Annoyed and perhaps a little unsure

Published

Hey all. I'm looking for some reassurance.

Had a first grader get sent to my office yesterday after walking under the monkey bars and subsequently catching a shoe to the face by the other kiddo swinging on said monkey bars. No s/s of injury were seen. PERLA was appropriate. Kiddo says their vision is a little blurry. Had them rinse their eyes out and I placed an icepack on it. Kiddo has icepack on their eye for 10 minutes and I reassess. No changes from initial assessment. Kiddo keeps rubbing their eye and says the blurriness is still there, but "just a little bit". Told kiddo to stop rubbing their eye and to rinse it out again but that I felt they were ok to return to class. Again, there were absolutely no signs of injury at all. Student denied any pain. Made sure to tell LD that if their eye wasn't better, or if it got worse, within a set time frame (i sent a note to the teacher with the time frame of 45 mins-1 hour) to make sure they came back so I could check them out again. Kiddo verbalizes agreement and takes note back to teacher. I don't see kiddo the rest of the day. Teacher says they never complained again.

Today I find out the parent called the teacher super mad yesterday about not being notified and now wants to speak to our principal about it. Now I'm second guessing everything I did yesterday and am stressing out about the whole situation.

Oh. And according to the student, (who has been in class all day with absolutely no complaints) they have an eye appointment today to make sure they haven't lost any vision in their eye.

How badly do you think I messed up?

I had the opposite today - wrist injury that I suspect is fractured. Dad who is an EMT used his x-ray vision to let me know I was wrong. Never once have I seen this girl in my office. Dad had her in tears before finally taking her. After reaming me out for not stocking OTC pain meds.

Ok dude, whatever!!! Buh-BYE!!!

I am sure I will see her first thing Monday morning...

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Specializes in 25 years NICU 5 years Telephone Triage.

I am a nurse in telephone triage. Whenever a caller with a head injury has blurry vision, we send them to the ED to r/o concussion. Blurry vision is a symptom that needs to be evaluated same day, but not necessarily by an eye dr. more ED because they can do a CT scan if needed. that's our policy anyway. But you do have to be cautious with eye issues. He might have been rubbing his eye to try and clear his blurry vision.

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Specializes in Lie detection.

Good assessment and I'm glad it wasn't serious. Calling parents is a PITA for sure and I try to avoid it if possible. But for this I would have called for sure. I always imagine what the kid might say when they got home and your likely said something like " oh I got kicked in the face at school today". Mom freaked and is now pissed.

I've been in a similar situation and just learned to pick up the phone and avoid the drama.

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Specializes in Peds, School Nurse, clinical instructor.

You didn't mess up, next time just call the parent ?

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Specializes in 25 years NICU 5 years Telephone Triage.

I would definitely call with any type of head injury, especially with blurry vision.

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Specializes in Pediatrics Retired.
23 hours ago, ILoveHorsesRN said:

I am a nurse in telephone triage. Whenever a caller with a head injury has blurry vision, we send them to the ED to r/o concussion. Blurry vision is a symptom that needs to be evaluated same day, but not necessarily by an eye dr. more ED because they can do a CT scan if needed. that's our policy anyway. But you do have to be cautious with eye issues. He might have been rubbing his eye to try and clear his blurry vision.

I realize today's litigious society has forced many telephone triage calls to end with "go to the ER." If we used those guidelines in school nursing we'd have to have a shuttle bus outside to shuffle the kids back and forth to the ER all day.

Schools have School Nurses to assess injuries based on the mechanism of injury, signs of injury, and symptoms reported. Based on Keeper's description of the injury and how the events of the day/evening unfolded this is simply a high strung parent who takes every opportunity to lash out when she thinks her kid has received some type of "insult;" whether physical or emotional.

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Specializes in kids.
On 4/5/2019 at 4:46 PM, EnoughWithTheIce said:

I had the opposite today - wrist injury that I suspect is fractured. Dad who is an EMT used his x-ray vision to let me know I was wrong. Never once have I seen this girl in my office. Dad had her in tears before finally taking her. After reaming me out for not stocking OTC pain meds.

Ok dude, whatever!!! Buh-BYE!!!

I am sure I will see her first thing Monday morning...

Any word on the wrist?

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15 minutes ago, NutmeggeRN said:

Any word on the wrist?

I'm curious as well.

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Specializes in School Nursing.

Sigh, I'm in a high school and have to call for practically every nick and scrape. Parents today seem to look for something to complain about no matter what the age. Parents complain about everything these days, so don't feel bad.

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Specializes in ICU/community health/school nursing.
On 4/7/2019 at 9:49 AM, ILoveHorsesRN said:

I am a nurse in telephone triage. Whenever a caller with a head injury has blurry vision, we send them to the ED to r/o concussion. Blurry vision is a symptom that needs to be evaluated same day, but not necessarily by an eye dr. more ED because they can do a CT scan if needed. that's our policy anyway. But you do have to be cautious with eye issues. He might have been rubbing his eye to try and clear his blurry vision.

Or there was no blurry vision, or the vision was blurry because he was rubbing it. I get where you're coming from...but there's no way to second guess this without being there.

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On 4/7/2019 at 9:49 AM, ILoveHorsesRN said:

I am a nurse in telephone triage. Whenever a caller with a head injury has blurry vision, we send them to the ED to r/o concussion. Blurry vision is a symptom that needs to be evaluated same day, but not necessarily by an eye dr. more ED because they can do a CT scan if needed. that's our policy anyway. But you do have to be cautious with eye issues. He might have been rubbing his eye to try and clear his blurry vision.

I can appreciate your position on this, and you're very right, head and/or eye injuries are very serious. Especially, when you're trying to triage over the phone and you cannot see your patient. However, this little fellow was sitting right in front of me and he didn't have a mark on him. Not even redness where the shoe apparently hit him. When I told him that his eye looked just fine and that it wasn't even red, that's when the eye rubbing started. And I'm not talking subtle rubbing. I'm talking he was all but pushing his fist through his eye, which is why I made him stop because I was concerned he was going to actually hurt himself because he was pushing his fist so hard into his eye.

I promise I'm not just going to write off a complaint of blurry vision or head injuries. I assess the whole situation and make my judgments based off what I'm told, what I find, and what I see.

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Specializes in 25 years NICU 5 years Telephone Triage.

You asked to have differing responses by coming here. If there was any mention of blurry vision it’s best just to call the parents.

You can’t see brain damage by looking at a kid. Trust me. I get it. I get parents calling about stuff before they are even with the kid.

What a fun job we have huh?

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