Hi all, I haven't really posted before, but I'd appreciate some feedback since school nursing is new to me and I'm really trying to grow and learn something from each experience. I like this position and really want to be successful. Today I was called on the playground by another teacher. The student was on the ground holding his head, not moving. Teacher says she did not witness fall, another student told teacher he fell and did not give many other details. When I get there teacher says his initial reaction was repeating "my head hurts", but when I got there to assess him, he wasn't following any commands (wasn't telling me his name, where he was, open eyes, squeeze fingers) just mumbling. Pupils were equal, dilated (approx.5 mm). Given all of this I did not feel I should move him so I made the decision to call 911. Last update I received he was now awake/alert and waiting results of a CT scan at the hospital. All other tests appeared normal. I did come to find out he does have a history of behavior problems, that he can be withdrawn. Did I overreact? Are there any other steps/assessment you would have done? Any other questions/commands you would have asked?
Specializes in Mental Health, Gerontology, Palliative.
I always operate to the principle I'd rather a doctor says to me "tenebrae you are being over cautious" than "tenebrae why the hell didnt you send this patient in 2 days ago"
I think you handled it right on the money, and as others have said a CT is not some random procedure completed without clear clinical rationale
Specializes in Mental Health, Gerontology, Palliative.
Also, if something were to go wrong down the track, you know that you have done everything you could possibly do for this person
I had an example last week. I had a patient with a chest infection, consolidation in the left lung. When I listened to his breath sounds, the consolidation had spread to his right lung. He also had a history of rapid deterioration so I made the decison to send him in to hospital
Responding to Amethya: I have seen kids with dilated pupils from meds they were on. But in this case, I would assume head injury and let the ER sort it out. We just don't have the tools to make the determination.
25 years of experience, I would have done the same. And you also did the right thing to discuss the experience here, it's hard in a solo position to not have the opportunity to decompress and review. Third you most definitely helped another school nurse to feel more confident in making a similar situation in the future.
Specializes in school nursing/ maternal/child hospital based.
I always operate to the principle I'd rather a doctor says to me "tenebrae you are being over cautious" than "tenebrae why the hell didnt you send this patient in 2 days ago"
I think you handled it right on the money, and as others have said a CT is not some random procedure completed without clear clinical rationale
You did just what I would have done. Head injuries are no joke, you assessed and found reason enough to send out. I agree that if the Docs thought this was BS, they never would have ordered the CT. Second guessing is such an unpleasant part of this job. Its a huge change going from a setting where you have an emergency and its all hands on deck to you are standing alone. We make decisions based on our assessment and gut. Be proud of yourself for being the nurse you are!
Thank you all so much Sometimes it's hard being out there alone, especially when dealing with others who don't know what we do. I'm really learning a lot and appreciate of all of you!
Specializes in Cardiology, School Nursing, General.
You did everything right! Great job.
Responding to Amethya: I have seen kids with dilated pupils from meds they were on. But in this case, I would assume head injury and let the ER sort it out. We just don't have the tools to make the determination.
Of course, but if you have a present injury, it's better safe than sorry.
Sometimes it's hard being out there alone, especially when dealing with others who don't know what we do. I'm really learning a lot and appreciate of all of you!
Tenebrae, BSN, RN
2,021 Posts
I always operate to the principle I'd rather a doctor says to me "tenebrae you are being over cautious" than "tenebrae why the hell didnt you send this patient in 2 days ago"
I think you handled it right on the money, and as others have said a CT is not some random procedure completed without clear clinical rationale