I would appreciate any advice on how to best handle this student.
Student quite dramatically holds his chest and starts breathing heavily claiming he has chest pains. Comes to me clutching his chest and when I assess him, his pulse ox is good, breath sounds are clear, vital signs are within normal limits. Once I explain this and get him breathing slower, he is quickly back to normal and heads off to class. This has happened multiple times a week in the last three weeks. Student has been doing this in classroom more frequently than I realized as the teachers have somewhat figured him out and only send him to me when the symptoms persist. In addition to chest pain, sometimes it's his nose tickles or he's "allergic to the classroom."
Mom is aware and tells me it has started happening at home and she is the one that told me "he is becoming a hypochondriac and something is ALWAYS wrong." PCP ruled out any medical issues and getting into some sort of counseling is in progress.
In the meantime, any ideas? He is missing quite a bit of instructional time and being disruptive to the classroom with his frequent "episodes." The teachers are at their wits end, I was thinking maybe have him come see me daily on the way to recess which is before lunch for a quick check out and talk to try to prevent disruption to the classroom but don't know if that will help feed the issue?
I honestly don't know if these are true panic attacks or a bit of acting on his part as yesterday he was fine and everything had subsided and when the assistant principal popped her head in to ask me a question about something else he immediately clutched his chest again.
I feel bad for the teachers as his behavior is so disruptive to the class as he is doing it multiple times a day ... classroom, art, PE, cafeteria. Miraculously it never happens at recess.
This afternoon when he came in he was holding one armpit then the other saying "oww!" and doubling over randomly. I've tried having him deep breath and he will be totally calm but then when I tell him it's time to go back to class he starts doing the "oww!" clutching himself action again.
The counselor is aware and made a referral to get an outside evaluation for counseling in the community. Basically the teachers and I are alone in figuring out how to deal with this in the classroom. Mom knows it's a problem but doesn't have any suggestions. I'm not sure if calling her when he is in my office would be helpful or not ... I do know that she WON'T leave work to come pick him up and create that cycle.
It is pretty obvious that he is trying to get out of class as it seems to happen most often during things that he does not want to participate in. I don't mind him coming in but the whole process gets old of him seemingly fine then getting pains as soon as going back to class is mentioned. The fact that is happened today right as I was going to eat lunch didn't help :)
River Song, again I have a couple of students in the same boat and I feel your pain!
Yesterday, I just looked at the student and said "You have been resting in my office for xx time during which I have seen nothing that tells me you cannot be in school at the this time. Therefore, I am signing your pass and you will return to class." I have taken other options out of the equation.
Student and I had a brief staring match, student sighed and took pass.
I have found frequent communication with principal and teachers helps A LOT. I will send an FYI email about frequent visits and that student is okay to stay in class. We have a space student can take a brief "rest" in that we make as boring as possible.
Same student sat with me for observation once after telling me they had "sharp stabbing pains in every part of my body" (Vitals normal, skin color normal, etc). I did not engage them and after 10 minutes student said they were bored and I smiled, signed their pass. Student started to protest but I told student that it appears they are healthy enough to be bored in my office, so they are healthy enough to be bored in math class.
Hang in there - these are the students that came just plain exhaust me!
Specializes in ICU/community health/school nursing.
"You have been resting in my office for xx time during which I have seen nothing that tells me you cannot be in school at the this time. Therefore, I am signing your pass and you will return to class." I have taken other options out of the equation.
Student and I had a brief staring match, student sighed and took pass.
Same student sat with me for observation once after telling me they had "sharp stabbing pains in every part of my body" (Vitals normal, skin color normal, etc). I did not engage them and after 10 minutes student said they were bored and I smiled, signed their pass. Student started to protest but I told student that it appears they are healthy enough to be bored in my office, so they are healthy enough to be bored in math class.
All the YES! YES. I am stealing your words and using them. Welcome to my clinic! When there's nothing really wrong with you, we treat that with therapeutic boredom.
I did not engage them and after 10 minutes student said they were bored and I smiled, signed their pass. Student started to protest but I told student that it appears they are healthy enough to be bored in my office, so they are healthy enough to be bored in math class.
Ah, Therapeutic Boredom , the school nurse's best friend.
When I was at the jr high I used it in spades. No conversation, no books, no devices, nada. A sick student will go to sleep. A bored student will complain.
Specializes in Cardiology, School Nursing, General.
I just tell him to go back to class, or I'll call the ambulance and they will have to perform surgery... WITH NEEDLES!
Then I call his mother so she can tell him to knock it off. 68% of my parents are Hispanics, so you always hear the mother cussing at them in Spanish and it brings a smile to my face. :)
Ah, Therapeutic Boredom , the school nurse's best friend.
When I was at the jr high I used it in spades. No conversation, no books, no devices, nada. A sick student will go to sleep. A bored student will complain.
Yaas!! i do this all the time. Turn back to my work and toil away. Once they start trying to tell me about their video games or movies or whatever it becomes clear that it's less a case of a virus and more so mathititis
Yaas!! i do this all the time. Turn back to my work and toil away. Once they start trying to tell me about their video games or movies or whatever it becomes clear that it's less a case of a virus and more so mathititis
I hear mathititis is highly contagious, especially in 4th-5th graders...
It's nice to know we each have one of these this year!
We had a meeting with the parents about the situation because she already had him thoroughly checked out (the little guy even convinced the doctor to do an upper GI!!) and he is FINE. Now he can only come to me for life threatening aliments, and he sees the counselor daily to go over techniques to better process his anxiety. It has only been around 3 weeks but it is seeming to help.
Sorry, but I just have to ask -- is this kid having any peer group or social interaction problems that would lead him to seek out positive attention at school? I know, I know, but humor the little voices in my head!
Sorry, but I just have to ask -- is this kid having any peer group or social interaction problems that would lead him to seek out positive attention at school? I know, I know, but humor the little voices in my head!
While I am not the OP, I will say that, for me, this option was explored. My most recent student that visited me often was very social and had many friends - student was actively avoiding classwork, but never complained of any physical symptoms during most social times, like gym class or lunch or field trips.
Specializes in ICU/community health/school nursing.
Sorry, but I just have to ask -- is this kid having any peer group or social interaction problems that would lead him to seek out positive attention at school? I know, I know, but humor the little voices in my head!
You are a kind and lovely person!! Sometimes it's good to listen to the voices...
JenTheSchoolRN, BSN, RN
3,035 Posts
River Song, again I have a couple of students in the same boat and I feel your pain!
Yesterday, I just looked at the student and said "You have been resting in my office for xx time during which I have seen nothing that tells me you cannot be in school at the this time. Therefore, I am signing your pass and you will return to class." I have taken other options out of the equation.
Student and I had a brief staring match, student sighed and took pass.
I have found frequent communication with principal and teachers helps A LOT. I will send an FYI email about frequent visits and that student is okay to stay in class. We have a space student can take a brief "rest" in that we make as boring as possible.
Same student sat with me for observation once after telling me they had "sharp stabbing pains in every part of my body" (Vitals normal, skin color normal, etc). I did not engage them and after 10 minutes student said they were bored and I smiled, signed their pass. Student started to protest but I told student that it appears they are healthy enough to be bored in my office, so they are healthy enough to be bored in math class.
Hang in there - these are the students that came just plain exhaust me!