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.

[algae1492]

It is important to always assess location of stomach discomfort. I suggest, as I do, have all the students point with one index finger - most will use entire hand - over their abdomen where the pain/discomfort is exactly located and to rate it 0/10. I typically end up with 1-2 cases of appendicitis with same day surgeries a school year. Food for thought. You notified parent and it seems fine.

[swimrun78]

Please do not beat yourself up over this! My little girl had an appendicitis 2 years ago when she was 7. I picked her up from daycare and she said she went to the Nurse at school because she had a stomachache. I asked if she felt better now she said yes. When we got home I thought she looked a little pale, then she said she did not want to eat a snack. That's when my "mommy radar" went off because my girl loves to eat! I thought she felt a little warm and she had a temperature of 100.8. I thought maybe she had the stomach flu or something. Then when we went to take here sister somewhere, she vomited in the car and grabbed at her right side. My instincts told me something was going on and we went to the ER, but I still thought it was probably just a stomach virus. Well a few hours later after CT scan she was diagnosed with appendicitis and had surgery! We went home the next day.

Since then at the school I work, I have had two students who have had an appendicitis. One boy came in twice, both times complaining of pain to his upper right side, no fever, no vomiting, eating normally. He seemed totally fine, I didn't even send him home, but I called his mom and just let her know what his complaints were and the symptoms of appendicitis were. He had surgery the next day! 2nd student came in complaining of stomachache to center of abdomen. He ate a couple crackers and was doing puzzles, seemed okay but would occasionally lean over and hold his abdomen. Again no fever, no nausea or vomiting. I ended up calling because he kept complaining about his stomach and his mom said she would just come get him. When he heard he was going home he jumped up and ran out of my office to get his stuff. I thought he was faking! Mom called the next day and said he had an emergency appendectomy that night! Both parents were very understanding and neither were mad, but I felt horrible. It happens!

[WineRN]

As everyone else has said, you are not at fault here whatsoever. You did your job perfectly and the little one got the treatment they needed! I call that a big win :)

[Kooky Korky, BSN, RN]

You probably know we are often taught to "look for horses, not for zebras". That is, look for usual issues, not unusual issues. In this case, you looked for the usual diabetic issues, not the unexpected, unusual appendicitis issues.

Well, the reason that "rare diseases happen rarely", which is another "truism" we are taught, could be that no one is really looking for them.

I don't know that you did anything wrong and it seems that the young man will be OK, thank God. Just broaden your differential diagnosis thinking. It is scary when we miss, but you got lucky, it seems.

Do they expect you to palpate or auscultate abdomens, lungs? Take VS?

BTW, a young relative had, over the course of a couple of months, intermittent abdominal pain that would literally drop him to the floor, doubled over. This is not a textbook picture of appendicitis.

4 trips to the pediatrician, 1 trip to the ER failed to detect appendicitis. So he was seen by 2 MD's and 2 NP's. Ped got exasperated with parents. Mom said she would like him to have further imaging.

Ped rather rudely & exasperatedly (because of PPS - persistent parent syndrome) agreed, sent him to a Hospital, where either US or CT showed the appendicitis, finally.

Poor kid was admitted then kept waiting for appy for at least 6 hours. He perforated - not sure when but he did perforate - unnecessarily.

2nd surgery later to drain something, during which the liver was punctured. Thank God he was OK, although the Anesthetist had a conniption fit when the child's BP began to fall.

Otherwise uncomplicated recovery, although his school year was messed up, double ABX and PICC required.

The point is that 4 different people missed the Dx - 2 doctors, 2 NP's. Then surgery was delayed another 6 hours. Then the interventional radiologist Resident punctured his liver. It happens.

Oh, and just for good measure, an RN tried to use a phlebitic vein for an IVPB. Of course, the real topper was the Resident telling Mom that "We don't really know what causes perforation"!! What ???!!! Do you think misdiagnosis and missed diagnosis over several weeks and being kept waiting another 6 hours after diagnosis was finally made MIGHT have anything to do with it?

Amazing that parents didn't sue. Mom said she was grateful for Medicaid that was paying to save her son's life, therefore was embarrassed to bring a lawsuit.

So sometimes we all fall short. Thank God for protection and mercy

[Julius Seizure]

It is important to always assess location of stomach discomfort. I suggest, as I do, have all the students point with one index finger - most will use entire hand - over their abdomen where the pain/discomfort is exactly located and to rate it 0/10. I typically end up with 1-2 cases of appendicitis with same day surgeries a school year. Food for thought. You notified parent and it seems fine.

This is a great tip. Generalized abdominal pain (hurts vaguely all over) is rarely as acutely concerning as "it hurts exactly right HERE" pain.

[JenTheSchoolRN, BSN, RN]

This is a great tip. Generalized abdominal pain (hurts vaguely all over) is rarely as acutely concerning as "it hurts exactly right HERE" pain.

Truth. When I ask a student where it hurts and I get a very specific answer without even asking (the point to spot next to belly button vs "everywhere" or "It just hurts") then my eyebrow raises a bit.

[Amethya]

He's back in school today, and he's doing quite well! He just has to wear stretchy pants for a while until his stitches are ready to come out.