Asthma Question

[Mrs.B]

I have a student, an asthmatic, who was recently put on Advair (takes that at home), uses an Albuterol inhaler PRN and also has an order for Albuterol nebs PRN. She is a very gregarious and charming 7th grader that I have gotten to know fairly well during the school year.

She comes to my office at least once a week c/o "tightness" and "wheezing." She is never SOB and upon listening to her lungs, I have never ONCE heard anything remotely sounding like a wheeze. I used to just have her sit "catch her breath" using some breathing techniques I've seen RTs do in the hospital and send her back to class never to hear from her again for the rest of the day.

Anyway, mom called me the other day and asked me (nicely, I might add) to please give her daughter a treatment whenever she wants it b/c "it makes her feel better." Mom also said that if she doesn't get a treatment when she c/o "tightness" that it is a s/s of the begining of a real, true, massive asthma attack. She also said that her daughter "always gets like this, this time of year (spring)." Mom denies that the student has any allergies but said that she'd be taking her daughter to the doctor over easter break. I took the inititive today and called the MD myself to ask him what he thought about mom telling me to give her nebs. Unfortunately, he wasn't very familiar with her case and wasn't able to help much. Except he was nice enough to say that he'd recommend allergy testing and would talk to her about exactly how much medication she's getting at home.

So, am I right to be wary about not giving this student a PRN neb who is: in no apparent distress, not SOB, not wheezing, and is talking, singing and fooling around in my office just b/c mom says she wants her to have it. I know that if she were a pt in the hospital and I called RT to come and look at her they'd tell me I was crazy and would NEVER give a tx unless it was ordered RTC. Is it possible that she is being overmedicated at home and her parents are enabling her? Am I being overly cautious? I feel like I'm doing something wrong.

Most important question: AM I MISSING SOMETHING HERE??????

Thanks,

Deb B.

[Sarah, RNBScN]

Send her to an asthma/peds. clinic for additional health teaching which includes the parents.

Something isn't right.

What is that saying? Never cry wolf....

[Mrs.B]

I put in for the $ for a peak flow meter today. The principal wanted me to write a letter explaining exactly what it was and what it was for (!). Meanwhile, with extra mouthpieces and s & h the total bill was $25 bucks!! It's not like I was asking for a raise, right? Well, hopefully I'll get it.

And....FYI...the famous student that prompted this discussion, has not been to my office once since I wrote my posting!!!

How's that for irony?

Watch, she'll walk in my door next period.....

Thanks for the advice!!

-Deb

[nessa1982]

Well at least with extra mouthpeices it can be used in the future :)

Hopefully all goes well

[kids]

Originally posted by renerian

For me, and I have been asthmatic since the age of 2 (now 46) wheezing comes late for me and I am in real trouble by them. I get tight fast, cough then wheeze, if I don't do it when the tight hits, I can still talk and such, I am in deep doo doo. I will be blue in minutes. I seldom wheeze but I always always cough. Does she cough? As a kid I was hard to pin down even in some of the attacks.

renerian

My daughter was dx w/ asthma at 6 and RAD at 10. She will sometimes have a short, infreq dry cough. She doesn't start wheezing until she is blue.

Her Ped was great...she encouraged her to "own" her asthma and to pay attention to what her body was saying to her, tighness in her chest and an ache in her mid back is her signal that her MDI isn't doing the job. Her need for tx is very dependant on her internal signals and she has ended up intubated a couple of times because an ER doc wouldn't listen to her words, only her chest and looked at "her" and not her ABGs. By 14 Andrea could guess with accuracy when she needed a neb tx, prednisone or a dose of Aminophyline.