Hyperventilation

[Spidey's mom, ADN, BSN, RN]

Hi all. I'm wondering if any of you ever wrote up an Action Plan for a student with hyperventilation?

I had one student show up in one of the elementary school offices while I just happened to be on campus last week. The funny thing is I'd done the mandated training for our stock epi-pens the day before to the office staff and principal. (Long story about new law in CA about stock epi-pens and no volunteers stepping up to be trained).

I assessed the student; 02 Sat 97%. Lungs clear. HR 120. Resp 32. No signs of anaphylaxis and no history of asthma. I had her do pursed-lip exhalation/sucking on a straw inhalation and using her diaphragm to breath. Calming voice. Etc. It calmed her down and then she started up again. Couldn't get a hold of parents right away.

When dad showed up in about 15 minutes, she calmed down but then it started again. He ended up taking her to the ER per my advice. She was diagnosed with hyperventilation. Paper bag treatment and breathing techniques/calming atmosphere. It took about 30 minutes and she finally stopped.

My concern is the office staff said if I hadn't been there, they'd have given the epi-pen. I spoke with her doc and he doesn't want this as it will make hyperventilation worse. Parents don't want it either. Doc also said "Paper bag was an old treatment that had no real physiologic basis. In theory it may have changed some acid-base equilibrium but it probably has more of a psychological effect than anything. It is not the standard of care. I think if there is no history or exposure, no throat swelling, or other allergic signs, epi should not be used as it may make hyperventilation worse". (He's also an ER doc and Family Practice Doc).

Parents say this happens occasionally at home as well so she has a history of hyperventilation.

Anyhooo . . . .. .I want to write up an Action Plan using breathing techniques.

Anyone ever write one of those that I could look at and get some ideas for how to write it? It is fairly simple but thought I toss the question out.

Thanks!

[Farawyn]

Do you have little paper lunch bags on hand?

[Spidey's mom, ADN, BSN, RN]

Do you have little paper lunch bags on hand?

Did you not read that using a paper bag is not "standard of care"??

[Farawyn]

Did you not read that using a paper bag is not "standard of care"??

I did. I am just thinking about what actually works..

[OldDude]

So what do the parents do when it happens at home?

[Spidey's mom, ADN, BSN, RN]

So what do the parents do when it happens at home?

The breathing techniques I mentioned already.

I guess I want to cover my tush and only use standard of care information. Just wondering if anyone else had written up an action plan for this.

Obviously, I can just write it up as her doc wants me to . . . . .

:)

[Farawyn]

The breathing techniques I mentioned already.

I guess I want to cover my tush and only use standard of care information. Just wondering if anyone else had written up an action plan for this.

Obviously, I can just write it up as her doc wants me to . . . . .

:)

There a re a lot of bags in this thread. I'm not even talking about age.

[Spidey's mom, ADN, BSN, RN]

There a re a lot of bags in this thread. I'm not even talking about age.

Makes complete sense though. Breathing into a paper bag for hyperventilation is not standard of care and I distinctly remember reading this years ago.

Edited to add . . . since hyperventilation isn't a usual "disease" that we write action plans for I'll just ask the doc to write me a "prescription" of sorts and I'll go with that.

Thanks anyway.

[JenTheSchoolRN, BSN, RN]

With students like the one you mentioned, usually getting them to quiet place first happens, followed by a one-on-one coaching of breathing techniques. I've written plans that include the designated "quiet place" and person/people that can best serve that particular student, followed by the step-by-step techniques to use and what usually works best for the student. [but seriously, doc, if a paper bag helps a certain student, I don't care about the literature...]

The hard part, sometimes, is getting staff to remember this student is hyperventilating, not an Epi-pen worthy offense .

[OldDude]

I haven't ever run across a care plan for hyperventilation. I agree with you though.... if you can get something from the MD with a diagnosis and some sort of action plan. THEN, if the paper bag is part of the MD's order, you're clear!!

[Spidey's mom, ADN, BSN, RN]

With students like the one you mentioned, usually getting them to quiet place first happens, followed by a one-on-one coaching of breathing techniques. I've written plans that include the designated "quiet place" and person/people that can best serve that particular student, followed by the step-by-step techniques to use and what usually works best for the student. [but seriously, doc, if a paper bag helps a certain student, I don't care about the literature...]

The hard part, sometimes, is getting staff to remember this student is hyperventilating, not an Epi-pen worthy offense .

Yep, quiet place is good but that means the office with scared staff who might just use an epi-pen. I need to get something in writing to soothe their qualms. They hate the mandates on high from California legislators making the office a med clinic without a nurse consistently.

I haven't ever run across a care plan for hyperventilation. I agree with you though.... if you can get something from the MD with a diagnosis and some sort of action plan. THEN, if the paper bag is part of the MD's order, you're clear!!

Nope - no paper bag. Not standard of care. He was adamant.

Thanks again folks.

[JenTheSchoolRN, BSN, RN]

Does your school have a counselor? A private office (i.e. principal's office/guidance counselor)? Those may be two quiet places to escort this student to. Is there a staff member at that school that you feel could handle this student without reaching for the Epi-pen first?

This sounds like a nightmare that could become "Let's Epi everyone!"