Nurse vs Para

[117800]

I recently had a student come with his Para. The Para was concerned because he had a "bad" cough and wanted me to check him out. I checked his vitals including 02 sat and listened to his lungs. She asked if I heard any wheezing and I replied "no". She was shocked because she stated she had listened to him and heard wheezing earlier in the morning. I asked her how and where she was listening to him. Her reply was... she put her ear on his back and heard it! I am not sure why they pay me to be the nurse when she is available.

[kidzcare]

Guilty, too. The hardest part of changing gears to school nursing was to check temperatures all the time. We never check our kids temps unless they are burning up, we don't treat them because that is what the body should be doing.

Me too! I check my kids' temps but I don't treat a fever unless they are very uncomfortable or in pain. I have been blessed with very healthy children!

[jesserpie]

This reminds me of an episode earlier this year...My son was sick with a fever and I ended up taking him to urgent care. I told the nurse his highest temp I had gotten was 102. After I admitted that no, I had not given him Tylenol before coming in, the assistant asked me if there was a reason I do not treat my child's fever. Then proceeded to lecture me about how he could have a seizure! As a paranoid nurse, I feel like it is beneficial for the doctor to see that he actually has a fever when we go in(I do give Tylenol if no such visit is in the immediate future.) And...I think there is some benefit to letting the body fight the infection itself until its over 101. I know that I don't believe just about anything patients or family tells me at this point:no:

[Spidey's mom, ADN, BSN, RN]

I was "that" nurse mom who never had a thermometer that worked.....

(hanging my head in shame)

Don't hang your head in shame . . . I do it too. Nothing wrong with it.

To tell the truth, if I didn't have a stethoscope, I might listen to kiddo's lungs by putting my ear to his back. You can hear audible wheezes without a stethoscope of course. And use vibrations felt by your hand:

There are a few techniques to do lung assessment without a stethoscope. Listening with a stethoscope is just part of a good exam. They can put their fingers on your ribs, most often on the back at the base of the lungs and feel for vibrations and equal expansion. Vibrations would vary as to the thickness of secretions and wheezing. This might tell him/her the difference between pulmonary edema and pneumonia. Wheezing produces a high pitched note and those vibrations can be felt. Unequal expansion could indicate pneumonia or atlectasis. Then there is percussion. The doctor will place his/her hand flat on the surface of your ribs and with the middle finger of his/her other hand will strike the nailbed of the middle finger of the hand that's on the chest. This will cause a vibration that travels through your lungs and if it is high pitched or hyper-resonant indicates absence of lung tissue or air present without lung tissue surrounding it, as in a pneumothorax. If the percussion note is dull it would indicate consolidation or lack of air entry as with pneumonia. If the note is somewhere between it indicates normal lungs. They do this all over your chest to locate an area of consolidation or hyperresonance. Of course these techniques are just providing more information so the doctor can, essentially, put two and two together with other symptoms. They also should be used in conjunction with a good listen with the stethoscope but it depends on what the doctor is looking for as to what techniques he/she uses.

There's always the old method of just putting a practiced ear against the chest and listen.

[ontheway2crna]

You can hear breath sounds and the heart by putting your ear against someones chest, a stethoscope just helps you maintain a comfortable distance when you are doing that, so I dont see why you are putting this lady down , if she says she heard wheezing she probably did and you should take that sort of thing more seriously next time and not let your ego get in the way because you may miss something big next time.

[GmaPearl BSN RN]

You can hear breath sounds and the heart by putting your ear against someones chest, a stethoscope just helps you maintain a comfortable distance when you are doing that, so I dont see why you are putting this lady down , if she says she heard wheezing she probably did and you should take that sort of thing more seriously next time and not let your ego get in the way because you may miss something big next time.

Respiratory assessment is not a para educators job. And if she indeed heard wheezes, that was the time to bring the kid to see the nurse.

[NutmeggeRN, BSN]

Respiratory assessment is not a para educators job. And if she indeed heard wheezes, that was the time to bring the kid to see the nurse.

Ding Ding Ding!!!

[tining, BSN, RN]

Congestion in the throat sounds like wheezing...until you cough it up.