Silly question about asthma

[mc3]

Occasionally I'll get one of my asthma students complaining about an asthma attack, but her lungs are nice and clear - no wheezing or diminished lung sounds. Vital signs are normal; no signs of respiratory distress but is open mouthed "wheezing" and heavily breathing, but I don't here anything amiss in her lungs. This girl has come with this twice, and has an inhaler here but she says it's not helping. Answers "yes" or "no" to questions. I'm not sure if she's being a drama queen, but I'm highly suspicious of this behavior . Each time I've called parent and reported my findings, and they've come to pick her up. Is it possible I'm missing something here? I've seen genuine asthma attacks, and they are indeed scary. Naturally, I don't want to overlook anything with her, and I always err on the side of caution and call parent...

Thanks for your input!

mc3:nurse:

[HangInThere, BSN, RN]

Well done, and good luck with those parents.

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

Well done, and good luck with those parents.

Thanks. It went fairly well.

1. They think their son has emotional issues which trigger the asthma and they use soothing methods at home to calm him. After his inhaler is used of course. Totally fine - but I made sure they realize whatever triggers the asthma attack, it IS an asthma attack.

2. They usually sneak him into the local clinic when he has these issues that the inhaler won't help. I made sure they realized I had no idea they did this and did not even know if the local clinic would "sneak" him in if I brought him.

3. They wanted the folks on the emergency list called first before we did anything like go to the ER. I made sure they realized that if his breathing issues are heading towards anything bad I'm not taking time to track down their emergency contacts. I had spoken with their babysitter who actually works at the school and I had left them a message on voice mail. If it tends towards a breathing emergency, to the ER we go.

4. They were concerned about insurance as they just signed up for (Obamacare) . . .. . two days before that day and are worried with all the snafus that their son has no insurance. I completely understood this concern but I won't check to see if you have insurance before I take your kiddo to the ER when he can't breath well.

5. This one is totally legit - their son was afraid his parents would get into trouble because the fact that they wouldn't let us have an inhaler at school was discussed in front of him in the ER because the physician specifically asked me. There was most likely some judgmental tone in some voices and I will admit to frustration in mine. So, yes, be careful about what you say in front of the kiddo.

6. I found out that this child's physician would not give them a prescription for another inhaler to have at school because she was worried about tachycardia (although he has no heart or other issues with have a fast heartbeat for awhile). Asthma and potential severe respiratory distress beats benign baseline tachycardia anyway. Right? I know this doc and like her and we work together with her hospice patients. She's really good and compassionate and makes more house calls than most docs. But on this, I disagree. The parents are fine that the ER doc wrote an Rx for an inhaler and that I have one at school now. But why didn't I know this when we asked about an inhaler at school since the beginning of school??

They kept saying they were not judging my medical decision - although they did ask "why take him to the ER when his 02 Sat was 96%". I explained that you look at the patient, not the numbers, and then went into the physiology of impending respiratory failure and how kids can compensate until they crump.

All in all a good meeting because they didn't fly off the handle. They had a written list of concerns. The principal let me have the meeting alone, which was great.

If all parents were teachable . . . .life would be good.

[Artistyc1]

Oddly, I had a child that was doing this. I even sent her to the hospital once, as she managed to be coughing to the point of vomiting. She wasn't helped by the inhaler. I am studying to be certified as an asthma educator, and found literature that was citing something called a "habitual cough". We found that we just had to tell her "Stop that!" and, she stopped.... It is VERY strange, but thought I would put that out there for you. She had her classroom turned upside down for MONTHS. Yet, her color would remain good; did find out that there were problems at home, but never really addressed that issue.

[Sudsy]

]Despite numerous requests, the mother has repeatedly refused to bring us a doctor's note or an Asthma Action Plan.

mc3:no:

In my state (MA) I just call the doctor's office and ask them to fax an Asthma Action Plan over. Then again, I am pretty sure it's a law here, and if it's not a law where you are.....

Good luck.

[Sudsy]

Wow, Spidey's Mom: big pat on the back!

[JenTheSchoolRN, BSN, RN]

Wow, Spidey's Mom: big pat on the back!

Ditto! You handled that beautifully in my eyes, Spidey's Mom! Asthma is no joke. I always, always watch those kids like a hawk - this winter on the East coast has been a bear for those kids with asthma in my school!

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

Thanks. I can't help but feel badly about their medical bill - hoping the insurance kicked in. But, they had not communicated with the school or with me about anything.

They aren't poor. They own a couple of businesses here in town. They aren't rich either.

Kid's health comes first. I need to talk with their doc to see if it is true that if the kiddo is having breathing trouble, she wants him brought to the office (which is steps away from the ER).

[Flare, ASN, BSN]

no, i have no regrets about sending a child out when i feel it's warranted and i have no second thoughts, especially when i know that they are insured. I'd rather them be looking at a hospital bill than a mortuary bill. And like you stated, had they just done what you had asked, it may have never come to that.

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

no, i have no regrets about sending a child out when i feel it's warranted and i have no second thoughts, especially when i know that they are insured. I'd rather them be looking at a hospital bill than a mortuary bill. And like you stated, had they just done what you had asked, it may have never come to that.

Absolutely - I have no regrets for taking him in. It was the right thing to do.

[Graciehope]

Can anyone give me more information on the Asthma Educator Certification?