kidluvinRN

Thanks for your replies.

Hello! It's me, wondering if anyone can give me some insight. I have not worked in psych and feel overwhelmed with this situation. My community based training (person centered) would respond to this using 2 person holds, transports. Techniques like sitting against a wall using arms and legs to hold the center person still until they calm. This works well, but I have concerns with safety d/t this child with a trach, respiratory, and seizure disorder. What do you all think?

Hi all, I could really use some advice. I am a community-based nurse who is working closely with a 13 yo with medical needs, developmental delay, and what I suspect maybe emerging bipolar (strong family hx). Child takes Zyprexa and is under psych care. I have been a caregiver with this child for a number of years, which has required that I be very skilled in behavior management and aviodance of power struggles (this child has been known to remove trach as an attention getting ploy) Not easy but I have managed to establish a good rapport with this child and am able to provide the medical care needed. Here is where this story begins: Over the last several weeks behavior has been severely escalated; self-abusive to the point of leaving bruises and marks; and yesterday erupted into a crisis where the immediate environment was trashed and restraint was needed. While attempting this I was hit, bitten and scratched until another person helped me with a two-person hold. This continued for close to one hour while we were transported home. Once there the child suddenly calmed and walked directly to the foster-mom and said "(name of child) hit and bit" It was eerie, like the child was talking about someone else. There was very little association with all that had just happened. Is this dissociation common with Bipolar or are we looking at something else here?! During these periods of escalation it is like I do not know this child; nothing I have done in the past helps; all of my good rapport is for naught!!!! Ultimately I am afraid that the escalated behavior with precipitate a medical crisis. I am working closely with her home but no one seems to know what to do. Any advice?

I thought it was the policy of this site to not engage in speculation about medical diagnosis!!!! Sorry for your daughters troubles, sounds like she needs are more compassionate primary care provider, perhaps a Nurse Practitioner.

In my experience LTC had an E-box; for antibiotics and frequently needed meds. Our Drs knew what we had, and would order what we could give right away!!! Me, I would have given the med 30 min late, write it in my note, and inform the next shift. I'd feel funny sitting in report saying that I had received but not yet started the med. .

Alcohol wash is fine as long as your hands aren't visibly soiled per CDC guidelines.

Last week was the longest short week I have ever had! Something must have been "in the air". So, is the cath something that you do regularly with this student? If so it would seem appropriate to use the private bathroom facility and close your office briefly at that time. What emergency procedures do they use when you aren't there?!? This student needs privacy; that must be accomodated.

Last week was the longest short week I have ever had! Something must have been "in the air". So, is the cath something that you do regularly with this student? If so it would seem appropriate to use the private bathroom facility and close your office briefly at that time. What emergency procedures do they use when you aren't there?!? This student needs privacy; that must be accomodated.

You go! You'll be a great nurse someday. I always heard "don't be a nurse be a doctor" when I was growing up. I knew I didn't want to be a doctor!! So I just gave up the whole thing, or let it go for awhile. . .until I had kids and encounters with nurses who inspired me! It is ashame that our society values caring and caregiving so little that this attitude continues.

Poor kid, it sounds like this family fell between the cracks, so to speak, as far as anyone following up with them. This family needs an advocate. Perhaps the insurance co. has case managers, school nurse, even a friend to go with them to the pediatricians so that they can express their needs. ...Personally, this type of thing drives me crazy, why wouldn't this family need to know how to keep their child safe and healthy, and especially since there is a history of aspiration!!!!! I would want a consult to GI, social work, a dr. order for thickener (so that insurance will pay), and ((((Hug)))) for this poor family.

I am not in your area; but I have held two positions with the MR/DD population as an RN. One in pediatric long-term care and the other for a school district as a 1:1 RN for a medically fragile child with MR/DD. Both experiences have been great.

I am not in your area; but I have held two positions with the MR/DD population as an RN. One in pediatric long-term care and the other for a school district as a 1:1 RN for a medically fragile child with MR/DD. Both experiences have been great.

Sounds like this child needs further medical attention; obviously colace,etc. not working. Could be something neurological; tethered cord syndrome can cause impaction in children although typically not that young. Definately dietary counseling and a better bowel routine are needed in the least.

Try venting the tube for air; that or some tape but that can get messy!

Try venting the tube for air; that or some tape but that can get messy!

Thanks for the replies; and yes he is starting to feel better. They started him on Augmentin for sinusitis. Is it just me or do other people completely lose their nursing instincts when it comes to their own children!?! I'm either "well you aren't bleeding, broken, don't have a fever, etc." or if there are actually symptoms of worry my mind jumps to worse case scenarios.

Good morning. I am looking for some advice or info. re: my 12 y.o.'s situation. He has had horrible headaches in the morning which improve over the day for the past week + he calls them "Throbbing" and also gets them when he gets up from sitting after a long period; for the last 4 days he has had periorbital edema upon awakening. Took one elevalted BP in the AM; but the rest WNL. He also has had a sore throat; afebrile for the past week. Yesterday I took him to the pediatrician. He was strep +, but urine, BP WNL. They ordered a sinus CT; which I am still waiting for results. However, he has had no signs of sinus infection; no nasal drainage, tenderness, or congestion!!! Can you have a sinus infection without any signs? Needless to say I'm a bit worried and I am wondering should they have checked anything else? Any thoughts appreciated.

Thats funny; I am the complete opposite. I'm good with difficult people and situations; but caths, blood draws, cardiac technical stuff, I always sweat it!...probably just dont do it enough. My comfort zone is respiratory. Vents took awhile to understand, but then like you say "old hat".

I took care of a young woman; she was a quad, no verbal abilities; yet you knew she was there because in particular when she saw a handsome guy she'd smile for all she was worth. A speech-language path was able to prove that she was aware and capable of learning by using a computer program which she controlled by eye-gaze and very slight facial movements. In the end this kept her out of a nursing home and in a more appropriate environment. This same computer program allowed her to turn her radio, fan, TV on and off. It took extra effort to set the equipment up; but what assistive tech can do is amazing!!!!! Are any of you all seeing this type of stuff for these patients?????

I also fully support the position of the AFT and think that their position actually supports the need for nurses in the schools. Who better to provide the care than nurses!

This is an interesting discussion. I work in the schools as an RN for one medically fragile child. Yes, there are many profoundly disabled children in our school, and many more all the time. This is a factor of both the push towards inclusion and the ability of our medical system to keep these kids going. I believe that these children have a right to be there and that they do gain from the school experience. Yet the more there are the harder it becomes to deal with finding appropriate classrooms, teachers, aids, buses, and yes Nurses! There are open applications for substitute nurses in my district. Regular school nurses do a wonderful job; given their ratios; of putting appropriate protocols in place for chronic conditions such as Asthma, Seizure Disorder, Diabetes. These spell out for school staff what actions to take; call parent, 9-1-1, etc. The problem as I see it, and why I think the teacher assoc. made a big deal about the diabetes is that the demands and pressures are increasing on school staff related to health care issues in the classroom. As smkopke pointed out, there are huge liability issues once you go beyond basic emergency care. The school nurses I know are careful to follow delegation rules to train anyone on any care beyond this level; and this is done regularly! My concern is that as nurses we are delegating away our needed role in education, a role that is growing. I think the teachers are right to say diabetes care is a nursing responsibility. The nursing care should be there whether thru protocols or delegation to deal with a child who maybe having a diabetic reaction; but how thin can school nurses be stretched?

Mermaid4, I think there are two points here. One is school staff responding to emergencies. The other is school staff providing routine nursing care. School staff should be trained in basic first aid and CPR. In my area I believe that a school must have 1 trained responder for 60 children in a building.

This is a very HOT topic in my community. Many more kids with chronic illness and disability are going to their neighborhood schools. Without a trained health professional in each school the only way to manage these children is to delegate aspects of their care (gastrostomy feedings, medications, straight caths, tracheal suctioning, and rectal seizure meds) This statement from the AFT reflects the reluctance of teachers to do this. I am glad for their support nursing should be for nurses. Our children deserve no less. I am afraid there will be bad outcomes before we strengthen the numbers of school nurses and take seriously the healthcare of this very vulnerable population.

I'm very proud to be a school nurse; (and yes you do get those weekends and holidays!) The wonderful thing about nursing is all of the different opportunites and niches available! How could you not love it?

I have not used magnets personally, although I do hear people swear by them. I do have concerns about healthcare workers, especially ER or EMS wearing them at work. The Vagal Nerve Stimulator (VNS) is becoming a more common treatment for seizure disorder. The device is triggered by a magnet and prolonged exposure to magnets will shut the device off. Wearing a strong magnet on your wrist might affect your patient with a VNS.