Anyway, last night was quite interesting. I was feeling pretty ready to go in to the psych unit yesterday, as things are sort of slowing down a bit around here with Thanksgiving break being an entire week (!) off but I was quickly reminded of how things go around there once I arrived. All but two of the beds were filled on the 17-bed unit and that probably meant we would also have two intakes throughout the evening.
After day shift report, me scribbling down every word I could, the two nursing students from the day shift walk in to the nurses' station. One of them tells me that so-and-so would be an interesting patient to take on, that she is showing some signs of experiencing internal stimuli. The other one tells me not to take D. as a patient since he stinks. Literally stinks, apparently, and is passing gas like noboby's business. Ok, great.
I decide to ask a newer nurse who is an alumni of my school if she'd mind if I follow her today. She says she doesn't mind and I watch her get all her meds ready for the evening. She sends me out to take some vital signs and I get a reading of 210/125 with a pulse of 111 on this guy. This person was a big guy with major depression who is detoxing from alcohol. What my preceptor really wanted me to do was to complete a full "Tranxene assessment," which includes taking vital signs, checking for tremors, diaphoresis (sweating), orientation to person, place, time, and situation, etc. I go back out and finish the assessment and he gets a high score, indicating that he needs 30 mg of the med. Preceptor, RN is really worried about him. Twenty minutes later we take his vitals and he's got a BP of 145/85. Nice, not great, but he's feeling better.
I take on my own patient for the first time since the summer (and that was only 3 days!) and for the first time in the psych-mental health unit. Ms. V. is my patient and the first thing I did was a one-to-one with her. Ms. V is hearing voices and she's hyperverbal with some pressured speech. She related some interesting stories about what the voices say, and they mostly talk about her. There are at least 2 of them, sometimes more, and they tell her to kill herself. They ask her what she's doing at the hospital, what she thinks she'll really get out of it. They wonder out loud in her head who she thinks she is. The voices come from the bushes, from the windows, from the vents. It seems to me that white noise sets them off but once they get going, she can't stop them. They make her cry and say mean things about her. This is the first time I've ever been faced with someone who is suffering in this way. She looks worried, scared; she admits that she never thought she'd be a crazy person. I realize that it could be any of us.
I did try redirecting her thoughts, asking her what the purpose is of listening to them. Reminding her that they are not real, that they are a malfunction of her brain at this time. That it is all chemical and physiological and that I am so happy she is here getting help. That her meds may be able to help her. I try to be a good student nurse but run out of words somewhere. I know she is looking to me for help. I want to grab a hold of something for her, I want to reassure her that it will all be ok....but I can't because it might not be.
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