How do you handle these?

bergren · Mar 15, 2010

Not sure what you are asking? I would assess and handle the same as any other injury.

LACA, BSN, LPN, RN · Mar 15, 2010

I had a school nurse once tell me that she didn't treat injuries that occured at home. So I was going to see if that was the norm....I treat them just like any other injury, but didn't know if everyone else did.

Keepstanding, ASN, RN · Mar 15, 2010

i will place a call to the parent most of the time. if a student has twisted their ankle at the roller rink on friday night and they come to me on monday morning, well there is not much i can do really. ice on a 36 hr.old injury won't help. parents are really the responsible party here. i will make a call.

many times parents use us as thier first line of health care. even if they were negligent in assuming responsibility for thier child over the weekend when it happened. frustration !! :uhoh3:

praiser :heartbeat

mustlovepoodles, RN · Mar 16, 2010

It depends on the injury. I've had kids who suffered a buckle fracture while skating over the weekend and parents insisted "it's just sprained." Okay, it may be, but she can't move the wrist and it's hurting so much she's crying. You have 15 minutes to pick her up and don't bring her back without a doctor's note. I've had two kids with infected 2nd degree burns that parents neglected. "Pick them up NOW and take them to the doctor or ER. Bring me a note." Or the kid who had suffered a head injury at home and showed up in my office with severe headache the next day. The history was concerning and parents were not responsive. I finally had to threaten them with CPS to get them to take him to the ER. By the time he got there he was altered. :eek: BAd, bad concussion. Stupid stupid parents.

Generally, I do not treat injuries that are 24hrs old, unless it is something unusual.LIke the kid whose mother beat her to a pulp (called CPS, taken straight to foster care) or the boy who suffered a bad injury to the shin bone which required stitches. His mother refused to provide pain medication and this kid was really suffering. All I had was ice and I made arrangements for him to come in twice a day for 4 days for icing. Otherwise, I will cover a bleeding cut or a knocked-off scab, but I do not put ice on old bruises nor bandaids on things that aren't bleeding, unless it is a large scrape in an exposed place.

bergren · Mar 16, 2010

I have never seen a district policy that stated that injuries that occur offsite will not be evaluated in school. If there is not a written policy stating such, a registered nurse would be obligated to assess and respond to a student presenting in the health office with an injury.

Flare, ASN, BSN · Mar 16, 2010

I'll assess anything brought into my office. That doesn't mean that everythnig needs treatment. Invisible cuts that happened on Friday night - wash it and get back to class. Joint injuries that happened over weekend but start hurting at the end of the day (just in time for the math pop quiz) - check range of motion (listen to the kid perform I Think I Broke It: The Musical) maybe ice for a few minutes and back to class. If they come in first thing in the AM with a home joint injury and can't complete range of motion then i'll call parents.

Never forget that unfortunately sometimes our job becomes "community clinic". PArents will send in sick and injured kids that need formal treatment and it's our job to advocate for these kids to ensure they get it. Not that there aren't the malingerers out there - the trick is learining the difference :)

LACA, BSN, LPN, RN · Mar 16, 2010

I don't really understand her way of thinking on not treating them just because the injury didn't happen at school. If they are in pain, bleeding, etc then they would need some sort of treatment! Yes, it bugs me when kids come in with a cut and tell me that it happened that morning at home and Mom/Dad told them to wait til they got to school and get a bandaid from me. Wow, really?? but, I guess that's the joy of being a school nurse!

SchoolNurseBSN · Mar 16, 2010

It is just all part of the job as a student advocate to assess EVERYTHING!

manjaNurse · Mar 23, 2010

Oh God!!! I think I broke it : The Musical!! that really cracked me up!!!

I received students with over the weekend injuries as well....if they said their shoulder is in pain since Saturday, I will ask them what did your parents do...if they said nothing, I'll just say then I can't do much either.

But if the kid came in looking genuinely in pain, I'll call the parents and get more info.

mustlovepoodles, RN · Mar 24, 2010

Oh God!!! I think I broke it : The Musical!! that really cracked me up!!!
I received students with over the weekend injuries as well....if they said their shoulder is in pain since Saturday, I will ask them what did your parents do...if they said nothing, I'll just say then I can't do much either.
But if the kid came in looking genuinely in pain, I'll call the parents and get more info.

I had one of these last year. An 8th grader who hurt his shoulder on Saturday. "What did your mom say?" "nothing." "Did she take you to the doctor?" "no." :rolleyes: The rt shoulder was obviously higher than the left and he couldn't hold a book or a pencil with his right hand. He had NO range of motion in the arm. So I call mom.

ring, ring...

"hello, John's mom? I have John here and I think his shoulder is really injured. He says he hurt it Saturday and i would have expected it would be better today, but he can't use the hand or arm at all. He needs to see his doctor right away." "okay. Send him home on the bus." "No, ma'am. I think it might be dislocated or fractured. He cannot go on the bus with this injury. Come get him now, please." "Okay."

Next day I call John in to check out the shoulder. Turns out mom didn't take him to the doctor and now the shoulder is really killing him. His lip is beaded with sweat and his lips are pale. so I call mom.

ring, ring...

"Hello, this is the school nurse again. I have John here and he is in extreme pain. He says you didn't take him to he doctor yesterday. You MUST take him to the doctor NOW. I think the shoulder may be dislocated or fractured." "I can't" "You must" "I can't. I'm sick" "I'm sorry you're sick, but he's badly hurt. He's 13 and he can't drive himself. Someone must pick him up and take him to the doctor NOW." "I can't" "Okay, I understand you are sick, but this is an emergency. If you cannot be here in 15 minutes I will need to call CPS and you can deal with them. They will call you from the ER, I'm sure." " Oooo-kaaaay, Iiiii'mmmmm cooooom-iiiiiinnnggg"

She comes to school, mad as hell. I smile and greet her, thank her for coming. She shoots me daggers. I tell her he cannot come back to school without a written note from the doctor.

Kid stays out of school for a day. comes back in a brace, He has a fractured shoulder. :mad: And mom didn't even send him with any tylenol or anything.

Some parents need to be held down and poked in the butt with a sharp stick. :devil:

bergren · Mar 24, 2010

Thanks for sharing that story.

I think what some of these kids experience at home is worse than any of us can imagine.

For a child whose parents don't care, I am glad that someone at school can care about them. Thanks for advocating for this child. Thanks for caring.