celeste7767

Wow, am I ever behind on what's going on!! I thought that most state boards wouldn't even allow someone to take the NCLEX if they had more than a traffic ticket on their criminal record. Personally, with the exception of some white-collar crimes that are felonies but seem to fit into the gray area in between (like bouncing checks or criminal speeding), I don't think we need people in our profession that have a history of felonious behavior. ANY crime that involves reckless or deliberate disregard for the life or well-being of another living organism whether it be a person or animal should be an automatic reason for excluding someone from the nursing profession. We need people in nursing who are compassionate, empathetic, and reasonable. I believe it is better to err on the side of the patient this matter.:heartbeat Celeste

I definitely remember Hilary making a derogatory remark regarding the nursing profession several years ago during the period in the 90's when hospitals were laying off RN's and lived to regret their decision when morbidity and mortality rates climbed as patients were cared for by those who had little knowledge of maintaining sterile fields, etc. I do not remember it being something that we read in print. I hate to attempt to paraphrase something that someone said when I can barely remember it myself. I only remember the substance of the comment was equivalent to saying that nurses don't have the education nor does their job require the intellectual requirements necessary that they should demand salaries in the range of MD's, lawyers, etc. It was during the time in the 1990's when there was a short-lived glut of nurses and they were being laid off and replaced by CNA's,LPN's, PCT'S in favor of the "bottom line". Hospitals (if not all their patients) lived to regret the err of their decision when mortality rates as well as morbidity rates increased with higher numbers of nosocomial infections and length of hospital stays. Unfortunately by the time the numbers were in, no one went back to Hilary to ask her opinion at that time. It is a darn shame when the people in charge of life and death of so many have to continually prove their worth to society. :redpinkhe

I got more than 60 free Contact hours from various sources and once one gets your name you get offers from others. Check out the following which you can do online, download the material if you want and some will even send you monthly free ceu offerings: www.infectioncontrolresource.org www.meniscus.com www.medscape.com www.safepractices.org I would strongly suggest not taking Basic Disaster Life Support or Advanced Disaster Life Support classes offered by an organization named CREST and usually supported by a respected university. I took the classes in Sept. 2007, passed them and was given a homemade certificate that did not list the 21 contact hours I was supposed to get. We were all told then that we would receive our CEUs and cards in the mail from the AMA. I have called and emailed several times and 5 months later and we still are waiting for our documents. WHAT A WASTE OF TIME AND MONEY. Try those above. You may spend time on the computer, but you'll get your ceu's immediately. Good luck to you!! Celeste7767:twocents:

Last Sept. 12, 13, 14 in Socorro, NM I took Basic and Advanced Disaster Life Support Classes sponsored by the Univ. of New Mexico Center for Disaster Medicine and for which I was supposed to get 21 contact hours Cont. ed. Well, after the classes concluded on the third day we each were given one certificate for each class with a blank space for us to fill in our names. No mention of any Continuing Ed. hours anywhere on the certificate. We were told by the course coordinator that we would get official cards from the AMA and certificates with the number of CEUs. In November I called the UNM Center for Disaster Medicine to find out if mine had gotten lost or what. I was told that the AMA has ONE SECRETARY TYPING UP ALL OF THE DOCUMENTS FOR EVERYONE IN THE ENTIRE COUNTRY!!! I JUST SENT ANOTHER EMAIL TO THIS PERSON AT THE UNIV.OF NEW MEXICO BECAUSE 5 MONTHS IS UNACCEPTABLE AND I THINK THE ENTIRE THING IS A BIG SCAM. I WOULD SUGGEST THAT IF ANY OF YOU ARE CONSIDERING TAKING THESE CLASSES, WHICH ARE LISTED OFFERED BY AN ORGANIZATION CALLED "Crest" and are listed as Basic Disaster Life Support and Advanced Disaster Life Support , don't take it. Although it had some good information, I cannot imagine that a professional organization would have one lone secretary (who has other duties as well) in sole charge of sending out thousands of documentation to students who have taken these classes. The person at U of New Mexico said that the secretary was slammed with 6 classes back to back after ours in September. if that is even true, you can bet that the class that I took in September which was one of the first has been delegated to the bottom of the pile or perhaps even further down to the bottom of the waste basket. PLEASE LET ME KNOW IF ANY OF YOU OUT THERE HAVE HAD THE SAME PROBLEMS GETTING YOUR CEU'S FROM THE AMA/CREST. Thanks, Celeste 7767:angryfire

My husband was recently hospitalized for 11 days for placement of urostomy via ileal conduit for bladder cancer with bone mets. Although I may sound like supernurse, in 32 yrs of nursing I have never had any experience with stomas. I do remember that in 1975, my first job on a surgical floor had patients who got colostomies, ileostomies, etc. and that when they were emotionally and physically able, they and a family caregiver attended classes where an ostomy nurse gave classes to these people whose lives had taken a sudden hairpin turn into no man's land and they were depressed and frightened. But there were always several other experienced nurses in the classes to help them learn about the various appliances and what would fit and work best for their body type, etc. When they went home, they had the name and phone number of one of the ostomy nurses to contact in case of emergencies or just questions or help walking one through their first pouch change. I know this sounds like a fairytale, but there were more things good about the 60's and 70's than just the 60's and 70's. We were enabled to give the best patient care we could devise. No idea was turned away if it helped prevent complications, promoted well-being and optimum health. 21st century health care is more like medical care was before Semmelweiss discovered that bacteria was the cause for puerperal fever in new mothers. Only the poor delivered their babies in hospitals; the wealthy delivered theirs at home with a midwife because upwards of 89% of newborns delivered in hospitals died within 5 days of unknown causes. It seems we have come full circle today. My husband's surgeon said that the nurses were all experienced in stoma care and would teach him all about it. No one on that unit knew anything about them and even admitted they did not get many there. On his last day before discharge, an ostomy nurse on her way to a "conference" dropped in to give my husband's nurse "the basics" on ostomy care and changing the appliance. She never told my husband her name, never addressed him by name and never addressed any of the instructions to him or allowed him time for questions or concerns. She never returned. The next day we were sent home with minimal supplies, no information with the exception of a 4 page ostomy care sheet that was incomplete and ended in mid sentence. It gave no practical advice or explanations or discussions of the various devices, how to place them, what is some kind of powder for, would we need it. It must be what this NEW KIND OF NURSE TEACHING IS ALL ABOUT. (NANDA) Tell the patient how it will affect his life; don't eat cheese, it will make the urine smell; what kind of clothes to wear. But no step by step instructions and illustrations to help with the practical side of such a radical change to ones body image. And discharge instructions!! WHAT A JOKE!!!! We were supposed to have a Home Health nurse out within a week after d/c. Still don't have one. She is supposed to come out Friday, 8 days late and the skin is breaking down and weeping because we don't have the supplies or instructions we need. Also, 30-40 years ago, there was a name and phone number of a contact person if the patient had any problems when he got home.No one, no where. ALL THE COMPUTERS, TECHNOLOGY, AND EVIDENCED BASED PRACTICE IS NOT GOING TO IMPROVE NURSING CARE AND MEDICAL PRACTICE WHEN NO ONE IS PRACTICING IT! AND NONE OF THE NURSES WITH THE EXCEPTION OF THE ONES IN THE STEPDOWN UNIT SEEMED TO CARE WHETHER THEIR PATIENTS WERE LYING IN FECES OR SCREAMING IN PAIN. THEY WERE ALWAYS GATHERED AROUND THE DESK AND THEIR COMPUTERS. It really is time to go back to the good old days.....and the well known old adage that went like this: "STAY AWAY AND OUT OF HOSPITALS NO MATTER WHAT HAPPENS TO YOU. EVERYONE KNOWS PEOPLE ONLY GO THERE TO DIE!! Celeste7767:madface:

When is it OK for the nurse to push the PCA button?? When you just got the patient up in the chair and he number and positioning of the infusion pumps, pleurevacs, O2 tubing etc. and the arterial line and CVP poles are separating the patient from being able to reach the PCA cord button. My husband was just such a patient in the hospital after surgery for bladder cancer and when he asked for his "pain button" we all looked at each other then searched until we finally found it. My husband asked if someone would push it for him; a very understanding and empathic nurse said, "Normally, this is a big, NO NO, but in this instance, its a YES, DEFINITELY. I am sure that that nurse will try to keep a closer eye on how she arranged the various apparatus from now on, so it was a good learning experience and I would have done thing. Critical thinking is separating following the book to the letter no matter what,from analyzing each situation, analyzing the "rules" and what situations led them to be written, drawing on previous evidenced based knowledge and using all of the above to make the best possible decision for the patient at that moment in time. There are no "all the time" or "never, never, evers" in nursing. :w00t:Celeste7767

WARNING: THIS POST IS REALLY LONG. BUT I HOPE MANY OF YOU WILL READ IT. I THINK IT IS A VERY IMPORTANT ISSUE FOR ALL NURSES. I haven't written a post for quite some time. My husband learned today that he has a "high grade invasive bladder cancer" from a cysto and biopsy he had done one week ago; he was originally hospitalized in acute renal failure which was reversed after one run of hemodialysis, the insertion of 2 nephrostomy tubes and a foley cath all of which he came home with on 11/3 and which I have been caring for. During the past several years I have witnessed some disturbing trends in nursing. In a world famous MAGNET hosptital in HOuston, TX. for 6 days no nurse did a head to toe or systems assessment on my husband; no nurse did a neuro check; no nurse asked questions regarding pain or other discomfort; no nurse ever physically touched my husband. I did all of his care and I wanted to do it, but I did wonder how the nurses charted on him when the only thing I had seen ANY of them do was give him his meds in spite of the fact that he was on a telemetry floor and was acutely ill. He had been admitted because of a sudden onset of mental status changes with confusion, disorientation, visual and auditory halucinations, slurred speech and stuttering, staggering gait and weakness of the extremities, particularly the legs. The did EEG, cardiac echo, MRI and MRA of the brain and extracerebral circulation, doppler of the carotids, skull films. The only thing they did not do was a lumbar puncture and I don't know why they didn't because he was discharged minimally improved with no diagnosis. I never saw any of his labs, but I bet his CBC differential showed elevated WBC's with a shift to the right because I have often thought that he could have had West Nile encephalitis since he came down with this where the mosquitoes that carry it were prevalent and I have cared for patients with viral encephalitis and he had many of the symptoms. He gradually recovered completely after several weeks. The point I really want to stress however is that from what I observed back then in Houston and now with nurses and Nurse Practitioners at the VA here in Arizona, I believe our profession to be at a critical juncture. Nursing is at the brink of losing its status as a profession partially due to the continuing shortage which initially brought about much needed increases in salaries but when the pay did not have the effect of bringing more competent, quality people into the ranks, desperate measures were sought to fill the vacancies left by aging baby boomers. We now can evaluate the consequences of some of the less desirable means utilized to fill the positions for competent RN's with what amounts to the equivalent of "warm bodies". Because of the current job market, former truck drivers, auto production workers and people who would never have considered nursing as a possible future job for themselves are signing up at record rates because it is a guaranteed job. People are going into nursing because they know they have a job waiting; because they can travel; because it is one of the few professions that you can start out in with an Associate Degree and I recently read that there is a push to get RN's out and working in something like 3 semesters. Many of these candidates have no realistic picture of the myriad of tasks that are involved in being a RN. Many would rather work in a sewer than touch or be touched by another living person's bodily fluids. Some people actually consider it from the prospective of the accessibility of narcotics. Recently when my husband was in the hospital in renal failure, he told me that one of the nurses did not give him the correct dose of his scheduled pain medication. He said that when he told the nurse that he was supposed to get one more pill,the nurse replied, "Well that's what is ordered". Yet for the 2 days that he was on that unit, the night nurses gave him the correct dose, the exact same dosage and the same pills that he had been taking at home for more than one year so there is little chance that my husband was mistaken. Unfortunately, he did not tell me this until after he was discharged and I admit that right now turning in that nurse is not my top priority. I would say for the most part that the nurses who write into this forum are the good nurses. Why? Because the bad nurses could give a rat's ass about anything to do with their job after they go home. I can hardly believe that they would spend time on their computer reading what other nurses think and say about their profession. To the bad nurses, nursing is just a paycheck. And most will get advanced degrees so they can "get away from the bedside", which is a good thing when you get right down to it. It is so sad to me to think that all the work that thousands of dedicated nurses have done over the past 3 decades to bring nursing the respect and status of professionalism that it deserves may be lost when the public gets wind of the some of the "trailer trash" types and "gangstas" we are letting into our ranks. I can't work right now; 30 years of 12 hour shifts, most without breaks and most that ended up being 13 or 14 hour shifts, took its toll on my body. I have too many ailments to list, but right now there isn't any kind of nursing that I would be able to do. Just sitting and typing this, I have had to stop several times because of the pain and stiffness I get. Nursing is not the kind of job that everyone should do. It is a profession that you really have to desire from the heart and know that there comes with it a lot of things that most people would call "icky"; but in spite of the "icky" if you can derive satisfaction from the patient who thanks you for starting his IV because no one else could, or who remarks "You must have been doing this for a long time; I can tell just by the way you can talk and work at the same time." If you can look back and feel good because you KNOW that there are people walking around today because YOU were there to provide expert emergency care that was needed during that critical moment between life and death and no one gave you a medal or a bonus or a raise but it was enough to know that it was your hands that helped save a life, THEN YOU KNOW YOU ARE IN THE RIGHT PROFESSION. Then you know you are a "GOOD NURSE". I know there are still good nurses out there. There was one in the ER named Manny who is young and fit and eager to learn, yet compassionate, caring, never forgetting that it is a human being in that bed. And when I read a lot of the posts in the forums, I see that you are out there and I thank God for you. Because we baby boomers are getting old and tired and we look at you because we see ourselves on the other side of the bed someday and hope that we will get one of the "good nurses". God bless you all!! SORRY THIS IS SO LONG,....AS USUAL..............

Geez, I almost had a stroke when I first read the question! My first reaction was, "Oh God, no, Please don't tell me that employers are regressing 50 years into the olden days when nurses wore long sleeved starched uniforms that were mid calf length and ALWAYS a cap and your school pin." What a relief when I read on some more. I have worn just enough make up to look "normal" since I was around 14 years old. I have very light strawberry blonde hair, green eyes, and my eyebrows and eyelashes are nearly invisible they are so light. (When I first got married I went to bed with my make up on and got up before my husband to wash it off and redo it!!) Also there was actually a period in the early to mid 1970's when minimal false eyelashes were in vogue as well as wigs. We all wore those to work as well, but no one thought anything about it because it was the fashion at the time and no one had a "Tammy-Faye" look about them either, God rest her soul.

I'll tell you one thing you can do but unless you want to get fired like I did, you better get most of the nurses on your unit to do the same thing. After I explained what would work to the other nurses, I was let go the next day I came back to work. This is it: Say you are shortstaffed and you're in charge; or you aren't in charge but you have a number of very sick patients or too many patients so that you can DOCUMENT THE REASONS CLEARLY WHY IT IS UNSAFE. You type it up, name the date, shift, and the supervisor(s) you notified about the problem and why it could result in poor patient outcomes or even a sentinel event. DO NOT USE PATIEN T NAMES IN YOUR REPORT SINCE THAT WOULD BE A BREACH OF THE HIPPA LAWS. USE EITHER ROOM AND BED NUMBERS OR MEDICAL RECORD NUMBERS TO IDENTIFY THE PATIENTS WHO ARE AT RISK. Explain how you presented your case to your immediate supervisor, then called your unit Manager and tell her that as a courtesy you are notifying her that you will be filing a report documenting the circumstances surrounding the events that have transpired thus far and any untoward events that may result possibly due to the understaffing issue. Explain that you will have a copy sent to the hospital administrator, the Director of Nursing or Executive Nursing Officer and keep a copy for yourself. Tell her this is the only way you can see that you will not be held ULTIMATELY LIABLE SHOULD A SENTINEL EVENT OCCUR, since without any evidence stating any different it might be construed that you never notified any of your superiors of the conditions on the unit during that shift. Believe me, documentation is the last thing administration wants because they have no or very little defense when faced with the cold hard facts that they each blatantly ignored. If you are in Charge, you may need to call the Executive Nursing Officer if your manager will not step up to the plate and find a solution like closing the unit to further admissions or coming in herself to work. If you are a staff nurse you can document only what your personal situation is with the patient load you have and explain in great detail why it is unsafe and that you do not want to risk not only a person's life but your professional license as well should things go south. You may also want to notify some of the physicians of your patients who you know would be sympathetic and concerned about your plight and their patient's welfare. I was the charge nurse in an ICU in a small community hospital and I was forced to type up such a report. I also explained to my nurses what I was going to be doing and allowed them to read it. I told them that uncontrovertible documentation is their only defense when faced with Shift Supervisors who refuse to get permission to close a unit to further admissions or worse with Nurse Executives and CEO's who won't back up their nurses because of the bottom line. Not one nurse would relate that they believed that they were understaffed and their patients at risk (even tho' they all complained about it to me) and they did not lose their jobs. I did lose mine but when I filed a wrongful termination claim with the Arizona Dept. of Economic Security, the Hospital was found in the wrong and I received 3 months of unemployment pay. Unfortunately, I have learned in 30 yrs of nursing that most nurses talk the talk, but are ultimately afraid to walk the walk and take that chance by fighting the good fight. Maybe if more would do it, hospitals would become more afraid of that tactic and might try a little harder to get staffing.

I graduated in 1975 and in 1980, started working 12 hour shifts in Critical Care, ER, CVICU, PICU, hemodialysis. After 30 yrs total, my body is wrecked , ruined. I have chronic vasculitis of both feet and ankles, arthritis of both feet, hands, knees, acetabulum bilaterally, spinal osteoarthritis which has decreased my height from 5ft 8inches to currently 5ft 6 and 1/4 inches. I have chronic pain nearly everywhere; I received Social Security disability effective November 2004, but just got eligible for Medicare but I have been without insurance coverage for 7 years until this May. I also have nerve entrapment at the shoulders and elbows as well as Carpal Tunnel syndrome of both hands and wrists. I started my nursing career at age 26; I am now 58 and can barely get out of bed. I could have all kinds of elective surgeries done to allegedly help increase my level of functioning and decrease the pain. Unfortunately, after what I have seen and what I now see in the medical arena in spite of the wonders of modern medical technology and such catchy phrases as "evidence based practice" and "patient centered care", I think I will take my chances continuing to wear wrist splints and doing what I can when I can and easing up when I can't do anymore. As for 12 hours shifts, the human body isn't stuctured to be able do the type of work required of a competent, compassionate, patient-driven nurse. Especially, when I would bet that 90% of all nurses who work 12 hour shifts work more than their required 3 shifts. I routinely screened my calls because I almost never worked more than my 3 required shifts but I was always being called to "help out because we're short tonight". There is no h istory of arthritis in my family, nor carpal tunnel. I know what is responsible. As more of us are forced to retire early due to job related maladies, hopefully it will become more apparent to the nursing profession as well as to the employers that the nursing shortage is not going to be shortened by wearing out employees 10 years prior to the normal age of retirement.

I'll start right off telling you all that I am probably the most CYNICAL nurse that is a member of this forum. When I started nursing school in 1971, I had no idea what the starting salary was; it was what I wanted to do so I didn't care. In 1975 in Indiana, my first job on nights on a major surgical unit with 26 beds, me and and a CNA on duty, I made $5.27 per hour. I worked 11pm to 7:30am, 8 hour shifts, every other weekend off. We almost never worked any overtime, we got our lunch and breaks, and we got out on time. After working 26 out of 31 years doing 12 hour shifts in Critical Care and ER, mostly without any breaks or any time off my feet, I am now on Social Security Disability at the age of 58. I have lost 2 inches in stature from severe spinal arthritis, I also have severe arthritis of my feet, knees, hips, hands, and right shoulder. I have severe carpal tunnel syndrome of both wrists. I wouldn't become a nurse today because today nurses are the ultimate fall-guy no matter what happens; the nurse is always to blame, (not the pharmacist, not the charge nurse, not the doctor) because the pharmacist and doctor have associations that PROTECT them from liability while the Boards of Nursing exist solely to PROTECT THE PUBLIC FROM THE NURSES and that crap about Charge Nurses being responsible for what other nurse do is just that, CRAP. And NO, I have never been disciplined by the board for anything. But I have seen it happen to 4 other excellent nurses that I know of and I cannot imagine how many others it happens to that I don't know of. I was not a workaholic either; I worked my 3 twelve hour shifts a week and that was it. But when I worked, I gave it 200%. I practically RAN down the halls as I gave my patients the best that I had to give and there are many people who are alive today because I was there when they needed a good nurse. But if I could do it again, I would NOT be a nurse. I would be an attorney or a medical technologist. NO amount of money is worth the emotional and physical toll it takes. Nursing is a job with lots of responsibility and very little authority or power. It is known as a job with the worst of both worlds. To those of you who are still taking prerequisite classes I say: GET OUT WHILE YOU STILL CAN!!

Sounds like a Circolectric Bed, used primarily in the early 1970's to 1980 for the quadraplegic patients to prevent skin breakdown and to change positions gradually to avert some of the autonomic problems associated with this class of patient. This was preferred over the Stryker frame by many neurosurgeons at the time because the patient was not flipped from supine to prone like a pancake. As with everything else in medicine, newer more comfortable and more efficient beds came along to replace them.

Whether someone gets terminated over something that is obviously "human error" in which no real crime, civil or legal, was committed and no one was hurt depends on one thing: Is there any other reason why they (your manager or the hospital) wants to get rid of you. If you have been there 6 years, you have presumably gotten 6 evaluations and been retained during that time for good reason. If you ARE terminated, file for unemployment. The hospital will state you are not eligible due to the termination. Then you file an appeal which you will be told how to do in the letter you get from your state's employment or labor dept. notifying you that your claim for unemployment has been denied. Then you prepare your case. You can have someone help with you like an attorney if you wish or you can do it on your own. Most unemployment hearings are telephone hearings done with an administrative law judge presiding. Whether you win or not will depend a lot on whether your Human Resources dept. followed the company's disciplinary action policies as stated in your employee handbook. You should get yours out and review the policies. Many companies give their employees a smaller version of the entire manual but the section on disciplinary action procedures should be in yours. I sincerely hope you do not have to resort to any of this. But from personal experience and from working as Assistant Director of Human Resources during a vacation from nursing about 16 years ago, I can tell you that when it goes to administrative leave, it usually means that the company is getting their ducks in a row for termination. I know this is not going to make you feel better. But keep in mind that you really have done nothing wrong; your explanation taken at face value makes it clear to any rational person that the worst thing you did was succumb to being human......you were overwhelmed and you FORGOT the pill in the pocket; but you were doing what every nurse is taught to do from day one: Priortize based on the acuity of the situations at hand. You could have ignored your patients and instead, taken the time to call the pharmacy, ask your charge nurse to help you rectify the error with the Pyxis and observe you wasting the medication. It probably would have taken 20 minutes to do that but you would not be in the situation you are in now. It might have been worse. You might instead have a patient who aspirated on vomit, or one who suffered a broken hip due to a fall; in other words incidents that could have been prevented had you not chosen to take care of the pill in the pocket first. The pill fell on the floor. It happens. You did right to take care of your patients FIRST. You forgot what in the total scheme of things was minor, but due to policy, narcotic laws, etc, etc, etc, has gotten you into a snarled mess. You still had the pill as evidence that you had no intention of diverting drugs for yourself or anyone else. When I read "med error", I thought you gave the wrong drug to the wrong patient or something like that. You did not commit a med error. A med error is wrong drug, wrong patient, wrong dose, wrong time, wrong route. Remember that from nursing school?? You made a policy error. You may still get terminated I am very sorry to say, because it would be a very stupid move on the part of the hospital. But the reality is that it does happen. But if it does, don't let it destroy you or your career. Fight it. Appeal it. YOU REALLY DID NOTHING WRONG. My prayers are with you. The very best of luck to you. You sound like a very good and conscientious nurse.

While I agree with the substance of what you are saying, I must state that when I hear a non-medical person say something that sounds medically dangerous or unsound I WILL make a comment. Like they say, "It's all in the delivery". We have an elderly man who sprays our house for insects (we live in the mountains of AZ with scorpions, centipedes,etc) monthly. This month he mentioned he had cataract surgery and that his surgeon had had to aspirate blood from his eye a couple of times; I know this man pretty well over the past 8 years, and know that he also takes aspirin prophylactically due to previous CAD. I merely mentioned to him that he should make sure that his surgeon is aware that he is on aspirin and any anticoagulants or NSAIDS. Another time while shopping at the local food coop, I ran into a young mother who had a 14month old who had had a severe case of croup; she said she had been scared to death when her infant started the typical "crowing sounds" of croup and seemed to be having some difficulty breathing. She said she took her to the ER and they told her to get a humidifier so she was using an old hot steam vaporizer that her mother had. I suggested that the cool mist humidifiers were more effective with decreasing the swelling that occurs in croup; I also mentioned what we used to tell mothers in the ER where I used to work: If your infant develops the symptoms of severe respiratory distress at home, take them out into the night air if its cool or as a last resort, while waiting for EMS, open the freezer and stand so the baby can breathe the cold air. It has saved more than one infant's life that I know of. Call me crazy, but when I know that someone is in need of some simple medical knowledge that could make a real difference in their life, I cannot withhold it and back off and tell them just to see their doctor. I always end ANYTHING I do tell them with, "But make sure you see your doctor about that", or "That's something you really need to let your Doctor know about." I have worked as a RN for more than 30 years and have never had a complaint or incident report against me for any reason.

As far as your question regarding demerol, I do know that in high doses or with patients who have decreased renal function, the active metabolite from it, normeperidine, does accumulate and can cause seizures. Demerol is NEVER used for chronic pain or in the terminally ill, because unlike morphine which has no ceiling dose, Demerol can reach toxic levels and cause seizures.