of commissioning program (ROTC, COTS), which can be competitive to get into depending on needs of the Air Force. If you direct enlist after high school you will be an enlisted member, not an officer (officers must have a college degree), and will not be going into nursing, though there are lots of medical specialty codes you could do (various tech and medic positions). The Air Force may have programs out there to become a nurse once you've been enlisted and trained into another specialty, but again, those may be competitive and based on needs of the Air Force...no guarantees at the time you're signing the enlistment paperwork. I agree with the poster that commented on what the paperwork says. No matter what you're told, read everything you sign if you decide to proceed. I loved being in the Air Force (though not as a nurse) and it has a lot of great opportunities, but make sure you know what you're getting into before you sign and take the oath. Good luck!

Grey's Anatomy scrubs were the only ones in the scrub store that I could consistently find in short sizes and solid colors (which I prefer over prints)...but I've never seen the show! I own three sets...

I did a share day for my job that I started this week, and all it inolved was shadowing a nurse on the unit for a few hours. The nurse manager was off the floor for the morning, so it was just a good opportunity for me to see the sort of unit it was and what sort of patients they cared for. I didn't do any patient care because I hadn't signed any sort of liability paperwork or anything like that...just stood back, observed, and asked questions. I was actually really glad I did it because it took away a lot of the anxiety of starting work there. I knew what to expect. Look at it as your opportunity to decide if this is a unit you want to work on. Good luck!

I feel your pain. I'm a new grad and just got hired into a critical care position starting on Monday. I'm incredibly nervous about my ability to grasp everything I'm going to need to learn. Does the hospital have a good training program? I know for me that's the only thing making me feel slightly better about it. They know you're a new nurse and surely expect you to have a lot to learn. Don't let your anxiety undermine your confidence. The way I see it, you got through nursing school, which means you have the ability to learn this stuff. Good luck!

I've been in the exact same boat. Just got a job at St. Agnes in Baltimore. I saw today that they have two clinical nurse 1 positions, which the recruiter told me in my interview are geared to new grads. Maybe give that a shot? Good luck!