Med admin difficulty

Published

I always have difficulty administering meds on this 12 year old student. He either hides them under his tongue or in his gums. Besides making him say "aahhh" what else can I do?

I'm getting different points of view and I completely understand where ya'll coming from. Now this is my plan, I will speak to admin and parents about it. If he continues to act like this then the mom can give the meds in morning before coming to school. How does that sound?

It's a morning dose and not an afternoon/lunch time? Then I'd say yes, he can do it at home.

The problem I've run into with that is that sometimes parents leave for work before the kid and (if it's a stimulant for ADD/ADHD) then they want it to be at full effectiveness while the child is at school. But he cannot be missing class time playing games or being difficult in the health office.

Up Vote Up Vote ×
It's a morning dose and not an afternoon/lunch time? Then I'd say yes, he can do it at home.

The problem I've run into with that is that sometimes parents leave for work before the kid and (if it's a stimulant for ADD/ADHD) then they want it to be at full effectiveness while the child is at school. But he cannot be missing class time playing games or being difficult in the health office.

I give him both morning and afternoon dose of Focalin.

"he cannot be missing class time playing games or being difficult in the health office" THIS IS exactly my point. I dont have the time to keep playing games with him so when he refused it this morning and went ahead and documented it. HOWEVER, the teacher aid kept insisting to take his meds.

Up Vote Up Vote ×
I give him both morning and afternoon dose of Focalin.

"he cannot be missing class time playing games or being difficult in the health office" THIS IS exactly my point. I dont have the time to keep playing games with him so when he refused it this morning and went ahead and documented it. HOWEVER, the teacher aid kept insisting to take his meds.

This is where it becomes sticky. Adults can refuse their meds but he is a minor and seems like he is doing it as a game or stalling.

Up Vote Up Vote ×
Exactly this, I had this issue last year with a very emotionally and mentally disturbed student (She got expelled at the end) and she would not take her medications. She almost got me in trouble and told my old admin I didn't administer her medication when I did. I found the empty pill shell on the floor and I told my admin.

After that I told them I'm not responsible for her behavior and if she doesn't take her medication, it's not on me if she refuses.

I totally remember this awful saga. I don't think I knew she ended up getting expelled in the end.

Up Vote Up Vote ×
Specializes in Psychiatry, Community, Nurse Manager, hospice.

Not a school nurse, but as a child and adolescent inpatient psych nurse I'll share how I dealt with med cheeking.

When a kid cheeks meds I have a serious conversation with him about how he is allowed to refuse his meds but not allowed to cheek them. If he cheeks them, it's a discipline issue. I need to account for all the meds. If they don't go in his body, they must go to me.

If If he is refusing, I like to know why. Make you tired? Don't think you need them? Brain fog? What is it? What do you think will work for you instead of meds? Are you willing to do therapy? The doc and parents need to know. An alternate plan will have to be developed.

Kids do have the right to refuse meds.

Up Vote Up Vote ×
Specializes in School Nurse, past Med Surge.

Back when I was subbing in MS there was a girl I was warned about who would occasionally cheek her meds. I asked her one day why, because she didn't seem like a defiant child. She said she didn't like the way it made her feel. So I called mom and suggested they talk to the doctor about finding a better fit for her.

Have you asked this kid why he does it? Is he just being a pistol or does he have genuine issues with how it affects him?

Up Vote Up Vote ×
Specializes in school nursing, ortho, trauma.

i had a kid a number of years ago, when I was just a bright little spark, who was compliant for me for ages. I'll admit that I was comfortable with him and didn't always watch him swallow it. I would turn and put his bottle away while he took it. Then one day I noticed that he palmed his ritalin instead of swallowing it when i tirned around quicker than he expected. We had a little chat - he had been palming it for about a week and by his admission tossing it in the trash because he wanted to see if he still needed it. Lesson learned - never get complacent. I always watch them swallow it now.

I have one med who I check her mouth, but not because she spits it out or cheeks it, because she'll just let it melt there and not swallow it (and complain about the taste!). Nothing like sucking on a focalin. Tasty!

Up Vote Up Vote ×
Specializes in CPN.

I don't check for cheeking, but try to keep a close eye on the kids. Being middle schoolers, I'm always worried about med sharing. Just the other day a few kids passed around gabapentin (dumb kids) they got from home and some took some of them. (Fortunately, they were small doses!) I'm part of the "kids have a right to refuse" party, so long as they talk to me about why, and if it becomes a regular issue it's referred to the admin and parent to figure out.

I recently ran into a similar issue of an 8th grader lying about a couple of high glucose levels. He even shows the meter to me every time and would just pull up an old result. Instead of getting hard core and helicopter-y with an 8th grader, I talked to him and his mom about it. While he didn't really admit to it or tell me why, mom and I think he's just always in a hurry to get to lunch and didn't want to be held up by ketone testing. I'd rather make sure he is getting the right insulin dose so I made sure he knew that I would ask how he was feeling and if he wanted to check his ketones and he could refuse. Then we just check ketones 2h post if his glucose is still high. Haven't had a problem since.

Up Vote Up Vote ×
Specializes in Cardiology, School Nursing, General.
I totally remember this awful saga. I don't think I knew she ended up getting expelled in the end.

Yeah she did because was causing too much issues and fights. It just got too much that they had to expel her. She would fight with the teachers, punched one on the face. Almost everyone at the school knew about her and hated her. I believe she had other issues besides ADHD, to the point of paranoia. It was pretty sad to see.

Up Vote Up Vote ×
+ Join the Discussion