electricblack

Hello to all my Psych nurses, I have been wondering, we use Artane or Cogentin to treat EPS in Psychiatric nursing a lot. I am just curious as to what is the difference between the two; why use the one over the other?

Does anyone here work for ONA (Ontario Nurses' Association)? I just have some inquiry about a situation that I've had the last few days with a colleague and am unsure of what to do. I can't be too sure if I was bullied by two staff or I was at a wrong in this situation and need someone's perspective in the matter...someone who is well versed with the Union Rules regarding workplace harassment. In desperate need of help... an IM would be great Thank you.

I'm from an Acute unit of 24, we do have groups running from 0900 to 1500 on weekdays and absolutely nothing on weekends. A good 30-40% attend the groups and the rest are usually to sick to join or just did not want to go. Voluntary or not we give these patients options and information regarding what they do in groups and it is up to the patient to consider it, usually nothing goes on in the unit that the majority start inquiring about groups, they try it and if it works they stay on it, if not then they tell us that it's just not working for them. We don't punish, if a person refuses to leave the room and try the groups, it's mainly because they are too depressed to do so and/or they just arrived in the unit and aren't at that stage yet. All in all I give them the information and the OPTION to join, I ask them that throughout the day and everyday that I am in at work, but at the end of the day, if they don't want to you can't make em. When it comes to medications, if they refuse it, I'm fine with that (unless it is a medical medication and is necessary, or that they are deemed incapable for Psych meds and are too ill to even decide). At the end of it all I question them why they refuse the meds (chances are they are afraid of side effects from past experiences, maybe more education is needed, a review of their meds by the Psychiatrist is needed--because if they don't take it at the hospital, they wont take it at home, and they'll be back for admission because of another exacerbation). I find that some people need to really step in these patient's shoes and really understand their current state of mind. The majority of staff have great intentions in mind by forcing them out of this "rot", but you have to really see HOW you can encourage them to motivate themselves.

Code Whites (always prep meds and have someone call security so its handled smoothly). We use either Zyprexa 5-10 or cocktail of Haldol (2.5-5mg), Ativan (1-2mg), and Cogentin (2mg). Always offer PO, usually the presence of security gets them to take it, sometimes having too much ppl can escalate them even more, always support em cuz it can be a very scary and traumatic experience to some). The med usually works very quickly and I usually encourage em to stay in a quiet environment like their room to let the med work. They either sleep, calm down, or it doesn't touch them in which case you need a security around or you a close observation (locked room or restraints... But make sure theyre deemed involuntary before all of this, and close obs for patient safety). Be careful of the elderly as well... It can affect your choice of medication.

New grads are desperate for jobs but I honestly would not recommend kijiji for jobs.

damn where are you from... sounds like you got a good offer soon as you finished

in my workplace if you report anything including verbal or irs... they are far from anonymous... management mentions who reported you while they do the meeting.

we had a staff coming in at work bumping into things and was previously fired for similar behaviour but because of her connections with management she got her job back and gave the nursing staff responsible for reporting her a difficult time at work. Anyway during my shift she called that shes on her way 1.5hr later she shows up sedated... mind you she drove to work. She can barely keep her eyes open then she was labile throughout her shift... yelling and inappropriately laughing with mentally ill clients... passing out on her desk spilling her pop all over and also on her seat... twice. She was bumping into furnitures and her seat is facing directly to pt lounge and the pts and visitors can see whats happening that we had to call the on call manager collectively as a team. Turns out the on call was her friend... in the end she did not get fired or warned and was given a few days off to relax.

great feedbacks... thank you guys.

COW Score = 9 (mild)

She has been on Percs for a good few years. I honestly am unsure if it was withdrawals but some senior nurses said it might be due to her history and presentation. She was afebrile and she has been on our unit for two days so far. Rhinitis was not present, pupils are responsive and she did have some nausea 0vomiting., as for her energy levels there was no decrease or increase aside from the fact that she became sedated after ativan was provided. She was assessed by an MD at midnite and states it was possible withdrawal symptoms and to contact the on call Psych. The on call Psych was provided as much details of her symptoms and she assumed the same thing. Her status did not really deteriorate, it was more that her symptoms did not improve after medications. ABC were not compromised aside from the slight elevation of bp possibly due to her moving around which did decrease after she settled. I was more worried for diagnosis that are possibly overlooked.

CrazyGoonRN thank you for the clarification.

No worries things like that happen. Next time just lower bed, make sure side rails are down unless it is stated or ordered (it is a form of restraint after all and can increase the risk for fall since theyd climb that stuff). Assess mental stats, sedation and determin which requires more frequent watch and reindtructions.

So it happens that I work nights and they put me in Charge even though I still lack the experience and traning of being a Charge Nurse. One of the staff working with me was also a new RN and her pt has been experiencing new symptoms of leg spasms. The charge nurse earlier on thought it might be EPS from her new medication 60mg Cipralex OD because she just started that day as well. Then she started feeling restless and by night time she is moving around unable to sleep. The charge nurse for that evening then assumed shes going through withdrawals. The pt also needed a walker because shes a falls risk but no walker was located as per my request earlier on in the day and she needed to be assessed by OT still (I wouldve grabbed any walker at that point just to prevent any possible falls). That night the medical doctor assessed her and decided she's low on phosphorus but would not prescribe anything since he believes shes withdrawing from her Percocets she used to take three or more a day and tried to OD on it prior to admission. At the end of the night we manage to get orders for Ativan 1mg q2h and Clonidine 0.1mg q6h. Two 1mg doses were given in four hours time and she remains drowsy but unresolved symptoms... clonidine was provided and vitals were done q1h and she was placed on q15 watch because she continues to get up of bed even though shes more a falls risk now than ever.. . her symptoms were not resolving at all. On call psych was on the phone with us on and off and neither her nor the med doctor on call would prescribe cogentin unless they have assessed the pt one on one... in fear of side effects like malignant hyperthermia. Blood work was done cbc creat lytes to avoid having kidney problems from her spasms... (0 seizure, afebrile, slightly hypertensive)....pt then had an unwitnessed fall as she tried to walk out her room. Mental status remains intact except that she is slightly sedated from the ativan and remains restless. We did an incident report, checked vitals and head to toe while she remains seated... no physical damage was seen... and she said she slid down rather than fall flat but had hit her head slightly on a chair... i had to request for a ct just to be precautious but she states shes in no pain and was just shakin up. All of these happened at 4am until 7am and all along she states that her spasms had progressed to her arms... yet the doctors did not deem it emergent enough to see her. We kept a very close eye on her and maintained q15 as she slept vitals were q1h and bp was slowly going down to her normal as she is now settled in bed... Glasgow coma was done q15 at first hour and we monitored her and documented everything. -----Sorry for the long background but thats what happened. I am not sure exactly where to go from here. I am still not well versed with the difference between EPS vs Withdrawal(Percocet) and am unsure if I handled the situation appropriately. Either way it did leave me shaken up and hope to be prepared for it next time. Some feedback would be appreciated.

So here's the situation, I am currently employed full time as a Psychiatric Nurse and have had six months experience so far. I love Psych Nursing--it's quite rewarding, but am currently feeling like this is not my 'home unit'. Unlike most new nurses, I yet have to find the one or two units that I will eventually settle in. I have had thoughts of eventually getting in ER or ICU Nursing and some new nurses just jump to the situation. I however feel like there is no rushing and would appreciate having some experience prior to moving on to something more 'intense'. I have had some experience as a student in Medical Surgical and have loved it. I understand that this field of nursing can be stressful as well and is quite different from the Psych Unit that I currently am working. My question is, to those that work in Med Surg or those who have made a successful transition from Psych to Med Surg...what prep courses can you recommend. How can I make myself more 'attractive' in terms of being a better applicant. I am currently in the Greater Toronto area and wouldn't mind taking some Leave of Absence from work and taking some of these courses. Would any of you recommend any specific course(s) in the area?