Use of Inhaler

[Keepstanding, ASN, RN]

I have a student who has an inhaler in the clinic for PRN use.

She comes to me at least every day stating that she is "wheezy".

I get my stethoscope and check for wheezes, crackles, anything out of the norm.

This kid sounds clear as a bell. No SOB, no wheezing, no cough, nothing.

So I do not administer the inhaler. Mom get's mad at me for withholding the medication. But the kid is not having any asthma !

Can you all help me out here. What do you do in cases like this ? Do you give the med either way, in order to please the parent, or do you not give it, because there is no indication of asthma noted ?

Thanks in advance for your help !

Praiser

[sirI, MSN, APRN, NP]

Presentation does not always include wheezing. The child could have SOB, chest tightness, perceived difficulty in breathing, throat discomfort, etc. Any of these could indicate air flow obstruction.

So, if one presents with c/o any of the above, yes, you should administer the inhaler tx.

Sounds as if this child needs to be reevaluated by his PCP.

[santhony44, MSN, RN, NP]

It's possible to be too "tight" to wheeze.

Give it.

Also, suggest that the child be re-evaluated by the PCP since the "rescue" medication is needed on a daily basis.

[JudithL_in_NH]

In the absence of clinical symptoms--good air movement auscultated, no cough, no wheeze, RR and HR WNL, skin pink, patient oriented and able to converse normally--I do not give the inhaler just because the student asks for it. Especially if the child can't articulate why they think they need it--that is, they're not saying I'm SOB or tight, just saying "I need my inhaler."

I have had a couple of kids who came every day--and it was more of a boredom, let me hang out at the nurse's office for a while kind of thing. Communication with the parents, who did not want the child coming to the nurse and taking meds without a good reason helped, too.

I've also had a parent or two who've insisted on daily administration of rescue inhalers without any rationale (no clinical basis, not coming off a cold, etc.) In these cases I've asked for a note from the PCP indicating scheduled daily dosing was needed at school--and then I've usually never heard from the parent again.

Judith L

[bergren]

Has doing a peak flow gone out of favor?

I agree wheezing is not the only criteria for administration.

Ask the student to come see you for you to check her in morning or at lunch and establish a proactive relationship with her, and reduce the time out of class.

[Flare, ASN, BSN]

Has doing a peak flow gone out of favor?

I agree wheezing is not the only criteria for administration.

Ask the student to come see you for you to check her in morning or at lunch and establish a proactive relationship with her, and reduce the time out of class.

I think peak flow is becoming slowly extinct. Which is a shame. I almost never see it in a students asthma action plan orders.

[dbmc]

In my school, the kids are allowed to keep the inhalers with them at all times.

[Keepstanding, ASN, RN]

In my school, the kids are allowed to keep the inhalers with them at all times.

dbmc,

what age group of students are you talking about ?

[canoehead, BSN, RN]

Let her use it and then listen 5 minutes afterwards to see if there is any improvement in air flow. If not, there was no reason for her to use it. When I was young kids would suck off the inhalers to get a bit of a buzz- albuterol mostly. My sister used to hand her puffer around the classroom so everyone could take a hit. Gross.

[dbmc]

Preschool thru 6th. When they are really young, they can come to the office if they need assistance. 99 percent of the time the parents tell us that the child knows how to use it and when. The parents still have to fill out a medication form to keep in the office. We've never had any problems so far with that policy. The problems occur only when the child forgets and leaves the inhaler at home and has an asthma attack.

[PageRespiratory!]

I think peak flow is becoming slowly extinct. Which is a shame. I almost never see it in a students asthma action plan orders.

Not true by any means, at my institution anyway. Peakflow studies are the BEST way to stop the prescriber from ordering unnecessary Tx's.

Are you guys teaching spacer use as well?

[TXNurseBSN]

I do baseline peak flows on all of my asthma kids. Then, I do another one when they come in for their rescue inhaler. I am in middle school and many of my kids use their inhaler to get out of class, get an excused tardy, etc. When the child AND parent see that you have objective data - you will not see them in your clinic everyday. Not to mention - peak flow will tell you their status when they ARE having an attack, and to see if their inhaler is indeed helping.