Resp Assessment before inhaler???

[villageRN, BSN, RN]

I have been working in a school setting with children with special needs for the last 4 years so I am a newbie to the "Health Suite Nurse / CSN role". I oriented for a new position today and the nurse did not listen to anyones lungs prior to them usiing their PRN inhalers. She allowed them to get the inhalers out of the cabinet and administer it to themselves without any assessment or intervention from her.

Like I mentioned...I'm new to the CSN role, so I wonder....Am I overreacting? Is this common practice in the school setting?

[ohiobobcat]

Sometimes kids pre-medicate before participating in gym or other physical activities. I wouldn't necessarily assess a kid if he/she were doing that. Otherwise, I typically listen to lungs prior to administering and inhaler, or shortly thereafter (like within seconds if I don't want to delay the inhaler for time it takes for me to assess lung sounds).

I work in a high school, and almost all of my kids carry their own inhalers and are allowed to self administer. I only see kids who are in significant distress, forgot their inhalers, or have special needs and don't have the capability to self administer.

[OyWithThePoodles, RN]

Agree with Bobcat, if it is prior to recess or PE (as many of our inhalers in the school setting are rx'd for) then no.

If a kid comes in saying they feel SOA, coughing, or otherwise need their inhaler, yes.

[Flare, ASN, BSN]

it's really situational dependent. Like prev stated - the pre PE / recess ones, there's no need. The one's that you give at the 4 hour mark because they are being treated at home and the parent called and asked you to treat Sally at 11:30 or whatever, you may or you may not. A child that comes in and says that they feel like they need it - I probably will give a quick listen more often than not.

[KKEGS, MSN, RN]

For kids requesting it PRN I might give a quick listen and I'll definitely listen afterwards but I would always allow them to use it whether I hear wheezing or tightness or not. As an asthma sufferer myself if I say I need my inhaler then I need my inhaler.

[JenTheSchoolRN, BSN, RN]

Sometimes kids pre-medicate before participating in gym or other physical activities. I wouldn't necessarily assess a kid if he/she were doing that. Otherwise, I typically listen to lungs prior to administering and inhaler, or shortly thereafter (like within seconds if I don't want to delay the inhaler for time it takes for me to assess lung sounds).

I work in a high school, and almost all of my kids carry their own inhalers and are allowed to self administer. I only see kids who are in significant distress, forgot their inhalers, or have special needs and don't have the capability to self administer.

Same. I have a few frequent flier HS students with more severe asthma that have inhalers in my office and they enter, give me what I call "the asthma wave" and head straight to my wall of inhalers/Epi-pens for their inhaler. After they use it, they sit for a couple of minutes and usually chat with me. I do a visual assessment then, looking at color, respiration rate, etc.

I know these students pretty well and I will take a listen if something seems "off," which is usually during/at the winter weather transition in New England. If I have a PRN inhaler for a student that never uses it, my "spidey senses" tingle and I'm likely to listen and probe for more.

[OldDude]

I have no scientific evidence to back this up but I think, on the elementary level, at least half the kids who come in from PE don't really need to use their inhaler; likely more than half. Same thing for pre-treating for PE. I would say 90% of them don't have EIB. If they legitimately needed to use their inhaler then why don't I see them in from recess, where they exert much more energy than they do at PE?

I could go on with example after example of why I think this but, for your time's sake, I'll just leave it at this.

Anyway, I often do not do a respiratory assessment before inhaler use. And NO, I do not deny them their inhaler; I just smile and go on with my day.

[AdobeRN]

I do the same as OldDude :) I never deny them the use of the inhaler. I do send a quick email to parents whenever a student uses the inhaler - sometimes parents are shocked that their child uses it so much at school, I have even had a few tell me not to administer unless there is clearly an issue because the kid does not use it at home or during the sporting events they are heavily involved in.

[GdBSN, RN]

If it is a student that only comes in occasionally for the PRN inhaler, I don't usually do a respiratory assessment. If they become frequent fliers, I will do an assessment and call parents, report my findings, and ask if they want me to administer the inhaler. When I am talking to the parents, I let them know how many times the student has come in for the inhaler and inform them that a trip to the doctor might be needed for better maintenance meds. Informing parents of the number of trips usually drops the FF visits to almost nothing.

[halohg, RN]

Agree with all the above and will add I give a full assessment including 02 Sat for those students thinking they have an inhaler in the health office only to find out they do not. Most are reassured with the full assessment and seeing the O2 Sat and can continue on with their day. For middle schoolers, I would say only 10% must leave for additional medical attention or have parent bring up inhaler for use.

[DEgalRN]

For my FF inhaler users, I usually won't do an assessment. For new ones I might so I can get a baseline understanding of what they sound like or feel like when they need their inhaler. I won't ever deny the use of an inhaler to one of my students though. And most do walk around with them on them.

I had one kid who kept coming for his inhaler who I did question. And I ended up telling him that if he didn't need his inhaler and just needed to get out of class for a minute, I understand, but he shouldn't use his inhaler then.

[SchoolNurseTXstyle]

For kids requesting it PRN I might give a quick listen and I'll definitely listen afterwards but I would always allow them to use it whether I hear wheezing or tightness or not. As an asthma sufferer myself if I say I need my inhaler then I need my inhaler.

Exactly what I do!