Inhalers?

rollernurse365 · Mar 27, 2015

The lanyard would be considered a choking risk.

The ones used at other districts are the kind with a break-away built in. They are used in k-12.

allnurses Guide · Mar 27, 2015

The ones used at other districts are the kind with a break-away built in. They are used in k-12.

I'm just saying . . ... . :sarcastic:

Everything is a risk. Everything is bullying. Everything is dangerous. One of the reasons I'm frustrated by my job.

Zero Tolerance for normal :banghead:

allnurses Guide · Mar 27, 2015

It is very frustrating when the parents aren't on board with their child's asthma action plan. As an asthma and allergy NP, I get a lot of frustrated calls from school nurses (and you are saints!) about why Johnny doesn't have inhalers at school or a plan on file. My office works really hard to keep track of these kids and make sure their plans are up to date, but we can't do a whole lot if the parents aren't engaged. And don't even get me started on the parents who smoke around their kids......

That being said, there are times that Q 4hour bronchodilators are appropriate. We recommend them when a kid with asthma gets a URI with cough, or has a history of a URI with exacerbation. We are happy to fax an order to that effect to the school if a parent lets us know their child has a cold, or if we see them in the office. Daily maintenance inhalers (steroid or steroid/LABA) should always be done at home, not at school, and proper use can often reduce the need for the prn bronchodilators. Getting both the parents and kids on board with that can be a challenge. Ultimately, the goal is to keep the child well and off of oral steroids.

OldDude · Mar 27, 2015

BCgradnurse..I completely agree with you and I believe we are saying the same thing; I have a cabinet packed full of inhalers...all with the same rx...2 puffs yadda yadda and a few with added rx for EIB. I have ONE asthma action plan for all those inhalers. I have experience working in a pediatric pulmonology clinic. And you bet - there are times when Q4 hour bronchodilators are appropriate but only appropriate with the practitioner's knowledge and instructions and really Q4....not just when the child is at school. It's difficult for me, as a RN, to morph a medication prescription label that says 2 puffs every 4 to 6 hours as needed for cough or wheeze to 2 puffs every 4 hours because I get a note or phone call from "mom" telling me to do that for a week at school. That's why I'll put up with it for a couple of days but beyond that I need to be sure the kid's practitioner approves of that.

Flare, ASN, BSN · Mar 27, 2015

It is very frustrating when the parents aren't on board with their child's asthma action plan. As an asthma and allergy NP, I get a lot of frustrated calls from school nurses (and you are saints!) about why Johnny doesn't have inhalers at school or a plan on file. My office works really hard to keep track of these kids and make sure their plans are up to date, but we can't do a whole lot if the parents aren't engaged. And don't even get me started on the parents who smoke around their kids......
That being said, there are times that Q 4hour bronchodilators are appropriate. We recommend them when a kid with asthma gets a URI with cough, or has a history of a URI with exacerbation. We are happy to fax an order to that effect to the school if a parent lets us know their child has a cold, or if we see them in the office. Daily maintenance inhalers (steroid or steroid/LABA) should always be done at home, not at school, and proper use can often reduce the need for the prn bronchodilators. Getting both the parents and kids on board with that can be a challenge. Ultimately, the goal is to keep the child well and off of oral steroids.

See this is where the problem often lies- i can't tell you how many kids will come into my office for their rescue inhaler on a regular basis, indicating to me that they do not have good control of their asthma. I'll ask them what they do at home and they tell me they just take the same inhaler when needed. That's it. No daily regimen. No preventative measures. And of course some of these kids are the ones that come in reeking of smoke. Then when you call the parents to ask about it - oh yes, they're working on it - they have to look into it. But then again they just barely got the AAP into you and it took the parents 3 weeks after that to send in the inhaler (or vice versa - you get the inhaler first then have to beg for the asthma action plan)

As far as the issue with giving Q4hr - if the parents are looking for a regular admin for a few days - they should be administering at home before school - so at best you'd probably only give once (figure given 7:30 am at home 11:30 by you then school should be out. ) but under regular orders, yes q 4 hr orders may buy you multiple admins in a day.

ceebeejay · Mar 27, 2015

I was taught, if an asthmatic says they need their inhaler to believe them. Period.

allnurses Guide · Mar 27, 2015

My 13 year old son has very well controlled asthma. In fact he hasn't had a real attack in 4 years though he does wheeze a bit when he is sick. He keeps an inhaler at school. It's a private school so there is no nurse but the staff knows if he asks for it - it is to be given to him no questions asked. He ran Cross Country and played basketball and football last year and during fire season carried the inhaler on his person. Even his doctor says he probably doesn't need it anymore but better safe than sorry!

Hppy

Red Kryptonite · Mar 28, 2015

I'm just starting with all this. My son is 14 1/2 and only started showing symptoms about a year ago during track season. We didn't recognize it at first. He's diagnosed as exercise-induced, and that's the only time he shows symptoms. Finally got him a long acting inhaler for regular home use and a rescue inhaler to keep with him. Hoping he gets more control because he's a three sport athlete and loves it. Plus, he's such a good runner I think he could have a real shot at it helping pay for college.

From my conversation with his doctor I realized there's a lot I don't know about asthma.

allnurses Guide · Mar 28, 2015

I'm just starting with all this. My son is 14 1/2 and only started showing symptoms about a year ago during track season. We didn't recognize it at first. He's diagnosed as exercise-induced, and that's the only time he shows symptoms. Finally got him a long acting inhaler for regular home use and a rescue inhaler to keep with him. Hoping he gets more control because he's a three sport athlete and loves it. Plus, he's such a good runner I think he could have a real shot at it helping pay for college.
From my conversation with his doctor I realized there's a lot I don't know about asthma.

Red _ My son really got control when he started running with a retired Army Ranger who teaches him martial arts. When they first started I brought the inhaler to the gym and was worried until they got back from their first two mile run. They arrived and my son was red in the face a blowing a bit but over-all ok. I asked the coach what he did and he told me "With all due respect I taught him how to breath!" They now run up to 13 miles regularly.

Hppy

rbytsdy · Mar 28, 2015

If I don't hear a wheeze, I will call parents to ask what they want me to do. I do find that most parents will give the okay to administer inhalers. I had a student coming in c/o that his chest felt tight. I kept calling the parents and they asked me to give the inhaler which I thought I was overkill..... until the day he actually came in wheezing. I got the inhaler first and then contacted the parent.

I have another student who comes down for frequent lung assessments. I call mom if I hear anything out of the ordinary since the student has been hospitalized for asthma several. If she starts getting congestion in her lungs, we usually do a few days of the inhaler. Apparently, it's working because her peak flow increased and her doctor was pleased with how she is doing.

I always figure that parents know these kids better than I do and kids know their bodies better than I do. Sometimes I 'll ask them to wait for a bit if their lungs sound really clear but if they return, they get the inhaler.

allnurses Guide · Mar 28, 2015

I was taught, if an asthmatic says they need their inhaler to believe them. Period.

I agree with this.

Had a kiddo come in to use his inhaler after being out on the playground. No wheezes, L/S clear, 02 Sat normal. But respirations a bit high. Used his inhaler. Still complained of his chest feeling tight and couldn't breath well. Used the inhaler again per action plan. No change. While this was going on, couldn't get ahold of the parents. Off to the ER he went - which the ER doc thanked me for.

Asthma can be a sneaky thing.

NutmeggeRN, BSN · Mar 28, 2015

I agree with this.
Had a kiddo come in to use his inhaler after being out on the playground. No wheezes, L/S clear, 02 Sat normal. But respirations a bit high. Used his inhaler. Still complained of his chest feeling tight and couldn't breath well. Used the inhaler again per action plan. No change. While this was going on, couldn't get ahold of the parents. Off to the ER he went - which the ER doc thanked me for.
Asthma can be a sneaky thing.

agreed, the inhaler I spoke of was prescribed to the sibling of the young lady on question, NOT to her. She has no PCP and nowhere in her medical hx was there ever a dx of asthma.