Asthma treatment

Published

Hello, I am new on allnurses. Are there any school nurses having difficulties with students having resistance to their neb treatments at school? I had a scary situation yesterday. A mother to a kindergarten student sent her child in to school, still wheezing! The teacher immediately sent the child to the Nurse's office. I started the neb treatment, checked pulse ox, and monitored vital signs. After the physician designated time, I gave him a second treatment. The student was still wheezing. I immediately called the mother and told her that I would probably need to call 911. The mother said that she would be at the school soon. The students VS were stable but I was afraid of rapid deterioration. When the mother arrived, I told her to call 911 or take the student immediately to the hospital ER. The report that I received later from the teacher, was the student was admitted to the hospital and overnight for observation. This is the second student or experience that I had with resistance to the nebulizer medication. Does anyone have a protocol or additional treatments in place or standing order for this resistance. Epi Pen , oxygen. I followed the student's family doctor's orders but this does not seem to be enough. Any comments welcome. Thank you!

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

I had the same situation last school year.

Parents would not bring an inhaler to school for elementary-aged student. One day he came in with wheezing and "pressure to my chest" and I couldn't get a hold of his parents and off the to ER we went.

Parents were not happy afterwards. But I've seen things turn on a dime with respiratory problems when I worked ER.

Up Vote Up Vote ×
Specializes in school nursing, ortho, trauma.

It annoys me when parents get irate with school nurse's decisions to send kids to the ER. It makes nurses question their own judgement and leads to tragedy. Do your thing. Call 9-1-1. Let the parents know ems is coming. the parent can always hurry to the school if they are close enough and sign off AMA... if they are too far to do that,then it's the argument ends there. Most ems arrivals take about 7-10 minutes depending on where you live then plan on another 5-10 minutes for their assessment - so a parent 10 minutes away would have a chance to get there. Just based on past experiences, that is.

Up Vote Up Vote ×

These parents were 200 miles away . . . .. ;)

Up Vote Up Vote ×

Not knowing the hx of this child's CLD, I would probably place the classification at moderate persistent and poorly controlled.

Albuterol does not always make wheezing go away. The inflammatory process is still there.

Do your assessment with the asthma score for severity. That is a great guide to relay the info to the doctor and for the EMTS to pass on to the ED.

Parents of kids with CLD are fatigued physically from staying up nights, financially stressed from medical bills (ambulance transports are not always covered) and emotionally exhausted from a combination of all of these factors. You have to understand this as you are making your case for 911. Most will understand but their stress level will still worry about everything else. It also could mean their child's CLD is worsening which is difficult to deal with even if it was an adult patient.

Up Vote Up Vote ×

Understand about ambulance bills- received one for $900 once!

Up Vote Up Vote ×

Ambulance bill or dead kid . . .?

This family had insurance by the way.

Up Vote Up Vote ×

I am not a school nurse, but I am both a peds respiratory nurse and an asthmatic. I think you did all the right things. Better to be safe than sorry. Asthma is scary and kids compensate very well and look somewhat stable . . . until they suddenly don't.

Your assessment skills and actions were validated by the fact that the child had to be admitted overnight.

Up Vote Up Vote ×

It goes without saying, of course, in any critical situation you do not worry about ambulance bills.

Up Vote Up Vote ×
Specializes in MedSurg Hospice.

You did the right thing. Never mess around with an asthmatic. They can turn so fast and so bad on you that you may not get to 911 or the ER, praying you can get an ET tube down if you happen to even have one with an order and are skilled/proficient at that procedure. Once the airway collapses, getting a support down the airway may not be possible. I really move fast on asthma patients. Take good care.

Up Vote Up Vote ×
Specializes in allergy and asthma, urgent care.
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.

Completely agree. I'm an Asthma and Allergy NP, and we frequently run into issues with kids who are not on controller meds for various reasons (not prescribed by PCP, parents feel kid is doing well and doesn't need them, fear of steroids, etc). We work closely with school nurses to ensure that these kids have action plans that address what to do in case of an exacerbation, and we see your frustration when a parent doesn't follow through with med compliance. We try to educate parents that controller meds are often necessary and are safe to use daily. There's several studies that prove that point. I'm glad "my" kids have their school nurses looking out for them.

Up Vote Up Vote ×
Completely agree. I'm an Asthma and Allergy NP, and we frequently run into issues with kids who are not on controller meds for various reasons (not prescribed by PCP, parents feel kid is doing well and doesn't need them, fear of steroids, etc). We work closely with school nurses to ensure that these kids have action plans that address what to do in case of an exacerbation, and we see your frustration when a parent doesn't follow through with med compliance. We try to educate parents that controller meds are often necessary and are safe to use daily. There's several studies that prove that point. I'm glad "my" kids have their school nurses looking out for them.

Oh my gosh . . .will you move to my area? I just don't get the same support and I want to be kind and say it is mostly due to the providers being super busy.

I have a terrible time getting action plans back from parents or providers.

Up Vote Up Vote ×

I'm having this issue now. I have a student whose asthma is poorly controlled. He comes to my office several days a week for treatments. He compensates really well. I'm always stuck between and rock and a hard place making the call for him. His parents will pick him up but I hate to see him miss so much school. I finally called the doctor on Monday and they made an appointment for him to be seen again. But I think my concerns make it a very serious issue since i"m actually listening to his lungs almost every day.

Up Vote Up Vote ×
+ Join the Discussion