ruby_jane

Oh my goodness - I have missed you all so much - but NOT THIS! You documented what you did. I likely wouldn't have done anything differently. Let the teacher field the ER bill...

My experience was that the kid had almost projectile vomiting as the GI response. Stomach ache - not so much BUT it's not impossible. But if the kid denies ingestion...what do you do with this? In a perfect world I'd monitor. Covid has messed with my perfect world.

I hate the "can you check him out? He smells like pot" assessments. Our old form had me assess nystagmus like five different ways..... Seriously, unless you have a doctor's order and a pee test, you are only documenting vitals, what you observe, and anything that the kid tells you. I always say I am not able to diagnose (and that answer works here, too).

Well this is interesting! I don't have a uterus anymore so I am no help. We are in phase 4 trials, folks. That's when all the unusual side effects show up.

You don't want to be "that nurse." The nurse who wanders away from handing over the inhaler because the symptom is unclear. My general practice is that I assess (PSO2, RR, auscultation for a good long time) and if I don't hear the wheezing and the RR is good and there's no SOB or positioning for comfort or blue lips....sometimes I'll ask the kid to have a cup of cold water, wait 10 and see if they're better. But I never don't give the inhaler. I just document why I was thinking it wasn't necessary. Don't second guess yourself. You're good at this.

I learned yesterday that in (less than) 5% of our kiddos, goopy bloodshot eyes may actually be COVID-related. As in, this is a new symptom we've discovered. But that opened up the can o' worms: If I send a kid out for diagnosis and the doctor does not do a COVID test but just treats the viral or bacterial conjunctivitis and I let the kid back in....I don't want to think about what that looks like. Good thing that conjunctivitis must be ruled out before return in my district. But I already suspect a lot of the local clinics (not the pediatricians specifically but the doc-in-the-boxes) are merely swabbing kids' sore throats for strep and not doing a COVID test. Last year said clinics were not even testing kids for the flu but just swabbing for strep. Anyone have any lived experience with this?

Is the teacher's doc aware of the fact the teacher isn't compliant because of the expense? Is there any other med that they can take? My beloved Dr. Singhania (if you're in the NTX and need an allergist or care for your asthma that is allergy-related) asks every single time if I can afford my RX. Singulair just went generic. Best of luck and an Old Dude pat on the back to you for helping the staff as well as the students.

It DOES look interesting....but looks like it would be for newer school nurses. I think you could speak effectively to (if not teach) many of these topics.

This is a great suggestion, for several reasons. Including....if the main office got contaminated or otherwise unusable there is a back up and it's stocked with supplies!

Not....necessarily. Pretend you don't know anything about SPED and ask for the evaluation.

In my district in north Texas he would likely meet the SPED category emotional disturbance, or possibly Other Health Impairment. The SPED assessment process is lengthy but we need to answer the question: Does this student need modifications to be successful? One the one hand - the SPED dx, while not permanent, will follow your student even if the re-evaluation does not show they need the service at the end of three years. On the other hand - it's easier to do the process when there is not a crisis than when there is. Either way, you may request the evaluation. This is not an individual decision: the ARD team makes it. Best of luck!

Did you go through a lawyer or just by yourself? If you lawyered up, have them ask for you. Otherwise I would call the case manager...TXBON is not known for happy surprises but I hope yours is a happy surprise.

I'm just dazzled that they thought to invite you. Nurses and nutrition staff work hand in hand a lot but a lot of people don't know that. Scenario: You have a kid who has a negative lunch balance, and parent has been informed but has not made any changes to the account. The parent did not complete the free/reduced lunch forms. This is the fourth time in six weeks that the student has a negative lunch balance. What do you do?

Generalized anxiety disorder? Dexmethylphenidate is a stimulant and I cannot imagine my anxious RJ Junior taking that to "help" the GAD she has. Yeesh. Because the brain's biochemistry is so individualized and because our psych models work like - here, try this, did it help? - it is possible it might work. It might not. It is probably off-label use. The BON frowns on me dosing something that's off-label. Is it possible the parent is rejecting the ADHD dx and the working dx is a compromise? If it was me and I had this question I'd call the prescriber for clarity. Also just for funsies I looked up Focalin and here is the contraindication section from the manufacturer: --CONTRAINDICATIONS------------------------------- • Agitation, marked anxiety, and tension (4.1) • Known hypersensitivity to methylphenidate or product components (4.2) • Glaucoma (4.3) • History of motor tics or a family history or diagnosis of Tourette’s syndrome (4.4) • During, or within a minimum of 14 days following discontinuation of treatment with a monoamine oxidase inhibitor (MAOI) (4.5)

Days like this I miss OldDude. BAM! Snatched from the jaws of death!! Or not. But you have NO WAY OF KNOWING! So, based on your assessment - a prudent nurse would not have allowed that teacher not to go to the hospital. She looked like she was having a stroke. EMS thought so too. You know how I know that? Because they didn't suggest that the teacher call someone or ask that administrators transport her. And perhaps this is a wake-up call for her or others. This is an awkward way to get attention. Are you angry that nobody called you for nigh on a half-hour? OK, that's legit but that's not on YOU. That's on THEM. It might warrant having the principal do an all-call that the nurse needs to be called at the beginning of an emergency. The administration definitely needs to know that this teacher is so weak she needs to nap daily. Because GOOD LORT what if that happened in front of her class? Plainly letting her teacher friend know is not good enough. Plainly the AP is not helping. The BP meds - eh, that's hearsay. Munchausens - eh, I don't diagnose. It would not surprise me that many teachers (and everyone) are having a flare in their normal mental health. Doesn't take much to push people over the edge these days. Texting - that's why I used to take phones away when I was a high school nurse. Because magically symptoms would leave when the kid could not be fiddling on their phone! It was a factor in assessment. Breathe deeply and remember: you cannot care more about this than they do. Your license is not in jeopardy but it's good that you did your diligence with documenting.

Bless his heart. That's not how it happens (at least in my district). That's why we offer the parent-purchased indemnity insurance. Any reasonable nurse would have removed that boot. You assessed pedal pulses (something I do not do regularly but may add to my list of interventions. Was it OldDude who used to talk about xray vision and how we generally don't have it? Don't second guess. The kid made a choice. Dad is blustery. Make sure your documentation looks solid and go on. Also - if you have the chance to reassess the kid and the kid walks in with no gait impairment....yeah I'd do that, too.

Anecdotally from friends: The two people I know who had COVID less than 90 days ago had a strong immunological reaction (YAY- Moderna vaccine may be working) - fever of 100-101, body aches. One person who had COVID in June had a similar reaction to the first Moderna vaccine but only a mild reaction to vaccine #2. Again, yay, Moderna vaccine seems to be working. I know nobody who got Pfizer's vaccine so have no data on that. Remember - we are all part of phase 4 trial. We do not know the answer to the question you ask but we will likely have better recommendations in 6 months.

But you're an awesome nurse-nurse.

Nope, you're not dumb. Fall happened outside your assigned area. You were not asked to assess or provide anything. Principal who might should have known better did not bother to call you til later. Even "later" I don't know if I would have run over to assess the staff because....what am I assessing? I'm assessing now, not six or 14 or whenever hours ago. What's the procedure for this in your district? I bet you will have an opportunity to re-educate someone....

I am assuming no history of this for you, yes? Please also consider reporting it to the vaccine system they have set up (it's not the traditional VAERS). We are all essentially phase 4 trialling both vaccines. Hang in there.

The Q word is VERY REAL. We used to have a hospitalist who would stand in the middle of the freaking ICU and say "Well you're having an easy night." And then it would all go to h-e-doublehockeystics. Any form of the Q word, including easy, simple, uncomplicated.... Shussh. Shush your mouth.

@SilverBells no judgment on my part. I drink 3-4 cups of coffee daily and might even sneak in a Coke Zero in between. This is not a "diet." You are reaching for stimulants and chewy, salty easy to grab snacks that soothe the neuroreceptors but do not provide nutrition. Problem is that when you cut back on the sweet or salty food your body will crave it for a while so things may feel worse. When I worked 12s (actually 14s) I would start off on the first shift with a nicely packed lunch that had more protein than carbs and a fruit and a vegetable. By the third shift I would eat almost anything out of a vending machine or the day old pizza. My suggestion is to find a way to incorporate 60-80 ounces of water every day. You're already filling with fluids but what you're giving yourself are mostly diuretics and chemicals (and I am a teeny bit worried about your kidneys). Once that happens - if you are able to get to a nutritionist that may be the easy button. Ruby Jane Junior is in college and I just paid for nutrition counseling that may save her life or at least move her from being a junk food carbaterian with a few menu suggestions/substitutions. If not, consider a meal delivery service or something that will allow you to at least have balanced nutrition on your days off. Worry about those days, first. Remember the body loves homeostasis and will compensate until it cannot. I wish you the best of luck! At least it's dark chocolate...for the heart benefits... :)

YEP. That's ICU, although it may be worse now with COVID than it was when I was in the ICU preceptoring "training class." There is simply too much to know and outside of training on cardiac rhythm and interpretation and memorizing some oft-used drugs....you may be on your own. You didn't ask this but: Critical care (ICU/Telemetry/what have you) and ER seem to have a lot in common but they don't really. One is about juggling and managing the complex needs of a set of patients whom we know are sick, and the other is about juggling many more patients to find out who is sick and who can get out of here and go see someone else. Mr. Ruby Jane was an ER nurse the first decade of his career and while his skills are still excellent, he does not know how to prioritize care. While I was an ICU nurse for the first year and I can prioritize care but when I have an emergency I literally have to reach waaay back and it all comes down to circulation/breathing/airway anyway. SO - perhaps you are feeling that push - that you like the ED setting and rhythm more than you like "critical care?" Just a thought. A previous poster advised that you give the gig a little time and once we're out of the COVID swamps things may be better.

I no longer remember what I made, only that the computer shut off pretty early and I nearly choked. But - you are right on about credentialing. Given that there are no legitimate nursing shortages in North Texas (we just have a shortage of hospitals willing to adequately train new or newish nurses) and there are legitimate shortages in other states - the compact may be the difference between getting staffing and not getting staffing. Does MI turn out so many new nurses that they can afford not to be part of the compact?

YAY! I love how this network was pulling for you.