Musculoskeletal Injuries

[SchoolNurseTXstyle]

Half of my clinic traffic is from old or minor injuries. I am at a middle school and they want ice for every tiny ache. I rarely see a kid with swellling or discoloration. The ROM is hard to assess beause they are so dramatic. I have them walk and get their own ice out of my freezer to see how they use affected limb.

Many parents send them to me for ace bandages / treatment for injuries that occurred outside of school.

1. I can't afford ace bandages. 2. I feel like ace bandages assume I have made a diagnosis and am now prescribing treatment.

Football players especially take up a lot of my time. I feel these kids are just utilizing an excuse to miss class. But, the one that you don't take seriously...........

Just curious on how other school nurses handle this on a day to day basis. I am seeing at least 15-20 kids out of 50-60 for what seems like nothing!

[mustlovepoodles, RN]

I think you are describing a pretty common experience among school nurses. I worked in a middle school before I transferred to elementary and I have to say, middle schoolers were waaaaaay worse about complaining over every little non-existant boo-boo than my 5yr olds are. Wah, wah, wah! All day long. Ooooh, the drama of it all. It got so bad that the principal decreed that ice packs could not leave the clinic--those buggers were using the ice as weapons to throw at each other, leaving big slippery puddles everywhere.

So I had to get serious about it. My rule was ice packs are issued only for injuries sustained in teh past 24 hours WITH evidence of swelling or bruising. No bruising? no ice pack, mister. You get a cold wet paper towel and back to class you go. Those who need an ice pack are required to sit quietly in the clinic with me, listening to my Beethoven CD for 10 minutes. That alone discouraged some of my kids! Range of motion can be tricky.

I always test range of motion on the uninjured side first. Well, that's not entirely true. I actually take a wrist, elbow, ankle into each hand, with my eyes focused on teh UNinjured joint. I gently feel around the joints to see if there is anything obvious. I set my gaze on the uninjured joint and talk to that joint while I'm manipulating BOTH joints at the same time. It's pretty amazing how this sleight of hand works. MAny, many times the "injured" joint is fully cooperative as long as I'm talking to the uninjured joint.

Of course, now and then something slips by me, but generally I have a pretty good BS detector. Good luck. Middle school nursing isn't for wimps!

[NutmeggeRN, BSN]

Mustlovepoodles, you are killing me!!!!!

[Flare, ASN, BSN]

i usually like to keep a few ace wraps on hand- but only for brand new injuries that i feel would benefit from a little compression or support before a more formal assessment can be made. Honestly, i don't even like to re-wrap the home applied ace bandages, but i will if it's been wrapped incorrectly. Don't even have any ace wraps in my new school - so these kids are outta luck until i can do an order of things that i want.

I've refined my BS detector over the years too - i'll tell the kids that you can tell are just going to go on and on about needing ice that they can ice it for a few minutes only during their free period - magically, when the treatment in on "their" time it gets forgotten about.