All pukes are not created equal

[SaltineQueen]

Normally, our "policy" is that kids are to be home for 24 hours after their last episode of vomiting/diarrhea. But, of course, there are exceptions to every rule...we have a number of kids who get motion sick on the bus, kids on spinny things at recess, etc. If you were to develop a set of guidelines to assess whether or not a puke is due to illness or just a fluke, what would you have on that list? Like a point system...X number of points = more likely a fluke and kid could probably be at school. So far I'm thinking: Fever? Have they eaten since? Meds on empty stomach? Coughing fit? Was it mucous or food?

[NurseHeatherBSNRN, ASN, BSN]

How soon after recess or gym? Multiple episodes or just multiple heaves? Does drinking a cup of water help or hurt?

[Cas1in72]

This every day!! So many times, especially with littles, you find out they had been coughing before the "puke" or they were in gym and drank a ton of water and ran laps then " puke" or its really hot out and they were expected to gobble down their lunch and went full out during recess, "puke" I keep trying and trying to explain to the staff that not every "puke" is equal to illness, but time and time again it gets thrown back at me "its policy" NO... persistent vomiting or vomiting with fever or kid looks bad and doesnt have any other circumstances surrounding the episode is a reason to exclude. They flip out when I tell a parent, " if LD doesnt vomit again or run a fever, they can return tomorrow" You would think Im trying to infect the entire school with Ebola. I feel like its common sense!!! But, then again, Im just the nurse around here. This has been an extremely long year..............

[UrbanHealthRN, BSN, RN]

The guidance I went by for pre-k kiddos was: a) 1 puke + at least one other illness symptom (fever, diarrhea, persistent abdominal pain, significant behavior change like frequent crying), or b) two or more pukes within 24 hours. Either of those situations earned a "be at home, not at school" award, and puking needed to be gone for 24 hours before returning. Even with older kids, I doubt something like a spinney recess game or too many Cheetos would provoke more than one vomit before the kiddo returns to normal.

[ruby_jane, BSN, RN]

Try telling that to the extremely germaphobic third grade teacher....

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[MrNurse(x2), ADN]

Why observation is so important. Viral puke has a signature smell and look. It is important to find out when they ate last. If it is viral and you don't get to observe it, give them water and you will know in five minutes. These are our assessment techniques.

[Cattz, ADN]

We have used 2 vomiting episodes or more in 24 hours = the Golden Ticket to go home. It works pretty well for the bus sick kid, the I drank 4 chocolate milk kid, the I gagged on my snot kid, and the went too many rounds on the merry-go-round kid, etc.

[Cas1in72]

20 minutes ago, MrNurse(x2) said:

Why observation is so important. Viral puke has a signature smell and look. It is important to find out when they ate last. If it is viral and you don't get to observe it, give them water and you will know in five minutes. These are our assessment techniques.

Exactly! I give them a cup of water, let them rest for 15 min and if no puke- back to class. In 5 years Ive only had 3 kids go on to puke in the classroom. The kids arent usually the problem for me, its the staff. I can not get it in their heads that not every puke is equal to illness. KIDS PUKE, I tell them. I have even had a teacher get in my face and say" if that kid pukes in my class its your fault and you are cleaning it up" Needless to say, that kid didnt puke( thank goodness!!!)