RESUMO
Through a case presentation, this article describes the assessment and management of a student presenting with a history of disordered eating and weight loss. As medical concerns are brought to the attention of the school nurse, it is important for the school nurse to be aware of common signs and symptoms seen in students with undiagnosed or established eating disorders, as well as possible medical complications associated with untreated or poorly controlled eating disorders. Possible signs and symptoms associated with eating disorders that require outpatient referral or emergent management is delineated in this article, and school nurses are provided with a helpful mnemonic called "BONES" to aid in the recognition of eating disorders in the school setting.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Serviços de Enfermagem Escolar , Atenção à Saúde , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Humanos , EstudantesRESUMO
Teen dating violence (TDV) has become more prevalent in our schools, exacerbated by the omnipotent presence of social media and portals of what dating and gender roles "should be" in Hollywood films and television shows. It is important to recognize that TDV is a threat to mental health, and potentially physical health, and school nurses should develop a framework for recognizing problematic social, physical, and emotional interactions between students. This article describes typical presentations of TDV through a case, providing a mnemonic for recognition and resources for prevention.
Assuntos
Comportamento do Adolescente , Violência por Parceiro Íntimo , Enfermeiras e Enfermeiros , Serviços de Enfermagem Escolar , Adolescente , Atenção à Saúde , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Instituições AcadêmicasRESUMO
Although students commonly present to the school nurses' office with physical chief complaints, there are many mental health concerns in the school-age population associated with emotional and physical consequences. Bullying is considered to be a public health crisis, plaguing students across the nation. It is important to develop a framework for recognizing problematic social and emotional interactions between students, like bullying, given the dire consequences on a student's physical and emotional well-being. This article describes typical presentations of bullying through a case scenario, providing a mnemonic for recognition and resources for prevention.
Assuntos
Bullying , Enfermeiras e Enfermeiros , Serviços de Enfermagem Escolar , Bullying/prevenção & controle , Atenção à Saúde , Humanos , Instituições Acadêmicas , EstudantesRESUMO
Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.
Assuntos
Emergências/enfermagem , Padrões de Prática em Enfermagem , Esportes , Adolescente , Traumatismos do Tornozelo/enfermagem , Traumatismos em Atletas/enfermagem , Golpe de Calor/enfermagem , Humanos , Luxações Articulares/enfermagem , Masculino , Entorses e Distensões/enfermagem , Lesões no CotoveloRESUMO
Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider's office, or directly to the closest emergency department via EMS). This article describes the initial assessment and management of two students presenting after syncopal events.
Assuntos
Diagnóstico de Enfermagem , Serviços de Enfermagem Escolar , Síncope/diagnóstico , Adolescente , Criança , Humanos , Síncope/enfermagemRESUMO
Although a student presenting with altered mental status due to substance use may occur infrequently in the school setting, it is of utmost importance to develop a differential diagnosis and to initiate stabilization of the student. This article describes the initial assessment and management of a student presenting with altered mental status, focusing on the differential diagnosis of altered mental status, on the varying presentations associated with common intoxications and ingestions, and on the screening tools available for the detection of depression and substance use.
Assuntos
Papel do Profissional de Enfermagem , Diagnóstico de Enfermagem , Estudantes , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Criança , Diagnóstico Diferencial , Humanos , Serviços de Saúde Escolar , Serviços de Enfermagem Escolar , Transtornos Relacionados ao Uso de Substâncias/enfermagemRESUMO
OBJECTIVE: The aim of the study was to determine the compliance of school transportation staff and school buses with recommendations for the safe transportation of children to and from school and school-related activities. METHODS: An electronic questionnaire was distributed to school transportation staff represented by the International Brotherhood of Teamsters during the 2013-2014 academic year. RESULTS: Analysis was performed on 558 completed questionnaires (13% usable response rate). Responders had previous training in first aid (89%), basic life support (28%), and cardiopulmonary resuscitation (52%). Seventy-eight percent of school buses in our sample had restraint devices and 87% had seat belt cutters. Responders reported the immediate availability of the following on their bus: communication devices (81%), first aid kits (97%), fire extinguishers (89%), automated external defibrillators (1%), and epinephrine autoinjectors (2%). Thirty percent of responders have had no previous training in the management of emergencies such as trouble breathing, severe allergic reaction, seizures, cardiac arrest or unresponsiveness, and head, neck, or extremity trauma. Thirteen percent of responders are unfamiliar with or have had no previous training on protocols regarding emergency shelters and community evacuation plans in the event of a disaster. CONCLUSIONS: Variability exists in the compliance of school transportation staff and school buses with recommendations for the safe transportation of children. Areas for improvement were identified, such as educating school transportation staff in the recognition and initial management of pediatric emergencies, ensuring the presence of restraint devices, increasing the immediate availability of certain emergency medications and equipment, and familiarizing school transportation staff with designated emergency shelters and community evacuation plans.
Assuntos
Planejamento em Desastres/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Veículos Automotores/normas , Instituições Acadêmicas/estatística & dados numéricos , Criança , Planejamento em Desastres/normas , Desastres , Emergências , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Instituições Acadêmicas/normas , Inquéritos e Questionários , Estados UnidosRESUMO
Abdominal pain is a common chief complaint encountered by school nurses. This article explains the etiology of abdominal pain in children and adolescents, describes the office assessment, and delineates life-threatening conditions associated with severe abdominal pain that may prompt the school nurse to transfer the student to a local emergency department.
Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/enfermagem , Apendicite/diagnóstico , Doenças Ovarianas/diagnóstico , Guias de Prática Clínica como Assunto , Serviços de Enfermagem Escolar/normas , Anormalidade Torcional/diagnóstico , Adolescente , Apendicite/enfermagem , Feminino , Humanos , Masculino , Doenças Ovarianas/enfermagem , Doenças Ovarianas/cirurgia , Anormalidade Torcional/enfermagem , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVES: The aim of the study was to determine the compliance of urgent care centers in the United States with published recommendations for office-based disaster preparedness. METHODS: An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. RESULTS: One hundred twenty-two questionnaires of the 872 distributed were available for analysis (14% usable response rate). Twenty-seven percent of centers have an established disaster plan for events that involve their establishment and surrounding community; 49% practice the plan at least once a year, 19% less frequent than once a year, and 32% never practice. Forty-seven percent of centers are familiar with designated emergency shelters and community evacuation plans. Seventeen percent of centers function as part of a surveillance system to provide early detection of any biologic/chemical/nuclear agents. Twenty-two percent of centers take part in local community and hospital disaster planning, exercises, and drills through emergency medical services and public health systems. Five percent of centers aid schools, child care centers, camps, and other child congregate facilities in disaster planning. Twenty-eight percent of centers have an assembled emergency/disaster kit, containing such items as water, first aid supplies, radios, flashlights, batteries, heavy-duty gloves, food, and sanitation supplies. CONCLUSIONS: Areas for improvement in urgent care center disaster preparedness were identified, such as developing an office disaster plan that is practiced at least yearly, becoming familiar with designated emergency shelters and community evacuation plans, providing surveillance to detect potential acts of terrorism, assisting community organizations (hospitals, schools, child care centers, etc) in disaster planning, and assembling office emergency/disaster kits.
Assuntos
Instituições de Assistência Ambulatorial/normas , Planejamento em Desastres/normas , Tratamento de Emergência/normas , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: To describe the compliance of urgent care centers in the United States with pediatric care recommendations for emergency preparedness as set forth by the American Academy of Pediatrics. METHODS: An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. RESULTS: A total of 122 questionnaires of the 872 distributed were available for analysis (14% usable response rate). The most common diagnoses reported for pediatric patients included otitis media (72%), upper respiratory illness (69%), strep pharyngitis (61%), bronchiolitis (30%), and extremity sprain/strain (28%). Seventy-one percent of centers have contacted community emergency medical services (EMS) to transport a critically ill or injured child to their local emergency department in the past year. Sixty-two percent of centers reported having an established written protocol with community EMS and 54% with their local emergency department or hospital. Centers reported the availability of the following essential medications and equipment: oxygen source (75%), nebulized/inhaled ß-agonist (95%), intravenous epinephrine (88%), oxygen masks/nasal cannula (89%), bag-valve-mask resuscitator (81%), suctioning device (60%), and automated external defibrillator (80%). Centers reported the presence of the following written emergency plans: respiratory distress (40%), seizures (67%), dehydration/shock (69%), head injury (59%), neck injury (67%), significant fracture (69%), and blunt chest or abdominal injury (81%). Forty-seven percent of centers conduct formal reviews of emergent or difficult cases in a quality improvement format. CONCLUSIONS: Areas for improvement in urgent care center preparedness were identified, such as increasing the availability of essential medications and equipment, establishing transfer and transport agreements with local hospitals and community EMS, and ensuring a structured quality improvement program.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Defesa Civil , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência , Fidelidade a Diretrizes , Pediatria/estatística & dados numéricos , Instituições de Assistência Ambulatorial/normas , Criança , Estudos Transversais , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Humanos , Pediatria/normas , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. METHODS: Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ≥ 10 participants, with trial data that were published within the last 5 years. RESULTS: Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. CONCLUSION: A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.