Autistic students

Kids on the spectrum often share certain traits, but they are very distinct individuals.  Their teachers are your best partner as they do know them best and their unique needs.  Always ask the child before you touch them or try to apply ice or a bandaid.  You will get to know each kiddo. 

I started out my school nursing career in a sped school for autistic children.  It was wonderful to see these kids learn and grow, but also challenging at times. @GmaPearl BSN RN is on point, as you get to know the children, you will find it easier to assess them.  Usually this population doesn't tolerate bandaids that well, so I tended to only use them when needed and then I'd be sure to secure it a bit more to give the staff time to stop them from picking it off.  

Distraction during assessment is key; If there is an activity/behavior/stim that is used as a reward with the student, use that to your advantage. I Have two students with severe autism in my building. One loves mirrors and the other loves to look at and stroke the heat grate in my office. I let them do those things and try my best to get their temps/look in ears/listen to lungs while they are distracted. You do have to be a little more thorough with your assessment of them since they cannot say what is wrong in ways that we will understand.

And talk to them the whole time. They may not be able to express themselves with words, but they likely understand some if not all of what you're saying. If they are brought to you for acting out of their norm, find out what the difference is. 

I remember a patient at the peds practice I worked at who was had severe autism. Non-verbal, and self-injurious behaviors were his norm. But the family brought him in because he began hitting himself/squeezing his crotch when normally it would be his head. The doc had the forethought to obtain a urine sample and he had a raging UTI. So even though he didn't say "My member hurts", he did show it in his own way.

On 11/23/2020 at 9:08 AM, k1p1ssk said:

 

I remember a patient at the peds practice I worked at who was had severe autism. Non-verbal, and self-injurious behaviors were his norm. But the family brought him in because he began hitting himself/squeezing his crotch when normally it would be his head. The doc had the forethought to obtain a urine sample and he had a raging UTI. So even though he didn't say "My member hurts", he did show it in his own way.

 

Good on that doc. I usually ask teachers what the student's normal is. Because perhaps head banging is normal, but it is usually the student banging their forehead and that day they are banging the back of their head, which may signal a change somewhere. 

Agree on always asking prior to touching, even if the student can't verbally respond - respect needs no words and can go a long way to relationship build because if may not seem like they understand, but they do 100%. I'm also talking constantly and telling them in simple terms what I'm doing before I do it. I have one student that loves my ice maker and the noise it makes as it makes ice and it works as a nice distraction during any needed exam.

I call home and talk to the parent if I have concerns. They know them best. But I do know they can also send them to school not feeling well. Also, the teachers have a habit of exaggerating symptoms to try to get me to send them home ? I stick around in the classroom to watch them for a few minutes to see their behavior/symptoms for myself. 

18 hours ago, Incognito-lpn said:

I call home and talk to the parent if I have concerns. They know them best. But I do know they can also send them to school not feeling well. Also, the teachers have a habit of exaggerating symptoms to try to get me to send them home ? I stick around in the classroom to watch them for a few minutes to see their behavior/symptoms for myself. 

Thank-you.  I don't know why this thread popped up on on my all nurses because I am not a school nurse....but I am a special needs mom (he is now an adult).   This is the best insight I have seen. The school nurse sometimes has to be a mitigator between opposing teams. It really is frustrating as a parent to have your kid sent home all the time often for no reason......not only is it burdensome for work but it really sent home the message your child isn't wanted which is really emotionally hard.    I will also admit I sometimes sent him to school when I knew I probably shouldn't.....   When in high school the nurse had the best strategy in contacting me with concerns by approaching issues with room for discussion. "hello,  B still has mildly red eyes without discharge for the past few days  and I know that this is likely viral conjunctivitis as you told the teacher,  but it makes the staff nervous.  would you consider asking his doctor for eye drops?    "hey B has been doing this shaking movement and staff are concerned they are seizures,  I know you have told them they are not , can you give me some more insight?"

Welcome to school nursing! ONE OF US! ONE OF US! ONE OF US!

I echo the comments above; utilizing parents/teachers to note behavior changes is so important.   You'll also get to know how staff members individually react to things; some want kids sent home for everything, others are much more laid back. (This dynamic is seen outside of special education, too.)  You'll develop your own style, but I encourage you to have firm boundaries across the board.

Thank you all so much for your input. You all bring out wonderful points that I have experienced first hand from learning each child is unique, the teachers that send the kids in for anything to be sent home (I even had the principal warn me!) to Rnis experience as a special needs parent which was truly amazing to read ?