Morning-glory

2 months after my concussion (mild to moderate, no LOC. I was unable to recall my address, photophobia and unable to walk straight) I was still feeling drepressed and sad because I was still having co-ordination problems and disorientation. It was all gone by the end of the 3rd month, but it made me realize that it is not just in the first couple of days after the head trauma that people feel miserable.

Doctors are usually very hesitant to write DNR orders. I have had huge battles on this issue with the doctors and the Public Guardian and Trustee of the residents. What it comes down to, is that the PG&T will not authorize a DNR ever. The doctor must make the determination that it would be "medically futile" and then order the DNR. Check the charting to see if any of this is in the progress notes. At least here, the PG&T is not allowed to make the DRN call. It is up to the Doctor to evaluate the person and determine if there is grounds for it. They don't like to do it, so if they do, it is a huge battle won. Even if a person has a guardian, we need to get the DNR from the NOK if there is one. Good luck and let us know what happens.

I might suggest that a set of medical directives or standing orders might be of use. If patient sneezes, do this If pt sneezes, do that. Dry cough, hydrate and monitor Loose stool x1, hold laxatives and reassess in 8 hours. Emisis, 50 mg gravol/dramamine, hold feed and reassess in 4 hours. Etc... Obviously somewhere along the way someone had a hissy fit and chronic MD calling was instated. This is a way out of the loop.

3 orientation shifts and 3 working shifts in a small rural hospital. They were hard work. 8hr shifts turned into 12 just because there were not enough staff to get all the work done on days or evenings. I was charge on my first shift and one of the docs ordered a linseed pultice. "You have got to be kidding me". CNA told me that I needed to go to the unit kitchen and the recipe was posted on the wall and that it took 20 minutes to make. I was supposed to be working with another RN who would do the po meds and I would do the IV meds and dressings. She called in sick so I was working with an RPN that was not allowed to give meds, so I had to do it all. The other person who was helping was a rocking CNA. We managed 8 day 1 post-ops, one gas-gangrene that was transfered out to the big hospital and I was to cover ICU while that nurse went for lunch. ICU had 3 fresh post MI's and I did not have a clue on how to care for them and monitor my own 12 patients at the same time. It was the hottest day of the summer with no A/C. I had an 18 month old asthmatic kid who was crying all the time so I strapped him on back for the shift and carried him with me while I was getting on with my day. The O2 tent treatments did allow me a break from the madness. 3 days of that and taped report at the end of it, and I was done.

Do you have email for staff? This might be a way to get the info out where people will read it. We have email at work and we get the minutes of all meetings that concern us. It can also be tagged to see how many people opened the email. Might be worth a try.

OK, first and foremost is your own safety. Getting injured by any patient is never a good way to get anything done. If the meds are not working, if he is on any, then you need lots of support. You should never go into a know violent patient's room alone, nor should anyone let you. I personally would never have assigned a patient like this to a student as he is a high risk patient. Too unpredictable and you cannot control him on your own. Psych nursing is an entierly different setting than the rest of nursing. I work on a high risk unit and have never been hit. PRNs, lots of staff and not pushing stuff like mouth care or bathing until it is desperate are the way to go. Offer, suggest, assist or cajole them into doing it, but never force anything on people. Not only is it undignified and belittling to patients, it is a risk that you should never take without others there in the room with you. And even then, I, wouldn't do it for anything except to give an injection. I would suggest that you speak with your instructor about the risks involved in caring for this patient. Good luck and stay safe.

You might also want to explore which gloves aggravate your hands. The regular gloves made my hands all red and itchy within a short period and bleeding by the end of the day, so I switched to the powder and latex free blue ones. They worked. A barrier cream applied in the morning and at the end of the day do help too. If you are using the cheap gloves, try the powder and latex-free ones. I suspect that the blue ones have some sort of anti-microbial properties, but they are gentler on the skin. We have the gloves ordered in for people with allergies so they may be hard to find on the ward. If they are not available at the hospital, buy a box for yourself at a drugstore and see how it goes. You need your hands to be in top shape, and if that means a couple of bucks on some decent gloves and barrier cream, then so be it. The soap that they use at work is really tough on hands and the alcohol gel is even worse. Try bringing some of your own soap in a small plastic bottle. Also know that there is bleach in the papertowels. Nothing you can do about that, but a barrier cream should really go a long way to helping fight the battle.

Old post on the subject of mouth care and products. https://allnurses.com/hospice-nursing/mouth-care-dying-103044.html

It probably is a remenant of days gone by, but at the same time, people can have it and not know, spreadning it around to those that are more vulnerable, who will develop the disease. My brother wanted to volunteer at a Senior's residence with his wife, but found him to be positive. They then did a chest X-ray and found that it was not in his lungs. Started him on meds and then he was able to go to the facility. The meds are awful, and he will always test positive. But better that, than develop active TB. He works on a ship and they are all in close quarters for long periods of time. I am still negative. Don't that this helped at all, but there are valid reasons to keep testing as TB can be in your system for a long time and you can spread it without being sick.

Started on Ortho and then followed the long twisted road to psych. Interesting journey. Working different places gives you a better understanding of the overall picture of health care in your area.

It is very difficult to cope when a friend has attempted suicide. Hopefully, she is getting the help that she so desperately needs. You do need to tell her that you care for her and that she is important to you. That said, there is obvously some real issues that she is not able to cope with. Understand that this was her decision and that you are not responsible for her choices. You need to focus on school. If you can be there for her, great. If it is too much for you, then you can give yourself some space and understand that there is nothing to feel guilty about. Sometimes the only way to be helpful is to stay out of the way. The next couple of weeks will be very difficult for her while she comes to understand what happened. With professional help and her family she will get through this. After all your exams are done you both will find it will be a better time to reconnect. Hugs,

I had a second year onc resident that didn't know what versed was. He didn't know the doses for scopolamine or morphine were either.

I love psych. It did take about 6 months to get comfortable on the unit, but I have been doing this for 5 years and I am not planning on going back to acute care. I landed this job by accident and I wasn't really sure that that was what I wanted. In acute care I never felt like I got everything done. In this job, I can get it all done and more. You do not need to be a battleaxe to work in psych. Even if you are a bit thin skinned, you will develop the skills to keep yourself comfortable and safe without changing who you are. These days, i would take a job in psych before anything else. You are not so tired at the end of the day, you can have a life and do your job. Good luck.

Why is it that if someone makes a mistake you tell them right away but if they do good, you feel you have to wait? Angelfire, I say tell them that you appreciate all that they have done for you. 6 months into a challenging job is a big deal. Bring in a little bunch of flowers or a snack with a little thank you note would be appreciated. Don't go overboard, but if you want to say thanks, I think you should do something. Keep up the good work.

Our school at the time I was there was into the "Roy Model". I was in nursing school, not taking philosophy. Why did we have to do all of this? It took me a long time to get over being angry that I had to learn this stuff. Even longer to figure out how it worked once I decided that I needed to learn this stuff to get through school. Some of my classmates would come in with 16 pages all tidy and packed full of information, listing 100's behaviours, their stimuli, goals and interventions. It was too much. I just didn't get it. I needed to keep it simple to understand what I was doing. I kept mine under 20 behaviours and kept it focused on 2-3 goals. I wasn't going to get an A, but it would get me through. That was 12 years ago and more. I certainly don't use the Roy Model officially, but it is in the way I think through what is going on with a patient. What ever model you use, it will give you the structure to sort out all the information you get from a patient and make it into something that you can manage. Understanding that problems have reasons and having the reasons helps you to look for the behaviours that signal a problem will make you a better nurse in the long run. I know you don't have a lot of time, but it might be easier to understand if you do up a care plan for yourself in the model that you are studying. BEHAVIOURS: What are your behaviours right at this moment? STIMULI: Why are you anxious? Too much to do and not enough time in the day to get it all done. NURSING DIAGNOSIS Something like anxiety r/t increased workload. INTERVENTIONS: what can you do about it right now (short term)-take a bath, have a cup of tea- and then what can you do about the longer range to decrease your anxiety (long-term goals) - get a cleaning service in to get all the housework done giving you more time to focus on school and family. EVALUATION: Felling better already!! This is all as an excercise and you will not pass if you hand this in as homework, but that is the simple version of what you will be doing. You may feel stressed and not know why, but if you lay it out in a workable fashion, then the solutions to the problems become easier to sort out. Good luck. By the way, my main excuse for not doing homework was housework. The house would be at it's cleanest when I was avoiding an assingment. If you can afford it, a cleaning service would be one of the best things you ever did for yourself and they are not as expensive as you think.