Asthma treatment

[Leegc]

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!

[vikivail26]

I love working by myself, but some days I wish I had another nurse to back me up. I have been an LPN for 11 years, but I have never work in an ER or critical care setting. I enjoyed reading some of the comments because I learned a lot. I did not realize a child go from bad to worse so quickly especially after medications. I have a lot of asthmatics at my school, but there is only a couple that worry me. More often I see students who come to the clinic for inhaler just to get out of class. We are not allowed to use pulse ox's and none of the students have peek flow meter for school use. I wish we could just for peace of mind. Any how you did the right thing and I appreciate the comments.

[Leegc]

Thank you. The pulse ox and flow meter are valuable tools.

[Finally2008]

I am having this problem with a student at my school. The Albuterol (inhaler or via nebulizer) is not touching his coughing and wheezing. Today, his mother told me that the ER doc told her--"He's fine if he's coughing and wheezing. This happens with asthma." Mom is furious every time I call her to pick him up. Two times his week, I have had to work his asthma action plan for the "Red Zone" and sent him on to the hospital. He is obviously not controlled. Mom told me when he enrolled, "His asthma is bad. Really, really bad and he has been hospitalized in ICU." But...she gets furious when I call her to pick him up...

Has as anyone ever had a child stay in school with coughing and wheezing?

[Happylady123]

I know this is an old post, but it stood out to me that you said the child was on the preventative steroids and resistant to nebulizer & inhaler. That happens to me too! I have asthma, and I have tried probably 6 different types of steroid controller meds. Each time I use one of them, my albuterol inhaler becomes ineffective. I could take 10 puffs, and it will have no effect. It's really scary. None of the doctors I have seen have heard of this. However, in the drug information booklet that comes with these meds, it says that if the albuterol/bronchodilator stops being effective to immediately stop the medication. So the drug companies know this is a possibility, even though it seems that no one else does.

[MrNurse(x2), ADN]

I had multiple emergency cards stating their child had Asthma when I first began here. I called EMS and asked response time to school ~ 10 minutes and sent a text to each parent saying that calling 911 was 10 minutes your child can't breath without an inhaler. I got inhalers to school for every one of them in a matter of days. If only that could work with vaccines.