Diabetic student having surgery

[Amethya]

Student is not here today and mom called telling me that yesterday, after he went home for severe stomach pains (We thought it was Diabetic issue), is having surgery for his appendix. I didn't think it would be that since usually when he has these stomach pains it's his glucose and ketones issue.

Mom said she will let us know how it goes, but I'm worried it might be my fault, or I didn't take care of him well enough.

[Farawyn]

One thing maybe to keep in mind...and we ALL do it...don't get hung up on one thing. For example, you keep mentioning the diabetes. YES, always take that into consideration, but it could be anything.

You did the right thing. The kid was in pain, you called Mom, and he went home. Don't overthink, and don't get locked in to one thought.

[Amethya]

Yeah...appendicitis is tricky. No one really knows what that little thing is for or why it gets angry & wants to come out. Like NOW!! It's a fickle little (useless) thing.

Thank you so much for assuring me. I'll keep an eye out in the future for this though, because I didn't think I would have a case like this, but I always send kids home for things like this, so hopefully he'll be better soon.

[Amethya]

One thing maybe to keep in mind...and we ALL do it...don't get hung up on one thing. For example, you keep mentioning the diabetes. YES, always take that into consideration, but it could be anything.

You did the right thing. The kid was in pain, you called Mom, and he went home. Don't overthink, and don't get locked in to one thought.

Thank you Farawyn.

[JenTheSchoolRN, BSN, RN]

The last I send out as a red flag for suspected appendicitis did not have rebound tenderness. They didn't even have a low grade temp. They had stomach discomfort located just to right of belly button, fatigue, nausea (no vomiting), and loss of appetite. I just had a hunch that happened to be right and I send the kid home with instructions to call the doctor to be seen that day because I can't diagnosis, just refer.

But, I'm a RN. I'm trained to have a hunch, so to speak. Assessment is part of the RN scope of practice. In my state, a MA can only use the guidelines set by an RN and you followed those and sent the kid home because they were unwell. Mom followed up with doctor. Kid got care they needed. That is the important part. You did fine.

[ruby_jane, BSN, RN]

One thing maybe to keep in mind...and we ALL do it...don't get hung up on one thing. For example, you keep mentioning the diabetes. YES, always take that into consideration, but it could be anything.

You did the right thing. The kid was in pain, you called Mom, and he went home. Don't overthink, and don't get locked in to one thought.

It's a great point.... kid with diabetes with stomach ache comes in and the first thing I ask is "what's your BSG?" Ketones...yep. Stomach ache. Looking for the horses and not the zebra because the hoofbeats are more likely to be a horse.

[JenTheSchoolRN, BSN, RN]

It's a great point.... kid with diabetes with stomach ache comes in and the first thing I ask is "what's your BSG?" Ketones...yep. Stomach ache. Looking for the horses and not the zebra because the hoofbeats are more likely to be a horse.

I do the same thing. And most of the time it is related (last student with diabetes I saw with stomachache had a BG of 482, for example).

But when BG is closer to normal and no ketones, may be time to start considering the zebra. Again, if one can assess for the zebra, of course :).

[Amethya]

It's a great point.... kid with diabetes with stomach ache comes in and the first thing I ask is "what's your BSG?" Ketones...yep. Stomach ache. Looking for the horses and not the zebra because the hoofbeats are more likely to be a horse.

Very true.

[OldDude]

If you had a standard Starfleet issue medical Tricorder like Dr. McCoy used on the USS Enterprise in Star Trek you could have diagnosed that appendicitis in less than a second...but you don't so you did the next best thing available. Good job!!

[LikeTheDeadSea, MSN, RN]

A few weeks ago I thought a kid was faking generalized stomachache- Chatty Cathy, no temp, no rebound tenderness, no nausea, literally nothing clinical. Swung by twice in one day. Not unusual. I even called home with a "clinically I don't see a reason for him to go home, but it's been twice and I just wanted to make you aware," call. Parent decided to grab him. HOURS later that evening it become ER visit symptoms and bye bye appendix.

Boy, did I feel like a butt.

Parent was appreciative of the phone call though, which is just my standard practice for repeating visits, even with nothing obvious, (...when I have time)

[AdobeRN]

You didn't miss anything and don't beat yourself up about it - you did the right by contacting the parent, not much else you could have done. My own kid had appendicitis and surgery when she was 7 - she did not have the classic symptoms, no pain or tenderness, no fever, only non stop vomiting - after a 24 hours of what seemed like continuous vomiting I took her to the ER where she was diagnosed after the CT.

[Amethya]

If you had a standard Starfleet issue medical Tricorder like Dr. McCoy used on the USS Enterprise in Star Trek you could have diagnosed that appendicitis in less than a second...but you don't so you did the next best thing available. Good job!!

I want that tricorder... xD

[Amethya]

Update:

So kiddo came out alright, is going to be in the hospital for at least 3 days. Hopefully this helps him and he won't have these stomach issues again. I talked to him on the phone, but he was still under anesthesia, so he was a bit loopy, but I did tell him I hope to see him soon and he gets well quickly.