Asthma treatment

abbyzabby · Mar 3, 2015

Call the primary care doctor that gave you the orders and express your concerns just as you did here.

SnowyJ, RN · Mar 3, 2015

As school nurse, we are limited in our scope of practice. You did the right thing by doing a full assessment, administering the neb and using your judgement. Do not feel you have to wait for a parent if a child is deteriorating. Better safe than sorry. You will know if they are working hard to breathe, and the neb isn't helping much. Once we have done our best, there comes a time to take the care to the next level. (911/EMS.) I know it's scary, I've had to call. But esp with children, their airway can constrict so quickly. Don't worry about making the wrong call.

Leegc · Mar 3, 2015

Thank you. This is a great site to receive support from other school nurses. Sometimes you have that "alone" feeling. Would you believe in the past a mother would not supply an inhaler for a student diagnosed with Asthma, after I called her many times and sent a note home. I ended up calling 911 when no one would respond by telephone from that family. The parents were very irate about me calling 911 and the student being taken to the emergency room. I know that I made the right decision , the student was getting worse. Sometimes a thankless job. Thanks all

SnowyJ, RN · Mar 3, 2015

It can feel very isolating. This is the most autonomy I have ever had in a job. That can have its benefits, but sometimes it's nice to have someone to bounce things off of. I agree, This forum is great.

rollernurse365 · Mar 3, 2015

You did the right thing. Those little ones can turn on you very fast. Trust your gut. It's usually right.

allnurses Guide · Mar 3, 2015

Remember that there is a two phase response during an exacerbation: bronchoconstriction followed by inflammation.

The nebs will help with the early phase (bronchoconstriction) but the more dangerous late phase inflammation does not respond as well to nebulizer/bronchodilator.

Hospital and steroids is the right call.

Are these students on meds appropriate for moderate persistent asthma or are they just on albuterol?

Sent from my iPhone.

Leegc · Mar 3, 2015

Thank you for your response. One student on Dulera, Singulair, Ventolin inhaler ,and neb treatments prescribed on his treatment plan. The physician specialist has changed his treatment plan several times. I have never seen a student so resistant- was just on steroid treatment. The other student just on inhalers and neb treatments. I suggested the mother see a specialist, as the doctor since hospitalization has not changed the treatment plan, so we are back to the same treatment. Thanks again for the information

Wave Watcher · Mar 3, 2015

I wonder if this kid is on a daily maintenance inhaler at home?

Good job handling the situation. I deal the same way...inhaler tx or neb tx.... x 2 if needed, call parents if still wheezing or low o2, or call 911 if child seems to be struggling I expect them to decline quickly.

Leegc · Mar 3, 2015

The student is on a daily maintenance inhaler. Just as you described, this is all that I can do. Many moons ago, I worked in the ER and there was a sense of security that there were other staff and needed equipment was readily available- but would never go back to those hospital days! Thanks for your response.

Wave Watcher · Mar 3, 2015

The student is on a daily maintenance inhaler. Just as you described, this is all that I can do. Many moons ago, I worked in the ER and there was a sense of security that there were other staff and needed equipment was readily available- but would never go back to those hospital days! Thanks for your response.

I'm with you! I worked the floors and I will take my asthmatics here at school over a hospital any day! Love my job and kiddos!

Leegc · Mar 3, 2015

Leegc

I'm with you! I worked the floors and I will take my asthmatics here at school over a hospital any day! Love my job and kiddos!