I am Breathless, I swear!!

[manjaNurse]

Hi guys,

Quite upset today. first case early in the morning - a Grade 3 boy complained of chest tightness. He was not in any distress....talking in full sentences...no hard breathing...no SOB....pulse rate normal...respiration normal...lungs are clear..no wheezing..he's pink and alert....

He has a one time episode last yr of breathing difficulties when he got into a close contact with a cat. There were no cats around this time.

He insisted he was breathless even when I told him that his findings were normal. So I called Dad. Dad agreed that he does not sound breathless but Dad wanted Mom to bring him home to get his inhaler (which was NEVER used before).

The Grade 3 were going for ice skating excursion. So, I told the teacher that he can't go since Mom is fetching him. The minute I told that to the teacher, he said he's not breathless anymore!!! So I called Dad again and said he wants to go. Dad said let him go but if he got breathless, Dad will fetch him back.

After the excursion, he came in my room again and said he's BREATHLESS AGAIN!! I refused to check him as he was pink, and talking normally.

OMG!!!

[mustlovepoodles, RN]

I had one like this last year, a 6th grader. He had pretty severe asthma, so he *could* be legitimately sick, but hardly ever was. He had been pulling that stuff all through elementary school and the ES nurse would call mom or aunties and they would always pick him up. Oy! So I insisted on listening to his breath sounds. As soon as i put my stethoscope on his chest he would hold his breath and push his chest in and out, mimicking breathing. I could say "Deep breath" all I wanted, this kid would not comply. So I gave up on the compliance and just left the stethoscope on his chest until he HAD to take a breath. Of course, after holding his breath for 60 seconds he had to breathe hard for a minute or so.

I called mom about it and she admitted that she had always been kinda soft on him about the asthma, but now she was in school so she couldn't just jump up and leave all the time. I told her that I would no longer call her unless he was wheezing and I would not call the aunties at all, unless it was truly an emergency. THEN I had to tackle the sad fact that this kid didn't even know how to use his inhaler! No wonder his asthma was bad! Sheesh.

[Flare, ASN, BSN]

Ah, it's really the feather merchants like this that keep us gainfully employed. If I have a child come in complaining that they can't breathe an assessment is always in order. Auscultatle lungs- as MLP said, the ones really trying to get over will hold their breath and puff their chests - but enentually they have to breathe. I also keep a fingertip pulse oximeter in my office for just such an occasion. It tells me if they are really in distress.

If their story changes to suit their wants and desires, their credibility goes out the window, they get an encapsulated version of "the boy that cried wolf" and sent back to class.

If that boy were my student he would be permitted on no further ice skating excursions until medically cleared by a doctor.

[luvschoolnursing, LPN]

I that type of situation, I always call the parent, but often I wait till AFTER I send the kid back to class, that way they can't get on the phone and convince mom they are dying. This week my big one is chest pain. How can you really tell if a kid is having chest pain? Of course I do a full assessment with a set of vitals, but if they are still c/o, then what.

I had one this week c/o "bandlike" pain, SOB and pain radiating down arm. I really thought he was just watching too many medical shows, but I just can't send a kid back out into the building with this type of complaint.VS were all good. Anyway, in this case, I called mom, of course she had no car, no way to get the kid so I said with his symptoms, I would need to send him out via EMS. Pain instantly disappeared AND mom instantly found a car to come pick him up. Oi!