mom upset about asthma

[katynurs22]

I'm new to this school and I was warned about this mother. She has a student who has permission to carry inhaler with her(5th grader), but last week, the student came in to clinic because she was in PE and the PE teacher sent her to the clinic. Her classroom teacher happened to see her walking here and walked her to the clinic and then went for the inhaler that was in the classroom. When the student arrived to the clinic, she was not in respiratory distress and no wheezing. Mom called me because she feels that teacher and principal do not listen to her or don't believe that her asthma is that severe. As the nurse, I'm kind of the middle because I have to listen to the parents and I'm trying to build rapport with them, just like they did with the previous school nurse. She was also upset because her daughter told her that she walked alone to the clinic that day(which is a lie, PE teacher didn't walk her, it was classroom teacher) and "she could have collapsed and no one was around". This student misses many days of school, she has already reached 30 days of absence, mom says it is due to her asthma. Anyway administration and teachers are fed up with this mom, they say she's just looking for attention, and now that she caught mine, she calls me because she feels comfortable talking to me. Does it seem like mom is exaggerating?

[Jolie, BSN]

I can't say whether or not Mom is exaggerating, but it does sound like there is little understanding or consensus among Mom, the student, you and the teachers.

Please consider scheduling a team meeting with all involved parties to discuss this child's needs, Mom's expectations, the physician's recommendations and to develop a consistent plan of care.

I do have one question: Why was the student in PE without her inhaler on her person?

[luvschoolnursing, LPN]

You need to write a 504 plan with specific recommendations that you have FROM THE PHYSICIAN. Get a release to talk to the physician and have him/her determine the severity of the asthma. Get this in writing. Mom may have such a relationship with the doctor that he will write whatever she wants, but at least you will be covered for the excessive absences and any reflection in the student's grades.

[Artistyc1]

Also, discuss with the parent what the past plan of care has been- any child that is missing that much school should be evaluated for the use of maintainence medications, and should not be using only an albuterol inhaler for treatment, anyway. If she is using the albuterol more than a few times per week, she may be a candidate.

[2ndgenschoolnurse]

Also, discuss with the parent what the past plan of care has been- any child that is missing that much school should be evaluated for the use of maintainence medications, and should not be using only an albuterol inhaler for treatment, anyway. If she is using the albuterol more than a few times per week, she may be a candidate.

Exactly what I was going to say. If she has missed that much school she should have been evaluated futher by her physcian, even if it is a day here and a day there. I would, as building a nursing report with the parent, call her and share your concerns about her daughter's asthma. Also, I would also do some teaching with the student and parent about Self Directed Meds...apparently she(the student and possibly the parent) need to be reminded of the responsibility of this direction/order. She was not being responsible, and the parent should understand that is a major criteria for being self-directed. To know about and understand when she needs this medication. Thank goodness it was not a full blown asthma attack, and how lucky she was that her teacher knew that the inhaler was in the classroom and got it for her, as one would assume that it was on her(the student) person, when going to PE class.

Parents can be tough, but with support and education, they may ease up, and have more confidence in our schools, and maybe not, maybe this is just her thing?

Good Luck!

[katynurs22]

Update on what happened:

We had a meeting with mom (principal, asst principal, classroom teacher and I). It went well, mom was cooperative, principals expressed their concern about academic progress and how she is falling behind. Teacher said she could help her during after school activities. Mom also admitted that maybe she is a little over protective. We talked about how the student should always have her inhaler with her, and mom said that the reason that she didn't have it with her was because she would carry it in a bag with the spacer, but we agreed that it would be a better idea to just take the inhaler in her pocket and not use spacer at school. She also wants an adult to accompany her child to clinic for any complaint of respiratory difficulty. The next week, mom visited the school again and brought a letter from an asthma specialist that she needed to be in a classroom inside the building instead of the portables. And the specialist also did an allergy test and apparently she's allergic to many things, he also changed her medications put her on pulmacort, two allergy medications, and some thing else can't remember. Mom states her condition has improved. But this week, her daughter came to the clinic brought a note from teacher that states stomach hurt, I remembered that she has started menstruating and I asked her if it was menstrual cramps or really stomachache, she stated it was cramps. I gave her a heating pad and after 15 minutes, no improvement, so I call mom since she lives down the street and asked her if she wants to bring motrin (cause I knew she would), she said she would take bout an hour but still wanted to give her med, so i send student back to class. Then when mom comes to give her the med, the student tells her quietly "I threw up", and mom asked if teacher knew, the student says "yes she just told me to go to RR and throw up" and so she takes her home.