!Ask Ms Anna
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agk's diary
21 May 2023 @ 00:15 UTC
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written on GPD Win 1
on couch, boots off, scrubs still on
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Q: Ms Anna, how many hours are you required to work
a week?
A: Uh, 40. But when I'm charge nurse I have to work
til my admissions, discharges, orders, notes,
etc are finished, which was 16 hours one shift
this week. When I'm on call and they call me I
have to come in. So 70 hours this week. If you
think I get a 2-day weekend after this you don't
understand what a wreck US hospitals are.
Q: Ms Anna, how was your morning?
A: There were 3 staff scheduled on the unit due to
the large, violent, strong, mad, flat-affect
man & 15 other patients. If he went off, he was
mine. Otherwise, I was to lead groups, etc. He
sat, hulking, preoccupied, withdrawn, back to
the corner. I built a little rapport but he was
a tough one. One of the 3 staff called in, so
there were 2 of us. The other has epilepsy &'d
been up 72 hours. She had aura, was labile &
crying, pupils dilated. She knew & I knew she'd
seize. She asked me not to call 911. After her
seizure it was just me.
Q: Ms. Anna, what are the rules for the extremely
defiant, unredirectable, persistantly homicidal
5-year-old who wants especially to kill the
person that just killed her brother, who you got
a blessed extra staff order for?
A: - Do not program with other children. All fur-
niture must be removed from day room where she
programs alone. Watch when entering or exiting
nursing station, she will run in.
- Do not let the patient lay on you, cuddle with
you, or physical contact other than high five,
fist bump, or similar contact that is not a
boundary violation.
- If the patient does these anyway, record on a
Boundary Violations Report. Have charge nurse
sign each violation that occurred their shift.
- Do not let the patient have pens, flashlights,
watches, or phones in hand.
- Do not go into a room with the patient in the
shower without a witness, even if attempting
to get them dressed. Always grab a witness.
- Avoid new movies towards bedtime, as they are
stimulating. Safe movies include: Frozen, Cin-
derella, Moana, and Encanto. Frozen is prefer-
red at bedtime; it's most familiar to patient.
- Toys should be picked up and put away at 1900
to allow patient to wind down for bedtime.
- Patient's persuaded by games and rewards. She
has a squishy toy which can be used to convin-
ce her to follow directions. It can take 'time
out' in nurses station if patient won't follow
directions.
- Blankets and pillow must stay in patient's
bedroom.
Q: Last question, Ms. Anna. What night meds do you
give kids?
A: In the morning 17 doses of Adderall, Concerta,
Ritalin, Focalin, Vyvanse, and everything else
you'd expect. At 1930? Uh...
5-year-old: clonidine 0.2mg
11-year-old: melatonin 5mg
7-year-old: Abilify 5mg, guanfacine 0.5mg
10-year-old: risperdone 0.25mg
8-year-old: clonidine 0.15mg, Vistaril 25mg
7-year-old: guanfacine 0.5mg
11-year-old: nothing
10-year-old: risperdone 0.25mg
9-year-old: melatonin 10mg, Vistaril 25mg,
guanfacine ER 4mg
7-year-old: melatonin 10mg, risperdone 0.25mg
9-year-old: cetirizine 10mg, melatonin 3mg
6-year-old: Zyprexa 5mg
7-year-old: lamotrigine 100mg, melatonin 7.5mg,
risperdone 1.5mg
11-year-old: guanfacine ER 3mg, melatonin 10mg,
Remeron 30mg, Paxil 20mg, Sero-
quel 25mg
11-year-old: Atarax 50mg, melatonin 10mg, risp-
dal 1mg
10-year-old: Celexa 10mg, lamotrigine 50mg,
melatonin 10mg, risperdal 0.25mg
6-year-old: melatonin 5mg
Go to sleep babies. You should see what I admin-
ister to grownups.
A more humane, less profit driven, more family-
oriented system would look very different. My co-
workers wouldn't be burning out, calling in, and
falling ill like falling dominoes.
Time for sleep. Back to the factory in the morning.
