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Blood Disorder and Severe Bruising

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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Have any of you ever had a child with a bleeding disorder come to school with constant new bruises to the face, arms, legs, etc.?   If so, how did you handle it? 

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SchoolNurseK is a BSN, RN and specializes in Home Health, School Nurse Newbie.

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Do you have MD documentation of this diagnosis? 

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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I was just about to ask...what do the orders say?

I suspect if it's not a hemophilia variant or other hemoglobinopathy...not much. But I'd love to see orders. If a parent was asking me to map a child's bruises daily....I'd want a set of orders for that.

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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24 minutes ago, SchoolNurseK said:

Do you have MD documentation of this diagnosis? 

No, I do not. I've filed 3 reports to CPS, and the guardian is supposed to bring documentation in today. I know that the child has had an open CPS case for a while, and after the third report another case worker came out to see the child. The original case worker (I could hear her yelling at the new one over the phone) says the child has a bleeding disorder that explains why she bruises easily but I've never been provided any documentation. 

I'm just wondering if y'all seen any case where severe contusions/bruising that wasn't abuse. 

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SchoolNurseK is a BSN, RN and specializes in Home Health, School Nurse Newbie.

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Document, document, document!!!  If you are allowed, I suggest attaching pictures to your notes as well.  Is there prior medical history in the Cum folder?  Surely this has been addressed in the past if it is an ongoing issue.

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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2 minutes ago, SchoolNurseK said:

Document, document, document!!!  If you are allowed, I suggest attaching pictures to your notes as well.  Is there prior medical history in the Cum folder?  Surely this has been addressed in the past if it is an ongoing issue.

This student has been with us a little over a month. There was no mention of any medical condition in the health survey filled out upon admission to our school but the guardian called after the first report and said she has a 'blood disorder', I asked for documentation then but never got any.   

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JenTheSchoolRN is a BSN, RN and specializes in School nursing.

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1 minute ago, lifelearningrn said:

This student has been with us a little over a month. There was no mention of any medical condition in the health survey filled out upon admission to our school but the guardian called after the first report and said she has a 'blood disorder', I asked for documentation then but never got any.   

Did the guardian also give you any information about the student's doctor? Because if I have that, I might call the doctor to see if diagnosis can be confirmed. 

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

2,307 Posts; 24,897 Profile Views

10 minutes ago, JenTheSchoolRN said:

Did the guardian also give you any information about the student's doctor? Because if I have that, I might call the doctor to see if diagnosis can be confirmed. 

As soon as I get the information I'll be calling the doctor for verification and hopefully a plan of action. 

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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So I got a visit report that shows slight anemia (RBC 3.98; HGB 11.1)..  

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laflaca has 5 years experience as a BSN, RN.

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1 hour ago, lifelearningrn said:

So I got a visit report that shows slight anemia (RBC 3.98; HGB 11.1)..  

Ohhhhhh boy. Hello, CPS, it's lifelearningrn again....

A parent of a kid with hemophilia is going to know the name of it by the time they're in school. This sounds very fishy.

Truly hope the kiddo is safe. Yikes. 

Edited by laflaca

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

2,307 Posts; 24,897 Profile Views

42 minutes ago, laflaca said:

Ohhhhhh boy. Hello, CPS, it's lifelearningrn again....

A parent of a kid with hemophilia is going to know the name of it by the time they're in school. This sounds very fishy.

Truly hope the kiddo is safe. Yikes. 

Right? This was pretty much the conversation I had before I left work today. 

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shark_nurse14 has 5 years experience as a BSN, RN and specializes in school nursing.

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Yikes...go with your gut on this one....

Any parent I've had of a child with a true bleeding disorder has made sure I have proper documentation and emergency medication/orders from MD before the child steps foot into the school. 

Also, student's I've had with bleeding disorders will frequently come to school with bruises to legs, sometimes arms, but RARELY their face. If there was ever a facial bruise/injury, parents would usually contact me with that information before it was brought to me by a concerned teacher.

A lot of parents whose children have bleeding disorders are hyper-vigilant, and the lack of concern or follow-up from your student's parent, along with the current CPS involvement, has my spidey nurse senses tingling. 

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