Caring for students in the Health Office
Most health office visits are for first aid or illness. Here are some common sense tips:
Head Bumps are a very common occurrence in school-aged children. Treat them seriously. Unless you were at the scene of the accident, you do not know how hard the student was hit. Be diligent about getting as much detail of the incident as you can, this will help you make a judgment as to whether to send the student back to class or home. If there is any doubt in your mind that the student has a significant head injury, send the child home. It is much safer for the parent to watch the child than to expect the teacher to determine if there is something wrong. If you are on the fence about whether to send them home or not, let the parent talk to their child and decide. Their phone conversation may be enough to determine that something is not right. Make sure your school has a head bump form to go home with the student. The form should include symptoms of a concussion that the family can watch for. As you know, neurological symptoms may not occur until hours after the injury. My best advice is to call a parent/guardian to alert them of the incident and inform them that a note indicating what to watch for will be coming home with the student.
Open wounds – treatment is common sense. Wash the wound with soap and water and cover it with a bandage. If the wound is the result of faulty or dangerous environment conditions in school (ex: a broken piece of playground equipment), alert your principal and custodian. If the wound is such that you suspect medical intervention is necessary, fill out an accident report according to your district’s guidelines. Some districts require that accident reports be completed for all injuries, check with your administration. Again, I recommend that you call the parent if the child is going home looking differently than how he arrived.
Sprains, strains, and fractures – you’re a nurse, you know what to do here! Immobilize the affected area and call the parent. Parents are the decision makers for their child. Don’t try to make the decision that the injury is minor and can wait until the student gets home from school. The parent may not agree with you, and the parent should be the one to make that decision. Let the parent talk to their child. They know them best.
Stomach aches are probably the most common complaint in the health office. Rule out the obvious (stomach flu, constipation, hunger, URI, etc.). Palpate the abdomen. Is there any tenderness? Is the child pale? If they are going to vomit, it usually doesn’t take long for that to happen. Take each case seriously, but remember that children come to school with a lot on their plates. Things may be crazy at home, they may not be doing well in school, or they may have a social issue at school. Review the health record if accessible. You will be able to identify the “frequent flyers” right away.Call the parent but do not assume that the child needs to go home. Nobody gets out of school without good reason; children learn quickly what it takes to “get out the door.” Ask the parent if the child has had any illness in the past few days. Ask if they have complained of a stomach ache recently. Explain to the parent that you do not want the child to go home unless there is good reason. Suggest that the parent talk to their child. Explain that you do not necessarily want the child to go home, but you need their help in making that decision.Chronic constipation and encoporesis (severe chronic constipation) are common in school-aged children. Constipation is usually the result of a combination of factors, including poor dietary intake, inconsistent toileting habits, and of course, the inhibition to eliminate while at school. Always offer the student an opportunity to use a washroom that can provide for privacy. Children should be assessed for constipation if they have a history of frequent abdominal pain. Sometimes parents are not even aware that their child has chronic constipation.Symptoms of vomiting or diarrhea are a ticket out the door. Children need to stay home until the symptoms have subsided for 24 hours.
Coughs and colds – every school-aged child comes to school with a cold. Just like adults, some children handle the illness better than others. If they have a fever or if they have a cough that impedes their ability to learn, they need to go home.
Head Lice – this is a common occurrence in children and is more of a nuisance than a health problem. Cases are usually identified by the parent or when the teacher notices a child scratching their head frequently. If you have no experience with head lice, please ask for help from someone who is experienced with this problem, or simply refer the child to their doctor for diagnosis. Many cases of head lice are misdiagnosed and stress as a result of the misdiagnosis can be avoided. I recommend the following website if you are unfamiliar with head lice: Head Lice Fact Sheet.
Many school districts exclude children from school when they are identified with head lice. The National Association of School Nurses and the American Academy of Pediatrics recommend that students be allowed to remain in school, even if they have nits or eggs in their hair.
NASN – Pediculosis Management in the School Setting
AAP Offers Updated Guidance on Treating Head Lice
Taking care of ill or injured employees is frequently the responsibility of the school nurse. It is important to maintain good documentation of the care that you provide for them. Check with your principal or fellow nurses to see how this is handled in your district.