asthma assessment

[kidzcare]

What is your process for assessment when an asthmatic student says they're having trouble breathing or chest tightness?

I had a student come in earlier saying her chest was tight. I listened to her lungs and they were clear throughout. Pulse ox was 80, heart rate elevated, breathing even and unlabored with no retractions. No difficulties with speech. Does not use a peak flow meter at home. She took her inhaler and her pulse ox came up to 93. I have her coming back in a bit for reassessment.

I had her resting in my office for a bit and there she was doing fine, so I had her return to class. Asthma makes me so nervous when there are very little objective findings.

[Massmagic]

Granny RRT -

I agree with you about the inhalers being readily available to students. We have a rule in our district that all doors need to be locked when out of the room.

I do not lock my door when I go out of the med office as Inhalers HAVE to be available to all asthmatic students at all times. I have argued with other nurses about leaving door unlocked when not in office, they feel as if they just can't do that, and plus they feel like it is a medication that should be locked in their med cabinet as well.

I feel differently as inhaler access is essential. I keep inhalers in an unlocked cabinet and not in my med cabinet. I have the cabinet labeled in BIG letters and inform all students that their inhalers are in that particular cabinet.

I have many asthmatics but I have one that is a problem and mother fails to recognize the importance of daily long term inhaled medication (advair, flovent,etc). When I try to tell her that her son needs this daily, she gets angry. I think she feels as if I am telling her that she doesn't know how to take care of her child (even though she doesn't). I have resorted to teaching the student (6th grade boy) that he needs to step up and take responsibility in taking his Advair daily - every day even when he is feeling fine.

When he is having difficulty with tightness, his pulse ox ranges from 96-98%. A low pulse ox is a late sign of not getting enough oxygen. This boy knows how he feels and I can tell he is having difficulty by just looking at him. I always call his mother when he feels as if his chest is tight and having difficulty breathing. I tell her that I have done everything that I can for her son -rescue inhaler/nebulizer, and that he continues with chest tightness. I then let mom talk to her own son and I let him tell her how he feels. This has worked much better than me telling her what she should do. (Some parents are just hard to deal with). She always comes and gets him. She has never not come to get him. I try to do the best I can with each TYPE of parent. The mother making the decision has helped in this particular difficult case.

School nursing is a challenge - I do like this site as many of you school nurses have so much to offer. I learn so much from everyone. Great site.

[kidzcare]

This again brings us back to asthma education.

If you are seeing this child almost daily, basic maintenance is probably not being done appropriately or poorly prescribed. How many know the appropriate dosage for maintenance inhalers? Most inhalers now have counters on so you and the child can keep a record. Have the child start a journal.

Thanks for your response! I don't know if I put in the original post that the reason I see this student everyday is to use the inhaler prior to PE, per the asthma action plan. She uses a maintenance inhaler at home BID. The cold in our area has triggered more symptoms for her.

I also know that there is some stress at home. Parents divorcing and she is getting used to the back and forth between mom and dad's places and that is causing a significant amount of anxiety for her.

[JenTheSchoolRN, BSN, RN]

As soon as I hear wheezing, I call a parent. My son has really mild (Thank God!) asthma and when it is exacerbated (usually only if he has a cold), my doctor's office wants to see him immediately if he is wheezing.

Oh, I called her. Every time. To be told: "did you do a neb treatment?" (The provider asks the same question). Wheezing is common for this student when exposed to an allergen the day before. Sometime the wheezing clears after a neb treatment (which I have an order for). Doc wants to see student if wheezing doesn't improve after a neb treatment, to which Mom comes asap to put student up and takes her straight to the doc.

Student also has anxiety issues, which can trigger asthma even more. I still call and follow the orders. Student's pulse ox has never dropped below 97% anytime.