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Discussion

HEEEEELP... ASAP

So I've seen this student about twice now. Yesterday afternoon she came in complaining of a stomach pain, like a knot feeling in her lower abdomen. I examined and everything felt and looked completely fine. So I gave her a TUMS tablet and sent her back to class. She came in again this morning with red puffy eyes and her teacher. Her teacher told me she is still complaining of the pain in her lower abdomen, then the teacher finally mentions re-occurring UTI in the patient! So I assume that is what it is but I couldn't take the temperature of the student orally. I'm having her lie down for now, and will take her temp axillary in about 30 mins. I'm about to refer her to the hospital because the group home she's in won't take her in to get checked. Oh, I forgot, this student has CP and cannot speak so she uses her tablet to converse with me. When I told her I will send her to the hospital she lit up brighter than the lights in my office. I called her teacher and asked about her bathroom trips and she told me she hasn't gone all morning, but was telling her teacher that she is starting to feel pain when she pees. I feel like the student just wants to be sent to the hospital because this jus isn't adding up. What should I do? I have a hard time telling her no because she is constantly saying we don't care about her and won't listen to her. Should I still refer her to the hospital?

Btw, this has happened when I first started working (when I was so gullible to everything :( ) but that's another story too long to tell.. in the end, she wasn't actually sick, she was jus seeking some attention from pretty much everybody.

&&&& her group home sucks cause their lazy and won't listen to their students. So whenever I call to have them take her to the hospital, they end up taking her to their nurses office and don't ever take her into the hospital.. blah

I just need help on what I should do with this student..

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    • Expert

    You are expecting too much from yourself. You can't diagnose a medical condition. Your assessment can only arise from the signs and symptoms during presentation. Regardless of whether you have been lied too or whether these are legitimate symptoms I think you should refer the kid on for further evaluation and don't second guess yourself if everything turns up negative. Better to be overcautious than wait and let the kid be overcome by a raging UTI, which as we know can cook up quickly.

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    Do you have a district nurse to consult? Can you send direct to ER or urgent care? Will she drink and try to go?

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    • Author

    Thanks OldDude, I just needed reassurance that I'm doing the right thing. Sometimes the staff from her group home will jus become "annoyed" and not answer the phone calls so I will jus stick with my plan

    and JustBeachyNurse No district nurse, but I will jus send her into ED for further evaluation

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    You are expecting too much from yourself. You can't diagnose a medical condition. Your assessment can only arise from the signs and symptoms during presentation. Regardless of whether you have been lied too or whether these are legitimate symptoms I think you should refer the kid on for further evaluation and don't second guess yourself if everything turns up negative. Better to be overcautious than wait and let the kid be overcome by a raging UTI, which as we know can cook up quickly.

    Agree with OldDude. Possible UTI often doesn't have a temp, but whenever the student communicates that it hurts when they pee, I am overcautious and always refer for further eval. Does the student have a PCP you can call? Or one that the home she is at works with?

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    I agree with OldDude. Refer her to a physician or ER, let them rule out any possible problems. Just because she have lied to you in the past does not mean she is lying to you now. Better safe than sorry.

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    Send to ED maybe she lit up because she knows she has a chance at relief

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    My first reaction was...Is she being sexually abused??? My second...Does she take bubble baths? (Which we all know can be the cause of frequent UTI's.)

    I would get her to an empathetic doc, ED or whomever, with an adult who will communicate with the medical professional.

    All of the above replies makes sense. I don't think she is faking.

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    Is there a caseworker or social worker involved through the group home? Is their neglect a reportable situation?

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    Call social services is what I would do. There is no harm in that.

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    My first thought was sexual abuse, too. It's rare for girls to develop recurring UTIs unless there is no safe environment to pee or they are being abused, in my experience. Unless, of course, she is old enough to be sexually active.

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