Distat. What Would You Do?

[lifelearningrn, BSN, RN]

Hi wonderful school nurses. I have question about distat administration. If a student with a very generic seizure action plan (do not restrain child, admin distat (if ordered) for seizures lasting >5 minutes, call 911 for seizures lasting >5 minutes, etc.) has a simple partial seizure and refuses to allow anyone to touch her (to even have her lay down), during seizure at school, would you forcibly restrain the child (Kinder) to administer distat?

[chare]

...has a simple partial seizure and refuses to allow anyone to touch her (to even have her lay down), during seizure at school, would you forcibly restrain the child (Kinder) to administer distat?

Why? Particularly when that action plan particularly states to not restrain the child.

[lifelearningrn, BSN, RN]

That's just it. The action plan states clearly not to restrain child, but also it states to administer distat for seizures lasting >5 minutes. It's very generic, it's identical to that of students who have generalized tonic clonic seizures, which administering distat after 5 minutes makes perfect sense for.. This student, with generic action plan, had a partial seizure lasting >5 minutes (first in school), but refused to to lay down, or be touched throughout the seizure. She was aware what was going on the entire time. She is non-verbal, and was holding herself up on the floor and crying, and when encouraged to lay down refused. She swatted away anyone who tried to touch her. Would you forcibly restrain a child in this situation to administer a drug like distat?

[caliotter3]

I would discuss this with the physician and then the parents, depending on what the physician says.

[GmaPearl BSN RN]

Sounds like she needs an Individualized Emergency Care Plan!

[lifelearningrn, BSN, RN]

Thanks for the replies. I have talked to both parent and doctor (actually her nurse) and the seizure e-plan is going to be adjusted and her rescue medication changed to sublingual.

My issue is until the student had a seizure in school, I had no way to know how inappropriate (imo) distat was for this student and her type of seizure. Now I know. Calling 911 after 5 minutes was also not an appropriate action (even though it's in the original e-plan) as this student's seizures usually last up to 10 minutes, so even mom doesn't call 911 or always take her to the ER.

I guess I'm just wondering if you all would have gone ahead and restrained the child (who was refusing to be touched or lay down) to administer a rectal medication.

[Flare, ASN, BSN]

no - i would not restrain a child unwilling to get a rectal medication. My guideline for diastat is that if you are aware that i'm giving it - then you're not getting it.

[Farawyn]

What Flare said. If she is cognizant enough to refuse it, she's not needing of it.

PLUS, the rest of the Care Plan.

[DEgalRN]

I can very rarely think of a situation where I would forcibly administer a medication. Most certainly not in this instance.

[kidzcare]

If she is cognizant enough to refuse it, she's not needing of it.

^^yep

[Supernrse01, BSN]

no - i would not restrain a child unwilling to get a rectal medication. My guideline for diastat is that if you are aware that i'm giving it - then you're not getting it.

My thoughts exactly!

[lifelearningrn, BSN, RN]

Thank you guys! :) I do feel confident in my choice, just needed some reassurance from other nurses. :)