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All pukes are not created equal

School   (640 Views | 7 Replies)

SaltineQueen specializes in School Nurse, past Med Surge.

1 Follower; 6,377 Profile Views; 881 Posts

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?

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NurseHeatherBSNRN has 6 years experience as a ASN, BSN and specializes in School Nursing.

35 Posts; 591 Profile Views

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

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Cas1in72 has 26 years experience and specializes in school nursing/ maternal/child hospital based.

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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..............

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UrbanHealthRN has 8 years experience as a BSN, RN and specializes in Pediatric/ Community and Public Health.

206 Posts; 3,187 Profile Views

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.

Edited by UrbanHealthRN

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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

😁😁

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MrNurse(x2) has 28 years experience as a ADN and specializes in IMC, school nursing.

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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.

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944 Posts; 6,953 Profile Views

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.

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Cas1in72 has 26 years experience and specializes in school nursing/ maternal/child hospital based.

168 Posts; 1,649 Profile Views

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!!!) 

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