coming from the hospital environment (and mostly teaching environments), I honestly never used an otoscope for an ear but kept it charged for the docs and residents. As for throats, if I had a post T&A I would definitely look for bleeding if I had concerns but not when a patient had a non-surgical sore throats.
I just am not sure what is a reasonable expectation for all the random sore throats and ear aches I get.
sore throats, I'm generally inquiring about runny nose/sniffles/history of seasonal allergies as a likely culprit as I have yet to have a febrile kid come in with a sore throat. I've looked in them but have yet to see any white patches or angry looking red throats.
ears: I was super excited to actually see an eardrum the other day when I was presented with an ear not full of wax, but it looked ok to me based on images I looked up online But what if it hadn't?
I guess I'm struggling with where nursing assessment ends and medical diagnosing is beginning. Regardless of what I find, I can't do anything about it other than send a note home or call the family if I want the parents to know.
Would appreciate other comments on how you handle sore throats and ear aches as I think I've gotten my stomach ache and headache interventions down and those are the majority of "illness" complaints I've been seeing so far.
Haven't read previous posts so sorry if duplicated.
I used to use my pen light to look at throats, but one day by battery was out and used the otoscope without the specula and liked it much better.
Throats: I look for redness, and whether it is just on the tonsils (maybe strep, let parent know but don't mention the word strep) or if it is also red at the back of the throat, which is likely drainage. If there are white patches I will definitely call home and report my findings.
Ears: I attempt to visualize the ear drum, sometimes with the wax it just isn't possible. If the ear drum is inflamed I call home and let them know, or if there is fluid. I used to work at my kiddos pediatrician so if one of my own has an ear infection/swimmers ear/fluid, they will let me look to while we are there so I can see what they look like. Which is nice If there is a foreign object that isn't sticking out of the ear, I call home and have them pick their kiddo up.
I seldom look into ears or at throats, unless I'm looking for a foreign body or if a parent asks me to. It's kinda like the parent complaining to you their kid did not have a fracture when you recommendation MD evaluation for an injury. "The doctor said his ear looked fine!" or "No strep, I guess that was a wasted trip!"...uh uh...I'm over that.
I look! I have a very nice otoscope that I inherited from the previous nurse. It doesn't take very long and usually corroborates the symptoms the student is telling me. I can also tell students "Your throat looks red and irritated, but not swollen. Take a cough drop/gargle with salt water and head back to class. Come back if it gets worse", as long as they don't have a fever.
I like looking in ears too! Red ear canals, red, angry looking ear drums, lots of wax! I love it. I usually will make a call if I see and redness or bulging ear drums. I always bilaterally compare. I will call to report symptoms but not necessarily send home for ear pain, unless it looks really nasty, or the student has a fever.
Fun story... I took a bug out of a kid's ear at camp over the summer. Camper came in saying they'd had a dream that a spider crawled in her ear and now she felt something. I looked with an otoscope and just saw black. Assumed it was old wax. She returned 45 minutes later (with friends) and asked me to look again... I decided to humor her and there is was- ready to crawl out. I grabbed some tweezers, pulled it out, and tried to keep her and her friends from freaking out (didn't work). Every time she saw me around camp for the rest of the summer, she would smile sheepishly at me and wave.
Had a kid when I was in school who had a soybean sprout in his ear. He had been helping on the farm and a dried, harvested bean went in his ear. And he never bothered to tell anyone until several showers later....
Also had the pleasure of helping an ER doc pull a LIVE MOTH out of a 3 year old's nose once. My ears are still ringing from that....
Fun story... I took a bug out of a kid's ear at camp over the summer. Camper came in saying they'd had a dream that a spider crawled in her ear and now she felt something. I looked with an otoscope and just saw black. Assumed it was old wax. She returned 45 minutes later (with friends) and asked me to look again... I decided to humor her and there is was- ready to crawl out. I grabbed some tweezers, pulled it out, and tried to keep her and her friends from freaking out (didn't work). Every time she saw me around camp for the rest of the summer, she would smile sheepishly at me and wave.
I found a bug in a student's ear once at school. It was in way too deep for me to extract with the tools I had in hand (likely would try some tips folks here shared with me if it happens again). Student was going crazy telling me was driving him crazy was the sound of it moving in his ear. I had to refer student out.
I had a kid get pencil lead lodged in his ear TWICE in a school year. He liked to scratch his ear canal with his sharpened pencil. It was sideways the first time and against the ear drum, the second time he perforated the ear drum and he had be to sedated in the ER to have it removed. Then, 2 days after the 2nd incident, his sister got an eraser stuck way up in her left nostril. A kid had walked by and tripped into her desk causing the pencil that she was resting on her lip to go into her nose. When she pulled the pencil out, the eraser was missing.
This summer my kid put a round lego in his nose...that was a fun ER trip. They used a fogarty cath to remove it! As we were leaving a little girl came in to have the nerds candies removed from her ears. Mom said the kiddo filled both ears!
Thank you to everyone for the responses. I honestly have a lot of frequent fliers that I've already detected in my 3 weeks as a school nurse so if nothing looks abnormal, I'm just sending home a note that they came to see me and for what. When a kid comes back more than once for the same issue, I'm making calls. Thankfully while I'm new, I have a health assistant with me temporarily and she speaks Spanish as almost 65% of my students are in ESL or dual language classes and I don't (yet) speak Spanish so it really makes it hard to have meaningful conversations with my families. I can't even converse with most of my Pre-Ks and Kinders so I try to smile a lot :)
I had a kid get pencil lead lodged in his ear TWICE in a school year. He liked to scratch his ear canal with his sharpened pencil. It was sideways the first time and against the ear drum, the second time he perforated the ear drum and he had be to sedated in the ER to have it removed. Then, 2 days after the 2nd incident, his sister got an eraser stuck way up in her left nostril. A kid had walked by and tripped into her desk causing the pencil that she was resting on her lip to go into her nose. When she pulled the pencil out, the eraser was missing.
This summer my kid put a round lego in his nose...that was a fun ER trip. They used a fogarty cath to remove it! As we were leaving a little girl came in to have the nerds candies removed from her ears. Mom said the kiddo filled both ears!
I remember when I was in elementary school, and one of the boys in my classroom decided to make his own braces with a paper clip. Didn't feel so good once it got stuck but he was embarrassed and tried to hide it until the teacher noticed him quietly crying.
Specializes in Cardiology, School Nursing, General.
Not a nurse, but I was trained on how to know the difference with throats and how they look if the person is sick, same with ears. I do that, just to tell the parent of my findings. "You're child is here with a fever, they have a very red inflammed throat." or "You're child is complaining of ear pain, I do see their ear is slightly red." Then tell to either come get their kid if it's something that extreme or what they'll like to do as the parent.
Specializes in Pediatrics, Hematology Oncology, School Nurse.
I only use my otoscope if a child complains that they stuck something in their ear (legos, erasers).
I only look in throats if a child has a fever. Parents really don't seem to want our opinions that something might be wrong with their child, unless there is a fever that requires them to be picked up from school.
OyWithThePoodles, RN
1,338 Posts
Haven't read previous posts so sorry if duplicated.
I used to use my pen light to look at throats, but one day by battery was out and used the otoscope without the specula and liked it much better.
Throats: I look for redness, and whether it is just on the tonsils (maybe strep, let parent know but don't mention the word strep) or if it is also red at the back of the throat, which is likely drainage. If there are white patches I will definitely call home and report my findings.
Ears: I attempt to visualize the ear drum, sometimes with the wax it just isn't possible. If the ear drum is inflamed I call home and let them know, or if there is fluid. I used to work at my kiddos pediatrician so if one of my own has an ear infection/swimmers ear/fluid, they will let me look to while we are there so I can see what they look like. Which is nice If there is a foreign object that isn't sticking out of the ear, I call home and have them pick their kiddo up.