*the-office

Business Cats Calendar

Keep your eye on the ball – of yarn – all year round with the business cats calendar. Purrrfect for feline friendly office environments – the calendar helps you stay organized while displaying some immaculately dressed kitties in their best business attire.

$20.00

Check It Out

Awesome Sh*t You Can Buy

Basics for the Wards: A Psych HPI

While the HPI is generally the same across the board, every specialty will have it’s own particular spin on it depending on what it is. Psychiatry is no different. 

- HPI
Why is the patient at the doctor’s office or hospital. Asking the patient this can give you some insight into their thought process and perception. However, sometimes it will be necessary to ask the patient’s family, friends, or whomever brought them there (EMS, police, etc). Include any pertinent information about the current episode (what led up to it, what happened), any previous episodes, how is this affecting the patient’s life, assess the patient’s support system, symptoms, and evaluate patient’s functioning.
Ex: 45 year old gentleman brought to ER by police, was found wandering in street at midnight yelling incoherently. The patient states he is here because his family is trying to kill him and take his fortune. This is the patient’s fifth visit at this hospital in the last two years, and is well known to the treatment team. In the ER the patient was visibly responding to internal stimuli.

- Past psychiatric history
Have they ever been diagnosed with a psychiatric illness, and if so, when? If there were any prior suicide attempts, include when they occurred and the methods used.
Ex: Patient was diagnosed with paranoid schizophrenia 25 years ago. He denies suicidal or homicidal ideations.

- Past medical history
The usual drill.
Ex: HTN, DMII

- Medications
Many psych patients are on medications, be sure to ask if they miss doses and how often. Include supplements.
Ex: risperidone, metformin, lisinopril. Patient has not picked up prescriptions in 2 months per pharmacy, patient states he does not need medicines.

- Allergies
The usual drill.
Ex: NKA

- Family history
Specifically interested in family psychiatric history, don’t forget to ask about suicides.
Ex: Per medical record, patient’s mother had bipolar disorder and his father committed suicide when the patient was 7.

- Social history
Ask about what a patient does for a living, how far they went in school, where they live, who else is in the home with them, how their childhood was, specifically ask about physical, sexual, verbal, and emotional abuse in their lifetime, ask about specific drugs (marijuana, coke, heroin, meth, etc), tobacco use and history, and alcohol use and history.
Ex: patient is homeless and is on disability, he reports snorting heroin in the last two months, he smokes a pack of cigarettes a day (started smoking at age 13) and drinks a fifth of whiskey when he can get it. After his father’s suicide he was sexually abused by his mother’s boyfriend until he was placed into foster care at 12. His only family contact is a sister, who states she has not seen or heard from the patient since February. 

- Review of systems
Still important to ask, but can be basic. I ask about dizziness, headache, runny nose, sort throat, cough, chest pain, heart racing, nausea, vomiting, abdominal pain, diarrhea, constipation, trouble urinating, and muscle or joint pains. 

- Physical exam
Most psych patients are very healthy and will have exams within normal limits. IT IS VERY IMPORTANT TO STILL EXAMINE THEM LIKE YOU DO ANY OTHER PATIENT.

- Mental status exam
This is the most important part other than the history. Also remember this is just a snapshot of the patient’s mental status at the time of questions, it can- and frequently does- change during the course of the patient’s treatment.
+ Appearance: physical (hygiene, posture), behavior (cooperative/noncooperative, eye contact good/fair/poor), attitude (guarded, hostile)
Ex: Patient appears disheveled and malodorous, poor eye contact, guarded but cooperative)
+ Speech: rate (pressured/fast/regular/slow), volume (loud/average/soft), tone (angry/sad)
Ex: Speech is slow, soft, and lacking intonation. He answers questions mostly in monosyllables.
+ Mood: what does the patient say about how they are feeling?
Ex: Patient states he is afraid.
+ Affect: How does the patient’s mood appear to you? Is it congruent with what the patient says (the patient says they are the saddest they’ve ever been but they are smiling and laughing)? Assess quality (flat/none, blunted/shallow, constricted/limited, full/average, and intense/greater than average) and motility (how fast they shift emotional states, sluggish/supple/labile).
Ex: Patient’s affect is flat with sluggish motility
+ Thought process: How the patient thinks and puts ideas together. Examples of descriptions can be loosing of associations (no logical connections), flight of ideas (fast stream, tangents), thought blocking (lack of communication, unable to get thoughts out), tangentiality (goes off on tangents without returning to questions), and circumstantiality (goes off on tangent but returns to question eventually).
Ex: Patient demonstrated thought blocking.
+ Thought content: How the patient expresses their ideas. Examples of description can be poverty/overabundance of thought, delusions (fixed false beliefs not shared by patient’s culture), suicidal and homicidal ideations, phobias (irrational fears), obsessions (intrusive recurring thoughts), and compulsions (repetitive behaviors, often linked to obsessions).
Ex: Patient demonstrates poverty of thought with paranoid delusions.
+ Consciousness: alert, drowsy, stuporous
+ Orientation: person, place, and time
+ Calculation: add/subtract simple equation (2+4, 10-5)
+ Memory: Assess immediate (can they remember 3 repeated words after 5 minutes), recent (what happened in the last week), recent past (what happened last few months), remote past (events from years and years ago)
+ Fund of knowledge: Who is the President/leader of country? Be sure to stay within bounds of patient’s culture and education level.
+ Attention/concentration: The dreaded serial 7s or spelling a short word backwards (world, apple, whatever)
+ Reading/writing: Can they read a sentence and copy it?
+ Abstract concepts: Explain connections or similarities between objects or understand simple proverbs.
+ Insight: Is the patient aware of their mental illness? Do they blame it on someone else? Can be absent, limited, or normal.
+ Judgement: Does the patient understand the effect of their actions and decisions? Ex: what would you do if you found a wallet on the ground? 

Good luck!

jó lenne,

ha az átlag felnőtteknek is lenne nyári szünet, már izgatottam készülnénk arra, hogy a kihúzós filcekkel felírjuk a frissen festett falra az óiócióációt, be lenne készítve az out of office üzenet is - “vakációzni mentem, viszlát szeptember elsején, távollétemben se keressen senkit, mert juhú!” - egész nyáron a balatonparton feküdnénk, és nagyon kevés pénzből is jól éreznénk magunkat, aztán augusztusra egy kicsit már hiányozna a munka meg a kollégák, ezért még egy utolsó nagyot fesztiváloznánk, hogy az utolsó héten már egyáltalán ne vágyjunk vissza, remegő gyomorral gondoljunk az unalmas szerződésekre, a meetingekre, a szigorú főnökökre, de aztán szeptember elsején azért mégis vidáman érkezzünk a rég látott, csokibarna kollégák közé, ebéd közben lelkesen elmesélve és kibeszélve a sok boldog nyári emléket

Two hours later and it still smells like fish. Kids….this is why we do not cook fish in the office. Especially a small office.

anonymous asked:

Prompt: Emma and Regina have sex in the mayor's office and Regina accidently presses the intercom, so everyone who is waiting for the town hall meeting to start, hears them. Maybe have them like, not dating yet but Regina can't wait any longer so she pretty much jumps Emma, who is hesitant but loves it, like 'are you sure you wanna do this' stuff. Then they enter the meeting and are confused why everyone's staring and laughing like that. I knoooow it's long, don't mind if you skip anything:D

Thank you for the prompt! Nope, not long just the way I like them :P  I’ve put the blame of who presses the intercom a mystery though… And I’m thinking on writing a longer version just like I did with “You summoned me”

Muffled growls could be heard from the intercom as the last one of the former fairy tales characters entered in the town hall. Snow brows rose when she heard the sound and looked at her surroundings, trying to gather what was happening. As the men and women started to whisper and point towards the speakers while trying to understand what they were hearing a second growl-followed by a chuckle- came through the speakers making a few of them cough and turn red as many others started to chuckle to themselves.

Meanwhile, inside Regina’s office the brunette was finishing with the banquet she was having with the blonde’s body; her lips were completely drenched on Emma’s essence and as the blonde woman growled once again the brunette repeated her chuckle, dropping her voice an octave and moving away for a few seconds making the other woman whimper in need.

“Come for me” She said, loud enough to make Emma whisper a soft yes that was lost when Regina’s lips returned to the blonde’s sex. Any possible doubts that the blonde could have had disappeared in that instant as her right hand grabbed tightly Regina’s head.

In the other side of the room Snow had stopped breathing, her face completely red as Ruby laughed as she looked at the corridor that directed to the mayor’s office.

“This is going to be fun” She whispered towards Belle at her side, who looked at her with her cheeks painfully tinted on a scarlet color.

Emma came with Regina’s name on her lips and the brunette rose, quickly cleaning her face and helping Emma to get back on her feet, the blonde’s knees wobbling a little as she abandoned the other woman’s desk and tried to follow the brunette’s steps with a dazzled look on her face.

The conversation they both had started a few minutes before wasn’t over yet and even in their state they knew it. Emma sighed as she slowly came down from her endorhin-induced state while Regina opened the door and carefully looked outside.

“This is what you really feel for me?”  The blonde found herself asking, chastising the slight tremble on her voice as they both walked down the corridor, approaching the main hall.

Regina didn’t answer albeit she pressed her hand against Emma’s nodding for a second before moving away from the woman and retouching her hair, carefully trying to appear as untouched and poised as ever.

However, when they both entered in the town hall they were received by some blank stares and a few toughs and chuckles that slowly turned into an collective laugh and a few “Told you so” from some sides of the room. Emma turned towards Ruby who was in that moment crouched at her mother’s side trying to understand what was happening. The werewolf merely pointed at the speakers, her own eyes twinkling mischievously and when Emma finally understood what had just happened she turned towards Regina, a blush covering completely the older woman’s face.

“Regina?” She said, trying to reach for the other woman as the brunette grabbed her by her arm and covered both of their bodies in a cloud of smoke.