Wangenheim Middle School

While the nurse is on site every day, we do need to remember that one half of her salary is paid for by the special education department. Two days a week are provided by the district for health assessments and screenings that may or may not result in special education services. Only one day out of ten is bought by the site for walk-in evaluations. This year, we have gone from averaging 40-60 student walk-ins per day to 90-120 student walk-ins per day. In addition, there are ordered procedures from IEPs and the students who are out of their physical education class due to injury or illness are now supervised in the health office. It has been a very mild cold and flu season this fall, so there is no epidemiological reason for the rise. The resulting traffic control is resulting in little time to do thorough evaluations on the students who really need to be seen immediately. Let's try using the following guidelines. Also, remind the students that it is necessary to get a pass from their teacher to go to the nurse for anything other than a visible injury and/or to report an assault. Once the student has signed into the health office, they must wait for the nurse to see them. Due to the other activities, this may not happen as quickly as it has in other years. Once there, the student must be dismissed by the nurse or other staff member.

1. HEARING & VISION REFERRALS - Make notes if a student begins to have headaches each time she/he reads or has a lesson to follow on the board. Is she/he squinting often? It may be time to have a student's eyes tested. Is your student sensitive to sounds or is not hearing you each time you are giving instructions? You may need to contact the nurse for a review of records and a hearing screening as well. Email this information to the nurse or leave a note. The right screenings may not be done if the student just appears in the health office with a pass. The nurse will send a pass for the student when it is possible to do a thorough test and follow-up.

2. HEADACHES - Dr. Taras has given the nurses specific orders as to when over-the-counter (OCT) medications such as Tylenol can be given. Briefly, it can be given for an observable injury to an extremity like a sprained ankle. The San Diego School District nurses cannot give OTCs for vague symptoms such as headaches. The American Academy of Pediatrics lists the most frequent cause of headaches in children between the ages of 11-17 as being withdrawal from over-the-counter medications such as Tylenol. Overuse or frequent use often causes rebound headaches. If your student is complaining of a headache, try to encourage drinking water throughout the day and allow them to make water fountain visits. Remind them that our coaches sell water after each physical education class. The nurse will no longer have water as this has become a source of unnecessary health office visits. Therefore the student may bring his/her own water, buy the coaches' water, or use the water fountains. Ask the student if he/she was up late the night before. Suggest an earlier bedtime. Some teachers recommend that their student rest his/her head on the desk. Also, inquiring whether or not the student has had breakfast or lunch and exactly what they have eaten that day helps to see if they are suffering from low blood sugar or little energy stores. This question is also important when students are complaining of upset stomachs. If this happens on several occasions, write the nurse a note. I can arrange for a student who does not qualify financially to receive a free breakfast and/or lunch daily for the remainder of the year. Do not send anyone to the health office for breakfast; the nurse cannot keep anything other than diabetic snacks and these must be sealed and in the refrigerator. Sharp migraine type headaches are certainly reason for sending your student to the health office.

3. UPSET STOMACH - Encourage using the bathroom facilities. Often nervousness, anxiety, or being emotionally upset leads to upset stomachs. On occasion, a student may be developing a chronic illness, check to see if the symptoms are happening at home. Vomiting is an extremely soft sign of disease; some healthy people vomit every day (ok, usually it is a reaction to stress or on purpose for weight control). In any case, sitting around the health office missing many classes will not help. Sharp stomach pains are certainly reason for sending your student to the health office.

4. VAGUE TIRED SYMPTOMS - Some students go through times when they begin to feel sympathy pains of others, (usually close friends), who are also in the health office. Some students, not all, will be complaining one minute, and suddenly when it is lunch time, or a class they enjoy, they are miraculously cured. Student's who begin to act in these ways need to be closely watched and instructed on when a health office visit is necessary. Sometimes it helps to conference with a parent to collaborate on whether their child has the same ailments out of school as in school. The cot rooms are used for procedures and are not available every period of the school day. Therefore, do not tell a student to go to the health office and rest; it probably will not be possible.

5. CUTS/SCRAPES - Ask your parents to donate a stash of Band-Aids. It does help to keep some Band-Aids for minor cuts that do not require more than washing and a small Band-Aid i.e.; paper cuts, minor scrape or old wounds in which a child's Band-Aid has been removed. Do not hesitate to send a student who has a cut/scrape that you feel needs further evaluation and treatment.

6. NOSEBLEEDS - Allowing for the occasional hemophiliac, these stop two minutes after the student pinches his/her nose closed and tilts his/her head forward (chin toward chest, not away from the chest). This also prevents others from receiving an unnecessary blood exposure. It does not matter why the nosebleed started; the cure is always the same. On rare occasions, the nurse needs to check to see if the student needs further evaluation for a broken nose.

7. PERSONAL - Yes, the female coaches' office and the health office are the only two places you can get sanitary supplies around this place.

These tips are recommended to help your students remain in the classroom whenever possible and to encourage children to realize their responsibilities as a student. These tips do not discourage a teacher from sending someone they feel is badly injured, or seriously ill no matter how many previous office visits. For those of you who are worried about the medical-legal implications, you will be following the guidelines recommended by the school site.