Do you ever say "no" to an inhaler request?

tining, BSN, RN · Dec 13, 2016

There is a PE teacher here who keeps a pulse oximeter on her at all times (I didn't give it to her, no idea where she got it) and sends me kids with a note "Pulse ox 95%, needs inhaler"
I can't.

Why would a coach have a pulse ox, I find THAT alarming. Is she an EMT/Nurse/MD/Paramedic? She is essentially diagnosing an exacerbation without a complete assessment. I would definitely speak to her stating she could be liable (scare tactic). I always consult with the parent on those I do not think need it as often as they request it.

tining, BSN, RN · Dec 13, 2016

I put paper tape on the inhaler and write name on that.

100kids, BSN, RN · Dec 13, 2016

My overall point in this post - we do the best we can with what we're given - yet we're still given grief and the shoulda coulda woulda by people that are not in our trenches.

This exactly!!! :yes:

100kids, BSN, RN · Dec 13, 2016

Why is a child separated from their inhaler during PE?
Why aren't they bronchodilating before exercise if they have been diagnosed with Exercise Induced Asthma?
If they are wheezing, you screwed up by not allowing them to bronchodilate prior to exercise. .

Nope. If they are supposed to bronchodilate before PE this would or should be in the orders from their Dr (we do have some with those instructions) but if it's not there and the orders are written "prn for tightness or wheezing" then there's nothing we can do. If they are having regular problems after PE I will call home and recommend they discuss it with their child's physician but I can't just change the orders to whatever I want.

What are the ages of all these kids who have their inhalers locked up in the office? We are going into 2017. Time to stop punishing kids for having asthma. I see 5 year olds who can tell me more about their medications than their caregivers can.

Are you kidding me? School Nurses are probably one of the biggest group of advocates for children with asthma. I try to have kids in my school self carry as early as possible but in my state Dr, parent and School Nurse permission is needed and often the physician or parents don't trust the kids to have them and want them kept in my office. I try to educate my students on their asthma because many of them are told basically nothing from their physician except take this inhaler if you need it and I try to help both them and their parents understand what their medications are doing (or supposed to do) and the discussions they may want to have with their Dr. if they are experiencing difficulties and/or are using their rescue medication frequently. I'm glad you see 5 years old who are so knowledgeable but I see kids age 3-12 who have no clue and many of their parents don't really understand it either.

To the OP No. I don't ever deny an inhaler but if there is frequent use I always call home and discuss the increased usage and the possible need to consult with their physician about getting better control of their asthma.

kidzcare · Dec 13, 2016

Wow! I used to make excuses for nurses who did this but that was before I worked PICU and witnessed a few children die of asthma.
Why is a child separated from their inhaler during PE?
Why aren't they bronchodilating before exercise if they have been diagnosed with Exercise Induced Asthma?
If they are wheezing, you screwed up by not allowing them to bronchodilate prior to exercise.
They may have air trapping which does not always wheeze. The SpO2 may not drop either. A decrease in SpO2 is a late sign and a very bad sign. You missed that window of opportunity. The PE teacher probably knows this which is why you have been given an SpO2 number.
What are the ages of all these kids who have their inhalers locked up in the office? We are going into 2017. Time to stop punishing kids for having asthma. I see 5 year olds who can tell me more about their medications than their caregivers can.

How long have you worked as a school nurse? If it's one day or more than you, of course, know that we do not lock up emergency medications, such as inhalers.

If I child has exercise induced asthma, then they will have dr orders to take their inhaler prior to PE/recess. It is not the fault of the nurse if that child does not have their inhaler because the parent failed to bring it in or fill out the necessary paperwork.

No child is being "punished" for having asthma. That makes it sound like a school nurse is telling a child in respiratory distress to suck it up.

Your post was presumptive and rude.

JerseyTomatoMDCrab, BSN · Dec 13, 2016

They may have air trapping which does not always wheeze. The SpO2 may not drop either. A decrease in SpO2 is a late sign and a very bad sign. You missed that window of opportunity. The PE teacher probably knows this which is why you have been given an SpO2 number

Yeah, I hear that becoming well versed in the pathophysiology of the respiratory systems is a requirement for PE teachers.

There is so much absurdity in your comment I can't even begin to address it all. You must not have read the original post or anything the previous comments have said.

Bye.

OldDude · Dec 13, 2016

I'm a big fan of the movie Mr. Woodcock, where the high school coach forces the asthmatic kid to run laps to learn how to control his asthma. That's what we do at my school. Lock up the inhalers and make the asthmatic kids run laps to break them of wanting to use their inhalers. What do their doctors know about asthma anyway???? :sarcastic:

100kids, BSN, RN · Dec 13, 2016

I'm a big fan of the movie Mr. Woodcock, where the high school coach forces the asthmatic kid to run laps to learn how to control his asthma. That's what we do at my school. Lock up the inhalers and make the asthmatic kids run laps to break them of wanting to use their inhalers. What do their doctors know about asthma anyway????

Exactly!!!

Supernrse01, BSN · Dec 13, 2016

Nope. If it becomes a habit or I am sincerely questioning the need or the frequency of requests, then I will call and speak to the parent, but I'm not denying that request just to have it end up being a true need that wasn't recognizable at the time. That's a whole other can of worms!

Farawyn · Dec 13, 2016

No, I would never refuse a kid his/her inhaler. If I thought they didn't truly need it I would speak to the parents about how their child presents.

My kids all self carry. So, I'm mostly off the hook.

Supernrse01, BSN · Dec 13, 2016

Wow! I used to make excuses for nurses who did this but that was before I worked PICU and witnessed a few children die of asthma.
Why is a child separated from their inhaler during PE?
Why aren't they bronchodilating before exercise if they have been diagnosed with Exercise Induced Asthma?
If they are wheezing, you screwed up by not allowing them to bronchodilate prior to exercise.
They may have air trapping which does not always wheeze. The SpO2 may not drop either. A decrease in SpO2 is a late sign and a very bad sign. You missed that window of opportunity. The PE teacher probably knows this which is why you have been given an SpO2 number.
What are the ages of all these kids who have their inhalers locked up in the office? We are going into 2017. Time to stop punishing kids for having asthma. I see 5 year olds who can tell me more about their medications than their caregivers can.

WOW!! You must be the luckiest school nurse in the world to work in the most perfect school!! Most of us here, I'm sure, are jealous of the perks you seem to have, including the 5 year olds who already know everything there is to know about their diagnosis and the medications they use to treat their symptoms! I can't imagine coming into work everyday to that fairytale place! I bet the head lice line up at your door to turn themselves in too, huh? No head check required.

Why comment on a school nurse forum when you are so clearly not a school nurse??

Farawyn · Dec 13, 2016

I'm a big fan of the movie Mr. Woodcock, where the high school coach forces the asthmatic kid to run laps to learn how to control his asthma. That's what we do at my school. Lock up the inhalers and make the asthmatic kids run laps to break them of wanting to use their inhalers. What do their doctors know about asthma anyway????

:inlove: