Feeling Very Confused (and a Little Hurt), Could Use Some Perspective

[UrbanHealthRN, BSN, RN]

Recently began working in a daycare/early childhood setting. I've done inpatient, outpatient, and community-based peds work before that. We've got a young infant with a hx of GERD and I guess also wheezing (or some sort of cold last month that included wheezing, I'm not exactly sure).

I was just made aware that staff have been giving him daily albuterol neb treatments. I guess this started a month and a half ago around the initial cold/wheezing/whatever episodes. I checked in with staff to make sure all paperwork etc. is in place. Albuterol box script simply says "give every 4 hours"...not as needed, or for xyz indications. Seems a little different to me than the albuterol scripts I'm used to seeing. Plus, it seems like family gives him a dose in the morning, we give him one mid-day, and then they do an evening dose....that's definitely not every four hours. Check the baby out today before his neb dose, he's sleeping quietly with clear lungs. Give him the neb and he's crying, coughing, reflux sx very apparent.

What I saw just wasn't making sense to me today (giving a neb to a baby with no s/s of respiratory distress? Cold sx are long gone too, though the reflux remains). Called family, they checked in with pedi office, office RN calls me back and is incredibly rude. Asks me why I'm not following doctors orders to give this med around the clock, questioning my assessment, making me feel like I don't know what I just saw because they've seen him in the office seven times and I've seen him less than that. I explained very calmly that there was confusion between family and staff re: frequency of administration, if the albuterol needed to be indicated for specific sx, etc. Told her if this is doctor's orders, we will definitely follow them. Hung up feeling utterly defeated, and I haven't felt like this in a long time. I totally understand that I'm the new guy in this picture, and I certainly don't expect to, or want to, undo everything that's been worked on in this baby's short life. I've just literally never seen an infant be on q 4 hr albuterol neb treatments for months.

Am I crazy? According to the office nurse I talked to, she hopes they'll be able to cut him down to prn nebs in the next few months. Meanwhile, he's got reflux up the wazoo that seems to be poorly addressed- I'm not even sure the family is aware of basic reflux feeding precautions. If there's something I don't know about reflux, or around the clock albuterol administration in young infants, somebody feel free to set me straight. I just really feel for this baby right now and his health problems.