Missed one

  1. I am still new but I feel like I'm pretty good at screening out my fakers. I've had a little boy be sent to me every day this week for a sore foot. He was playing around at home and fell down the stairs. Normal ROM, no swelling, and most importantly I saw this little one doing jump rope in PE without ANY signs of pain. I spoke to his mom the first day and she was asked if I thought she should get checked out and I said no (because of the reasons above).

    Guess who just came into my room escorted by her teacher who announced "Let's show the nurse what we have on our foot!" He has a boot on and supposedly has "multiple broken bones" per the teacher. I still haven't received any paperwork but I now feel a awful for missing it.
    •  
  2. Visit WineRN profile page

    About WineRN, BSN, RN

    Joined: Oct '15; Posts: 949; Likes: 2,827
    Specialty: 4 year(s) of experience

    47 Comments

  3. by   Kittery
    I've missed a broken foot, too, and like you, felt awful about it. But we do not have x-ray vision and can only go on our assessment. I would've done the same as you did, but this is my 5th year in school nursing and I've had swollen, black and blue fingers come back "just bruised" and fingers and toes that appear totally normal come back broken. So now my line is "this is what I'm seeing but fingers and toes (and feet) can be tricky so if your child continues to complain, get it checked out." Don't beat yourself up over this!
  4. by   OldDude
    Crutches?
  5. by   JenTheSchoolRN
    Meh, we will all miss something. After all, no x-ray vision and we're not perfect and the foot and hand can be tricky and often a small fracture can be missed, even after seeing a doctor. When a parent asks if a student seen "be seen," I, like Kittery, give them my mantra: if it doesn't improve or worsens, have someone take a look. But waiting a day or two doesn't make a huge difference really.

    And yep, I've also sent out very swollen ankles and toes to be diagnosed as badly bruised or a sprain and seen better looking limbs come back with a fracture diagnosis. I'm also in year 5 as a school nurse. I think we all ripen better with age .
  6. by   SaltineQueen
    I've had a string of possible sprains/breaks this year, some of them turned out to be sprained/broken, some not. And it's gone both ways - I've thought they were fine & it wasn't and I've thought it was sprained and it wasn't. When I'm talking to parents about something I'm not sure about I always add, "If there's not much improvement in the next two or three days you should get it checked by your doctor." Still feel bad when I'm wrong, though.
  7. by   Flare
    Don't beat yourself up. Some kids have an amazing threshold for pain. I've had kids with questionable broken arms that have played basketball at recess and gone about their day that have come in the next day sporting their shiny new cast. My own daughter wasn't taken to the ER for her buckle fracture in her wrist until almost 24 hrs later only because i noticed she was holding her arm funny after we picked her up from swimming (which she insisted she felt fine to go to). She was all smiles in the ER until they told her it was broken, then her face was all mopey. I am so glad i got pictures of before and after the news of the break (she was 6 at the time). Boy did I feel like i earned the horrible mom/ nurse award.
  8. by   ruby_jane
    Technically, according to your assessments, you did not miss anything. The student was walkie talkie and also jumpy.

    And it's also possible that the boot came from home because the parent placed it on the kid without going to see the doctor.

    Maybe he did something at home to exacerbate the foot. Smile and wave!! And see about crutches or PE restriction.
  9. by   NutmeggeRN
    Meh...I would not lose an sleep over it...and what is the issue with the teacher who needed to point out your obvious fail?! Aye yay yay....
  10. by   OldDude
    So how did this turn out?
  11. by   WineRN
    Quote from NutmeggeRN
    Meh...I would not lose an sleep over it...and what is the issue with the teacher who needed to point out your obvious fail?! Aye yay yay....
    This teacher likes to pretend her hand is better my thermometer (so many passes with "fever?" written on them). I had to talk with her at the start of the year because she would send me the same little ones multiple times during the day just for temp checks. So the fact that I was wrong about something was exciting to her.

    And currently the parents still haven't returned my call, and I haven't received any paperwork.
  12. by   kidzcare
    We have all been there. Like others pointed out, I've had situations where I was *certain* there was a fracture (immediate swelling, no ROM) and turned out to be a sprain. And I had a field day incident like yours- Frequent flier came in with pain to lower leg after falling. Sat in my office for 10 minutes with ice and then asked to go back out. Played in the bounce house, running around. Hairline fracture. His mom was not upset. She knew all the staff saw him bouncing around after and that things sometimes get missed.

    I had another kid after a PE injury who I couldn't decide if he was exaggerating symptoms because he seemed perfectly fine unless I asked him to raise his arms above the shoulder level. Waited 40 minutes for dad to come get him....broken clavicle.
  13. by   ruralseok
    Just be glad you didn't make it to Facebook for it to be shared multiple times, the local paper, and local tv. I made all 3 with 16 years of experience in school nursing. No deformity, bruising, swelling, Positive pulses, full ROM. Dozen kids in my office crying and puking. I felt horrible and thought I was going to have a nervous breakdown. I had a huge amount of support form coworkers and community although I couldn't say anything because of HIPPA. You had to know the family, they lived for drama. I am usually overly cautious.
  14. by   kidzcare
    Quote from ruralseok
    Just be glad you didn't make it to Facebook for it to be shared multiple times, the local paper, and local tv. I made all 3 with 16 years of experience in school nursing. No deformity, bruising, swelling, Positive pulses, full ROM. Dozen kids in my office crying and puking. I felt horrible and thought I was going to have a nervous breakdown. I had a huge amount of support form coworkers and community although I couldn't say anything because of HIPPA. You had to know the family, they lived for drama. I am usually overly cautious.
    Yikes! So sorry that you had to deal with that!

close