Bladder Scanning

I would not bladder scan at school. That could set you up for trouble down the road. Bladder scanning would require the student to pull their pants down just enough for this to possibly be an issue, and the parents did not give you permission to do that. I would call for an ambulance. Not urinating for 24 hours or more needs to be addressed sooner rather than later. That student has to be so uncomfortable, and he/she could possibly end up with pyelonephritis. 

I wouldn't bladder scan without an order - I might consider calling the kid's PCP and seeing if they'd give me a 1x verbal order though! Might be a waste of time, but you never know... I think it's only a nursing judgement if your facility has standing orders - like a nursing home might.

I don't think I would have called EMS unless vitals or presentation looked bleak. I would have however, let the parents know that based on the current situation, I was keeping the student with me, and rechecking VS every 30min-1hr, and if there was any kind of major change - subjective or objective - I would need to call EMS. 

I've never been faced with this exact scenario, but with other situations where a kiddo is likely to end up in the ED anyway (think suspicious ortho injuries or concussion symptoms), the parents sometimes say to just call EMS and they'll meet the kid at the hospital, or miraculously, they've suddenly been transported home and can be to the school in 10 minutes. 

I feel like it would be a miracle to even have a bladder scanner LOL.

If the student was feeling fine but hasn't peed in 24 hours I'd worry about pyelonephritis as well, and pain, but they seem fine. I'd definitely encourage reaching out to the PCP or urgent care, or ER if that is not available. They may need a straight cath.

Jollysox said:

Update: parent called after taking the kid to be seen. Magically they were able to pee almost immediately after getting home before getting seen by a Dr. and all labs and tests were perfectly fine. 

Not saying they were faking but, I have seen a recent uptick in kids coming to my office with wild, vaguely critical complaints - my ER/critical care brain is looking at them thinking "If you actually had these symptoms you are describing, you'd be on the floor..." - but they seem to know exactly what to say to get me to send them home and get seen by a doctor. I just don't want to have that one time where I blow them off and then it actually ends up being an emergency, but I'm tired of feeding into all of this. Not sure if its social media where they're getting these ideas or what. 

My cynical brain is thinking these kids asked chatgpt to come up with such scenarios.....

Chat gpt, tiktok...IDK. My cynical take is that this generation loves the victim roll. They all have "trauma", and all have some sort of health problem - this is not to take away from the children that absolutely do have these things. But it's become a trend to self-diagnose based off things they've seen online. We have several kids this year telling our school psychologist that they have dissociative identity disorder, that's this year's trendy mental health diagnosis. It affects roughly 1% of the population....

Oye  self diagnosis... When they say they have anxiety ( and I am not aware of any diagnosis) my first question is to ask "When did the doctor made that decision diagnosis? I wasn't aware that you were having  issues...I'll check in with mom/dad/guardian for an update so I can best help you here."

The walk backs on the Dx are pretty frequent... (I am inHS)

Yes, I have also noticed this. I had kids give me a laundry list of things they're "diagnosed" with and respond with "Wow, none of that is listed in your forms. I will call mom/dad and discuss this with them because it's important that I clarify these." and am usually met with "No! Don't call them." hmm....

Definitely would not bladder scan. School is not a hospital and it's pointless because the hospital will do it again and it might not be super comfortable for the kid and they'd wonder why the school nurse did it when she can't do anything to treat it. I think at our hospital there's a written protocol we can bladder scan if certain criteria are met that's been signed off by a physician so not having any protocol in a school I wouldn't even consider it. I'd call the parents to pick up asap. The fact the kid got up and got ready for school, came to school without mentioning it to the parents and then not acting all that bothered clues you in they probably are not being completely truthful but you never know and it's not our place to diagnose or prove it. 

I've had that happen a couple times. One time the child did need catherized at the hospital and antibiotics for a bad infection. Another time the kid ended up remembering they had in fact peed the night before after they got to the hospital and was able to on their own all of a sudden. Better safe than sorry.