Silly question about asthma

Finally2008 · Nov 3, 2013

I have two little girls who present exactly as this girl seems to be. They both sit nicely and calmly and all their vitals and breath sounds are fine, but they tell me their inhalers didn't help. As one little guy told me one time, though, "No one else knows what I feel like inside." At least her parents are good about coming when you call!

anie10 · Nov 3, 2013

the little girl may be faking, however as an asthmatic the previous poster is right. You don't know how I feel inside when I am having an attack.

Additionally, you may be setting the school system up for a lawsuit if you feel she's faked it for the last time and you are WRONG.

You kind of remind me of the nurses that were in my daughter's school when she was a child that would say "Well, if she's allergic to peanut butter, she just shouldnt eat it.":cautious:

SaoirseRN · Nov 3, 2013

Erring on the side of caution is probably the best thing to do. Who knows, like the little boy a couple of posts up, perhaps what she is feeling is subtle enough not to be seen by you, but maybe she knows from experience that when she starts feeling that way, it's going to get worse. Could be she goes home, has a nebulizer treatment and feels better.

Jolie, BSN · Nov 3, 2013

...you may be setting the school system up for a lawsuit if you feel she's faked it for the last time and you are WRONG.
You kind of remind me of the nurses that were in my daughter's school when she was a child that would say "Well, if she's allergic to peanut butter, she just shouldnt eat it.":cautious:

I'm sorry that you are not satisfied with the nurses in your daughter's school, but I dont think that justifies jumping on this poster who specifically asked for information and advice because she wants to "err on the side of caution" in regards to her students.

To mc3:

I encourage you to fully assess each student who comes to you, each and every time. This will help to accomplish 2 things. First you will come to know the students and their individual presentations so that you will eventually be able to detect subtle deviations from the norm that they may be experiencing. Secondly, it will help to build trust. Students want to be taken seriously. Knowing that the nurse will carefully evaluate them each and every time will build trust with truly ill children and drive the fakers away.

I wholeheartedly agree with the statement that only the student knows how s/he is feeling at the time. Looks and assessments CAN be deceiving. So once my assessment is complete, I always give the inhaler to a student requesting it who has a valid order, regardless of my interpretation, and hold that student for observation for a period of time. Following up with parents, as you have been doing, is important also.

Keep in mind that other conditions, including anxiety, vocal cord dysfunction, respiratory infections, reflux, allergies, etc. can mimic asthma.

Thanks for the discussion :)

mc3, ASN, RN · Nov 4, 2013

Umm, I think you're being a little hostile. I did say I always err on the side of caution, correct? You don't know me at all; I told you how I always respond whether I think it's genuine, fake or in-between.

You kind of remind me of someone who makes judgments while disregarding the facts. :sarcastic:

mc3, ASN, RN · Nov 4, 2013

I'm sorry that you are not satisfied with the nurses in your daughter's school, but I dont think that justifies jumping on this poster who specifically asked for information and advice because she wants to "err on the side of caution" in regards to her students.
To mc3:
I encourage you to fully assess each student who comes to you, each and every time. This will help to accomplish 2 things. First you will come to know the students and their individual presentations so that you will eventually be able to detect subtle deviations from the norm that they may be experiencing. Secondly, it will help to build trust. Students want to be taken seriously. Knowing that the nurse will carefully evaluate them each and every time will build trust with truly ill children and drive the fakers away.
I wholeheartedly agree with the statement that only the student knows how s/he is feeling at the time. Looks and assessments CAN be deceiving. So once my assessment is complete, I always give the inhaler to a student requesting it who has a valid order, regardless of my interpretation, and hold that student for observation for a period of time. Following up with parents, as you have been doing, is important also.
Keep in mind that other conditions, including anxiety, vocal cord dysfunction, respiratory infections, reflux, allergies, etc. can mimic asthma.
Thanks for the discussion :)

Thank you for your support. I always do as you suggest. I was just really wondering, that's all.

mc3 :nurse:

NutmeggeRN, BSN · Nov 4, 2013

Some kids do fake asthma symptoms and some present with asthma like symptoms when it is actually stress/anxiety.

100kids, BSN, RN · Nov 4, 2013

I have a frequent flyer who often asks for his inhaler when I think he's faking BUT... I do an assessment, give him his inhaler and get in touch with his dad to let him know his vitals, my assessment and that he used the inhaler. I document it all. This child comes in with lots of different "ailments" all day long but I am not denying access to an inhaler. It's good her parents are so responsive to you. Keep it up. You're doing everything you can at that point.

fetch, BSN, RN · Nov 4, 2013

If you are comfortable doing so, sometimes I have them sit quietly with water after my initial assessment to see if that helps - sometimes after a few minutes they start talking to me and perk right up, like they need to know someone is believing/caring for them as suggested above. (Or like they just got worked up in class/outside, and need a few minutes away from friends to calm back down.) After 5 minutes and 1 water, I re-listen and ask if they feel like resting helped or if they need their inhaler. I usually try to validate how they are feeling when I do that - "your lungs sound OK to me but I know sometimes your lungs feel tight before I can hear anything. Do you feel like you need your inhaler right now, or do are you feeling better?"

I would never tell them flat-out "no," even when I think there's nothing going on, but sometimes that sitting quietly part helps them calm down enough to realize they're ok.

Also, for the inhaler that isn't helping - did you check that it's not empty? I know, silly question! But I've been fooled before by those ProAirs that didn't have the counter on the back and wondered "gee why isn't this working" - well duh, can't work when there's nothing there!

BSNbeauty, BSN, RN · Nov 6, 2013

I've seen the same thing. I always give the inhaler and if no relief call the parents. Thats all we can do. I do not think you are missing anything,

pjwb061076 · Nov 20, 2013

This is definitely not silly... Just this year I've been struggling with the same thing. My student does not present at all. Lungs are clear, shows absolutely no signs of distress. She talks and I can even get her to smile. But when prompted or asked to help during the assessment she becomes obstinate in her behavior. When asked to breathe, she will actually stop breathing on purpose so I can't hear her. I've questioned myself over and over if giving her medication is the right thing. I even faxed a letter over to her doctor asking for help in determining her presentations, and if they could suggest anything. The MD never contacted me back. It's to the point where I simply assess and then always give her the medication because I don't know how she feels, but I am very frustrated.