Do you look...

[chasinRT]

in ears and throats? I have been told recently that if a child comes to me with a sore throat or earache, I should not take a look. I am to just report it to the parents. What do you do?

[amnesiac1c]

Yes, I do look so I can share what I see as a part of my assessment. Of course I always emphasize to parents that I cannot diagnose ear infection, strep, etc. But I have found beads, pieces of broken pencil & beans in ears so I do think it's important.

[rbytsdy]

I look. I am really only looking for big issues like a bulging eardrums, cerumen impaction (if they are failing hearing tests, picking at ears, etc). Sometimes kids complain about their ears and just the canal is red since they've been sticking their fingers in there! I had a kid sent to me once with red stuff coming out of his ear. Teacher panicked thinking it was blood (that's what I thought at first). Turns out his brother stuck a candy in there and it was melting....

[Spidey's mom, ADN, BSN, RN]

We also have a district physician. They write and sign off on our standing orders for our emergency anaphylaxis and respiratory distress protocols (we have stock epi and albuterol with tubing and neb machines that can be given per the standing orders).

I know some districts have this. A law was passed in my state recently allowing this but no local physicians will take that chance . . .for now. We shall see.

The only epi-pens or albuterol we have are the meds the students bring themselves. We have NO stock medications. And I'm still waiting on parents to bring in an epi-pen for their student. One gets respiratory symptoms as the allergic reaction and mom told me they can't afford the epi-pens. And yes, I've given her info about how to get them.

So, basically the healthcare plan is call 911.

[JustBeachyNurse, LPN]

I know some districts have this. A law was passed in my state recently allowing this but no local physicians will take that chance . . .for now. We shall see.

The only epi-pens or albuterol we have are the meds the students bring themselves. We have NO stock medications. And I'm still waiting on parents to bring in an epi-pen for their student. One gets respiratory symptoms as the allergic reaction and mom told me they can't afford the epi-pens. And yes, I've given her info about how to get them.

So, basically the healthcare plan is call 911.

The district should see if an urgent care or ER physician would contract to sign off on nursing protocol/standing orders including emergency hypoglycemia, allergy/anaphylaxis, respiratory distress protocols (so you can have a glucometer (often can get free from manufacturer + test strips), albuterol nebs (there used to be a reduced cost nebulizer and neb tubing offered for school districts with a signed order), and epipen kit

[Spidey's mom, ADN, BSN, RN]

We have mostly "doc in the box" ER docs from another community.

Our local physicians, who used to be our full staff of ER docs are only working very part-time there. And so far, due to liability concerns, no one wants to do it.

It's a new concept here . . . . might take some time. Plus, I'm the only nurse with 11 campuses. And I work part-time. Hard to convince a physician to let a lay-person be in control.

[JenTheSchoolRN, BSN, RN]

I look. And mostly it is because I have so many kids telling me their throat hurts and requesting cough drops (MS/HS). I give them a sympathetic look and say, "okay, let me take a look." I get the deer in headlights look, especially if I explain what I see (with the caveat of "I cannot diagnosis anything, let your parent know if it persists, etc"). Word got around and I see less kids for cough drops now

I did catch what I thought might be a weird right-sided bacterial throat infection; kid didn't have tonsils, had no temp - sent him home with recommendation parent take him to the doctor. Student saw doctor and then ENT specialist and they still have no clue what it is. Luckily the second stronger antibiotic is helping, poor kid was miserable for a while.

I wish I had an otoscope. Thinking of seeing if I can work my budget to purchase a decent one.

[kidzcare]

I look in throats all day. I tell the kids "Let's take your temperature, because that's where we always start and I'll take a look in your throat to see if there is anything suspicious looking... Do you know what i mean by suspicious looking?" They usually say no. So I tell them I'll be looking for swelling or red/white areas that could indicate an infection (read: something you cannot fake). I tell them what I see, usually mild swelling and give a cough drop. And I have a sign on my cough drop container that says "Cough drops are not CANDY. Please take only one" Then I make them wash their hands as they leave telling them that is how we will keep from spreading germs to our friends and teachers :) If I do see red or white stuff I call home and tell the parents to come get them and that they should get a swab. They are generally OK with it.

I have an otoscope, but hate using it. I've never seen anything obvious and I'm afraid of missing something.

[SouthernSchoolNurse]

JustBeachy, I have a physician that is willing to write standing orders for strep swabs as long as it is legal. Could you please share your policy or any research you have regarding the legality with me? I would not be doing them as a diagnostic as I cannot diagnose and/or prescribe as needed to treat. However, I would like to be able to do them to help prevent missed school when no strep is present and to prevent spreading strep.

Thanks, in advance for any help.

[jnemartin, BSN, RN]

I just ordered myself an otoscope from School Health.com! You can actually get them inexpensively on Amazon, as well as an otoscope-like device that actually hooks up to your computer and takes a photo of the ear drum.

I do a lot of throat checks and can easily identify swollen/inflamed tonsils or red throat, and I let parents know what I've seen when I refer them to doctor. I'm fine with doing this for ears, too.

I do get a bit annoyed when students say "my throat hurts, can you look and see if I have strep"... but I use it as a teaching moment. Surprisingly, a lot of them know that they need an actual culture to dx strep, but they want to get a "professional" opinion/look, and I respect that.