Please help ! What would you do for this situation ?

[NurseLoveJoy88, ASN, RN]

So I have a student who suffers from severe Headaches from time to time thus the doctor has written an order for him to have motrin ( 300 mg) every time he gets a HA. So no big deal right. I've only given him his meds a total of 10 times this school year. However every time he gets a HA its during math class. :zzzzz The first time he got meds it was in the AM, but all the times after that its been either in the beggining of math or at the end of math. Dad says he does suffer in math sometimes... I just hate to keep medicating this kid if math really is the problem for him.

Meds is only temporary relief I truly believe we need to focus on the cause here instead of always giving him is motrin.

I've went to my boss who is a RN several times to tell her about the pattern but all she keeps saying is " well keep an eye on it" So what do we do for now ? I've been keeping an eye on it.

There was one time I saw him 3 times in one week ! I told him and dad that taking Motrin daily may have some undesired effects for its not recommended for long term use.

So what would you school nurses do ? :nurse:

Should I keep giving him the meds even when I know math is causing the HA ? or should I investigate other alternatives before just giving him his med ?

Don't know what to do ? :zzzzz

[traumaRUs, MSN, APRN]

I would turf it to the RN and refuse to give motrin - NSAIDS are not benign meds and their chronic use needs to be evaluated.

[NurseLoveJoy88, ASN, RN]

I would turf it to the RN and refuse to give motrin - NSAIDS are not benign meds and their chronic use needs to be evaluated.

She is delegating this to me so do I still have the right to refuse ? The orders say give for HAs, I talked with her about it before administering the meds. and she still says give it.

I feel like I'm stuck, if he comes tomorrow I just may refuse to give the meds. I don't want to be held liable for anything.

[Aneroo, LPN]

I do not think 10 times in the school years would count as abuse.

What time is his class? If it's before lunch- is he eating breakfast?

Where does he sit in class? Does he need a vision screening to be closer to the board?

Is he being bullied in class? Does he hate math and doesn't want to be in class (although I would think he'd be there more often if that were the case, like my girl who came WEEKLY during math).

[traumaRUs, MSN, APRN]

The abuse was the three times in one week that the OP discussed. NSAIDS cause ulcers and renal failure - not a med I would be wanting to continue to give to a child for whom no cause of the H/A is noted.

[bergren]

If math is giving him a headache, it still hurts, there is still pain. The possibilities above are all possible, but also there might be something in that room that is triggering the headaches. Does the teacher wear a fragrance? Or a classmate who is only in that class? Or maybe there is mold? open windows and freshly mowed grass or a tree that just released pollen? Is there a possiblity that the headaches are migraines? Any aura? Photophobia? Is he in puberty? Migraines can be caused by many triggers, fluctuating hormones, a food at lunch, ...

I would not withhold medication despite the math pattern if the assessment indicated he was in pain.

[NurseLoveJoy88, ASN, RN]

Thanks for all the responses. Pain is very subjective and I've decided to continue to follow the docs order in giving him his meds even if I know math is causing it.

It doesn't matter what is triggering his HA I have a order that says " give at the beggining of a HA" The doctor also says he suffers from migrains.

I just hope he doesn't have any undesired effects, thats all. I also wish I can try non-pharmological relief methods and use the motrin as a last resort. However, this is contraindicated due to the doctors order.

Thanks for the responses.

[BabyLady, BSN, RN]

To me, this sounds like the kid is getting a stress headache.

One of two things are causing it:

1. He is having difficulty with math and needs additional assistance.

2. His teacher is the problem.

One is an easy fix: Rx: A good tutor.

The second problem...not so easy.

[bandaider]

I have run into this scenario as well. What I have tried to do is to Send home a summary of X's student c/o headache that week, or that month. If I have a signed consent (our corporation tries to get a consent to releae medical with the student's Dr included on our OTC consent form at registration) I also call or fax a summary of clinic visits and X's the OTC med was given to the Dr. Then, hopefully, if there is any follow-up needed surely someone will notice. I also am quick to contact the parent and teacher and voice my observations: Gosh, he comes a couple times a week, but I've noticed it's always during math class? Any ideas here? I try to remind myself that I'm part of the team, just not necessarily the team captain!

Good Luck!

[bergren]

I would definitely check out the classroom for a migraine trigger. Is the teacher female? Find out if she is wearing perfume. Is it after lunch? Have him keep a food diary.

Common triggers: http://www.healthcentral.com/migraine/triggers-22175-5.html

[kidsnurse1969]

I would also consider following up on the Motrin to see if it is working. There might be something more effective that can be used if this is not working.