Pain Management / Sedation

Letters to the Editor – July/August 2009

Opioids and the sleeping giant

“Avoid the dangers of opioid therapy” in the May issue discusses respiratory depression but doesn’t mention sleep apnea, a problem that can worsen with opioid therapy, especially in a ostanesthesia setting.

A recent study found that 75% of patients taking drugs for chronic pain had sleep apnea. Other studies show a higher-than-normal adverse event rate in perioperative patients with sleep apnea. And data demonstrate higher rates of unanticipated admissions to intensive care units and serious complications in postoperative patients with sleep apnea.

To detect apnea, nurses can use some simple questionnaires. Sleep characterized by loud, interrupted snoring can also alert nurses to the possibility of sleep apnea. Nurses should be aware of the sleeping giant that is sleep apnea, so they can reduce risk and improve patient safety.

Robyn Woidtke, RN, BSHS, RPSGT, CCRA, RAC
Castro Valley, CA

Safe drug disposal

In the May article “Avoid the dangers of opioid therapy,” the author says nurses should teach patients to dispose of a used fentanyl patch by placing it in a closed container or flushing it down the toilet. The safest way to dispose of a drug is incineration.

“Operation Medicine Cabinet,” a program available across the country, is designed to prevent improper disposal of over-the-counter and prescription drugs and keep them out of our water supplies. When questions about safe drug disposal arise, nurses should know that this program and others can provide the right answers.


Janet Reeves, RN
Youngstown, OH

An education on the nursing shortage

I read many articles on nursing staff retention and externships for new graduates, but I’d like to relate another side of the nursing shortage. I am an RN with an MSN who hasn’t had a bedside position in more than 20 years. Instead, I’ve worked in case management and discharge planning. When I found myself jobless at the end of 2008, I researched different routes to take as a nurse and located some online refresher programs. For me, the online approach was excellent, but to complete the course, I had to find and participate in a hospital preceptor program for 80 to 100 hours.

I reached out to several hospitals and other refresher programs to find the clinical hours I needed, but I never did. Several contacts never even responded to my inquiries. How is it that hospitals have no means to provide 80 to 100 hours to a nurse like me? Don’t they see that a returning nurse can help ease the shortage?

Melinda G. Silverberg, MSN, RN, CCM
Livingston, NJ

Clarification: “Making community health care culturally correct” in the May issue included the ASKED model on page 14. This model was written by Dr. Josepha Campinha-Bacote in 2002. For more information, visit: http://www.transculturalcare.net/Cultural_Competence_Model.htm.

Correction: In the April issue, the table on page 10 titled “Assessing cranial nerves in the unconscious patient” has an incorrect label for cranial nerve VII. It should be “Facial.”

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