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Asthma, no inhaler, WWYD?

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nursex23 has 2 years experience as a BSN, RN.

1,493 Profile Views; 111 Posts

It happens pretty often that students forget their inhalers (MS). Every time it's happened there was no distress, O2 sats were mid to high 90s, mild wheezing and every other time someone was able to bring the inhaler within a reasonable time. But yesterday I had a student who had some wheezing and chest tightness, O2 93-95% up to 98% with deep breathing. I called dad who said he will bring her inhaler. 30 mins go by, no dad no inhaler, no change in student. I called and he said 15-20 mins. 30 mins go by still no dad. I called for admin to bring me a Coke (it had worked for a previous student) and then I called dad with no answer. I had the secretaries calling him too with no luck for about an hour. She was stable to where I did not feel an ambulance was necessary but I wanted to call one anyway because she was going on 2 hours wheezing and chest tightness. Finally dad shows up. She takes her inhaler, we wait about 5 mins and O2 is up to 99%, clear lungs, no chest tightness. I was so frustrated because this whole thing took 2 hours where I was constantly assessing her for changes while other students are still coming in and out. Had I known it was going to be 2 hours I think I would have called for an ambulance just to get her help sooner. I'm also not going to give them Coke and send them to class because it's definatley not a replacement for their inhaler. 

What do you all think of this? Would you have called an ambulance? 

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Flare is a ASN, BSN and specializes in school nursing, ortho, trauma.

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sometimes you have to be "that person" in order to get a reasonable reaction out of a parent.  If I felt as though I has a student who was wheezing, mildly de-satting, I'd give the parent the 30 minutes that you initially gave.  When I call the parent back at that 30 minute mark, and was told 15-20, I would probably tell them that was fine, but if the time exceeded the 20 minuted that was now promised (so now close to an hour total) that ems would be called.  

The parent can always sign an RMA if they get there and EMS is doing their thing.  Not that I've done that too often, but sometimes going through the whole rigamarole is what you need to get parents to realize that this is serious.  

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SaltineQueen specializes in School Nurse, past Med Surge.

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Does your state allow for you to stock albuterol?  My go to "in the mean time" tricks have been drinking warm water & pursed lip/deep breathing.  I probably would have called after the 2nd time frame had elapsed, though.  If for no other reason (hate to say it) than to shock the parent into seeing the urgency of the situation.  Kids can go south so quickly...

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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I hear you. It's frustrating. Beyond frustrating really.

With sats in the high 90s, was sweet pea positioning for comfort? Retractions? Air hunger? Feeling of impending doom? All of that would drive me to call EMS.

In the absence of sx other than wheeze....well, I am not sure. I did not see what you saw. Once you take charge of a wheezing kid you have to reasonably re-assess (and in my head, 20 minutes is reasonable if there's been no change). 

I think I would have said to parent (because I do) - "If his condition worsens and you are not here I will have to call EMS." That sometimes lights a fire....sometimes not so much.

Kids CAN (and do) go south and you never know when that will happen. Kudos to you.

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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Time for the conversation - to prevent this from happening in the future I am providing you with an asthma action plan, yada, yada, yada.

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SnowDark38 has 4 years experience as a BSN and specializes in Pelvic Neuroscience and School Nursing.

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It can be really scary when that happens. Especially when you have younger ones who don't always tell their teacher that they're having trouble breathing. Everyone's pretty much right. As long as she had high 90s sats and was not deteriorating, give dad a warning for an EMS call if he does not arrive by the end of the 20 minutes. It's the for the well-being of the student. 

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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Just renewed an asthma 504.  No inhaler at school for the two years I am at this campus.  No visit from student to health office in 3 years.  Sent action plan and self-carry forms in November.

When 504 coordinator said we no longer need a 504 for asthma due to the above, then mom was all about having an inhaler on campus - "God forbid he has an emergency"

Had to do a phone conference 504 because mom would not answer phone or come in for meeting. :banghead:

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beachynurse has 35 years experience as a ASN, BSN and specializes in School Nursing.

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I'm in a high school and always keep tea and coffee in my clinic, plenty of sugar and no cal sweetener (for the girls).  I use this to treat mild wheezing or chest tightness when there is no inhaler available. Between the caffeine being a bronchodilator, and the warmth relaxing the airway I can usually be successful in getting the kiddo feeling well enough and clear enough to go back to class. 

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beachynurse has 35 years experience as a ASN, BSN and specializes in School Nursing.

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2 hours ago, tining said:

Just renewed an asthma 504.  No inhaler at school for the two years I am at this campus.  No visit from student to health office in 3 years.  Sent action plan and self-carry forms in November.

When 504 coordinator said we no longer need a 504 for asthma due to the above, then mom was all about having an inhaler on campus - "God forbid he has an emergency"

Had to do a phone conference 504 because mom would not answer phone or come in for meeting. :banghead:

I had a kiddo with a 504 for a food allergy for 2 years while in high school. The student was desensitized and we no longer had orders for the epi-pen. Mom was told that he was no longer eligible for the 504, she wasn't happy, and the MD wouldn't write her a life threatening allergy plan just to keep the 504.

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CanIcallmymom has 4 years experience.

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15 hours ago, beachynurse said:

I had a kiddo with a 504 for a food allergy for 2 years while in high school. The student was desensitized and we no longer had orders for the epi-pen. Mom was told that he was no longer eligible for the 504, she wasn't happy, and the MD wouldn't write her a life threatening allergy plan just to keep the 504.

I've had similar this year. We did not renew a 504 for a student with no records of visits for asthma, and had a food allergy (that no longer required epi-pen per mom). When you take away their 504, they suddenly provide all the documentation you've been banging down their door for.

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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^^^^ YES^^^^

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nursex23 has 2 years experience as a BSN, RN.

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I called dad and told him that we don't have an action plan in place and that the student NEEDS to be bringing her inhaler to school or she can leave one here. Dad said, "well she doesn't really have asthma, she grew out of it but when she gets out of breath I give her her sister's inhaler." 👀 What?!

I told him that she has asthma on her physical forms, therefore she has asthma and needs an action plan in place along with her OWN inhaler in school everyday. Otherwise she can go to her pediatrician and have them evaluate if she still has asthma or not. Judging my assessment of her last week, she needs an action plan..

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