Injury assessments

[denstar]

Hi - I am in an elementary school (through 5th grade) and we are looking to see what other schools do for injuries that might be in more delicate areas (any area that would involve removing or pulling down of pants-private area or upper thigh). Barring an emergency, do any schools have a policy on how to assess injuries that would involve removing clothing? My own instinct, again barring an emergency, is to relay the information I have to parents and have them come look at the area with the student. I am not comfortable with asking a child to pull down pants for an assessment. Administration is wondering if we have 2 staff present and phone consent from a parent, would it be appropriate for the nurse to remove clothing to assess the area? Any feedback on what other schools do or policies in place would be appreciated. Thank you!

[k1p1ssk, BSN, RN]

Hi! I have faced this several times. If it is a non-emergency situation (I.e. got kicked in the genitalia or student is complaining of itching/pain of unknown etiology) I would call home, let the parent know what happened/the complaint, and ask them if they want me to examine the area with a chaperone present IF the student is OK with it. If the answer is yes and the student consents, I will visually inspect the area with another adult present in the room. If the parent or the student says no, then I would let the parent know that I would monitor the student for persistent/worsening symptoms (if trauma related), and if after an amount of time (30 min? an hour?) I would be calling back for parent pick up. Any trauma that doesn't seem serious enough for inspection, I just let the parent know so that they can check in with their kid later in the day. It hasn't happened to me in my career as a nurse, but I personally know two gentlemen who had trauma to their scrotum/testes that resulted in testicular atrophy because they were too embarrassed to tell anyone about the swelling following their injuries when they were teens.

The only time I didn't call home before inspecting was when a student was bitten by a dog. It had happened the day before and he didn't tell anyone. Based on what he was describing, I was incredibly concerned that he had an infection, and knowing his Mom doesn't drive, I was prepared to call an ambulance and send him to the ER. Thankfully the dog didn't break the skin, but it was some of the worst bruising I'd ever seen. I let his mom know after the fact and she was absolutely fine with it given the circumstances. She walked right to the school and took him home with her and they got a ride to the doctors as a precaution.