Stroke Sx’s....Complacent Teachers

ErikWeeWoo, BSN, RN, EMT-P · Jan 18, 2021

8 hours ago, schoolnurse1118 said:

I’ll try to make a long story short.
Thursday I was paged to come check on a teacher “bring the BP cuff ASAP!” I run upstairs and find her in a very catatonic state. Do a FAST assessment on her. She can’t speak, can’t raise her right arm, can’t smile, she was just....out of it. Looked almost grey, eyes glassed over. She made out the word “stabbing” and used her left arm to touch her right arm. Immediately told my coworker to call 911 and page for another to grab the AED just in case. Her vitals were pretty normal, lower BP but nothing too crazy. Luckily EMT’s were literally at the light near my school so they got to her less than 5 minutes than I did. They do an EKG, normal. Vitals normal. Transport her for testing, started IV in ambulance. On the way out tears are streaming down her face and she can make out “no hospitals”

Fast forward until this weekend. I hear from some very reliable sources that “these episodes happen all the time” and that she apparently had one at home that morning. She herself told her teaching partner this. Some days she’s so tired she goes to the break room to sleep. Basically her teaching partner and the assistant principal are covering for her. I’m beside myself. When I did a little investigating I was able to find out I was called 27 minutes after she had a “fainting spell” in class. No one said a word about it that day. So they took it into their own hands to handle it and then once she deteriorated they called me.

-Found out she was texting less than 2 hours after it first began. Also that she takes BP meds when convenient for her. So far all they’ve told me is she had very low potassium levels. She’s home and will have further testing this week. A few teachers asked if she could have Munchausens. She does love attention but this would be crazy! Just the texting so soon and not wanting to go to the hospital. It was definitely something but if she’s messing with her meds it’ll obviously throw your levels off and really screw with your heart.

I will not stand for this or have my nursing license on the line for this. I documented the *** out of it and I have a meeting with this assistant principal as well as the principal on Mondays morning. I have no idea what all the principal knows, but he’s about to find out everything.

I feel that in my anger and disappointment I’m not thinking straight. What else do I do? These teachers must be held accountable. I can’t help but think if they were nurses they’d be charged with negligence!!

I honestly think you did a pretty good job. Her co-workers may or may not of had duty to act, failure to act on their part is no reflection on you and likely something that nobody can or will be held accountable for. Depending on the laws of your state, you probably did have duty to act.

You intervened when you were made aware there was a problem, you provided a reasonable assessment, and you took reasonable actions. I'm not sure what else anyone would expect of you, just make sure the school district pays for your crystal ball and magic wand if they want more. Just keep up with documentation, make those above you aware of any safety concerns, and maybe seek advice regarding specifics from someone in a supervisory nursing role there.

Honestly I wouldn't be surprised, but there's not a lot you can do about that aside from speculate to yourself. Keep in mind there's a difference between malingering and munchausens. Munchausens patients are usually much more extreme for reasons that are harder to determine, malingering patients usually just want some benefit or avoidance of responsibility. Maybe it's neither, maybe it's one, maybe it's a little bit of both.

NutmeggeRN, BSN · Jan 19, 2021

Yowsa...that left arm pain could very well be low K+ (I have had that after a norovirus episode ? however...somebody (admin) needs to have a talk with her and then her coworkers and get some answers as to why they acted they way they did.

People obviously have a right to their medical privacy v but when it impacts their work environment, admin has a right to ask for a note that states he is safe to teach and be with children. (don't need a dx, just a clearance)

You did just what you are educated to do...assess and refer.

Flare, ASN, BSN · Jan 19, 2021

You handled it perfectly. You can only work with what is right in front of you. I will say, that if this person is having fainting spells with such frequency that she needs to sleep mid-day or co-workers are familiar with the process and can wait 20+ minutes before seeking further help, then perhaps she may need to get a new physical to determine if she is fit for duty.

ruby_jane, BSN, RN · Jan 20, 2021

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.