Inhaler Usage

Purple_Scrubs, BSN, RN · Feb 12, 2009

I always let the child use it when they ask for it. Who knows, maybe they sense something coming on before we can perceive the signs of them needing it. Who am I to say that there is not a certain "feeling" that they recognize before the wheezes start? I don't have the reference, but I read somewhere in a "asthma-friendly school" publication of some sort that it was best practice not to deny inhaler use, and I'd rather err on the side of caution.

I did have one kid who was coming in literally every day at the same time. He does have orders to use it 30 min before exercise, but he only has PE 2-3 times per week, and on the other days he would say he felt like he needed it. Once this became a pattern I told him "if this keeps up, it means your medicine is not working very well and I'll have to talk to your mom about taking you to the doctor to see if you need a different medicine." That took care of it, he only comes in now on PE days and very occasionally on other days.

BunnyBunnyBSNRN, ASN, BSN · Feb 12, 2009

i have only had this situation a couple of times, but what i do is explain to the child that the lungs are clear, their heart rate and resp rates are normal and they are showing no signs of resp distress. i let them sit for 10- 20 minutes and encourage them to go back to class reassuring them that i'm here till 3:30p if they need me. if they insist on using the inhaler, i would contact the parent and explain my finding and how i am not going to give medication that is un-necessary.

luvschoolnursing, LPN · Feb 15, 2009

I would assess them, then let them use it, then let the parents know what my assessment showed. I wouldn't withhold the inhaler.

RochesterRN-BSN, BSN, RN · Feb 15, 2009

I might be looking into other causes for the child to be feeling short of breath. Maybe the assessment for a medical cause for the SOB shows nothing but keep in mind other possibilities.......Anxiety is the first thing I would think of. This can cause a feeling of SOB, a feeling of choking, chest tightness........Depending on the age of the child he/she may not be able to verbalize this but with a few questions and looking at his/her body language....taking a little time to investigate further....there also may be something the child is avoiding by coming for the inhaler, alterior motives...hiding from someing or attention seeking. Just a though coming from a psych nurse and ex respiratory nurse.....especially in a person who has both anxiety issues and asthma...the two work in a vicious cycle....when an asthmatic is anxious they suddenly worry that they can't breath--real or not--and when they truly can't breath it creates anxiety--cyclical.

Just a few ideas--sometimes you might need to think outside the box.

Good luck....

bergren · Feb 15, 2009

I would not withhold an inhaler. I agree that the child might be able to assess the beginnings of a reaction to a trigger. How old is the child? Why is he or she not self-carrying?

What does the child's Asthma Action Plan say about inhaler use? If the provider did not give you one, get the provider (and the providers for all of your kids with asthma ) to fill it out: http://www.aap.org/schooledinasthma/tools.htm

If they have one, here is an assessment tool to evaluate if the asthma action plan is working: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asth_act_plan_frm.pdf

The American Lung Association’s Open Airways for Schools is a program to strengthen the students' self-management skills. You could offer Open Airways to all the kids with asthma and not single this child out.

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44142

American Lung Associations Asthma Friendly Schools Program:

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22590#toolkit

Kids Asthma Bill of Rights

http://www.lungsandiego.org/ASTHMA/advocate_rights.asp

SchoolNurseBSN · Feb 16, 2009

I agree with not withholding the inhaler. I do a thorough assessment, give the inhaler. If it becomes a habit, then I involve the parent and the ordering physician

Flare, ASN, BSN · Feb 17, 2009

I would not withhold the inhaler. I would do a very thorough assessment, including calling the parent to confirm the time of the last dose, if any then document document document. These kids usually know their bodies well. If they are beginning to feel the initial tightness of SOB developing, far be it from me to deny them their inhaler. And besides, in my state in a child is deemed capable by doctor and parents, they are permitted to carry and self administer.

Lorie P. · Feb 17, 2009

i would let the child use the inhaler and be sure to document it.

my daughter is an asthmatic and she knows how and when to use her inhaler. she is a self carrier and the nurse knows it.

there are times that she says she needs to use it and there are know symptoms indicating she should use it then, but usually in 5-10 minutes she will start to wheeze, cough and get that tightness in her chest and that will lead to anxiety, sob , etc. etc.

by allowing her to use her inhaler without s/s , many full blown asthma attacks have been avoided.

just my thoughts!