Assessing the student on drugs

[cjl_RN]

What does your assessment consist of for students who are believed to be on drugs? (I am a nurse at the middle school level) Adminstration brings them to me to be checked out and make sure their stable. I do a full set of vitals and check their pupils and alertness and orientation. Also pay attention to any odors.

[Cattitude]

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.

Old timer that hasn't posted in forever here! Yes we carry it in all of our 30+ schools in the district, including elementary.

Thankfully I don't think I'll ever have to use it. XXXXX

[T-ROD, LPN]

I typically do a set of vitals. Check pupils and tracking. We have a community police office on campus so if we think its possible they go see them.

Honestly every kid I have ever checked if they was guilty would fes up the minute the b/p cuff goes on or they show no signs of anxiety or nerves.

I think honestly its used more as a scare tactic when I come in. LOL!!!

[Duranie]

I think it's difficult to assess students while on drugs, especially when the amphetamine causes my penlight to shake.

Wait...what are we assessing for again?

Aren't you a smarty pants....

{Don't mind me....I just don't know how I didn't think of it first....}

[mslove717]

I have a "substance abuse assessment" form I fill out. It's largely subjective. It includes VS, behavior, eyes, movement, coordination tests (finger to nose, walk straight line), appearance and smell. Principals bring kids down like I will magically know. I usually say I found little out of the ordinary. It's sometimes frustrating because i am NOT trained to proclaim if someone is on illegal drugs or not. A couple times I have had to go to superintendent suspension hearings and I let them know this is my assessment but it does not objectively measure drug use. Our MS nurse went to a training put on by state police who say school nurses should NOT do the assessments - it should be done by principals. Well that will never happen. Anything with the body... call the nurse!

Only things ever suspected are alcohol or marijuana at least.

And we have stock Narcan and all nurses in district were trained. Some fought it but I personally like having it. It's technically our personal Narcan that was given to us at the training. To me it's a lifesaving med, why withhold it because I dislike drugs?

[mslove717]

this is my form too! same as already posted (site isn't letting me quote it?)

Date:_______________ Time______________

PHYSICAL ASSESSMENT

BP ________ Pulse _________

Respirations _________ Temperature _______

Symptoms Observed

Affect/Emotion/Behavior: Yes No

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:

__________________________________________________ ________________

[Flare, ASN, BSN]

And we have stock Narcan and all nurses in district were trained. Some fought it but I personally like having it. It's technically our personal Narcan that was given to us at the training. To me it's a lifesaving med, why withhold it because I dislike drugs?

I don't think it's really THAT necessary that I have it in my pk-8 school given the fact that in the small town district where I work all of the police carry narcan and have a fast response. Legislation was passed for 9-12 schools to stock it, but that doesn't mean we can't. I can even have lay people give it as long as they are trained, which I have some that are. However I still make it a point to have the school md write an order for ME to give it under standing orders. At the end of the day I still have a medical license to protect, even if you can get narcan otc at the pharmacies here now.

[Mavnurse17, BSN, RN]

I have had a rough time with my 'substance abuse assessments.' My school used to use a specific form, but I've been told not to use it. Finally my nurse supervisor told us we should be doing neuro assessments on kids brought to use for suspected substance abuse (orientation, pupil assessment, grip strength, ability to follow commands, can they walk a straight line, etc). I struggle with administrators relying on me as a tool to say if a student is/is not using. I hesitate to take VS on EVERY student brought to me for drug assessment, as an elevated BP/ pulse could be caused by a lot of different things (hello... maybe this kid is tachy because they were just escorted into the clinic by an officer??) I use my best nursing judgement to decide if I take VS on a kid brought in for this assessment. Otherwise, it's a one minute neuro check and if they're safe, they go back to administration.

[Roy Hanson]

define DRUGS..Pot, you can smell! If they are on presciption drugs, you need details..side effects etc. Pot you can smell, like cigarette smoke on clothing OR breath! Has your school a policy on kids smoking..pot or cig's. If pot, tell them to go home, they WILL disrupt classes.

[Flare, ASN, BSN]

but here's the thing, Roy, with the e-cigs and vapes you can't necessarily smell pot or cigarettes. They don't leave a residual odor on clothing. It may let out a smell in the moment but it's unlikely that a student using the newer technology will smell like the back row at a Greatful dead concert

[NutmeggeRN, BSN]

but here's the thing, Roy, with the e-cigs and vapes you can't necessarily smell pot or cigarettes. They don't leave a residual odor on clothing. It may let out a smell in the moment but it's unlikely that a student using the newer technology will smell like the back row at a Greatful dead concert

Our policy changed to add ALL electronic stuff; vape, juul, cartridges anything associated with this as drug parafernalia. Comes with a hefty penalty.

[MJ 0990]

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.

It's funny you mention homes having it because I had never heard of that until recently when I was looking at covered drugs under my new insurance plan and there it was. So you can get a prescription for it and go fill it.

I'd love to see some studies done on the rate of ODs since it's use. Do you think there might be more because users are aware the effects can be reversed and their lives saved? Or that a friend could carry it to administer just in case?

(Btw I'm still a nursing student)

[NutmeggeRN, BSN]

It's funny you mention homes having it because I had never heard of that until recently when I was looking at covered drugs under my new insurance plan and there it was. So you can get a prescription for it and go fill it.

I'd love to see some studies done on the rate of ODs since it's use. Do you think there might be more because users are aware the effects can be reversed and their lives saved? Or that a friend could carry it to administer just in case?

(Btw I'm still a nursing student)

And then there was article about the nurse who was denied life insurance because she carried, for her job, Narcan...