What should I do??

manjaNurse · Mar 24, 2010

I did not send her home this time. Talked to my principal...talked to her teacher..and we haf decided that we haf to keep a lookout for this kid!! so glad that the teacher n principal trust my judgement!!

Most of the parents here are too caring....the minute I called to give some info or update on what happened, they will come rushing to get their kids home!!

Purple_Scrubs, BSN, RN · Mar 24, 2010

For c/o dizziness, I usually get a full set of vital signs, ask about the last time the student ate (could be hunger), recent PE or recess activities, etc. If all vitals are normal and food or activity is not an issue, I usually let them rest then send back to class and follow up with a call home after the fact.

The student's behavior while they are in my office tells me loads about how they are really feeling. If they are looking around, interested in what I am doing or what other students are doing, talking or playing, then I do not buy the dizzy thing. If they are covering their eyes, unsteady on their feet, not wanting to get up, eat or drink, I am more likely to think something is really going on and call for the parent to come get them. Occasionally I have offerred a book to read...a student with true dizzyness is not going to want to sit and read a book, at least I wouldn't.

BunnyBunnyBSNRN, ASN, BSN · Mar 24, 2010

[color=deepskyblue]besides what purple said, i also ask them to stand on one foot and close their eyes. "dizzy" can't hold it's balance.

mustlovepoodles, RN · Mar 24, 2010

I concur with Purplescrubs. Look at the whole child. If she's standing there animatedly talking to you or other students, chances are she's not real sick. I find that a LOT of my students are mildly dehydrated. The only think they drink at school is chocolate milk. So my first intervention after vitals is drink 2 small cups of water. With dizziness I do a full eval, then let them sit at my little desk and color for 10 minutes or so. If they are really sick, they'll usually put their head down. At the least, they will look distressed. If they can sit there and color, all lively and interacting with other students, they can go back to class. Sometimes, if I suspect there may be fever brewing I"ll let them lie down for 20 min. My frequent flyers will lie there for about 2 minutes and then it gets very boring(I don't talk with them--they have to listen to my classical music and be quiet.) Some of them will go to sleep and that alone often makes them feel better.

A word about frequent flyers--My rule is if I"ve seen a kid more than 4 times in 4 weeks I put a call in to the parent, to see if there is some significant health issue. We discuss the situation, what might be causing it and what we might do about it. If there is nothing, then I talk to the teachers and principal and we come up with a plan to keep the child in class. If the behavior continues, I get the counselor involved. Last year I had a transfer student who came every day for the first 6 days with variations on "I don't feel good." No symptoms, of course. Talked to mom, said he did the same thing at the old school and the nurse just let him lay down in the clinic. :rolleyes: Well, that wasn't going to happen anymore. Mom and I talked to the boy and I talked to the teachers & counselor. The behavior continued. NOthing we did had any effect on this kid--he even told me he just wanted to get out of class! FInally, I took him to the office and we had a pow-wow with the principal. I told them both that I would be sending to the principal Billy every time he comes to the clinic unless I can see something obvious. Even that didn't deterr him, untill about the 3rd time he did it--the principal took him to in-school suspension for the remainder of the day. It did sink in eventually that we were not going to reward his behavior and all he was going to get was negative consequences.

Of course, you still have to be alert to frequent flyers. They *do* get sick sometimes and you don't want to ever assume that they're always faking it. :nurse:

manjaNurse · Mar 25, 2010

Wow!! thanks guys...

She was actually very animated in my clinic...telling stories on the upcoming plans for the Easter hols. She was also hungry and dehydrated. When I offered her drinks, she drank 5 cups!! I add glucose on one of the cups.

She was better but very upset that she was not allowed to go home or call mommy.

Flare, ASN, BSN · Mar 25, 2010

yes, sounds like a real malingerer to me.