Swollen fingers

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I’ve had a TON recently... some happening at home over the weekend and then coming in first thing Monday, others while they are here. I’ve only had one this year that I was pretty sure was broken, but honestly jammed, dislocated, sprained- they can all look the same!! How do y’all know when to ice and watch or send on? I feel like they all want a big production ?

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Unless it's glaringly obvious that something is broken, I give them an ice pack and send them back to class. If they return I'll make a call home.

I'll also make a call home if I'm unsure or questioning anything.

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Specializes in Pediatrics Retired.

If it's from home I don't do anything but call a parent and ask them what THEY want to do about it.

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Specializes in School Nurse, past Med Surge.

I'm usually a lot less sympathetic to things that happened at home that parents have had time to address. If they have decent ROM I give them ice & send them on their way. A second visit would get a call home but not with a suggestion to come pick up their kid...just as a head's up.

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Thank y’all for the information. Makes me feel a lot better. And I agree, I am so much less sympathetic about stuff that happen at home. ??‍♀️

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Specializes in ICU/community health/school nursing.

Ditto to all the above AND, to cover my bases, I recommend an eval by their PCP because if it hurts bad enough after 24/48/72 hours they need to see someone!

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On 4/22/2019 at 7:12 AM, jess11RN said:

Unless it's glaringly obvious that something is broken, I give them an ice pack and send them back to class. If they return I'll make a call home.

I'll also make a call home if I'm unsure or questioning anything.

This was my approach at first, but early in the SY I did this with an injured finger, and as soon as I sent the kid back to class (PE), the teacher called home and had mom pick up. It was, in fact, broken. The whole situation was a mess- I looked dumb for not catching a broken bone, and the PE teacher was way out of line for calling home to arrange pick up. But anyways, now I ice and ibu and call if there is swelling, if no swelling I reassess in 30-60 min and go from there. Usually always call home for ankle/wrist or finger/toe injuries because it's just so hard to tell without an xray.

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Specializes in School nursing.
28 minutes ago, jnemartin said:

This was my approach at first, but early in the SY I did this with an injured finger, and as soon as I sent the kid back to class (PE), the teacher called home and had mom pick up. It was, in fact, broken. The whole situation was a mess- I looked dumb for not catching a broken bone, and the PE teacher was way out of line for calling home to arrange pick up. But anyways, now I ice and ibu and call if there is swelling, if no swelling I reassess in 30-60 min and go from there. Usually always call home for ankle/wrist or finger/toe injuries because it's just so hard to tell without an xray.

Thing is for a broken finger (or toe) there isn't much they will do unless it is a terrible break right on growth plate. Did they cast the hand for this student or just splint it?

Fingers are tricky beasts. And kids jam and hurt them all. the. time. I don't call home from every jammed finger with no swelling and full range of motion (nor give ibuprofen), but have iced area if student requests.

I have also used what I call the writing test if finger injury is on their dominant hand. I hand the student a piece of paper and a pencil and ask them to write their name. I have found this an interesting assessment tool.

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9 minutes ago, JenTheSchoolRN said:

Thing is for a broken finger (or toe) there isn't much they will do unless it is a terrible break right on growth plate. Did they cast the hand for this student or just splint it?

In this case, they casted it and then he wore a brace for quite a while. I don't remember the specifics. I work in a very affluent area, so any tiny break that you or I would not normally treat very extensively is like 3 months of PT and a series of casts/braces with this population. Live and learn, I guess

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55 minutes ago, jnemartin said:

In this case, they casted it and then he wore a brace for quite a while. I don't remember the specifics. I work in a very affluent area, so any tiny break that you or I would not normally treat very extensively is like 3 months of PT and a series of casts/braces with this population. Live and learn, I guess

Oh, geez. That's crazy!

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As a medic, all that can be assessed is PMS. Is there still good pulse, movement, and sensation. In other words, any risk they will lose the finger. Do you ever offer to buddy splint or otherwise splint the finger? That will at least relieve and protect the break if there is one. If the pain seems extreme after given time to calm a bit, call the parent and let them decide.

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