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basketball13

basketball13

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  1. basketball13

    appendicitis

    Hello everyone, I am looking for some feedback. I had a 3rd grader come into my office mid morning the other day. She said that she felt like she may throw up. She did not have a fever, had eaten breakfast earlier in the morning, and she said she had a normal BM that morning. She had no specific area of tenderness or guarding of her abdomen. A couple other kids have had the stomach virus, so I thought she probably had the stomach virus or maybe it was from eating too much candy (this was after Halloween). I told her if she vomited or felt worse to return to the office. I told her to try to eat lunch and see what happens (lunch was about an hour later). I left to go to another school at lunch time, and I actually left a couple hours early from the other school that day for my own medical appointment so I did not follow up with anyone that day about her. The next morning I found out she had returned to the office later in the afternoon (still no vomiting or fever). They let her rest in the office for a little bit, but did not send her home. Apparently, her parents took her to the ER later that night for appendicitis, and her appendix was remove the next afternoon. She is fine, but I hate that I didn't catch it. Is there anything you would have done differently? Anything else you think I should have done that would have helped me recognize appendicitis? Of course, anytime a child complains of a stomach ache/nausea I consider appendicitis, but in this case I just did not have much reason to believe it was appendicitis, at least not at that point of time. I just want to do better in the future and appreciate any feedback you may have!
  2. basketball13

    called 911

    No, they didn't do much other than put O2 on her. They listened to her lungs when they first got there and said that her lung sounds were clear- which they most definitely were not. They took her BP, and I already had my pulse ox on her finger. That was pretty much it. Her mom did take her to the doctor and she has an inhaler prescribed which is at school now thankfully.
  3. basketball13

    called 911

    Thank you all. I am glad I called 911. In the future if something like this happens again and I am far away, I will tell them to call 911. The way the secretary described her condition to me, I was not sure how serious it was. Plus, this school calls me all the time for minor things. One time they called me and said this little girl hurt her knee really bad and needed checked. I drove over to the school, and when I got there she wasn't in the office. They said she was sitting on the bleachers in the gym. I walked in the gym and she was doing jumping jacks and running. The secretary was like "she was crying a lot!" lol. Regardless, better safe than sorry!
  4. basketball13

    called 911

    Thank you all! I definitely wish we had portable O2 tanks lol. Do you all think I should have considered giving her epi (and call 911 of course)? I just want to know better for next time.
  5. basketball13

    called 911

    I did at least tell the secretary that if she seems to be getting worse before I got there, not to hesitate to call 911, but I wasn't sure if I should have went ahead and told her to call 911 or not. The bad thing is is that I have no cell service between the two schools. Of course, I did not think of this until I was on the road. I wish we could stock albuterol, but it's a state law we can only stock epi and narcan. Narcan was just added this year, but our schools don't stock that as of now. Just epi.
  6. basketball13

    called 911

    I am a relatively new school nurse. The other day I got a phone call from one of my elementary schools (while I was at one of the my other schools) that a student was short of breath and struggling to breathe. They stated that she had been running in gym class when it started. No PMH or allergies that we knew of. I asked a few questions and then drove over to that school as fast as I could (about 15 minutes). Her face was bright red, lung sounds were wheezing, very labored breathing, tachypneic, O2 in the low 80s. She'd been like this for about 20 minutes at this point. Principal said she hasdn't gotten any better. Attempted to call mom, but initially could not reach her, so I called 911. While I called 911, the secretary reached the mother and she was on her way as well. EMS got there and put 2L of O2 on her. Within a couple of minutes, the wheezing went away, her O2 went up to the mid 90s, and her breathing became less labored. Mom arrived after the student looked much better from the oxygen. Mom has asthma. We took the O2 off of her and she continued to do fine at this point. EMS talked to the mom and didn't feel that she needed to go to the ER, but encouraged her to follow up with her PCP and get tested for asthma (which I generally agreed with). Mom ended up taking the student home and said she was going to call her PCP. Of course, since this has happened I've been questioning whether calling 911 was the right thing to do or if I should have held off. The nearest hospital is 45 minutes away. I had absolutely nothing at school that I could give her (we can only stock epi and narcan). What would you have done?
  7. basketball13

    Psych to School Nurse?

    After I graduated a few years back I worked and floated between a cardiac floor, medsurg, and 2 psych units for a about a year and then worked the psych unit for a couple years before starting school nursing a year ago. I think a psych nurse can absolutely be a school nurse, especially if it's your dream. Psych comes in handy in school nursing. If it's always been your dream, I think you'll be happy with the switch.
  8. basketball13

    handling a willful child

    THankyou!!
  9. basketball13

    handling a willful child

    Thank You to everyone who was encouraging and kindly gave advice to my original question. And a special thanks to the ones who even stuck up for me!
  10. basketball13

    handling a willful child

    Some Clarifications: 1. There is a doctors order for the insulin. There is a sliding scale ordered. However, there is a clause in the order that says the parents and school nurse may adjust it if needed. For example, I may adjust it based upon what she had to eat, if she is going outside for recess, whether or not she has gym, etc. I document everything related to this. I also look at how her blood sugar's been running the past few days and her reaction to the insulin. Some have suggested that if I see patterns then the doctor should be notified and he should adjust accordingly. That would be fine, but these trends do not last for long periods of times. That is what kind of makes it difficult. A trend may last a few days, but then it changes again. I've looked back at her blood sugars and insulin and there is no real pattern. There have been times when I've given 5 units for a blood sugar of 80 at lunch and in the afternoon her sugar was in the mid 100s. At other times I've given just 2 units for the same blood sugar and her afternoon blood sugar was still in the mid 100s. There is never a pattern or trend that lasts more than a few days at a time. I think a pump would be beneficial, but the parents aren't really on board with that at this time anyway. THe child plays contact sports and I think that may be why they're hesitant. 2. As for my comment regarding describing the other nurse as "older in her 40s," and me "younger in my 20s," I just meant that I wondered if part of my issue in taking care of this child has to do with the fact that the student see the other nurse as more of a mother type figure (therefore, listens better to her) and sees me more as a teenager (therefore, doesn't listen to me as well... also she has a sister who is around my age who the student bosses at home too). I was just attempting to describe the situation.. and why I may be having difficulty with the student..... It's kind of like when you work in a hospital and are in report and describe a patient as an "80 year old female with heart failure..." It was just a description of what is going on. Why is being told your "older" offensive anyway? It's a state of being. But I digress, and won't do it again. 3. Thank you to everyone who has given me advice about how to handle the child. And thank you to those who KINDLY gave advice and shared their experience in managing her blood sugar and insulin. I never expected to get backlash for this post. I just feel like my original post was picked apart, and to be honest I feel a little torn down. So extra thanks to those who stuck up for me.
  11. basketball13

    handling a willful child

    Sigh, see above.... There IS a doctor's order... I've clarified this a couple of times. If I knew how to edit the original post, I would. I'm a new user on here. I have called the mother, but this doesn't seem to scare her... probably because she's got this same bossy attitude at home and doesn't face much consequence at home regardless. The discipline system at this particular school is to go to the principle's office pretty much. I've never actually done this, but perhaps I should go this route? I don't know.. I just feel weird sending a kid to the principle's office...
  12. basketball13

    handling a willful child

    lol too funny! I understand that. I worked on a psych geriatric unit before I started this job, and some of those sweet, geriatric patients sure were a handful sometimes! I loved it though.
  13. basketball13

    handling a willful child

    First, like I clarified earlier.... There is a dr.'s order on file for the insulin. There is a sliding scale ordered. HOWEVER, there is a clause in the order stating that the insulin may be adjusted based upon the parents' and school nurses' discretion. (For example, if she had pepperoni rolls and is not going outside for recess, etc., then she would get maybe a unit or 2 more than she would if she had say salmon and was going outside for recess even though her blood sugar was the same before lunch both times.) I really was just trying to shorten the original post so I didn't explain this in the original post. Clearly, this was a mistake due to the backlash I am getting instead of advice on how to handle this willful child from so many of those who replied. I am far too paranoid and anxious of a person to violate my license. 2nd what in the world does "trolling" mean? I mean really?
  14. basketball13

    handling a willful child

    I myself have wondered if a pump for her would be more beneficial for her. She can be fairly unpredictable at times. She actually did go into DKA over the summer. She had gotten a bad case of mono which caused her spleen to enlarge etc. and she went into DKA. I agree with the more doctor involvement. The whole family has type 1 so I think perhaps they don't always see it as a real big deal. At the end of the day (245 pm) if she is above 250, she gets 1 unit (per doctor order). That actually is usually okay because she gets home around 4 and eats dinner at this time so she gets checked and covered at that time. The one unit usually helps keep her number reasonable when she gets home. However, if she is up in the 300 range, I go ahead and give 2 sometimes 3 units. She's been known to drop in the afternoon though which is why the order (1 unit) is so low. I rarely have to cover her in the afternoon though. She's usually in the 150 range. Lol, when I first got into school nursing and learned about how to manage her diabetes at school I was in shock. I mean I came from the hospital setting where there is a set sliding scale. A blood sugar below 150 at meal times would not get any coverage (not counting any scheduled insulin). The first day I had her, her blood sugar was 85 at lunch. I was thinking she didn't need any, but the other nurse told me to give her at least 2 units. We were having pepperoni rolls that day and she rose to around 350 by 2:30!
  15. basketball13

    handling a willful child

    Let me rephrase. There is a sliding scale, but there is a clause that also says up to parental and nurse discretion as well (I can't remember the exact wording). If we followed the sliding scale to a T, she would not be controlled at ALL. That is why there is that clause in the order. As far as the more experienced 40 year old nurse statement goes, I just meant that I wondered if the student looks at the other nurse as more of a mother type figure (and therefore, listens to her better), and looks at me more like a teenager (and therefore, does not listen to me as well). It was not meant to be offensive at all. And I am not sure why offense was taken to be honest. So please ask me to clarify something if you don't understand what I meant. It is difficult to explain everything via a keyboard.
  16. basketball13

    handling a willful child

    Let me give you a quick background. My county only ever employed 1 school nurse at a time. They finally added a second school nurse (me!) a few months ago. There is a diabetic student in 4th grade. She gets insulin around lunch time. THere is no set sliding scale as to how much coverage she gets. It's up to the parents and at school it's up to the school nurse to decide how much she gets. She also gets rechecked at the end of the day and if her number is over a certain number, she gets 1 to 2 more units. Her blood sugar can be very unpredictable at times but I have gotten her fairly figured out. Here are my issues. When I am checking her blood sugar and deciding on how many units to give her at lunch I have a hard time getting her to do what I ask her to do. Whether it be to actually check her blood sugar, to actually take her insulin, how much insulin to take, to tell me what she had for lunch, etc. Sometimes she will argue with me about how many units she needs (and I do listen to her and her rationale and there have been a couple times that I wanted to give say 3 units, but she wanted 4 so I did go with 4, but then she was a little bit low at the end of the day so I rarely do what she wants unless it's in agreement with me anyways,) I spend a good 5-10 minutes at lunch time arguing with her about how much insulin to take. The thing is, she is almost always a good number in the afternoon so I don't understand why she always argues with me at lunch time anyway. This was the big kicker last week though. On wednesdays I am at another school at the end of day and only come back over if she is above that certain number and needs covered. The teachers text me her number. Last week though she lied to her teacher and said she was 127 (no coverage or intervention) which was texted to me. However, the next day at lunch I came in and looked back at her blood sugars and saw it was ACTUALLY 280 (requiring 1 unit of insulin). I questioned her about it and called her out on it (explaining how dangerous doing stuff like this is for her) and talked to her teachers. She had lied (though she claims the meter is just wrong blah blah blah). Anyway, I told her from now on she had to show her number to her teachers which made her mad and she tried arguing with me AGAIN. I spoke to the principle as well and we called the parent to explain what had happen and also explained the trouble I've had with her. I don't think anything was said or done to her though at home. However, she is incredibly angry at me still today and argued with me again over everything and again argued about how much insulin to take today at lunch. I was incredibly firm with her, even raised my voice (something I don't really do. I am an easy going person), etc. I'm at a loss. She likes to say "the other nurse doesn't do this or that." The other nurse is in her 40s and I'm young and in my 20s so I don't know if that's part of the issue? Or if she just got so used to the other nurse and doesn't know how to take me? The other nurse and I switch schools every month so I only have to handle her a month at a time, but I just don't know what to do with her. Any advice??? Sorry for rambling and I hope that made sense? lol I'm just so frusterated, and don't want something bad to happen related to all this.
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