Shanna M

I work in a psychiatric hospital and we are affiliated with a local hospital. Pt's are admitted to PMU (psych med unit) after suicide attempts, to get medically cleared to be admitted to inpatient-sometimes family will bring pts with their first psychotic break/manic episodes to the ER and then they get referred to us from there. When we have patients requiring medical care or that the psychiatrists want to have further evaluated for medical symptoms we will send them out to PMU.

It's interesting that nobody mentioned the pay rate of traveling nurses....I'm curious to know how much they make...I've been thinking of going into it.

Yep that pretty much sums it up. Where I work we are responsible for vitals, close observation of all Patients 5 times per hour, visiting hours/protocol, we do half of new admissions paperwork/interviewing, we run one group/class usually a goals group or some kind of coping skills group, assist Pt's and nurses with whatever they need help with, interview our patients once a shift on symptoms and just talk with them, chart behavior and responses of depression/anxiety/hallucinations levels etc, and we do the 1:1's on patients if we have them.

I think some nurses tend to not give as good of care as they could to mentally ill patient's d/t their dx. Yes sometimes psych pt's will tell you they are having chest pain to get sent to the er for meds or just to get off the ward, but there are times also when it is accurate. We had a pt once who complained of chest pain that radiated down the arm and we sent the pt to the er and come to find out they had a heart attack. What would have happened if we chalked it up to oh they are mentally ill there is nothing wrong with them? I see it too often from people in the psych hospital and it saddens me all of the issues surrounding psych patients...not receiving adequate care because staff doesn't believe them, being treated as less than a human being d/t their dx, not receiving compassion and empathy. Even while borderline personality disorder pt's are difficult to work with and many do not like to work with them their need for attention is a problem they have- part of their diagnosis, these people are ill, they are not in the hospital for no reason or because it's the Ritz Carlton.

We just went over lateral violence in my class last semester, and unfortunately I've seen it at every job I've worked in- it was worse when I worked in Geriatrics though. It is sad that that we are doing the work of healing people and especially in psych trying to build them up to return out into the world and yet we can tear each other apart like vicious dogs.

I will put "Pt has been out in social areas and interactions are appropriate" or "Pt isolates to self when in social areas" or "Pt has been isolative to room the entire shift" never seen anyone report visible on the unit before.

haha yes we are :) I'm also at GRCC. Small world I wanted to put that DM in my plan somewhere to but I guess it comes down to priorities and we only really need 2 r/t causes and apparently the edema takes priority for skin breakdown over the DM. Edema Puts a Pt at risk for skin integrity impairment because when the skin is stretched taughtly over the edematous area it is subject to crack or weap fluids putting the skin at risk for breakdown. You can elevate the Pt's legs even though they have CHF just not while they are lying in bed. They can be elevated while the Pt is setting up in a chair. So the interventions that I put r/t the immobility were (and I think I got carried away further than I needed to) turn Pt q2 hours while in bed use pillows with repositioning, get Pt out of bed and have them sit up for 10 min TID- my rationale for this is b/c he in only tolerating 15 min BID and we want to increase his ability to stay up so I want to slowly incorporate him sitting up more frequently, use appropriate skin hygiene products/skin protectants, thoroughly cleanse/dry the skin especially after elimination as stool/urine breaks the skin down, have the Pt eat adequate protein as diets that don't have adequate protein are more susceptible to skin breakdown. I think I put some other things in there too but I'm trying to rush and type this up before I have to get ready for class. The ROM you listed I think is also a good one, I was going to include it on my care plan as well but I ran out of room lol. Good Luck!

Ok thank you this has been helpful :)

No I added that into my care plan already that was actually the first reason that I listed, but I want to make sure that I am thorough and don't miss anything. I thought it might also be important to note that because the Pt has DM that also causes them to be at risk, but maybe I don't need to go that far, I don't know.

I think it's important to note that the Pt is at risk for skin breakdown because he is Diabetic so I'm not sure how I could incorporate that into my care plan, maybe I'm getting too far ahead of myself. What exactly is it about having Diabetes that puts Pt's at risk for skin issues? Is it poor circulation? So maybe a possible cause could be poor circulation rather than listing Diabetes?

So the etiology part of the care plan never involves medical reasons for the nursing diagnosis, only the signs of that medical diagnosis that the PT is exhibiting? I know that the nursing diagnosis is never the actual medical diagnosis but I was unsure if I could say that the PT is at risk of skin breakdown due to being Diabetic.

I just started my first week of nursing school and I'm working on my first nursing care plan. The nursing diagnosis that we are given to work with is Risk for Skin Integrity Impairment. The Pt's medical diagnosis/conditions include CHF, DM-type 1, +2 pitting edema, paraplegic. I have a background in working in Geriatrics and know that Diabetics are at risk for issues with their skin, however when I look up the nursing diagnosis online and in our book Diabetes is not listed as a possible cause for skin integrity impairment..I'm just a little confused about this can someone clarify this for me please?