Asthmatic Child

  1. I wanted to get your guys advice on a situation I had experienced last week. A little background about me is I have been a nurse for 7 years adult inpatient nursing. I began to sub as a school nurse not all that long ago. I bounce around to different schools. I came into a complex situation. I had a elementary student come to me just a few mins prior before school let out for the day
    with asthma attack. He was flushed, headache, tachy, coughing, sob, and wheezing a/ stethoscope. He was able to tell me his name and I seen he had a PRN inhaler. I administered as ordered. Pulse ox was not located with other equipment so there was 1 min delay in taking it he had 1 puff of inhaler. O2 Sats 94%. It occurred to me To ask if the child rode the bus since they were beginning to dismiss students. He said yes. He's sats did go to 98%, ranging 95-98%, sob lessens, color much better, no coughing, wheezing isn't as pronounced-still heard. It's obvious child symptoms are starting to dissolve. Also At the time a long term staff member was in the clinic with me said mom never answers the phone. This school is in a lower poverty area, so that's not uncommon, even if the child does have a life-threatening condition. However, i still attempted to call-she DID answer. I let her know the situation she said "put him on the bus. I have no other vehicle or any other means for him to
    get home." She assured me she'd be at the bus stops with his treatments and the bus ride wasn't long. I did what she asked and escorted the child
    to the bus. I didn't feel he needed the squad, but I also wasn't 100% comfortable whim getting on the bus w/o a parent or health care personnel, despite he was going back to his baseline. My ultimately goal is to keep this child safe and well. Is there something else I am missing I could have done differently or more efficient? What should I have done if she didn't answer the phone? It just through me for a loop! Thanks I'm advance!
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    About cjl_RN

    Joined: Apr '18; Posts: 13; Likes: 4

    8 Comments

  3. by   iggywench
    I probably would have done the same thing. If you felt like the child wasn't in any danger, your only choice was to put him on the bus, since mom wasn't able to come. You don't want to keep a child off the bus, then have to try to figure out how to get them home.
  4. by   OldDude
    Under those circumstances I would have done the same thing. There is adult supervision on the bus and they have the ability to summon help if needed.
  5. by   ruby_jane
    Quote from cjl_RN
    I didn't feel he needed the squad, but I also wasn't 100% comfortable whim getting on the bus w/o a parent or health care personnel, despite he was going back to his baseline. What should I have done if she didn't answer the phone? It just through me for a loop! Thanks I'm advance!
    That's because you're a good nurse! Document the pants off of "parent declined to pick student up." If you could not reach a parent and you did not feel confident sending the kid on the bus....I'd have called EMS. Even though I know that the bus driver will stop and call EMS if needed. Those are individual judgment calls that are made as you are assessing your student and there's no cookbooking them. I would rather not be "that nurse" that sent the child on the bus if s/he is going to worsen. You could document that the child had improved, and that parent declined pick up despite being told the situation. Good job.
  6. by   bsyrn
    I Agree with the others, you did the right thing but make sure you document it well. I would prepare a care plan and emergency action plan detailing what to do in case of emergency, including if Mom does not answer. Get some good emergency contact numbers also.
  7. by   cjl_RN
    I am only a sub right now and there was emergency plan but it was very basic. But i also
    Seen in the medication log The student had been coming down more Regularly for inhaler within the past week. Maybe the regular should look into a prophylactic dose? His attack was stimulated by activity it was "fun Friday".
    Or since he does have asthma w/ frequent pen inhaler use he should be assessed during school hours and not just when he has an attack. But you guys know more than me, I'm Still very new to this type of nursing!
  8. by   cjl_RN
    So I asked the Head school nurse and she said if you can't get ahold of mom in that situation and the child was moving air and symptoms were
    Improving and not declining put him on the bus. He was not critical enough to be squaded out,
    But I felt a parent should have been with him until attack completely subsided. However though my mom is an ER nurse who said she wouldn't have put him on the bus if mom didn't answer put noticed the principal who should have been able to drive student home ( I don't know about this and she isn't a school nurse)
  9. by   cjl_RN
    Like I've said I'm still learning everything, but don't the bus drivers get a copy of the care and action plans ?
  10. by   ruby_jane
    Quote from cjl_RN
    Like I've said I'm still learning everything, but don't the bus drivers get a copy of the care and action plans ?
    It depends. I am required by my policy to send the "bus barn" a list of students who have medical conditions (asthma, diabetes, those with EpiPens, those with seizures...)

    The bus barn then communicates this to the drivers - BUT even when we used to train our drivers, we learned that there are always sub drivers who have zero knowledge of what's going on. So reasonably, the only thing I can expect is for the driver to call EMS.

    Regarding your replaying this scenario with other nurses: good nurses do this - we trouble-shoot our responses all the time. Never make a clinical decision on what any other nurse thinks or says, though. You're the one on the ground. You are seeing what you're seeing. If your gut tells you to call EMS, do it! No principal I know would drive a kid home....if we're worried enough about the kid getting on the bus then we should call EMS.

    There was a catastrophic situation in Philly where an asthmatic child died because nobody was willing to call EMS. Unfortunately, that school didn't have a nurse on duty that day.

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