Minor Questions - page 5

If there is already something like this, please let me know, but I thought there could be a thread for minor questions that we would feel silly to start an entire topic for. I know there are a lot... Read More

  1. by   moreoreo
    Question:

    Today I had a third grader with hx seizures (used to have Diastat at school, MD states on most recent physical that condition is well-controlled with medication) come in stating she felt like she would have a seizure because she was "tingling." Student has come in VERY frequently lately but for other reasons (usually S/A). No other complaints other than having a headache in the morning. No fever. We had student lie down on cot. Health aide sat beside her throughout her visit. I called parent right away who stated one of them would arrive within 30 minutes. She hasn't had an episode in 2.5 years. I informed parent we would call EMS if she did have a seizure/lose consciousness/etc. Throughout the wait student was alert, smiling, even laughing, even as her arms and legs started to twitch(?) on and off. At no time did her overall body tone or consciousness change. When dad arrived I got the wheelchair and stayed close but she stood up and got into it so quickly I could barely assist her. Dad took her to the doctor.

    District nurse thinks I could have called EMS if she was twitching off and on for more than 5 minutes. Admittedly, during this time I had a scheduled procedure and many other students arriving. She was within eye sight so I kept an eye on her as I took care of the others and at no moment did I feel like she was unstable. I do realize I should have noted the time of the first "twitch" which I did not do, which makes the whole story hazy.

    Any thoughts?
  2. by   MrNurse(x2)
    Wondering if it could be something else, like anxiety? Her frequent visits may mean there is something going on in class that she is trying to avoid. Or, she may have been seizing. I don't think I would have called EMS if parents were quick in getting there, I may have called doctor's office for their advice. Please remember hind sight is 20/20.
    Last edit by MrNurse(x2) on May 24
  3. by   SaltineQueen
    Quote from moreoreo
    Does anyone know about how much it cost to implement their computer charting system? Our "system" involves index cards and Excel spreadsheets up the wazoo. Binders and folders galore. It's not something that I could decide to implement but I am just curious. When an inhaler is brought in or I have to note a new health concern I have to edit several different documents and print out new copies. It almost keeps me up at night to worry if I made sure I edited everything, even though I consider myself an organized person.
    We use CareDox, which I believe is free. I don't know all the in & outs, but I believe they do get non identifiable data from us. Some people really poo-poo CareDox because of that, but they are fully HIPAA & FERPA compliant. Our legal team did a review of their services before we started using CD & is confident in that.
  4. by   chiefswife
    Quote from grammy1
    How often do your diabetics change their lancets? I swear, one of mine says she only changes it when it's too dull to draw blood anymore.
    I try to remember to change the lancets at the end of every day - I have a 5th grader and a 4th grader who would NEVER change it if it was up to them and a kinder kiddo who would change it every time if I let her.
  5. by   MrNurse(x2)
    Quote from BethG73
    We use CareDox, which I believe is free. I don't know all the in & outs, but I believe they do get non identifiable data from us. Some people really poo-poo CareDox because of that, but they are fully HIPAA & FERPA compliant. Our legal team did a review of their services before we started using CD & is confident in that.
    When I was researching software I really wanted the free systems to be viable, but I found that should you need them for litigation there could be problems. I would assume being a legal team, they covered those bases.
  6. by   chiefswife
    Quote from moreoreo
    Question:

    Today I had a third grader with hx seizures (used to have Diastat at school, MD states on most recent physical that condition is well-controlled with medication) come in stating she felt like she would have a seizure because she was "tingling." Student has come in VERY frequently lately but for other reasons (usually S/A). No other complaints other than having a headache in the morning. No fever. We had student lie down on cot. Health aide sat beside her throughout her visit. I called parent right away who stated one of them would arrive within 30 minutes. She hasn't had an episode in 2.5 years. I informed parent we would call EMS if she did have a seizure/lose consciousness/etc. Throughout the wait student was alert, smiling, even laughing, even as her arms and legs started to twitch(?) on and off. At no time did her overall body tone or consciousness change. When dad arrived I got the wheelchair and stayed close but she stood up and got into it so quickly I could barely assist her. Dad took her to the doctor.

    District nurse thinks I could have called EMS if she was twitching off and on for more than 5 minutes. Admittedly, during this time I had a scheduled procedure and many other students arriving. She was within eye sight so I kept an eye on her as I took care of the others and at no moment did I feel like she was unstable. I do realize I should have noted the time of the first "twitch" which I did not do, which makes the whole story hazy.

    Any thoughts?
    IMO, I wouldn't have called EMS for the situation you described.
  7. by   NutmeggeRN
    I don't think I would have called either. Her care plan should identify the parameter, uncontrolled seizing over 5 mins, no relief with meds etc. I have a young lady who is due to graduate shortly and she has days where she is "twitchy', often it is related to fatigue.
  8. by   moreoreo
    Quote from MrNurse(x2)
    Wondering if it could be something else, like anxiety? Her frequent visits may mean there is something going on in class that she is trying to avoid. Or, she may have been seizing. I don't think I would have called EMS if parents were quick in getting there, I may have called doctor's office for their advice. Please remember hind sight is 20/20.
    That's a possibility. I felt bad because my health aide and I were just mentioning how she has been coming in an awful lot, always looking a little sheepish for coming in (as some of our frequent fliers do, as if they realize they are not really ill) but then yesterday was different.

    Quote from BethG73
    We use CareDox, which I believe is free. I don't know all the in & outs, but I believe they do get non identifiable data from us. Some people really poo-poo CareDox because of that, but they are fully HIPAA & FERPA compliant. Our legal team did a review of their services before we started using CD & is confident in that.
    That is super helpful to know. I am doing small bits of research to see if my superv can be convinced to consider any EHR. I am currently in a nurse informatics class and had to write a paper in which I was supposed to discuss "my facility's electronic record system" (and instructor told me to focus on now, even if my "facility" does not have one, and told me not to write about my last job's EHR) and most of her comments on the side of my paper are along the lines of, "I'm so sorry," "Hopefully your facility implements an electronic record soon," "this would be so much safer with an electronic record," etc.

    Quote from chiefswife
    IMO, I wouldn't have called EMS for the situation you described.
    Quote from NutmeggeRN
    I don't think I would have called either. Her care plan should identify the parameter, uncontrolled seizing over 5 mins, no relief with meds etc. I have a young lady who is due to graduate shortly and she has days where she is "twitchy', often it is related to fatigue.
    Thank you both for your thoughts. I think if my supervisor were here she may have felt differently, but then again her threshold for calling seems lower than mine at times (with fevers for example, but lower for broken bones). What's frustrating is that I came in mid-year and there are a lot of students who used to have care plans who I think should still have care plans who do not and then things come up and my supervisor says, "he/she should have one" (not blaming me, but kind of lamenting the fact that there has been so much turnover here that things have fallen through the cracks). Now there are just 10 days left of school but I have some doubts of how to act if this happens again. I asked Dad to fax the school a clearance to return and any instructions (apparently doctor did not feel this was a seizure) but we haven't received anything yet . Hopefully I can get a release and sort things out but there is so little school left.

    Thank you everyone. I should just rename this thread to "moreoreo's neediness thread" but I'm glad others have been posting their minor questions!!
  9. by   WineRN

    Situation:

    I had a special needs student brought to me because they noticed he was chomping on something that was plastic during class. No one could ID what it was and the student was fighting them when they tried to get him to spit it out so they rushed to my office. I tried to spray some water in his mouth but that caused him to swallow so the para ended up holding his arms down so I could get his mouth open to start scraping his tongue with a tongue blade. He actually like it and stopped fighting pretty quickly so I got a lot out but I know he swallowed some. I called home and his parents said that he does that when he is angry and didn't seem to care.

    Question

    How do you get a tiny one to open their mouth?!
  10. by   moreoreo
    Quote from WineRN

    Situation:

    I had a special needs student brought to me because they noticed he was chomping on something that was plastic during class. No one could ID what it was and the student was fighting them when they tried to get him to spit it out so they rushed to my office. I tried to spray some water in his mouth but that caused him to swallow so the para ended up holding his arms down so I could get his mouth open to start scraping his tongue with a tongue blade. He actually like it and stopped fighting pretty quickly so I got a lot out but I know he swallowed some. I called home and his parents said that he does that when he is angry and didn't seem to care.

    Question

    How do you get a tiny one to open their mouth?!
    Pinch their nose? I know that is an old school technique and maybe not the safest so I'm curious to hear other ideas!
  11. by   SaltineQueen
    Quote from MrNurse(x2)
    When I was researching software I really wanted the free systems to be viable, but I found that should you need them for litigation there could be problems. I would assume being a legal team, they covered those bases.
    Tell me more, please...
  12. by   Ree250k
    Quote from SaltineQueen
    We use CareDox, which I believe is free. I don't know all the in & outs, but I believe they do get non identifiable data from us. Some people really poo-poo CareDox because of that, but they are fully HIPAA & FERPA compliant. Our legal team did a review of their services before we started using CD & is confident in that.
    Do you know if Caredox takes insurance?

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