Random Questions?

Guests · Nov 14, 2017

Do you mean double checking the amount drawn up when a student does it him/herself? If so, I would. My only T1D student is 7 years old. While he does self inject, I always draw it up for him.

We are lucky because we have special "calm down" rooms so there are special rooms for that purpose. I would never allow my office to be used in such a way, as it needs to be a safe and quiet place for kids to be seen when they are not feeling well.

ruby_jane, BSN, RN · Nov 14, 2017

In TX we're an extension of the home environment, and the parent is not double checking if s/he's assisting the student. I double check the kids if they have "assistance from school nurse" written in to their care plan. But I'm in HS and not sure if that's helpful to you.

Regarding cool down: Handful of kids with anxiety/oppositional disorders who have it written (with my approval) in their 504 or ARD that they can come here to cool down for a specified period of time (15-20 minutes). They can't walk in from the cafeteria in the morning and decide they need a break before school starts. But mostly it's been effective because of therapeutic boredom.

A kid who's a danger to self or others must be monitored and you don't have time to do that unless it's an emergency. If someone's in the clinic with you monitoring (and you have space) I guess that's ok....but not preferable, because there's vomit and illness in the clinic.

Hope today is better.

Farawyn · Nov 14, 2017

I don't have anyone on insulin at this time, but yes, I did double check, even the big kids.

As for a calm down, why not?

As long as there are no puking kids in here, my room has been used many times for stressed or high kids.

It's a HEALTH Office.

chasinRT · Nov 14, 2017

I don't double check the amount dialed up on the pen but I ALWAYS double check my math when calculating the dose. When I had students dialing up their own I did check them prior to injecting (elementary age). Occasionally have students who come in to calm down but they always have staff with them and I am not responsible for them.

kidzcare · Nov 14, 2017

JustRNingAlong said:
Hello.
So, in the school setting, are you double checking insulin?
Also, how do you deal with situations where staff/teachers/administrators want to make the nurse's office the place for students to de-escalate/calm down so they aren't a danger to themselves and/or to others?

I have not double checked insulin on older kids and most of them have had pumps. I started double checking accuchecks for a T1 girl who was lying to me about being low to get snacks (her mom sent in oatmeal cookies and fruit by the foot). That was in my first 2 months of school nursing. She would tell me her BG was in the 60s and then have a snack and bolus. When I finally checked the history on her glucometer she was within normal range. Oops. Learning experience for me.

The health office is not a place for a student who is dangerous to de-escalate. First of all because there could be an emergency in the health office at any time or the nurse could be called to an emergency and now have to first find someone to watch the student. Second, I have been in this situation where a student was brought to my office to wait and he was stomping around my office and breathing heavy, cursing loudly, very upset. My desk was in a position that to get to the door I would have to go around the desk or jump it if he came at me. The secretary went to close my office door to keep other students in the office from hearing and I opened it and whispered "Do not put me behind a closed door with an agitated student, I need another adult in here!" She didn't mean any harm, she was simply trying to minimize the distraction and wasn't thinking about my office being closed off.

Csn2016, BSN · Nov 14, 2017

I draw up the insulin for my one diabetic who receives injections (shes only 6 but even if she were older I'd always double check). Last year (my first year in school nursing) I was not double checking the pumps as my one 'older' diabetic was plugging in her numbers. She'd drop her blood sugar every afternoon like clockwork and it finally dawned on me that she was entering higher carbs in her pump to give her more insulin and drop her sugar in the afternoon to get out of her one class in particular she did not like. I started double checking her numbers when she'd enter them and suddenly no more low blood sugars in the afternoon! All though for a while she'd come down and say "I feel low" (even though her continuous monitor would say she was well with in normal range) just to get out of class to check her sugar.

Farawyn · Nov 14, 2017

kidzcare said:
I have not double checked insulin on older kids and most of them have had pumps. I started double checking accuchecks for a T1 girl who was lying to me about being low to get snacks (her mom sent in oatmeal cookies and fruit by the foot). That was in my first 2 months of school nursing. She would tell me her BG was in the 60s and then have a snack and bolus. When I finally checked the history on her glucometer she was within normal range. Oops. Learning experience for me.
The health office is not a place for a student who is dangerous to de-escalate. First of all because there could be an emergency in the health office at any time or the nurse could be called to an emergency and now have to first find someone to watch the student. Second, I have been in this situation where a student was brought to my office to wait and he was stomping around my office and breathing heavy, cursing loudly, very upset. My desk was in a position that to get to the door I would have to go around the desk or jump it if he came at me. The secretary went to close my office door to keep other students in the office from hearing and I opened it and whispered "Do not put me behind a closed door with an agitated student, I need another adult in here!" She didn't mean any harm, she was simply trying to minimize the distraction and wasn't thinking about my office being closed off.

I always have other staff with the student.

Not fair to you at all.

Flare, ASN, BSN · Nov 14, 2017

i have been a place of de-escalation - BUT that is because i am one of the few in the building that is trained in proper student restraint AND is not afraid to actually do it should it need to be done. This isn't to say that i haven't been as mad as a honey badger when someone's wrestled an aggressive student into my office full of kids and i've had to either clear out or transport out the student having the behavioral issue out and away from the sick students. I remind them when the dust settles that i am one person. ONE.

JenTheSchoolRN, BSN, RN · Nov 14, 2017

Flare said:
i have been a place of de-escalation - BUT that is because i am one of the few in the building that is trained in proper student restraint AND is not afraid to actually do it should it need to be done. This isn't to say that i haven't been as mad as a honey badger when someone's wrestled an aggressive student into my office full of kids and i've had to either clear out or transport out the student having the behavioral issue out and away from the sick students. I remind them when the dust settles that i am one person. ONE.

I, too, am also trained to properly restrain a student if needed. But I am much, much lower on the totem pool, so to speak as my school actually had our entire middle school team (teachers and staff) trained because we had a cohort of students entering the middle school that may require it. I will have to re-certify every year.

But my office is not usually the go-to place for this. We have a few small designated rooms and min is only used if dangerous situation arises in basement suddenly (my office is in our basement - my cave, I call it) and when that happens, I have additional adult help and my office is quickly cleared if absolutely needed.

scuba nurse, BSN, MSN, RN · Nov 14, 2017

I have a 1st grade diabetic with an insulin pen and he sets the pen to the amount I tell him and I give it, but I double check the amount first. I wouldn't trust him, he is all over the place!

As far as behavior issues: In my old school, the principal used to always send them to me to "calm down" and have a time out to rest, which I hated because it was a total behavioral/discipline issue that I had nothing to do with. And some would destroy my office, and I had to close for other students to come to. That was one huge issues I had and I have no idea how it worked out. In my new school, I do not deal with that at all!!!

AdobeRN · Nov 14, 2017

If I am administering the insulin I do not have anyone to double check me. If the student is drawing it up - I will double check them. I have 1 on an insulin pump - I just watch his fingers when entering the info, sometimes he is quick with the buttons and makes mistakes.

I have a de-escalation room in my office - only available office space to do so on the campus. A few years ago they came in and removed the electrical outlets, put in a key operated light switch, removed all items out of the room - basically it is a 10x10 empty room. We only have a few kids right now that use it. It is a pain in the rear for me - while I don't need to do anything with these behavior kids it does prevent all other kids from coming into my office if they need anything. I am usually standing at the door telling other kids to return to class if their complaint is not urgent & just on standby if the CORE team needs anything.