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  1. nurseprnRN

    Human Foods Which Cats Can't Eat

    I once was told to feed my animals beef kidneys, stewed, and since they were cheap as dirt I did that even though the stewing made the house smell like the tunnels in the subway used as urinals by half of the homeless population in the city. Alas, I discovered that this acidosis-generating food made my 12-week-old kitten severely osteopenic to the point where I fractured his femur pulling him out of some tangled wires, and then he fractured his humerus jumping off the couch. Imagine how terrible that made me feel. And I had to explain to the staff at the animal hospital that I really wasn't abusing him. Oh, I cried so hard over this.... He got a teeny little Steinman pin in his femur and a Thomas splint on his humerus, and six weeks in a cage (at home) while we tanked him up on Vitamin D and supplementary calcium until he got cleared on repeat films. Had that cat for 17 years.
  2. nurseprnRN

    What would you do if faced with this ethical dilemma?

    let's review the primary ethical principals required of all nurses in all situations (check your ana scope of practice and your nurse practice act if you forgot this important lecture at school, or if you don't believe me): respect for autonomy: whose life is it, anyway? whose choice is it? yours? not really. for somebody to make an autonomous decision he must have all the facts needed to make an informed one. i think in this case it's very clear that the nurse's responsibility is to provide information on hospice and palliative care, whether or not this is a personal situation or a work situation. also consider moving through the plissit model for counseling-- permission, i.e., letting the person know you are a safe person with whom to talk about a subject; limited information, as an introduction and to see what else they want to know; specific suggestions, as applicable; and intensive therapy, meaning referral to someone who knows more about it than you do. i think you can see how this would apply here. nonmaleficence: this is the, "do no harm" part. if this patient is reported to (someone) and is then forced to spend his last days in restraint (chemical or physical or both), is this harmful to his well-being? i think the answer is clear on that, and it's also counter to the principal of autonomy. the nurse's ethical duty is to minimize risk of harm of whatever source. beneficience: this means doing or actively promoting what is good. what are the benefits of a chosen course of action? does it promote health in the nurse's patient? "health" can mean optimal comfort as well as (or more than, in this case) cure. what will help this person the most now? again, referral to hospice meets this requirement. justice: is this the right and fair thing to do? after these, the next tier of ethical duty includes: veracity: a nurse has an ethical duty to tell the truth to patients and clients, not to conceal information which would detract from the provision of ethical care as above. what truth is being discussed here? "truth for the moment" is a valid concept in this regard. he says one thing now. he may change, or not. confidentiality: absent clear and present danger to self or others, nothing justifies breaking a patient confidence. as this person has an immediately terminal disease, it's hard to say that the consideration of suicide is a greater danger to him than his condition. it is quite foreseeable that removing his autonomy would be a greater danger to well-being in his final weeks. so it would be ethically wrong to break his confidence. fidelity: a nurse has a duty to keep a promise made. you can avoid making one, as when a child asks you to keep a promise not to tell about sexual abuse; you can say that you cannot make that promise but you will promise to do everything in your power to help that child to be safe. if you promised this patient to keep his confidence, or to find out information for him, or even just to come visit him every day and hold his hand, that's a promise. hope this is helpful to you in dealing with ethical dilemmas in your professional and personal life. it's always worth reviewing now and then to make sure.
  3. too stoopid to be a lawyer. didn't they teach her how to do research in college, so she could, like, evaluate these things first?
  4. nurseprnRN

    claiming "against my beliefs" for immunizations?

    although you can play any card you want, there are many hospitals (if not most) and other health care facilities that won't let you in the door as an employee or student without titers that indicate you are not going to be carrying preventable infectious diseases to their vulnerable patients. you can complain about it all you want, but they are allowed to have bona fide rationales for this kind of refusal, and they are right to do it. so. wanna be a nurse? and yes, that doc that published the lancet paper claiming mercury in vaccines caused autism has been thoroughly, thoroughly debunked, and has withdrawn his paper. he withdrew it. there's no mercury compounds in vaccines anymore anyway, even though there is and was no credible evidence it was harmful. so your friends' home schooled kids are "incredibly healthy." they don't get out much, do they? if they're planning on staying down on the farm all their lives, they might avoid exposure to infectious disease. but if they get into town to go to the museum, go away to college, or ride in a greyhound bus, you can kiss that goodbye. there's a reason they're immunizing for "childhood diseases"-- get them as an adult and you are a lot sicker. as i was born before 1957, i had the big ones-- chicken pox, measles, rubella, and mumps, and scarlet fever too. i remember them all. as a nurse, mother, and now grandmother, i am amazed that people think that these are harmless and that vaccination is orders of magnitude worse. they have no memory, as i do, of their classmates' mother having spontaneous abortions or blind babies when their kids brought home rubella in mom's first trimester (if they, the mothers, hadn't had it themselves), or babies born dead or deaf from measles, or teenagers who somehow escaped mumps as children only to become permanently sterile when their testes were fried. my uncle did that. or being kept inside in the summer because it was thought that polio would get you if you went swimming-- i remember classmates with braces. i can now, as a parent, imagine the terror my parents must have felt for us when summer rolled around-- they knew kids in iron lungs when they were young. there are still some alive in them, after all these years.the first oral vaccine came in when i was in junior high. my mother grew up in a very isolated area and was home schooled (they lived on a mountain where my grandfather was a mining engineer) and so she never had chickenpox as a child. (she got good and sick with measles when she was sent away to boarding school as a teen.) when i brought chickenpox home from kindergarten, my 2 year old brother got it-- and so did my six-week-old baby sister, because although she was breastfed she got no immunity from my mother, who lacked it. and my mother was very ill indeed, with pneumonia and permanent neurological damage to her eyes, and at 6 weeks postpartum, too. i had a boss who got chickenpox as an adult and damn near died of it when she grew the pox lesions in her lungs. no laughing matter, i promise you. at our house we had measles and mumps the same spring-- i can't remember who had what first, but one of us had mumps while the other two had measles (sister was in the hospital with asthma, so she missed out on all of it), and then two weeks or so later we all the the one we didn't have before. quite a spring. both of my kids had chickenpox in a rare fall outbreak-- it's usually a disease of springtime. they were sick, but they did fine with it. in immunoincompetent kids (like kids with chronic diseases, cerebral palsy, leukemia or other malignancies...) it's life-threatening. and of course, when we get old and become relatively immunoincomptetent, we'll be at risk for shingles- another condition that doesn't sound too bad until you know somebody with it. you know how your foot burns as it recovers from being "asleep" after you've crossed your legs and compressed the peroneal nerve in the back of your knee? you can stand it because you know it will be fine in a minute, but it hurts like a sunuvab**** for that minute, doesn't it? that's nerve pain...and shingles is nerve pain caused by the varicella (chickenpox virus) that's been living in there since you had chickenpox as a child. it wakes up and expresses itself along a nerve root distribution-- you can look up "dermatomes" and see where they could be. imagine that burning pain reaching from your spine all the way around your chest like a handful of flaming fingers...and it doesn't stop in a minute, it goes on for weeks, and the skin over that dermatome breaks out like one huge chickenpox lesion. that's shingles. there is a vaccine for elders for it now, with variable effectiveness (because you have to have a good immune system to make antibodies from getting a vaccine, and elder immune systems can be a little weak). but how much better would it be if the kid never got it in the first place. people have no idea what it would be like in about two years if there were no effective vaccines for these diseases, because they have no cultural memory of them and they know them only from cartoons. ta'int funny, mcgee, as my grandmother (who lived through the 1918 influenza epidemic) would say. getcher fool immunizations and be done c it.
  5. nurseprnRN

    Can a fat nurse be a good nurse?

    yep. (5'10", 250#, and earning a great income at what i do) and btw, did anyone see the recent study that found that people with higher levels of environmental chemicals in their blood are more likely to be obese and diabetic, that in people with low levels there is lower obesity and no relationship between obesity and diabetes, and children who had higher levels in their cord blood are many times more likely to be obese and diabetic as they grow? i wonder how much of the soaring obesity rates in my (boomer) generation and younger can be related to the chemical soup we grew up with and live in now? food for thought.
  6. nurseprnRN

    Next time you're at Jimmy John's.....

    my kid gave me an apron, which i cherish, that says, this is not burger king. you'll have it our way or you won't have the son of a ***** at all.
  7. nurseprnRN

    Why do so many nurses not know how to spell?

    " for information only it is: mistakes not mistakeas communicator not comminicater grammar not grammer just saying. if you are posting in the hopes of improving these things in others. spell them correctly yourself." (sic) of course those were spelled wrong, and completely intentionally. sorry that i forgot to include the rolling eyeballs; i was quoting the threads as they come to me, with all the errors that characterize this sort of thread, and neglected to realize that irony-recognition isn't high here. my bad. i am glad to see that one person recognizes those errors, though.:lol2:
  8. nurseprnRN

    Why do so many nurses not know how to spell?

    i regularly get into discussions like this in various lists and such. i edit my professional journal and am dismayed by the errors in submissions i get; i review thousands of pages of medical records every year (hell, sometimes thousands every month) and it's scary to see how many health professionals cannot accurately convey information on patient care in writing. this makes for very interesting legal issues sometimes...just saying, in case you think nobody ever reads your charting or if someone did, it wouldn't matter "because they know what i mean." wrong-o. i'm the one who had a vicious 8th-grade english teacher and whose visual learning style makes misspellings, grammatical errors, and ridiculous usage leap off the page and spit in my eye. the threads always proceed like this: 1) (whine about how unfair it is to be judged on misspellings. i am a good person and people think i am bad because i don't spell. i know i don't spell well but i won't change. they prejudge me. i communicate perfectly well, all my friends say so.) 2) what difference does it make? we all have spell-check now. you are a good person and a good communicater even if you don't spell. good post! 2a) everybody makes misteakes. who's perfect? let them cast the first stone!!!!!!! 3) misspelling and bad usage, especially of professional terms, are sloppy and unprofessional. you don't have to like it but potential employers will hold that against you, especially if you do it habitually and make no effort to change. bad habit, not a badge of honor. 3a) we can tell the difference between simple typos (the/teh, adjacent letters being hit by a rapid-fire fingertip, e.g.) and habitual errors (there/they're/their, its/it's, [and in our world] mucus/mucous). 4) you grammer nazis make me sick! we are here to be supportive of fellow professionals! this isn't formal writing! this forum is to share ideas! nurses eat their young! (or some variation thereof). (although i must say my favorite example of all time came out "... make me sic!" my fellow editors will get why this made me hoot out loud and i will remember it to my grave.) 5 ff) repeat all of the above ad lib., in any order desired. weep over your strunk and white, and go write a nice note to grammar girl (http://grammar.quickanddirtytips.com/) follow thread until you're sick of reading it; give up on the idea that grammar and usage will ever improve as long as so many ignorant and poorly-taught people find it irrelevant. that would be right....about....now.
  9. nurseprnRN

    Nurses in TV Shows

    i loathe gray's anatomy because they make it very clear in every episode that the biggest insult you can give a physician is to mistake her for a nurse. screw that. for really great insight into how to respond to how tv, movie, and print media make us look stupid, subordinate, and insignificant in health care (and to the people all around us who learned that lesson ooh so well), check out the truth about nursing, found at www.truthaboutnursing.org you will be glad you did.
  10. nurseprnRN

    why is this patient not allowed to die?

    from a strictly legal standpoint, no one else can sign permits for her surgery unless that person is her legal guardian. hospitals often have a spouse or parent sign for an adult in an emergency, but that's mostly as a way to make the signer think that if "something goes wrong" then they will be less able to sue, because, "well, i signed the permit..." in a true life-or-death emergency, no permit is needed for surgery, because the law assumes (perhaps inaccurately, but it does the best it can) that a person would want to have his/her life saved in a life-threatening situation. for other interventions, a permit signed by the legally responsible person is needed. this is often ignored, but you could press the issue and object to further treatment. she cannot be declared incompetent without a legal hearing-- just having some physician or psychologist say so is not legally binding. therefore, you need to consult an attorney about getting guardianship over her, stat. once you have that, you can take her home and enroll her in hospice, or refuse care that you think is prolonging her agony, because you are her guardian. you could make them order her for palliative care or dnr, comfort measures only. if you are strong enough for this route and have the support of your family, then god bless you for it. can i be your sister too? we can all stand with you.
  11. nurseprnRN

    My concience is beating me up....

    oh. my. god. 1) your "friend" knows perfectly well that what she did is a crime; she knows you know it too. and she chose to do it anyway, and to involve you in it by telling you. 2) narcan (naloxone) is given to reverse effects of opioids, not benzodiazepines (like ativan, lorazepam). so your "friend" also doesn't know what she is doing when she does what she knows she shouldn't do. 3) if there's such loose control over controlled substances in your facility, there may well be other people abusing (and being abused). this has to stop. will you get into trouble for not reporting this instantly? yeah, probably some. but i can absolutely promise you that if you go in there and say, "i am so sorry i didn't tell you right away but i was so stunned i just froze. i'll take whatever punishment you want to give me," they and the board of nursing will let you off a great deal easier than they will when they catch her (and they will, they will, sooner or later; count on that) and she tells them you knew all about it. in fact, she may be counting on that to keep you quiet. some "friend." get in there first thing tomorrow morning; report to the facility risk manager if you are too afraid to go to your manager. you might get anonymity that way. maybe. or maybe not. but this is your professional responsibility. let us know what happens!

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