If your teacher says you should go home, you're probably ok to stay

[nursex23]

I had a teacher bring a student down to my office. Teacher says "she was in here earlier but I think it's time to go home." Student had been in earlier with cramps and we called home to bring her ibuprofen but dad said it would be about an hour. Now she's crying. Teacher keeps repeating that she should go home. I asked the student if it's still cramps that have gotten worse or is this something new. Student said it was just the cramps. Again, teacher says she should go home. I told the student in front of the teacher that she can be in school if it's just cramps but I asked the student what she wanted to do, call dad and see where he is with pain medicine or see if he can pick you up? The student said the medication always works for her so she wants to wait for the medication. Called dad who said he was outside parking the car. Teacher had nothing to say after that. ?

[CanIcallmymom, BSN, RN]

26 minutes ago, JenTheSchoolRN said:

This is why I have the long heating packs. They cover the length of the abdomen and are great for menstrual cramps.

(MacGill has them: https://www.macgill.com/economy-reusable-hot-cold-gel-pack-5-x-11-24-case.html)

But I also have the perk of OTC orders that include ibuprofen and acetaminophen - great to have for cramps. But if I did not have these orders, If student were in so much pain that they could not stay in class, I'd dismiss (have a few students in that category). If not, I'd sent them back with heating pack and call them back when Dad arrived with meds. Then I'd look into order from student's doctor and for Dad to provide ibuprofen so this isn't a future issue.

I've also encouraged parents to have a discussion with their child's doctor if cramps are very severe and affecting their child's ability to learn/function on a regular basis. Because they don't always have to.

I used to give the gel hot packs out, but I would, unknowingly, have kids reheating them in the microwaves (high school kids), which are way too high powered in the cafeteria, and exploding them. Or they would leave them in random places or never bring them back. I quit giving them out and only have a few, so I pretend I don't have them at all any longer.

[BrisketRN, BSN, RN]

31 minutes ago, JenTheSchoolRN said:

This is why I have the long heating packs. They cover the length of the abdomen and are great for menstrual cramps.

(MacGill has them: https://www.macgill.com/economy-reusable-hot-cold-gel-pack-5-x-11-24-case.html)

How many uses do these last? I bought the single use heat packs last year. Half of them came broken or hard as a rock and the other half were ransacked by middle school girls.

[JenTheSchoolRN, BSN, RN]

Just now, BiscuitRN said:

How many uses do these last? I bought the single use heat packs last year. Half of them came broken or hard as a rock and the other half were ransacked by middle school girls.

They get through an entire year easily for me - IF they are treated correctly. And I budget for the ones that don't make their way back to me, but the kids are actually pretty good at returning them. I have a return spot for them at my door and drop off happens most often during lunch and end of school day.

I also give instructions to my HS kids that can access a microwave on maximum heating times. All the microwaves in the building are the same grade (my office one is actually pretty powerful) so that helps ;).

MS kids don't have microwave assess so will come to me to return/reheat if needed.

[ARN]

32 minutes ago, JenTheSchoolRN said:

I've also encouraged parents to have a discussion with their child's doctor if cramps are very severe and affecting their child's ability to learn/function on a regular basis. Because they don't always have to. 

this. I have a convo with them about what do you do at home? this is what we need to try to have in place for you at school. heat/meds/rest? they get a limited amount of time in my office. If you are struggling to the point that you need to go home I recommend that they talk to their doctor about what else they can do to help. we don't get to call in once a month or more to work due to our periods unfortunately. I have certainly had times when I just wanted to crawl under the covers and stay there. but we have to figure out what to do about it.

[JenTheSchoolRN, BSN, RN]

8 minutes ago, ARN said:

this. I have a convo with them about what do you do at home? this is what we need to try to have in place for you at school. heat/meds/rest? they get a limited amount of time in my office. If you are struggling to the point that you need to go home I recommend that they talk to their doctor about what else they can do to help. we don't get to call in once a month or more to work due to our periods unfortunately. I have certainly had times when I just wanted to crawl under the covers and stay there. but we have to figure out what to do about it.

Yep. I actually went on birth control pills at 14 because of severe cramps. (I almost passed out at school one day due to them.) Happened to my mom as well when she was my age, but she was awesome. After I almost passed out at school, she was like enough and while it was super awkward at first she brought me to her gynecologist at 14 vs my PCP. And it was a HUGE help.

Many parents are reluctant to consider this because it feels like their child is too young and that this also opens the door to them having sex. Now it is not my place to parent, but I will tell parents that birth control pills are prescribed commonly to treat a variety of reproductive related conditions, including menstrual cramps. And will offer resources if they need help talking to their child or doctor and that their doctor can help them look at all option when it comes to helping their child.

And then I remind them I will also be covering this topic with their child in 7th and 8th grade health and sending home parent guides as well :).

And now I might have hijacked this thread...sorry!

[nursex23, BSN, RN]

2 minutes ago, JenTheSchoolRN said:

And now I might have hijacked this thread...sorry!

I'm a brand new school nurse and you're proving so much valuable info!!

[SandIsMyGlitterRN, BSN, RN]

I have learned in my years of school nursing that every teaching degree must have come with a minor in medicine. LOL!!!

[ruby_jane, BSN, RN]

18 hours ago, llg said:

Because the teacher didn't want the girl doubled over and crying in class. The girl should have been allowed to wait in the nurse's office until the Dad arrived with the medication. Or, if severe cramps are a regular problem for this girl, she should be able to bring the med to school with her, or keep it in the RN office, or whatever the policy is for students who need to take meds regularly.

When I was young, I suffered from terrible cramps -- some of which were totally overwhelming. I wasn't able to do anything during those times. If she is really suffering, she shouldn't have to sit in class.

I'm going to respectfully disagree about waiting until Dad shows up. "I'll be there in a few minutes" can mean anything from 15 minutes to 3 hours.

I have a school with preK through 8, two cots, and a high percentage of influenza. Waiting with a heating pad for a few minutes provides temporary relief, and I can usually guarantee 10-15 minutes before I need the bed for a vomiter or a student with a fever. Our policies vary wildly on whether a student may take OTC meds at school.

I also encourage students to get one of the period-tracking apps for their phone. And....if you know it's a problem, pre-medicate for sure. At home. Because ibuprofen lasts 6-8 hours.

[llg, PhD, RN]

1 minute ago, ruby_jane said:

I'm going to respectfully disagree about waiting until Dad shows up. "I'll be there in a few minutes" can mean anything from 15 minutes to 3 hours.

I have a school with preK through 8, two cots, and a high percentage of influenza. Waiting with a heating pad for a few minutes provides temporary relief, and I can usually guarantee 10-15 minutes before I need the bed for a vomiter or a student with a fever. Our policies vary wildly on whether a student may take OTC meds at school.

I also encourage students to get one of the period-tracking apps for their phone. And....if you know it's a problem, pre-medicate for sure. At home. Because ibuprofen lasts 6-8 hours.

I don't think we really disagree. If a measure such as a heating pad can relieve the symptoms, then the student is not still suffering and she can go back to class. I agree with that. It's just if those measures don't work and she is still suffering significantly that she should be excused from class.

I also agree that if this girl suffers from significant cramps regularly, then a plan should be made with her family to handle this better on a regular basis -- such as with pre-medication and/or medication kept at school that she can access when needed, etc.

But no kid who is suffering significantly should be sent back to class if they don't want to go.

[Kooky Korky, BSN, RN]

On 12/12/2019 at 2:41 PM, tining said:

Offer heating pad for 10 minutes.

Personally I would not have kept in office if med was going to be a while. Student is missing instruction time, a big non-no in middle and high school.

But if she is in too much pain to focus, she should be in the clinic resting with the heating pad.

[beachynurse, ASN, BSN]

On 12/12/2019 at 3:35 PM, llg said:

Because the teacher didn't want the girl doubled over and crying in class. The girl should have been allowed to wait in the nurse's office until the Dad arrived with the medication. Or, if severe cramps are a regular problem for this girl, she should be able to bring the med to school with her, or keep it in the RN office, or whatever the policy is for students who need to take meds regularly.

When I was young, I suffered from terrible cramps -- some of which were totally overwhelming. I wasn't able to do anything during those times. If she is really suffering, she shouldn't have to sit in class.

I'm afraid that I must disagree with some of your posting. In high school, at least mine, if you miss more than 15 minutes of class you are counted as absent. I try really hard not to keep kids in the clinic for long because of that rule. If the student came to me and said that they were ok to return to class, I take them at their word, and send them back to wait for parent arrival there. When the parent arrives, I always talk to them about getting an MD order for the student to have their med at school, and provide the parent with one to take to the MD. More often than not, the order does not get filled out, because the parent prefers to bring the meds.

Now if the child is doubled over, I will let them lie down for a few minutes. We do not have heating pads, due to the risk of potential burning.

I had awful cramps too as a teenager, but I had to suck it up. My parents were unable to come for me unless it was emergent. My mom did not consider cramps to be emergent, but something that we had to learn to deal with, and deal with it I did.

[Jedrnurse, BSN, RN]

It drives me crazy when teachers fan the flames.

Cue overly dramatic/wants-to-be-sympathetic voice: "Oh my god! You don't look good! You must be sick!"

Kids often take their cues from adults. Many times given a spiel like that their "sickness" will rise to the level of the teacher's dramatic pronouncement.