Inhalers?

OldDude · Mar 26, 2015

Scheduled inhaler use makes me tired.....I'll put up with it for a couple of days and then I require a MD order to continue; if their condition requires scheduled bronchodilators every 4 hours for more than 48 hours they don't need to be at school. Most of the time these kids say they aren't using their inhaler at home anyway.

javgjv2012 · Mar 26, 2015

I have one kid that will take his in inhaler if he is starting to get sick. If he has a cold or something mom will email me asking for him to come take it once a day for like a week. She says this really helps to prevent coughing and asthma attacks which get worse when he is sick.

GrannyRRT · Mar 26, 2015

_yWhat are the inhalers? Nasal or oral?

Does the child with a cough have RAD?

What level is their asthma classified at? Some require a scheduled SABA as well as inbetween.

Do they also have CLD from NICU days?

Are the kids active?

Inhalers are not just for "distress"!

If that child is head bobbing and can't speak, they failed to recognize the early signs they should have been taught.

We teach kids how not to get into distress to the point of not being able to speak. For some a cough is a sign their airways are reacting to something.

We also encourage inhalers before exercising for some.

Every child we see has a variation which requires specific modifications in their action plan for short and long term. Yes some are on q 4 tx scheduled for a few days and even long term or at least until the right combo of maintenance meds are found. They should not be made to feel stupid or left out by the school system.

Has their inhaled steroid been altered? What about being on a PO steroid as maintenance or acute?

But then, we also have parents who follow the lead of the nurse in the hospital who calls RT for "every" cough and sneeze to give a neb or inhaler.

Or maybe, the mother has seen her child on a ventilator. She may be feeling guilty for not taking her child's symptoms seriously before the head bobbing and inability to speak.

Why are inhalers still locked up in the office?

NutmeggeRN, BSN · Mar 26, 2015

Why are inhalers still locked up in the office?

Not in my school, (HS) they are supposed to carry them and check in with me if they are not getting adequate relief. I have a backup (in case they forgot theirs at home) that is prescribed by their own PCP.

Not sure she was making the child feel stupid or leaving them out. IMHO.

Sounds like (by your user name) that you are/were an RRT?

Farawyn · Mar 26, 2015

Some of my inhalers are locked up at the parent's request so the student (usually 7th grade boy) doesn't lose it.

Most of the kids self carry/adminster.

JenTheSchoolRN, BSN, RN · Mar 26, 2015

If I let some of the kids carry their own inhalers, they would lose them, so i have some in my office by parent request. But they aren't locked up. I have an inhaler wall - a snow with a slot for every inhaler (and/or Epi-pen) for easy, fast access by any staff member. My office door does have a code on it, but the code is known by all office staff.

And I have quite a few students that per their asthma action plan are to use their inhalers every four hours if sick with a cold, allergy flare-up. I request the asthma action plan as part of the asthma paperwork (along with medication order for the inhaler). Does the child have one?

Windchaser22 · Mar 26, 2015

Olddude I always enjoy and learn from your comments!

tranquillight · Mar 26, 2015

I request an asthma action plan for all of my asthmatics that have inhalers in school. Any type of cough/allergies/cold they are instructed to take their inhalers every 4 hours. Usually I work with the parents so that they give the inhaler prior to school start, I give it around noon time and then they give it again once they get home from school. Definitely helps prevent a lot of problems with my students that tend to have asthma flare ups with any cold symptoms! :)

GrannyRRT · Mar 26, 2015

Scheduled inhaler use makes me tired.....I'll put up with it for a couple of days and then I require a MD order to continue; if their condition requires scheduled bronchodilators every 4 hours for more than 48 hours they don't need to be at school. Most of the time these kids say they aren't using their inhaler at home anyway.

Old Dude, your attitude is scary. You sound like you have already given up on these kids and there is a high probability your attitude shows to the kids. You are like the old meanie school nurse the kids tell me about on their follow up visits. There are many reasons why a child is placed on q4. No, asthmatics do not need to stay at home or on the bench during sports. We do whatever is necessary in their action plan while other adjustments are being made. Your state does take asthma very seriously and it might be of benefit for you to do some reviewing as to what is offered for resources in your area by the state. Don't become the problem by encouraging noncompliance with your attitude.

Here is a link for your state.

https://www.dshs.state.tx.us/asthma/

https://www.dshs.state.tx.us/asthma/educationalmaterials.shtm

This info can be applied to other states as well.

SassyTachyRN · Mar 26, 2015

I have a handful of kids who will use them q4 when ill, usually for a week or two. I also have a bad asthmatic who comes q4 daily (1030, 1430) and I've seen a world of a difference with him from the beginning of the year. He used to wind up in distress and I would have to send him home/ER back in the fall. I also have 5 kids who come before recess daily for before activity inhaler use.

GrannyRRT · Mar 26, 2015

During my almost 4 decades as a pedi/neo RRT, I have heard and seen a lot. Participating in the campaign to get legislature passed for inhalers in the hands of kids at school was a biggie. It also showed me what opposition the pro side was up against from the nurses in some schools. But, that gets into the political side. I have seen the size of some school campuses and can not imagine waiting for someone to bring the inhaler or to actually have to walk the length of a couple of football fields to get it.

I will share some of the attitudes I face when trying to educate other health care professionals (esp nurses) and the comments I hear from kids. At first I used to give the School Nurses the benefit of the doubt but then after hearing the same comments from several children, I could predict what some were going to say based on their school and the nurse.

"You don't need an inhaler. You are talking."

"MDIs are useless. If you really had a problem they would have given you a nebulizer."

Or,

"If the kid had nebulizer instead of that pos inhaler I wouldn't have to call the medics."

"If you have to take an inhaler before playing sports then you probably shouldn't be playing sports."

"You'll lose your inhaler."

Yes some kids do lose their inhaler. But some also are not even given the chance to lose their inhaler. We try to issue a clinical (smaller total # of sprays) inhaler for them to carry or to have as a back up at school. This gives them the opportunity to be accountable for when they use it or lose it.

"You have to wheeze to be having an asthma attack."

"They're on an inhaler."

For a more simple review of what we teach the child, for those who don't want more details, here is a link which covers what we tell the parent and the child.

Handling an Asthma Flare-Up#

From the link:

Spot the Clues
After you've had a few flare-ups, you may notice that you feel a
certain way when a flare-up is coming on. You might have a tight chest,
an itchy throat, or a tired feeling. Or do you have a cough, even though
you don't have a cold? If you have a peak flow meter, this might be a good time to use it.
Have a Plan
Get help if you feel like a flare-up is about to happen. Let people around you know what's going on, and then remember your asthma action plan.
That's the written plan created with your doctor that tells you which
medicine to take and what to do next. Don't ignore the flare-up or hope
it will go away on its own. It won't and you might end up in the emergency room.

It is unfortunate when kids do go to the School Nurse and are told things which contradict what they have been taught. Yes, that does make them feel embarrassed and stupid depending on your delivery. "You're not in distress."

I encourage School Nurses to read through some of the links I have posted here in other discussions about asthma and inhalers. I also encourage you to take the steps to become Asthma Educators so you can better open the lines of communication with the Asthma Educators working with Pediatricians and Pulmonologists. Just following orders or a plan of action is not always enough. You should also understand how that plan was derived so you can better assist the students.