High BP in High Schooler

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Hello all,

I have a student in our high school that will have bouts (I'm thinking anxiety) where their HR shoots up to the 140s - 160s, BP like 200s/100s. No substances involved, no caffeine, this is very good student. We have called a squad before, and they actually ended up being in SVT. This has happened a couple of times since then, minus the SVT. Mom keeps saying there is a Dr. appointment scheduled but I've heard nothing. I am about at my wits end as I feel this is a huge liability and unsafe. Is it irrational to tell the parent that the student is not to return until I have a doctor's note saying everything is stable and they're OK to be here? 

And before its asked, yes, CPS is involved and aware of my concerns. 

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Not sure how a doctor's note will help the kid. He/she will have these episodes wherever he/she is and if it's at school, so much the better IMO. If the kid is symptomatic enough from hypertension with/without tachycardia to come to you, it's a trip to the hospital every time until there is medical clearance.  Don't see how keeping the kid out of school helps the situation. 

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offlabel said:

 it's a trip to the hospital every time until there is medical clearance.  

I agree, but also parents never answer the phone, and I cannot call the squad 3-4 days a week and run to the hospital with them every single time and sit there all day until a parent decides to show up. Don't get me wrong, I will if I have to, I will never put a child's life at risk. But we are trying other techniques to lower BP as long as they're stable before calling the squad - most of this issue is anxiety related.  I have 600+ other students that also need me, and I am the only nurse.  It's divorced parents playing hot potato with the kid, neither wanting to interrupt their own lives over this. 

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nurse__ab19 said:

I agree, but also parents never answer the phone, and I cannot call the squad 3-4 days a week and run to the hospital with them every single time and sit there all day until a parent decides to show up. Don't get me wrong, I will if I have to, I will never put a child's life at risk. But we are trying other techniques to lower BP as long as they're stable before calling the squad - most of this issue is anxiety related.  I have 600+ other students that also need me, and I am the only nurse.  It's divorced parents playing hot potato with the kid, neither wanting to interrupt their own lives over this. 

Poor kid...sure didn't ask for this...

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nurse__ab19 said:

I agree, but also parents never answer the phone, and I cannot call the squad 3-4 days a week and run to the hospital with them every single time and sit there all day until a parent decides to show up. Don't get me wrong, I will if I have to, I will never put a child's life at risk. But we are trying other techniques to lower BP as long as they're stable before calling the squad - most of this issue is anxiety related.  I have 600+ other students that also need me, and I am the only nurse.  It's divorced parents playing hot potato with the kid, neither wanting to interrupt their own lives over this. 

I would be talking to child protection about this; as a nurse you have a duty of care to ensure that child abuse is reported. Parents thinking that it's all about them, is absolutely not OK.

Th situation at home, is probably the cause for the HTN.

Either way, If in doubt, always tell someone.

Involve the authorities, and don't stuff around. Be a nurse of action.

 

Just my opinion

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dhitchenor said:


Either way, If in doubt, always tell someone.

Involve the authorities, and don't stuff around. Be a nurse of action.

 

 

They are, as stated in the last sentence of my original post. 

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Prolly energy drinks in play too, I'd be willing to bet....

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Specializes in School Nurse. Having conversations with littles..

If you have done everything you can do to get the care and attention that your student needs and deserves. I would hotline it e.v.e.r.y. t.I.m.e. there is an episode at school, until you have evidence that the student has been to the Dr. for eval.  IDK what state your are in. But, in Missouri- every hotline called is kept in the system. 

In this instance- I would also fill out this  form and send it home with the student. Sorry- can't attach it from where it is saved. This creates your own paper trail. I'd also mail it to the other parent.

Good luck and please update us!

__________________________________________________________________________

School Health Illness/Injury Referral

Student's Name:                                                                   Date:

Reason for Concern: 

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

                                            Thank You ~~         Nurse ______________

 -----------------------------------------------------------------------------------------

 Health Care Provider please complete:                             Date: ___________________

Pertinent Findings/ Plan/Relevant Information for School: __________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

When may student return to school? _________________ 

Will student require frequent absences from class? No / Yes

Activity Restriction: No / Yes/Explain ___________________________________________________________________________

 ___________________________________________________________________________

__________________________________________________________________________

 

Follow-up Appointment recommended - No / Yes- When? _____________________

 

Health Care Provider: ______________________________________________________                                                                     

Address/Phone: __________________________________________________________                       

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Sorry, a bit of an off topic question, but tell me about calling a squad at your school? Who all does that involve and how does that happen? I did school nursing for a couple years a few years ago, and I'm mulling around the idea of going back once my littlest starts kindergarten next year. We didn't have anything like that and if it is what it sounds like, that would have been amazing. 

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Never mind, I realized you mean calling EMS ... my coffee will kick in soon I think 🤦‍♀️ 

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Specializes in Informatics, Pediatrics, Home Health.

This is serious. But, is there a pattern to this? Does it occur at certain times of the day, certain classes, etc? If you truly believe it's anxiety, does your school have a counselor she could talk with? I know these are stop-gap measures, and she definitely needs to be seen by her physician, but it can't hurt to try. 

 

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Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

Interesting post and comments.  But first, my caveat:  I've been a RN longer than many of you have been alive (LOL) but have ZERO experience with children other than ER visits in distant past. I don't even have children of my own!  I'm talking double ZERO experience.  Therefore, my comments/questions may be totally inappropriate.

My first thought is that a bp entering into the 200/100 range is dangerous for anyone.  Perhaps less so for a teen, but I wouldn't want to be the person standing there when/if a stroke occurred.  Or if he/she lost consciousness d/t low cardiac output, fell, hit head... any number of scenarios.  How often do these episodes occur?  You said CPS was involved. What have they done/ what have they reported back to you, if anything?  How long ago was CPS referral made?  If nothing has happened, I'd keep reporting with every episode.  I'd be the dog with a bone.  On prior trips to ER, what was the outcome?  I understand your hesitation in not wanting to call EMS or go to ER but you said "I cannot call the squad 3-4 days a week and run to the hospital with them every single time...".  Is it happening that frequently?  To my mind, that's even more concerning.  Aren't you legally obligated to call EMS for those findings?  And if yes, that might get the attention of the powers that be that can help you address the issue.

Do you have a district nursing supervisor (or even a medical director).  If yes, I would involve them immediately.  In writing.  Paper trail. I'd also send my concerns to the school district administrator.  I may be 100% off the wall wrong, but IMO you are in a position of having some serious legal liability if anything negative happens on your watch.

One other comment.  Another poster mentioned energy drinks.  That may be a very valid concern given the frequency of these SVT episodes.  I sincerely wish you the best of luck as you navigate this issue.  It's definitely thorny.

OK...one more comment.  Several years back I was looking for a "relatively" easy nursing job for my "retirement" job.  A non-nurse friend suggested school nursing.  "That will be easy-peasy" she said.  Yeah.  Right.  What non-nurses sometimes think!  

 

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