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JuliRN specializes in Psychiatric.

JuliRN's Latest Activity

  1. JuliRN

    New RN...excited

    I'm a 24 year old RN who works at a 16 bed psych facility. The age of our pt.'s varies, many times a lot of them are older than me but I find that my age really isn't an issue at all, no matter how old the pt. is. I do lots of 1:1, conduct groups, etc. There is a lot of nurse-pt. contact where I'm working (along with the dreaded paperwork) but I've found that as long as the pt.'s perceive you as being genuine and sincere, age means very little to them.
  2. JuliRN

    IM meds question

    Our admitting orders allow us to list different po/im medications prn. We do have a few listed for agitation, but if we have someone tearing up the unit, threatening staff, harming self/others, I'm definitely on the phone with doctor getting something stronger that will cater exactly to that specific pt.'s needs.
  3. If a pt. is escalating we will often offer the use of the "quiet room" aka the seclusion room with the door open. For some pt's it's helpful for them to be able to go somewhere quiet and collect themselves. This isn't considered a restraint. Whenever that door does get locked, it is a restraint.
  4. JuliRN

    PRN Psych medications

    If a patient is out of control and presents as a danger to self, staff, or other patients then we can administer an IM (after notifying MD that the pt. is refusing PO). The downside to this is the huge amount of paperwork we have to do since this is considered a chemical restraint. It's really beneficial to build a good rapport with your pt. as this will make them (in some cases) less leery in taking a po prn.
  5. At my facility we do a de-escalation form with all new admits. It's basically a little packet where the patient can list some things that set them off, things that upset them more during a crisis, things that help when they are becoming agitated, etc. The lists are pretty specific with some of the options that patients are given. For example, one of the questions might be "Who do you prefer to intervene when you are becoming agitated"? Some of the answers are Older male staff, younger male staff, older female staff, young female staff, etc. These are all in the front of patients charts so it's really worthwhile to look them over at the beginning of each shift. =]
  6. JuliRN

    Which diagnosis?

    Definitely acute psychosis. Those patients we have admitted who are using spice/K2/bath salts/and even meth can become extremely psychotic and destructive. A lot of these patients don't seem to respond well to antipsychotics for the first day or so either.
  7. JuliRN

    Any experience with pseudoseizures?

    We had a patient at my facility who was admitted after extensive sexual/physical abuse throughout her life. She came to us from ICU and while I was getting report, the nurse informed me that she had pseudoseizures. This was my first encounter with a "pseudo" seizure. We've had other patients on the unit seize in the past, but this was new to me. I initially assumed that the seizures this patient experienced were fake until she started having them on the unit. The seizures were very real, and they honestly looked much like a grand mal. They normally lasted less than 1 minute, the patient was exhausted after, had a h/a etc. I started doing some research on pseudoseizures because once I'd actually witnessed the sz activity there was no way that the patient was faking them. From what I could find a pseudoseizure is a defense mechanism which made sense as this particular patient's seizures were triggered by stressful situations. The next time we get a patient in who's had a history of pseudoseizures, I'll take it quite a bit more seriously. We've also had patients come in who literally fake their own seizures, and it's pretty obvious to tell, especially while in the middle of a "seizure" the patient will ask staff "can't you tell I'm having a seizure?!". Yeah.