Hi all. I'm wondering if any of you ever wrote up an Action Plan for a student with hyperventilation?
I had one student show up in one of the elementary school offices while I just happened to be on campus last week. The funny thing is I'd done the mandated training for our stock epi-pens the day before to the office staff and principal. (Long story about new law in CA about stock epi-pens and no volunteers stepping up to be trained).
I assessed the student; 02 Sat 97%. Lungs clear. HR 120. Resp 32. No signs of anaphylaxis and no history of asthma. I had her do pursed-lip exhalation/sucking on a straw inhalation and using her diaphragm to breath. Calming voice. Etc. It calmed her down and then she started up again. Couldn't get a hold of parents right away.
When dad showed up in about 15 minutes, she calmed down but then it started again. He ended up taking her to the ER per my advice. She was diagnosed with hyperventilation. Paper bag treatment and breathing techniques/calming atmosphere. It took about 30 minutes and she finally stopped.
My concern is the office staff said if I hadn't been there, they'd have given the epi-pen. I spoke with her doc and he doesn't want this as it will make hyperventilation worse. Parents don't want it either. Doc also said "Paper bag was an old treatment that had no real physiologic basis. In theory it may have changed some acid-base equilibrium but it probably has more of a psychological effect than anything. It is not the standard of care. I think if there is no history or exposure, no throat swelling, or other allergic signs, epi should not be used as it may make hyperventilation worse". (He's also an ER doc and Family Practice Doc).
Parents say this happens occasionally at home as well so she has a history of hyperventilation.
Anyhooo . . . .. .I want to write up an Action Plan using breathing techniques.
Anyone ever write one of those that I could look at and get some ideas for how to write it? It is fairly simple but thought I toss the question out.
Poor girl. What seems to trigger her hyperventilation? Does she have social anxiety or test anxiety or general anxiety? Treating the symptom is of course important but I wonder if some mindfulness CBT could benefit her so she can handle the stressor instead of the aftermath?
I may be way off here, just thinking out loud (in print).
It could probably help, but I hate to say, I have found that sometimes the girls just get like that, for lack of a better term to describe it. And then they have an audience of other kids, and teachers, and it builds...
Does your school have a counselor? A private office (i.e. principal's office/guidance counselor)? Those may be two quiet places to escort this student to. Is there a staff member at that school that you feel could handle this student without reaching for the Epi-pen first?
This sounds like a nightmare that could become "Let's Epi everyone!"
I have a little tiny room just off the cafeteria where I do H&V's. I'll probably do that next time BUT . . . . I may not be on campus then.
Poor girl. What seems to trigger her hyperventilation? Does she have social anxiety or test anxiety or general anxiety? Treating the symptom is of course important but I wonder if some mindfulness CBT could benefit her so she can handle the stressor instead of the aftermath?
I may be way off here, just thinking out loud (in print).
She and her brother are seeing a counselor who is helping the family. Sperm and egg donors neglected them both but they were pretty young when they were removed from the home.
This is an older couple (well, around MY age) whose own children are grown. They took in these kids as foster parents and then adopted. Wonderful parents!
I have a little tiny room just off the cafeteria where I do H&V's. I'll probably do that next time BUT . . . . I may not be on campus then.
She and her brother are seeing a counselor who is helping the family. Sperm and egg donors neglected them both but they were pretty young when they were removed from the home.
This is an older couple (well, around MY age) whose own children are grown. They took in these kids as foster parents and then adopted. Wonderful parents!
Poor girl. What seems to trigger her hyperventilation? Does she have social anxiety or test anxiety or general anxiety? Treating the symptom is of course important but I wonder if some mindfulness CBT could benefit her so she can handle the stressor instead of the aftermath?
I may be way off here, just thinking out loud (in print).
I was thinking anxiety as well, with the elevated HR
Yes it does. As I think back to my nights at the ER, when my cohorts and I were all alone, with no one to call, you figure out what works and go with it....may not be the "standard of care" but that's part of being a patient advocate. Heck, if I thought putting a Viking helmet on someone would reverse their condition, I'd try it. Know what I mean?
Yes it does. As I think back to my nights at the ER, when my cohorts and I were all alone, with no one to call, you figure out what works and go with it....may not be the "standard of care" but that's part of being a patient advocate. Heck, if I thought putting a Viking helmet on someone would reverse their condition, I'd try it. Know what I mean?
I feel like school nursing is all about the "non-standard" things that work to help a kid, physically and mentally.
I feel like school nursing is all about the "non-standard" things that work to help a kid, physically and mentally.
I agree. But . . . . . . the bureaucratic nonsense that dictates how I am supposed to do things says otherwise.
And . . . I found out yesterday that all the schools in our county will be audited by the mean old government workers this fall.
If the "t's" aren't crossed and the "i's" not dotted, we will get fined.
I can't write up a policy willy nilly . . . .but just came from a stock epi-pen training at one of the elementary schools and the new law here in CA that went into effect states the person trained has to have a current CPR card. Only one person had one.
The law states the sup has to ask for 2 volunteers per campus. We didn't get many takers. So we decided to train office staff and principals/vice principals. At this campus today, a bunch of teachers wanted to come in to the training and I let them.
I also encouraged them to get their union involved in getting them CPR training.
Maybe your student hyperbreather could focus on counting all the tiny little bags. You certainly wouldn't want to cause any harm with your non-standard of care treatment. LOL
Farawyn
12,646 Posts
It could probably help, but I hate to say, I have found that sometimes the girls just get like that, for lack of a better term to describe it. And then they have an audience of other kids, and teachers, and it builds...