Panic Attacks

[GdBSN, RN]

I'm a HS nurse and am dealing with a lot of panic attacks this year. They are full blown attacks with hyperventilation, shaking, unable to stand...etc. I am chasing my tail all over this school this year for students having attacks in the classroom. When I contact parents about seeing a doctor for possible treatment, they agree and state they will take their LD to be evaluated. Until the next week or month when I'm called to the classroom for the same student, and the student states they have not seen a doctor. I guess my question is, how do you guys treat reoccurring panic attacks when parents don't take their student for a physician eval?

[nursetlm, ADN]

That must be exhausting. I work in an elementary school and don't see too many panic attacks- but we had one child I recall a few years ago whose psychiatrist gave me and our counselor a care plan for her. I ruled out anything physical and then the counselor took over mostly. It would be tough if they didn't get help from their own physician/ pysch. I would sure be getting my principal involved and have a meeting with the parent.

I hope to see other nurses with more experience chime in.

[ihavealltheice]

If you determine that it is a panic attack and nothing medical, you should get your social worker involved. They're better equipped with the knowledge to help with the mental aspect. They shouldn't be going to you at all.

[ruby_jane, BSN, RN]

8 minutes ago, ihavealltheice said:

If you determine that it is a panic attack and nothing medical, you should get your social worker involved. They're better equipped with the knowledge to help with the mental aspect. They shouldn't be going to you at all.

And consider a 504. A 504 is usually driven by a doctor's order BUT if the student is consistently unable to attend class due to being in your office - that might drive something in the parent. This is a multidisciplinary issue. Good luck!

[guest83140]

I had a year like that once before with several girls. We learnt one was from social media drama, one with anxiety over testing and one wanted to lay down because she had a newborn baby at home and thought she could get attention to go to the nurse to sleep. Well, the first one, I let the counsellor and AP deal with the social media drama and it soon stopped. The teacher helped with the anxiety issues by allowing her to take her test separately and the other one was more difficult because she played it down with 911 called because she would not open her eyes or respond. But soon her out of state mother told on her and uncovered her real faking episodes and she was exposed. So it took the guardian/parent being truthful with the school in essence. Families know usually.

[Mavnurse17, BSN, RN]

I had a student like this last year... senior in HS. He'd get them bad enough that he'd have to stop and sit in the hallway, which prompted teachers to escort him to the clinic. Happened every 2 weeks for about a month at one point. I sent him out to get bloodwork/testing done; doctors found nothing. I explained to him that in the absence of a physical problem, it could be a mental health problem. Student said he refused to go to counseling/therapy/etc because he "didn't believe in it." Yet, he continued to have these breakdowns in school and he'd be escorted to my office every time. Mom never answered or returned my phone calls. I got really tired of it after a while and sent him back to class after I determined that his VS/overall assessment was medically 'normal.' I couldn't keep letting him just sit in my office for an hour when he refused to help himself.

[BeckyESRN]

I would get admin and the counselor involved for sure. I'm a big fan of grounding exercises for my own anxiety and they work pretty well for some of my anxious kiddos here. My personal favorite is:

5 things you see

4 things you can hear

3 things you can touch

2 things you can smell

1 thing you like about yourself

Granted, once things have escalated to full blown panic attack, this isn't going to be possible, but it may be a good teaching tool.

[mainecoonRN92, BSN, RN]

22 hours ago, BeckyESRN said:

I would get admin and the counselor involved for sure. I'm a big fan of grounding exercises for my own anxiety and they work pretty well for some of my anxious kiddos here. My personal favorite is:

5 things you see

4 things you can hear

3 things you can touch

2 things you can smell

1 thing you like about yourself

Granted, once things have escalated to full blown panic attack, this isn't going to be possible, but it may be a good teaching tool.

This is one of my favorite grounding exercises. And it works for most ages. I also use some guided meditation apps on my phone that help kiddos control their breathing that I find works well for my younger population who are so memorized by technology.

I agree that this shouldn't be addressed solely by medical alone, I would involve the social worker, school psych, counselors, etc.

[guest464345]

7 hours ago, mainecoonRN92 said:

This is one of my favorite grounding exercises. And it works for most ages. I also use some guided meditation apps on my phone that help kiddos control their breathing that I find works well for my younger population who are so memorized by technology.

I agree that this shouldn't be addressed solely by medical alone, I would involve the social worker, school psych, counselors, etc.

+1 for this grounding exercise; I use it almost every week. Another version is, "You get to go on a trip. Where do you want to go? OK, name 5 things you will pack....4 things you will hear when you get there....3 things you will see on your trip.....two things you will eat on your trip....1 thing you'll bring back home with you"

I also use "star breathing" or "square breathing" (for example see: http://www.appleschools.ca/files/Star_Breathing_Instructions.pdf) once they're able to listen to instructions.

BUT, also agree with above advice to start turfing this stuff to the SW or counselor. If you are known as being TOO good at managing panic attacks, you're going to get them all, and these kids need an amount of time that you probably don't have.

[GdBSN, RN]

On 11/8/2019 at 1:00 PM, BeckyESRN said:

I would get admin and the counselor involved for sure. I'm a big fan of grounding exercises for my own anxiety and they work pretty well for some of my anxious kiddos here. My personal favorite is:

5 things you see

4 things you can hear

3 things you can touch

2 things you can smell

1 thing you like about yourself

Granted, once things have escalated to full blown panic attack, this isn't going to be possible, but it may be a good teaching tool.

Yes! I have little laminated cards I give to students with the grounding exercises on it.

[vampiregirl, BSN, RN]

Not a school nurse, but have encountered an increasing number of kids in the camp setting who have anxiety attacks that aren't listed on the medical and/ or confidential forms submitted prior to camp.

Some of these kids are have already identified strategies that work for them and just need some encouragement to be able to implement them. I think one of more important roles for healthcare professionals in this situation is to empower these kids to self-implement calming techniques. Having symptoms of anxiety can just be miserable - no matter what age the patient is!

[vampiregirl, BSN, RN]

On 11/8/2019 at 1:26 PM, Mavnurse17 said:

Student said he refused to go to counseling/therapy/etc because he "didn't believe in it." Yet, he continued to have these breakdowns in school and he'd be escorted to my office every time. Mom never answered or returned my phone calls.

Makes me wonder whether the parents influenced the student's view on mental health treatment. Sad that the stigma regarding mental health continues...