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Posted on: Sun, 09/10/2006 - 2:32pm
anonymous's picture
Joined: 05/28/2009 - 16:42

I'm sorry mamabear I don't have the exact wording handy and at this point my concern is that the school nurse had no right to change the doctor's orders. If she had any questions or concerns she should have called the doctor's office (she didn't, I checked) and she should have called me. I have never met nor spoken with her.
The doctor is not advising them to admin the epi willy nilly. It had specifics (symptoms and what to do) on his orders and one was that Epi was to be the first thing/treatment or whatever you want to call it. Not Bendadryl, then albuterol inhaler and then Epi.

Posted on: Sun, 09/10/2006 - 3:48pm
Corvallis Mom's picture
Joined: 05/22/2001 - 09:00

Quote:Originally posted by that'smetrying:
[b]Why would you want the school to use the epi-pen before any reaction is witnessed? I'm confused...
Yes, epi is generally safe, but I wouldn't want some over zealous administrator giving my kid epi with no signs of a reactions ie, tingling mouth, hives or swelling, etc..Did I miss something?
This is frequently advised for kids like mine-- who have experienced very rapid descent into grade 4 anaphylaxis from ultra-trace amounts. The thinking is that [i]if there is a known ingestion of pn[/i] there is probably not enough time to "wait and see" what kind of symptoms will appear. Treat first and hope you are quick enough.
(Having seen DD's two grade 4 rxns, I'm a believer.)

Posted on: Sun, 09/10/2006 - 11:03pm
Kathy L.'s picture
Joined: 07/30/1999 - 09:00

Our allergist ordered Epi first (as taken from the "checklist" of symptoms from FAAN's emergency action plan sheet), except for one symptom (don't have it in front of me). I was surprised about that. He said that the protocol that *I* would follow may be different than what he wants the school to follow due to the "wait & see" approach that the school might take.

Posted on: Sun, 09/10/2006 - 11:48pm
MommaBear's picture
Joined: 09/23/2002 - 09:00

Quote:Originally posted by ~*Trace*~:
[b]I'm sorry mamabear I don't have the exact wording handy and at this point my concern is that the school nurse had no right to change the doctor's orders.
Never said she did. Just trying to figure out what didn't "click" with her. Ya know? She might have jumped the gun if faced with an order she [i]couldn't[/i] follow. Of course, rewriting "dr's orders" isn't permissible, and is the "wrong way" to handle something like that.....just trying to see [i]what happened[/i].
If indeed, she did "rewrite" doctors orders.
It's just not something I frequently encounter, [i]even from school nurses[/i]. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] As a matter of fact, that's not the group of nurses I'd find suspect of such an offense. KWIM?

Posted on: Mon, 09/11/2006 - 1:25am
saknjmom's picture
Joined: 04/02/2003 - 09:00

How did you realize that the school nurse changed the orders?
Once I turn in the paperwork for medication, I never see it again.
I would report it to the person in charge of school nurses at the state level.
Did you ask her why she amended the doctors protocol? This is very scary.

Posted on: Mon, 09/11/2006 - 2:40am
NicoleinNH's picture
Joined: 06/21/2003 - 09:00

[This message has been edited by NicoleinNH (edited June 09, 2007).]

Posted on: Mon, 09/11/2006 - 2:50am
MommaBear's picture
Joined: 09/23/2002 - 09:00

Quote:Originally posted by NicoleinNH:
[b]Mommabear and others-It is not uncommon for allergists to prescribe Epi prior to any symptoms for kids who have already shown quick anaphylactic reactions. My daughter's care plan written by her physicians (pediatrician and pediatric allergist) states the school staff is to administer Epinephrine if they know my daughter ingested peanut (before she shows any symptoms--but I doubt the school would "know" she had ingested it because they can't/don't watch her constantly). [/b]
that's my point. I don't see where "treatment" was for [i]known ingestion[/i]. I'd like to know what signs and symptoms the physican prescribed epi for [i]before an anaphylactic reaction.[/i]
I mean, when dealing with the [i]unknown[/i]. Not knowing if anything has been ingested. Just looking at "signs and symptoms".

Posted on: Mon, 09/11/2006 - 3:44am
Anonymous's picture
Anonymous (not verified)

Edited because after reading the entire thread, my question was already answered.
[This message has been edited by AnnaMarie (edited September 11, 2006).]

Posted on: Mon, 09/11/2006 - 7:38am
anonymous's picture
Joined: 05/28/2009 - 16:42

Thanks everyone for your suggestions, advice and concern. We took ds to school to day and were met by the school director who wanted to have a meeting with us. She apologized that the nurse changed the doctors orders (said the nurse was confused by the doctor's notes) and that she (the school director) called the doctor's office on Friday to get clarification.
Here are his orders (since I have them sitting right here I won't be omitting key words this time, lol!~)
"I apologize again for the confusion and resulting concern with our nursing plan yesterday. In order to better clarify our responsibiliy to R, I called the nurse ad the doctor's office (names omitted). We reviewed, once again, the current doctor's orders. The following is my understanding of my discussion with the nurse and what the current orders state we must do if ingestion or contact with ANY type of tree nut or peanut is suspected or known:
1 Admin EpiPen
2. Admin Albuterol MDI - 2 puffs w/spacer
3. Administer Benadryl- 3.5 tsp
4. Call 9-1-1
5. Call parents
(4&5 should be done immediately by another staff member)
Symptoms: Hives, rash, itching, itching/swelling of the lips/tongue/mouth/throat, nausea, abdominal cramping, diarrhea and or vomiting, shortness of breath, repetitive coughing, wheezing "thready" pulse, passing out.
And they notated the "accomodations" they've made.
I took the letter to the doctor's office who approved it and said they're impressed that the school seems to be finally "getting it".
The reason I know the nurse changed the orders is because I took the doctor's orders to the school and made copies for me, the school director and for the med bag. When I picked ds up from school on Wed. on of the class aids was telling me about their epipen training class and that now she knows that if any symptoms show then to admin. Benadryl. I immed opened the med bag to find the copy of the doctor's orders gone and found the nurses orders in the bag.
The nurse changed things from the order above to:
Albuterol inhaler
The symptoms were listed as well. Specific symtoms for the Benadryl and certain symptoms for the inhaler and certain (the most severe) symptoms for the EpiPen.
As soon as I saw the nurses paperwork I went straight to the school director, had her pull her copy from the doctor and showed her the difference. While she agreed the difference was huge she said they have to go by what the school nurse says. I kept ds out of school both Thurs and Fri (telling the school director that's what I was doing due to these orders being changed) and then she called the doctor's office on Friday.
When I saw the nurse (at the doctor's office) today she told me that she told the school director that the school nurse had no right to change the orders and in fact the doctor will be calling the school nurse.
In today's meeting the school director told me she has been in contact w/the district's special ed director and that she's requested a 504 meeting.
So, all of that went well, I think. However, his teacher is very negative and overwhelmed and stressed and quite frankly I'm not sure what to do about it. She told us again today she's got 20 other kids to worry about and ds isn't her only concern. She also is very unclear of when or why to give the epi. (She asked me why I didn't give ds the epi when he woke up throwing up at school the day he got the concussion!) We are feeling like we're on a roller coaster ride. You know the one step forward and two steps back sort of thing? We felt very good after our meeting today and then when we spoke w/the teacher we felt we should grab ds and run far and fast, ugh!
Maybe too I shouldn't harbor on the fact she referred to ds as a "problem". "He's not my problem once he leaves my classroom" didn't sit well with me after going through so much, kwim?
In all seriousness the teacher most definitely needs some one and one training with the school nurse or even my ds doctor. I hate though that I can tell she'd rather he just go away.
Oh, the school director did say "you know, if you're so concerned w/his safety there are other options. You could homeschool him". I told her that I get concerned when I think everything is planned out and then the school nurses changes doctor's orders. That's what worries me". She said, she understoood.
[This message has been edited by ~*Trace*~ (edited September 11, 2006).]

Posted on: Mon, 09/11/2006 - 8:16am
Carefulmom's picture
Joined: 01/03/2002 - 09:00

I would give the teacher the FAAN video "It Only Takes One Bite" and meet one on one with her to practice the epipen until she is comfortable. If you have any expired ones, you can have her practice into an orange. It is very helpful. I really think it is best for the parent to meet one on one with the teacher if the teacher seems confused. My dd is 11 and I always meet with the teachers on my own anyhow, even if the nurse meets with them too. I always want to be sure they really get it. Glad to hear the change of orders got straightened out at least!


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