For this clinical rotation, Kenzie and I were placed with the FNP and the Psych NP. We were able to talk to both of the nurses and discuss the assessments they do and were able to look over the different forms they used to document their assessments. There were three new admits scheduled to come in for assessments, but we were only able to actually see two of them done. The first one that came in was a 14 year old boy, we watched as the FNP measured his height and weight, checked his hearing, blood pressure and temp,then asked him some questions about past medical history and if he was sexually active. She then checked his vision, checked his back for scoliosis and performed a rhomberg test. She then had him sit on the examination table and auscultated his lungs, and heart. After doing all of that she explained to him about the tb test she was going to perform and how she would slowly insert the needle of the syringe just under his skin but would not insert the entire bevel of the needle. The boy was very interested in watching the process and when she pushed the plunger to inject the TB serum a little shot into his eye. He said "oh you got me" then said it got into his eye and was burning. She asked him if he wanted any saline to rinse his eye and he said no, then asked if it was poison. When she said no he seemed a little relieved and then happy when she offered him a snack as he left the room.
The second patient was a 15 year old boy. She did a mini assessment with him since he had already had a full exam within the last 45 days. She asked Kenzie to measure his height and weight and me to take his blood pressure and temperature. She asked him his past medical history and if he was sexually active. He said he was sexually active and she asked how long ago was his last encounter and he said two weeks ago, she asked if he used condoms and he said yes. She moved on to the rest of the mini assessment and when she got to the tb test she told him he could watch if he wanted to. He said he would not watch because he does not like needles. When she finished the mini assessment on him she offered him a snack as well.
Kenzie and I then went and sat up front with the FNP and Psych NP, the Psych NP handed us copies of the chart of the third patient that was coming in for her assessment. The notes in the girls chart said that she was having thoughts of killing her school counselor and that shadows talked to her and were trying to kill her. We were discussing this information with the nurses and the discussion then turned to a patient that was diagnosed with cerebral palsy and walked with a scissor gate, due to his scissor gate he was having trouble walking in his shoes without the shoelaces. I asked the nurse if the parents were able to send him shoes that he would be better able to walk in and the nurse said that he was not on good terms with his parents due to him sexually assaulting his little sister. The nurse went to her computer and pulled up his chart and said she was wrong, the boy had penetrated his 15 year old twin brother, molested his little sister and admitted to beastiality with the family dog. This was all completely shocking to me. She said he was never going to be allowed home if he were to be released from the facility and due to his family not wanting anything to do with him the facility would have to provide him with the proper shoes.
After we had lunch Kenzie and I sat in on group therapy in the Springhill 2 girls unit. This therapy session was interesting in that the therapist focused on having the girls share positive affirmations for the other girls on the unit and themselves. The girls each stated that a certain girl was able to help them through a tough situation by listening to them when they needed to talk. One girl shared that she was proud of herself for losing some weight by increasing her physical activity. Another girl said that she was proud because she had not had any thoughts of self harm nor had she acted out on it when she had one thought.
This day I demonstrated professionalism when I was able to check the 15 year old boy's blood pressure and temperature and did not laugh when the 14 year old boy asked if he had poison in his eye. The experience of this day has broadened my mind and has made me think that I might want to explore the mental health aspect of nursing. While it makes me sad that the 15 year old boy was already sexually active, many of the children there need an advocate and not just someone that is just going push meds.