Asthma Question

[Britrn04, BSN, MSN, RN]

I have 2 siblings in my school that have asthma. Both kids have albuterol nebulizers at school and are suppose to take Flovent at home. The 6 grade child seems to be the kid that makes sure he gets his meds and also his 2 grade brother. They started on Flovent daily at home after I hounded the parent daily to take to the ped again. I asked the ped to give me the order for Flovent and I will give at school. Mom refused...also I have the problem of the weekend and sending inhalers back and forth. I am only at school 3 days a week too. Both kids are always sick. I don't think they take their Flovent consistently. I am so unsure what to do. I see them 2-3 times a week and will give them a neb tx for wheezing or chest tightness. Often the neb helps...sometimes I send home if I can reach the parent if wheezing persists. Mother is hard to get a hold of and I have asked her to get a ref to the asthma clinic (they have medicaid). These kids stress me so much. I worry about them having a severe asthma attack during PE or recess. My principal sucks really and have asked for help, but she "will always get back to me later." Does anyone have have experience with kids like this? Parents like this? Principals like this :-)?

[intheweeds]

So sorry. That sounds like an anxiety-provoking situation... while it's not so uncommon to have kids like this, having a principal that won't back you up makes it a much bigger deal. What happens with the kids when you're not at school--is there another nurse? If wheezing persists and you can't reach the mom, what do you do? I would try to force the issue with the principal and try to schedule a mtg with the parent and principal. I find that being extremely direct helps (e.g., "I am extremely concerned for the safety of these kids and am worried that an emergency will occur in the near future. I don't think we can put this issue off any longer.") You may need to warn the mother that you will need to call 911 if the kids are wheezing and she is unreachable.

[kegreat]

I would just let the parent know that 911 will be called in emergent situations. I do agree to try to meet with the parent and the principal if you feel the principal is in your corner. Hopefully the parent will show up! Also isn't that a case of child abuse, if the parents aren't giving the required medication?

[Britrn04, BSN, MSN, RN]

I spoke with the Mom again today and she promised me they were both taking Flovent and little one on Zyrtec. She says she will get them into the Asthma and Allergy clinic for further eval :-/ I have the 2 grade teacher approaching the principal to see if we can schedule a meeting to all sit down together. Maybe if it comes from a teacher from an educational standpoint (missing class, poor learning environment etc etc) she may sit up and listen. Mom knows I will call 911 in a heartbeat, but she won't be paying the bill....! Thanks for your input!

[Wave Watcher]

We would consider this medical neglect from what you have described. If a child is using his/her rescue inhaler more than 3x a week it is considered uncontrolled asthma and needs to follow up with specialist. I agree with meetings and then last resort 911 if needed. Document your butt off! Good luck!

[brillohead, ADN, RN]

I'm another one who thinks this is medical neglect and CPS/social services could be involved.

Hopefully your sit-down meeting happens as does the asthma clinic appointment!

[Britrn04, BSN, MSN, RN]

I spoke with the Ped/Dr yesterday and he wants to see them both in his office Monday morning. He told me that Mom has called in for refill on the Flovent recently. He is going to re-eval and ref out to pulm as needed. We have a sit down meeting next week scheduled with teacher/principal/parent/nurse. My boss is attending too, so hopefully this gets resolved. If it all doesn't fall into place next week.....I agree, it has gone too far!! THANKS ALL!