Assessing the student on drugs

  1. What does your assessment consist of for students who are believed to be on drugs? (I am a nurse at the middle school level) Adminstration brings them to me to be checked out and make sure their stable. I do a full set of vitals and check their pupils and alertness and orientation. Also pay attention to any odors.
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    About cjl_RN

    Joined: Apr '18; Posts: 55; Likes: 54

    46 Comments

  3. by   OldDude
    Although I'm not certified and seldom utilize it at school on the elementary I think the horizontal gaze nystagmus is the best method for indicating impairment and the need for further assessment.
  4. by   laflaca
    I am new as a high school nurse. Our district has a standard form used for impairment evals - basically vitals, pupils, orientation, nystagmus, stand-and-turn and Romberg, and some questions....but I seriously question the value of these assessments. Or at least I'm frustrated by them, because typically what the principal or teacher wants is "proof."

    Our form is basically an adapted police field assessment, which was intended to screen for impairment and legally support a decision to detain the person and require they provide evidence - a breathalyzer or blood test. But since in a school we don't do laboratory tests to confirm or rule out substance use, and since we're not building a court case, what's the point? Some of the kids referred to me are surely high as kites (on marijuana or occasionally something else), but if they're regular smokers who aren't dumb enough to do it in front of witnesses in the parking lot and breeze in reeking of weed, there is not any definitive exam to "prove" it. Even if they smell like pot, I'll note that but it doesn't prove anything.

    If a kid has pinpoint pupils and respirations of 4/minute, or if they're agitated and hallucinating, I'm calling 911 regardless of whether it's from drugs or something else. If the kid is upright, walkie-talkie and doing math problems, denying any use, denying any physical complaint, they're probably going back to class; staff can still call parents if they're aware of some concern. I'm basically just figuring out if they're safe and stable; I don't have secret drug-detection powers!

    Personally I fill out the form, noting my observations, I'll document whether the kid admits to any use, and I'll provide education to the kid about risks - but I tell the teacher or principal every time AND document on the form, "Substance use cannot be confirmed or ruled out without laboratory testing, which is not available in this setting."
    Last edit by laflaca on Dec 3
  5. by   JenTheSchoolRN
    What Laflaca said.

    My admin is pretty supportive when I flat out tell them I cannot "prove" anything. But they will still I ask "But do you think...?" I can only tell if I notice anything different from a student's baseline. And of the students I've been asked to assess, I am very familiar with their baselines so I can provide that information.

    Of course, when the student is flat out caught smoking MJ in the school bathroom...they don't need me there .
  6. by   Flare
    The latest craze in my school is vaping. Fortunately, it seems like they are only vaping nicotine while in school and reserving the cannabis for their weekend parties. Crafty little buggers are even cutting holes into their hoodies so they can hide their juul or whatever in there. The e-vape doesn't leave a stench on them and if they are using thc oil, there isn't much of a smell on them. As far as assessment goes, it's pretty much a safety assessment. VS, balance, gaze, etc. Like previously stated, a modified police sobriety test is what I use however I make it clear to the administrator /teacher / whomever is making the claim of possibly impairment that I am unable to make the determination of under the influence or not. I can only give an opinion of whether or not I feel the child is safe to remain in school or has results different from their norm.
    Last edit by Flare on Dec 4 : Reason: clarity -forgot the un in unable
  7. by   JenTheSchoolRN
    Quote from Flare
    The latest craze in my school is vaping. Fortunately, it seems like they are only vaping nicotine while in school and reserving the cannabis for their weekend parties. Crafty little buggers are even cutting holes into their hoodies so they can hide their juul or whatever in there. The e-vape doesn't leave a stench on them and if they are using thc oil, there isn't much of a smell on them. As far as assessment goes, it's pretty much a safety assessment. VS, balance, gaze, etc. Like previously stated, a modified police sobriety test is what I use however I make it clear to the administrator /teacher / whomever is making the claim of possibly impairment that I am able to make the determination of under the influence or not. I can only give an opinion of whether or not I feel the child is safe to remain in school or has results different from their norm.
    Also THIS.

    But we have caught them with a juul in the act. Our Dean is a crafty man and I love him for it.
  8. by   ruby_jane
    My least favorite thing as a high school nurse. The form we had was ridiculous - assessing nystagmus four or five different ways. I love what Laflaca said.

    If you're really interested in best practice you could consult your local ER (or ER doc group). But in our outpatient setting, really all you can do is a good set of vitals and a good history and move along.
  9. by   Amethya
    You can't prove it. I mean if you can smell it on them and you can see it? Last year I was asked to check a student and it's like, what do you want me to do? Vitals? ummm okay, but I'm not trained in this so I don't know what to look for. The kid was smoking a actual vape in class and it was strawberry flavor and smell, I even saw the cartridge, nothing but just non-nicotine vape stuff.
  10. by   Farawyn
    The vapes and juuls are bad news.
  11. by   OldDude
    Quote from ruby_jane
    My least favorite thing as a high school nurse. The form we had was ridiculous - assessing nystagmus four or five different ways. I love what Laflaca said.

    If you're really interested in best practice you could consult your local ER (or ER doc group). But in our outpatient setting, really all you can do is a good set of vitals and a good history and move along.
    AYE!! School Nurses are often used as scape goats for administration to forward their agenda/s. It's a slippery slope and one must be very careful in having a "opinion" about the student's mental state.

    I'm glad I'm on the elementary level.
  12. by   GdBSN
    It seems like I've had to do more and more drug assessments lately. The admin are very on board with knowing that I cannot provide a definitive answer, only lab work can do that. I keep my assessment of the student to ensuring they are safe, primarily vital signs, pupils, and orientation. I keep my report very factual, trying to keep my opinion out of it. Admin will usually take over from there. Our officer on campus has said they really can't prove anything unless the student is caught with drugs/alcohol on campus or confesses to taking something.
  13. by   Duranie
    Just curious, now that naloxone is OTC in 46 (48?) states, do any of you have it as a stock med, similar to epi-pens?
    Have any of you considered asking TPTB to allow you to have it in your arsenal?
    It seems like it could be prudent, given how many of you seem to be being asked to assess for possible drug-use.

    There are groups out there that are recommending that every household have naloxone in the "med cabinet" much the same way ipecac used to be recommended. If every home should have it, shouldn't every school?
    Just a bit of food for thought.... idk where I am on the issue, frankly.
    Last edit by Duranie on Dec 4
  14. by   JenTheSchoolRN
    Quote from Duranie
    Just curious, now that naloxone is OTC in 46 (48?) states, do any of you have it as a stock med, similar to epi-pens?
    Have any of you considered asking TPTB to allow you to have it in your arsenal?
    It seems like it could be prudent, given how many of you seem to be being asked to assess for possible drug-use.

    There are groups out there that are recommending that every household have naloxone in the "med cabinet" much the same way ipecac used to be recommended. If every home should have it, shouldn't every school?
    Just a bit of food for thought.... idk where I am on the issue, frankly.
    I don't, but likely it is a matter of time. The fire station one block away stocks it and when I call 911, they are the first to respond (bringing me O2 as well since I, like many schools, do not have it).

    However, it is now being required/recommended in every school in my state. My and my school physician go back and forth on it. My one hesitation has to do more with back-up for any reactions that could happen AFTER I give the med and not really health reactions, more like do I have extra strong hands to help me if I need back-up. (The fire department has me there.) But I know I will get past that and it will be in my arsenal soon.

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