Assessing the student on drugs

JenTheSchoolRN, BSN, RN · Dec 5, 2018

Just curious, now that naloxone is OTC in 46 (48?) states, do any of you have it as a stock med, similar to epi-pens?
Have any of you considered asking TPTB to allow you to have it in your orificenal?
It seems like it could be prudent, given how many of you seem to be being asked to assess for possible drug-use.
There are groups out there that are recommending that every household have naloxone in the "med cabinet" much the same way ipecac used to be recommended. If every home should have it, shouldn't every school?
Just a bit of food for thought.... idk where I am on the issue, frankly.

I don't, but likely it is a matter of time. The fire station one block away stocks it and when I call 911, they are the first to respond (bringing me O2 as well since I, like many schools, do not have it).

However, it is now being required/recommended in every school in my state. My and my school physician go back and forth on it. My one hesitation has to do more with back-up for any reactions that could happen AFTER I give the med and not really health reactions, more like do I have extra strong hands to help me if I need back-up. (The fire department has me there.) But I know I will get past that and it will be in my orificenal soon.

beachynurse, ASN, BSN · Dec 5, 2018

We are not allowed to have stock Nalaxone in our clinics, but our resource officers have it in their offices. There is an "agreement for it's use" if he is not there. I would not be able to stand by and let a kid die all the while knowing I had access to the medication that could save them. I totally know the potential consequences, but I couodn't live with myself if I let a kid die.

Guests · Dec 5, 2018

I work K-3, so thankfully have not dealt with this. But curious what the point is? Is it so admin can call the parents and send the kid home, saying they can't be in school? Or for disciplinary actions? Just curious. I feel like it's one thing if it a safety issue, but I would hate to have the responsibility to be the one deciding if a kid warrants disciplinary action, etc. I can already see certain parents trying to say the school nurse is wrong, can't diagnose, etc.

JenTheSchoolRN, BSN, RN · Dec 5, 2018

I work K-3, so thankfully have not dealt with this. But curious what the point is? Is it so admin can call the parents and send the kid home, saying they can't be in school? Or for disciplinary actions? Just curious. I feel like it's one thing if it a safety issue, but I would hate to have the responsibility to be the one deciding if a kid warrants disciplinary action, etc. I can already see certain parents trying to say the school nurse is wrong, can't diagnose, etc.

Drug use or suspected drug use on/off school property is usually clearly outlined in the student handbook. It is in ours. However, thankfully, there is nothing stating my role in it. If student is caught with drugs, suspected of using drugs on school property, they have a suspension hearing after during an investigation. I am not part of either of these things.

My notes to the dean are usually vitals and/or anything that I see that is different from a student's baseline if I have a student's baseline to compare. But admin also is covering their end with my assessment to not really confirm anything, but to make sure that this isn't a situation that means the student needs immediate medical care.

To be honest, it hasn't been an issue. 9.9/10 the student will actually own up to it or the parents know or suspected. And for illegal substances (which is basically everything as MJ isn't legal until age 21) the school police might get involved as well, depending on the situation.

CanIcallmymom, BSN, RN · Dec 5, 2018

I work K-3, so thankfully have not dealt with this. But curious what the point is? Is it so admin can call the parents and send the kid home, saying they can't be in school? Or for disciplinary actions? Just curious. I feel like it's one thing if it a safety issue, but I would hate to have the responsibility to be the one deciding if a kid warrants disciplinary action, etc. I can already see certain parents trying to say the school nurse is wrong, can't diagnose, etc.

I have a friend nurse at a K-4 school that has had an overdose on school properly. Kid took parent's med.

Guests · Dec 5, 2018

Drug use or suspected drug use on/off school property is usually clearly outlined in the student handbook. It is in ours. However, thankfully, there is nothing stating my role in it. If student is caught with drugs, suspected of using drugs on school property, they have a suspension hearing after during an investigation. I am not part of either of these things.
My notes to the dean are usually vitals and/or anything that I see that is different from a student's baseline if I have a student's baseline to compare. But admin also is covering their end with my assessment to not really confirm anything, but to make sure that this isn't a situation that means the student needs immediate medical care.
To be honest, it hasn't been an issue. 9.9/10 the student will actually own up to it or the parents know or suspected. And for illegal substances (which is basically everything as MJ isn't legal until age 21) the school police might get involved as well, depending on the situation.

I guess I am thinking how can they prove the kid used drugs at school, rather than arrive on something already? I am sure it is a very grey area sometimes. Just not a position I would want to be in- glad I work with the littles for this reason.

CanIcallmymom, BSN, RN · Dec 5, 2018

I have not been asked to assess any students for obvious s/s impairment, etc. this school year, thank goodness. I am in the high school level...

NutmeggeRN, BSN · Dec 5, 2018

I work K-3, so thankfully have not dealt with this. But curious what the point is? Is it so admin can call the parents and send the kid home, saying they can't be in school? Or for disciplinary actions? Just curious. I feel like it's one thing if it a safety issue, but I would hate to have the responsibility to be the one deciding if a kid warrants disciplinary action, etc. I can already see certain parents trying to say the school nurse is wrong, can't diagnose, etc.

To ensure they are medically stable, if not 911. If they are not in danger then it beomes a disciplinary issue.

ana010 · Dec 5, 2018

My admin understands I can report objective findings. In my experience, VS out of normal range and enlarged or pinpoint pupils, plus odors present lead the admin to question more pointedly. There is no "proving it" by a nurse in a school setting. And I haven't decided if kids think I'm safe or just want it off their chests, but they often tell me and I let them know I am bound by my ethics to report to admin.

stephrooth · Dec 5, 2018

This is my Form

Date:_______________ Time______________

PHYSICAL ASSESSMENT

BP ________ Pulse _________

Respirations _________ Temperature _______

Symptoms Observed

Affect/Emotion/Behavior: YesNo

Agitation __________

Combative behavior _____ _____

Exaggerated self-confidence _____ _____

Excitability _____ _____

Flat affect __________

Flight of ideas __________

Increased emotional instability_________

Irritability __________

Mood swings __________

Quarrelsome __________

Suspicious __________

Eyes:

Inability of eyes to hold a

fixed position on lateral gaze__________

Markedly contracted or

pinpoint pupils __________

Pupils dilated/appear frozen __________

Pupils non-reactive to light __________

Red eyes-conjunctiva injection________

Watery eyes __________

Speech:

Difficulty in articulation __________

Incoherent __________

Rapid __________

Slurred __________

Mental Alertness:

Confusion __________

Decreased attention span __________

Depression __________

Drowsiness __________

Euphoria __________

Groggy __________

Poor judgment __________

Slow reaction time __________

Sluggish _____ _____

Stupor __________

Nurse in attendance:

_________________________________

Neurological: Yes No

Inability to perform rapid

alternative movements __________

Inability to put finger to

nose, finger to finger,

stand on one foot with

eyes closed or, walk

In a straight line _____ _____

Jerky irregular movements____ _____

Tremors _____ _____

Poor coordination _____ _____

Other Signs and Symptoms:

Chills _____ _____

Cramps _____ _____

Distortion of space _____ _____

Dizziness _____ _____

Nausea/vomiting _____ _____

Body and breath odor _____ _____

Odor on hands _____ _____

Odor on breath _____ _____

Clothes: ___________________________________________________________________________________________________

MEDICAL HISTORY:

Diabetic _____ _____

Seizure disorder _____ _____

Unconsciousness _____ _____

Substance abuse _____ _____

Medication _____ _____

Other:

__________________________________________________________________

NutmeggeRN, BSN · Dec 5, 2018

This is my Form
Date:_______________ Time______________
PHYSICAL ASSESSMENT
BP ________ Pulse _________
Respirations _________ Temperature _______
Symptoms Observed
Affect/Emotion/Behavior: YesNo
Agitation __________
Combative behavior _____ _____
Exaggerated self-confidence _____ _____
Excitability _____ _____
Flat affect __________
Flight of ideas __________
Increased emotional instability_________
Irritability __________
Mood swings __________
Quarrelsome __________
Suspicious __________
Eyes:
Inability of eyes to hold a
fixed position on lateral gaze__________
Markedly contracted or
pinpoint pupils __________
Pupils dilated/appear frozen __________
Pupils non-reactive to light __________
Red eyes-conjunctiva injection________
Watery eyes __________
Speech:
Difficulty in articulation __________
Incoherent __________
Rapid __________
Slurred __________
Mental Alertness:
Confusion __________
Decreased attention span __________
Depression __________
Drowsiness __________
Euphoria __________
Groggy __________
Poor judgment __________
Slow reaction time __________
Sluggish _____ _____
Stupor __________
Nurse in attendance:
_________________________________
Neurological: Yes No
Inability to perform rapid
alternative movements __________
Inability to put finger to
nose, finger to finger,
stand on one foot with
eyes closed or, walk
In a straight line _____ _____
Jerky irregular movements____ _____
Tremors _____ _____
Poor coordination _____ _____
Other Signs and Symptoms:
Chills _____ _____
Cramps _____ _____
Distortion of space _____ _____
Dizziness _____ _____
Nausea/vomiting _____ _____
Body and breath odor _____ _____
Odor on hands _____ _____
Odor on breath _____ _____
Clothes: ___________________________________________________________________________________________________
MEDICAL HISTORY:
Diabetic _____ _____
Seizure disorder _____ _____
Unconsciousness _____ _____
Substance abuse _____ _____
Medication _____ _____
Other:
__________________________________________________________________

Great form! Are the two dashes after each sympton for either yes or no?

Duranie · Dec 5, 2018

This is my Form
Date:_______________ Time______________
PHYSICAL ASSESSMENT
BP ________ Pulse _________
Respirations _________ Temperature _______
Symptoms Observed
Affect/Emotion/Behavior: YesNo
Agitation __________
Combative behavior _____ _____
Exaggerated self-confidence _____ _____
Excitability _____ _____
Flat affect __________
Flight of ideas __________
Increased emotional instability_________
Irritability __________
Mood swings __________
Quarrelsome __________

Great form! Are the two dashes after each sympton for either yes or no?

Formatting kind of hid it but yeah, that's what it was. I like the form... I wouldn't want to be smelling a student's hands or body though :yuck: ....