Under the Influence Assessment

[OyWithThePoodles, RN]

Alright y'all. I tried searching, promise. And I could not find a previous post on this even though I know they're there. 

I am at a high school now (working with Mr. Poodles!!) and I am unfamiliar with how to assess the students if they're suspected to be under the influence. I was brought one yesterday: Upon entering I first checked smell, through my mask of course. No smell of alcohol or marijuana noted. I check her pupils, gait, speech, how she reacted when I said was going to call mom (about an actual medical concern). I found nothing of concern. The SRO came in after and said his findings were the same. 

My question is: Is there anything else I should've done? Do you all make them do almost like a sobriety test (I.e. walk a straight line, nose to finger, etc.)?  I want to make sure I am doing everything I can do detect an abnormality if it's there, I've been in elementary the last 6 years, and thankfully, I never had this issue. My 9 years in the hospital dealing with DT patients yields some assistance, but I want advice from my "co-workers". 

Miss y'all. Covid is taking up so much of our time I know we aren't on here as much. 

[NutmeggeRN, BSN]

Sounds like you covered your bases. I do check their eye for response to light. I also check their HR and BP. It is usually pretty evident if they are under the influence. They may have taken something with a vape, and may not be impaired but still doing something naughty. If I think they are under the influence, I usually call them on it and they will cave. When a kid gets really agitated and belligerent, that is almost always a clear sign of some impairment. And I always do this with administration. 911 if they are in any danger.

[OyWithThePoodles, RN]

2 minutes ago, NutmeggeRN said:

Sounds like you covered your bases. I do check their eye for response to light. I also check their HR and BP. It is usually pretty evident if they are under the influence. They may have taken something with a vape, and may not be impaired but still doing something naughty. If I think they are under the influence, I usually call them on iot and they will cave. When a kid gets really agitated and belligerent, that is almost always a clear sign of some impairment. And I always do this with administration. 911 if they are in any danger.

Admin is the one who brought her to me, she had already been searched and questioned by the SRO and he said she had no suspicious reactions or answers, which was good. I wanted to make sure there wasn't anything I didn't do. Thank you!

[guest83140]

I have a substance assessment double-sided sheet created by our nurse supv. When they bring the person, usually security, it has to be authorized by the admin. Front side (date, time, student name, gender, campus, the person doing eval. (has to be RN). witness, past/present illness/injury, medical prob, last medication, last meal, last slept, first set of vitals, contacts or glasses, yes or no, Pupil size, equal yes or no, circle size, pupils to room light, darkness, eyes, normal or other describe, conjunctiva normal, redness, other. Oral inspection of tongue, gums, lips, normal, green, brown black blisters other. General appearance normal eyelid tremors, body shaking, unkempt, poor hygiene. Back side Speech (circle) clear, ans. ques. appro, garbled, slurred, incomplete sentence, other (describe). Breath odor (circle) appears normal rancid other 9describe).  Mental status (circle appears normal flat affect hallucinations delusions disoriented lethargic confused incom sent. incr alertness other (describe). Behavior (circle) appears normal, paranoid, anxious depressed hyperactive euphoric other (describe). Stands (circle) gait is steady swaying unable to stand w/o using arms for balance, falling down, other (describe). Last vital signs and time taken temp b/p p r. Student's comments. Summary of abnormalities (3 blank lines) Nurse name and date

[OyWithThePoodles, RN]

29 minutes ago, Dimple58 said:

I have a substance assessment double-sided sheet created by our nurse supv. When they bring the person, usually security, it has to be authorized by the admin. Front side (date, time, student name, gender, campus, the person doing eval. (has to be RN). witness, past/present illness/injury, medical prob, last medication, last meal, last slept, first set of vitals, contacts or glasses, yes or no, Pupil size, equal yes or no, circle size, pupils to room light, darkness, eyes, normal or other describe, conjunctiva normal, redness, other. Oral inspection of tongue, gums, lips, normal, green, brown black blisters other. General appearance normal eyelid tremors, body shaking, unkempt, poor hygiene. Back side Speech (circle) clear, ans. ques. appro, garbled, slurred, incomplete sentence, other (describe). Breath odor (circle) appears normal rancid other 9describe).  Mental status (circle appears normal flat affect hallucinations delusions disoriented lethargic confused incom sent. incr alertness other (describe). Behavior (circle) appears normal, paranoid, anxious depressed hyperactive euphoric other (describe). Stands (circle) gait is steady swaying unable to stand w/o using arms for balance, falling down, other (describe). Last vital signs and time taken temp b/p p r. Student's comments. Summary of abnormalities (3 blank lines) Nurse name and date

Any chance you'd wanna maybe sneak me a copy of that? ?

[Jedrnurse, BSN, RN]

In warmer months, I have them do a "come to my house and mow my lawn" assessment. 

Now that we're in Winter it's a "come to my house and shovel my driveway" version...

Seriously, though. What were the indicators that made staff suspicious in the first place?

[OyWithThePoodles, RN]

2 hours ago, Jedrnurse said:

In warmer months, I have them do a "come to my house and mow my lawn" assessment. 

Now that we're in Winter it's a "come to my house and shovel my driveway" version...

Seriously, though. What were the indicators that made staff suspicious in the first place?

Okay... it's been a long day and my brain is tired. What in the world is a "come to my house and mow my lawn" assessment? ?

Extremely bloodshot eyes. 

[Jedrnurse, BSN, RN]

1 hour ago, OyWithThePoodles said:

Okay... it's been a long day and my brain is tired. What in the world is a "come to my house and mow my lawn" assessment? ?

Extremely bloodshot eyes. 

More useful than walking a straight line and tests for good hand/eye coordination. AND the grass gets cut...?

[Cattz, ADN]

I attended a training several years ago. I think it was called DRE (Drug Recognition Expert- for  Schools.) Very, very good. I am attaching some information from it on assessment. And a couple of different assessment records that came from that training. 

Good luck- Cattz

DAR Pupilometer.pdf

Drug_assessment2[1].doc

Physical Assessment Checklist- Drugs.doc

Substance abuse assessment.doc

[OyWithThePoodles, RN]

On 1/28/2021 at 12:21 PM, Cattz said:

I attended a training several years ago. I think it was called DRE (Drug Recognition Expert- for  Schools.) Very, very good. I am attaching some information from it on assessment. And a couple of different assessment records that came from that training. 

Good luck- Cattz

DAR Pupilometer.pdf

Drug_assessment2[1].doc

Physical Assessment Checklist- Drugs.doc

Substance abuse assessment.doc

THANK YOU!!

[guest464345]

I know there was a previous thread....I couldn't find it either.

My opinion, which may not be the majority opinion, is that "impairment evals" are not a nursing gig.  I don't have drug tests or an order to administer them.  Principals will ask if a kid is under the influence, and my answer is that I have no way to confirm or rule out substance use, medically or legally.  I will certainly not chart or report that a kid has been using, unless they tell me they've been using -  and then I will use their direct quote as documentation.  (And probably 80% of the time the student will tell me!)

That heel to toe line-walking business is designed for cops to show probable cause for a breathalyzer or blood draw in the field; it's not  diagnostic of anything. If a student can't walk straight, or is confused, or is unconscious, my job is keep them safe and get them to medical care.  They can do a tox screen in the ER.  Being a cop is not my job.

What *is* my job...doing a nursing evaluation and determining if someone is unstable. Protecting students' medical privacy. Making myself available to talk to kids who have concerns about substance abuse for themselves or their friends/family.  Keeping myself educated about drugs of abuse.  Understanding that substance use decisions are interwoven with other struggles in students' lives. Using motivational interviewing strategies to help students move toward healthy changes.  Developing relationships in which kids feel safe to talk to me honestly. Coordinating with our social worker to get treatment referrals when needed. 

[amoLucia]

laflaca - very informative. I believe I've heard similar as you post.