Phys. Assessment for Standing Meds

[tomn13]

Hi -- I am a School Nurse for a respite program that runs every other week. Something interesting happened the other day that I didn't really ever think about and then had a philosophical debate with a nursing-friend over... I wanted to come here for more opinions.

I have a student, aged 8, who receives ex-lax (Chocolate Squares) three times a day: Once during school hours. Nearly every morning when the child is dropped off, the mother verbally confirms with me that I'll administer the ex-lax. And, without fail, I administer the ex-lax.

Another Nurse had to administer the ex-lax recently, and before administering it she listened for bowel sounds and took the child's blood pressure. My colleagues at the school thought it was the strangest thing. I defended the nurse for doing this action that I don't do. After all, I do suppose it's more correct to do that kind of assessment.

I don't want to engage in a philosophical conversation here, exactly, but I'm just curious As a school nurse, would YOU listen for bowel sounds for the administration of a tid ex-lax?

[NutmeggeRN, BSN]

Curious if you can give w/o MD order (unless you have one) as the sodium phosphate could be an issue. Is it FDA approved for that age group?

[cid1]

Is it a tid order to be given as needed or no matter what? Is it a signed MD order?

[tomn13]

@ NutmeggeRN -- Definitely have an MD order; wouldn't be administering anything without one.

@ cid1 -- a standing TID order. She receives exlax at 8a, noon (That's mine), and 6p. And yes, definitely a signed, real, full order from an MD.

So I wouldn't say it's "Give no matter what" because, as an example, if she came to my nurse's office and the staff was like "LOL she keeps pooping blood, time for ex-lax?" I'd say heck no.

FYI for clarity; this is a school for children with disabilities. Not that this is directly important, but it could answer some questions that haven't been asked yet.

[cid1]

I think I would give it as ordered unless she is having diarrhea, etc

[tomn13]

@ cid1 -- would you do any sort of physical assessment? Listening for bowel sounds, abdominal pain/tenderness/guarding, blood pressure, etc?

[toomuchbaloney]

I would give the med. I would advise the mother of any observations or assessments which are relevant.

[Eleven011]

I would not do an assesment everytime unless I had guidance from a Dr. order on what to do with results of an assesment - For example - hold med if hyperactive bowel sounds. Or, like others mentioned, it was told to me student was having obvious diarrhea.