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

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Do any of my school nurse pals ever encounter a child who so blatantly doesn't need their inhaler that you tell them they cannot have it? I'm curious.

We have on occasion. Frequently, after running the mile at PE, they mistake SOB from running for asthma. If their lungs are perfectly clear we'll have them wait a few minutes and hydrate. That usually takes care of it. Then there are those that you can hear wheezing as they walk through the door--no stethoscope needed!

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:

This is a great thread. We really do need more education and support at school for kids with asthma.

Exercise-induced asthma does need to be treated - it is a narrowing of the airways due to strenuous exercise (I know you guys know this:inlove: ). Most people with asthma will have episodes of exercise-induced asthma. I've experienced it at the end of my first 6 mile run (well, jog ;) ) and I don't have asthma and it was a scary feeling. The goal is prevention so yeah, an inhaler prior would be nice. But . . . you have to have a physician's order. Usually the order are only for kids EXPERIENCING an asthma attack.

As school nurses, we are handicapped by either a lack of parents compliance with getting us the physician's orders we need to properly manager the student or not bringing the inhaler to school.

I've written before about one set of parents I battled with all 5 years I was the school nurse. Their son had asthma and would come in needing an inhaler either just from sitting in the classroom or from running outside in the cold air. I ended up having to get him to the ER twice. The parents were not happy but they left me with no choice since they didn't bring in an inhaler or physician's orders.

I'd never hold back on getting a kid his/her inhaler. They know their body pretty well for the most part and can feel an impending attack without outwards symptoms . . . yet.

This is a hard job when you don't get the cooperation you need from parents or doctors' offices.

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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.

LOL, luckily, one of our PE coaches is a respiratory therapist. She deals with the asthmatics very well.

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Specializes in Emergency Nursing.
I never tell them no either although there have been several occasions where I wanted to. I'm asking because a kiddo today came in "for coughing" and asked for his inhaler. Lungs CTA, coloring great and not a single cough while he was waiting for me to finish with another student. He is a real frequent flier but never asks for his inhaler so I gave it to him. I later asked the teacher how his cough was and she said he wasn't coughing at all, before or after his visit, so when little darling came back an hour later (for something unrelated--- I told you he is a FF) I asked why he said he was coughing when Mrs. Teacher said he wasn't. His reply? "She's a liar."

He's 6.

Oy.

Ouch! That's stone cold coming from a 6-year-old :cool:

!Chris :specs:

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Specializes in IMC, school nursing.
His reply? "She's a liar."

He's 6.

Oy.

This is what the parents will retort with, too.

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Specializes in med-surg, IMC, school nursing, NICU.
Ouch! That reply from him is stone cold out of a 6 year old :cool:

!Chris :specs:

It was completely deadpan and he looked me right in the eye when he said it. Run run run run run run run awayyyyy!

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It was completely deadpan and he looked me right in the eye when he said it. Run run run run run run run awayyyyy!

Yeah but . . . don't we school nurses (I'm retired though ya know) complain about teachers sending us kids for no real reason?

I wouldn't put it past a teacher to . . . tell a fib. ;)

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Specializes in ED, School Nurse.
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.

This is terrifying. Just wait until she stops a kid from coming to see you even though he/she requested it because his pulse ox "was fine!!!".... until it's not.

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No I do not deny them their inhalers but believe me when they come in singing and bebopping round, I want to!!

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Absolutely! We have kids that come in and say they need their inhaler and when asked why "I just think I need it". If their lungs are clear in all fields, they sit with water and are rechecked after a few, if no changes RTC. Wheezes and chest tightness I will obviously give it to them, but some are just using it for avoidance reasons and sympathy.

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He/she is right. I've seen a lot of asthma exacerbations during my Pediatric ER clinical, some with a lot of wheezing (that wheeze you can hear even without a stethoscope) with pulse ox between 95-100%.

A friend of mine is just an exemple. She had an severe asthma exacerbation during one of our clinicals, with a pulse ox number of 97%.

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Specializes in School nursing.
He/she is right. I've seen a lot of asthma exacerbations during my Pediatric ER clinical, some with a lot of wheezing (that wheeze you can hear even without a stethoscope) with pulse ox between 95-100%.

A friend of mine is just an exemple. She had an severe asthma exacerbation during one of our clinicals, with a pulse ox number of 97%.

Are you referring to the gym teacher with the pulse ox?

Pulse Ox can be within normal range during an asthma attack, true. But lung sounds are not. I have heard wheezes with a stethoscope and a pulse ox of 98. Kids compensate well until they suddenly just, well, can't anymore.

That said, pulse ox is also not a great tool in the school setting. It really tells me nothing because when a kid is suddenly below 95, there are typically many other signs going on before that point. And I don't carry O2, so...

A gym teacher carrying a pulse ox, though...I'd try running the mile and checking your numbers right after stopping. Not to mention that a 95% reading on a portable one may be typical; I've seen 88% on kid who no symptoms talking and chatting away and I move to another finger with a better read at it's 98%.

If a child can't catch his/her breath or presents with additional symptoms after a brief normal rest period, I want to see them, but likely they won't be waking to my office and I'll be heading their way.

I continue to learn about asthma as I am aware there is much more I can learn. But I have also seen that students will learn that asking for their inhaler will get them some time out of class; and that if they are presenting often and with no additional symptoms and asthma that typically does not present with any symptoms outside of the school setting, they may be using it more than needed if they are seeking an escape from class.

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Specializes in Pediatrics Retired.
He/she is right. I've seen a lot of asthma exacerbations during my Pediatric ER clinical, some with a lot of wheezing (that wheeze you can hear even without a stethoscope) with pulse ox between 95-100%.

A friend of mine is just an exemple. She had an severe asthma exacerbation during one of our clinicals, with a pulse ox number of 97%.

Yes, as Jen mentioned above...all examples of compensation. The younger the patient, the quicker they die when they can compensate no longer. I use a pulse ox but I rely more on my own assessment first and foremost. As we have all been taught, "Don't treat the monitor." My campus is PK thru 5th grade. My gold standard for identifying distress is pulse rate. If I have a kid with a normal and regular pulse rate for age I don't get too worked up. If I have a 5th grader with an O2 sat of 98 and a pulse rate of 150, I know they are compensating for some reason and move on to the next step of assessment and intervention. Don't treat the monitor.

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