Help with a head injury

[nursex23, BSN, RN]

Has anyone had experience with students having a hard time returning to school after head injuries? I have a student with many absences due to a head injury that happened early 2019. Most of these absences are due to mom keeping him home for headaches and nausea & vomiting. He's missed about 45 days this school year. He has a 504 but all it says in relation to managing his symptoms is for him to put his head down when he has a headache. I've tried talking to mom to get any updates or maybe if we could talk to the doctor about how to better manage his symptoms but she gets very vague about what's going on. I'm working with the social worker on how to proceed but we're both unsure of what else to do. How would you approach this?

[tining, BSN, RN]

How about Homebound.

[nursex23, BSN, RN]

Ah! I completely forgot to mention that homebound tutoring is what we are thinking about. However, the social worker wants to do everything we can to get him in school. After a year though, shouldn't he have more of a plan to manage these symptoms.

[ruby_jane, BSN, RN]

My Spidey senses are tingling on this one.

So yay, you've already had a convo with the social worker. Loop the Administration in.

A 504 needs a doctor's orders. So you have a name of a doctor. I'd call his/her staff and discuss options (maybe they won't talk with you but it's less than a year ago so maybe they will). Also if the symptoms remain this bad this far in...the kid needs a reassessment, not just mom judgment. Are we skirting around medical neglect here? Just asking. I don't know.

If it's been a year, you need a review of the 504 and an update. Jussayin.

The 504 doesn't protect against truancy unless there's specific language about keeping the student home when acutely ill. Will truancy contact the mom if the requisite number of days have been met? She has no official doctor's note for absences, it's just her decision, right?

Final thought - does your district have an intermittent homebound program? It sounds like it's time for that.

Best of luck. Let us know what happens.

1 minute ago, nursex23 said:

Ah! I completely forgot to mention that homebound tutoring is what we are thinking about. However, the social worker wants to do everything we can to get him in school. After a year though, shouldn't he have more of a plan to manage these symptoms.

The social worker is not going to get what she wants here. Something else is going on.

[MrNurse(x2), ADN]

Sounds like anxiety induced N/V and the "head injury" is a convenient landmark event to cover. What is the age of this student?

[SaltineQueen]

I'm curious about the circumstances of the head injury...how severe was it? I agree that I'd be trying to talk to the doctor.

[BeckyESRN]

Our, now retired HS nurse, had a student with a severe concussion, unable to be at school due to symptoms being intensified by lovely school lighting, increased mental work load, and too much uncontrollable sensory input (smells, noises, etc.). Student was home bound for a year, but the school received weekly to biweekly progress reports from the team of physicians at the concussion/sports medicine clinic.

If these symptoms are truly keeping the student from instruction, it sound like a more skilled/specialized team of physicians are needed.

[k1p1ssk, BSN, RN]

This student needs sports medicine and/or neurospsych on board, especially if he's experiencing symptoms nearly a year later. And you need access to those notes if/when it happens.

[cid1]

I have a student out since September from an altercation with another student causing a concussion- has been out since. Homebound tutoring only began 6 weeks ago and just got continued for an additional 6 weeks. I have so many issues with it including student not being in school but going on school trips and flying in airplanes with seemingly no issues. Our district seems to not be fighting anything mom wants due to potential lawsuit. It is crazy! No advice, sorry!

[nursex23, BSN, RN]

Update: I really want to discuss this with the doctor but, I don't know if this is a state thing or district thing, we need a release of information form from mom which I'm not really sure how to approach because she doesn't really want to discuss his symptoms. The social worker said she would try to help get that.

The student is about 12 and I do think that anxiety is defiantly a component. The social worker made a good point that it could be because he's missing so much it's getting harder and harder for him to keep up and that's making him anxious. I've only been here since November so I'm reading through his notes trying to get a better understanding. I asked mom if there was any update on his condition from a doctor's note for an appointment back in October and she said there won't be any update until March. I know something is really off about this and I don't know how to tread with this one.

The social worker even suggested maybe there's some Munchhausen by proxy at play because she keeps excusing him but there's very little medical notes provided, the last one was from October.

The 504 is from March 2019 which says he can be in school and to put his head down when he has a headache or go to the nurse if his symptoms worsen. I think he defiantly may need homebound tutoring but I feel like we also need updates on his condition to better help him.

[ruby_jane, BSN, RN]

1 hour ago, nursex23 said:

The social worker even suggested maybe there's some Munchhausen by proxy at play because she keeps excusing him but there's very little medical notes provided, the last one was from October.

The 504 is from March 2019 which says he can be in school and to put his head down when he has a headache or go to the nurse if his symptoms worsen. I think he defiantly may need homebound tutoring but I feel like we also need updates on his condition to better help him.

SPIDEY SENSES.

The 504 is less than a year old. You have a doctor's orders and you share the patient...they will likely talk with you and you lose nothing in the ask. If not, then I would call another 504 meeting ASAP. Because the condition has plainly changed/not improved and the student may need SPED or HB.

[Flare, ASN, BSN]

This is a tricky one - you don't want to dismiss the kid's pain and symptoms, but at the same time, you don't want to play into it either. What is the student doing for symptom management at home? I ask because I had a student with a similar situation where (imho) a few simple headache management techniques would have been key such as allowing sunglasses or access to pain medication (* my student said he took occasional analgesics - i told them over and over, even sending the med form with him when i knew he was leaving for the dr. he "forgot to ask". ) or ensuring adequate hydration. Point is, often times there are solutions there, but none that are desireable to either the parent, student or both. In my student's case, he ended up getting overwhelmed by all the work he fell behind on and wanted it all just to go away without having to be accountable for any of it.