Exclude for vomiting

[Margaret K. Stephen]

How do you exclude for vomiting? Our state guidelines say to consider exclusion for vomiting more than once in 24 hours. The nurse I work with tends to exclude after one episode of vomiting. This is for high school, BTW. Input appreciated!

[BrisketRN, BSN, RN]

It really depends on the reason for vomiting. Some high schoolers vomit because they took a medication on an empty stomach, got car sick, or saw someone else vomit. If there isn't a clear explanation (and usually even when there is) I'll have the students rest for at least 20 minutes, and I'll see if they can keep water and some crackers down. If there's no fever, they're insisting they feel alright, and they've only vomited once then I allow them to go back to class.

[JenTheSchoolRN, BSN, RN]

14 hours ago, BiscuitRN said:

It really depends on the reason for vomiting. Some high schoolers vomit because they took a medication on an empty stomach, got car sick, or saw someone else vomit. If there isn't a clear explanation (and usually even when there is) I'll have the students rest for at least 20 minutes, and I'll see if they can keep water and some crackers down. If there's no fever, they're insisting they feel alright, and they've only vomited once then I allow them to go back to class.

Same for me.

Also, anxiety. I see anxiety related vomit a lot more, especially in HS. Oh, and allergy season post-nasal drip vomit. I ask students to tell me what vomit looked like if it was not witnessed.

But, yes, I do crackers, water, maybe a peppermint, and observation before determining if this a warranted send-home vomit situation.

[CanIcallmymom, BSN, RN]

15 hours ago, BiscuitRN said:

It really depends on the reason for vomiting. Some high schoolers vomit because they took a medication on an empty stomach, got car sick, or saw someone else vomit. If there isn't a clear explanation (and usually even when there is) I'll have the students rest for at least 20 minutes, and I'll see if they can keep water and some crackers down. If there's no fever, they're insisting they feel alright, and they've only vomited once then I allow them to go back to class.

I do the same thing. We have a no vomit x 24 hours policy, but admin has often said "I trust your judgment" when I let a kid stay if they knew of the vomiting episode.

ETA: I'm high school as well. And I have several that I swear can vomit on command. Several sick after meds...pregnant students...

Some students, if they insist they still feel sick after vomiting, I will call right away...especially if they are not in my office often. Every situation is a little different.

[ruby_jane, BSN, RN]

Is this nurse you work with in charge of the clinic? Then...I guess that's the way it is!

In HS I would NEVER, ever have excluded for one vomit (especially a Bigfoot vomit, unwitnessed). For many of the aforementioned reasons.

Here in ES/MS - vomit in front of a reasonable prudent person and get out. I mean it. Leave. Gone. Boom. Why? Because the reasons for vomiting are a lot more cut and dried down here.

[Flare, ASN, BSN]

i agree - it really calls for assessment and judgement. Kid puked once because their lunch didn't agree / spin too hard on the playground / throat full of phlegm - rest for a bit, water, back to class.

Report of a bigfoot vomit (that's one that *nobody* saw - learned that term on here and i love it!) water, rest, back to class.

The kid that literally has NO visits all year, looks terrible and says they just puked in the bathroom i am definitely more apt to send home no questions asked. Using my office sparingly has its advantages.

[CanIcallmymom, BSN, RN]

8 minutes ago, Flare said:

Using my office sparingly has its advantages.

I tell my FF this all the time!

[EnoughWithTheIce]

I am in middle school so Bigfoot vomit is a daily struggle. EVERY.SINGLE.DAY - especially from athletics.

Crackers, water - if they hold it down then they go back to class.

[Margaret K. Stephen]

47 minutes ago, ruby_jane said:

Is this nurse you work with in charge of the clinic? Then...I guess that's the way it is!

I'm in charge. But I've been here 5 months and she's been here umpteen years... ?

Good feedback here, everyone. Thank you. I agree exclusion should depend on assessment.

What's your readmission criteria? We do 24 hours vomit free. I think that can be excessive especially since we are quick to exclude. One afternoon of upset stomach with vomiting x 1 shouldn't necessarily mean out the next day (in the absense of signs/symptoms of contagious illness.)

[nursekoll, BSN, RN]

54 minutes ago, Margaret K. Stephen said:

What's your readmission criteria? We do 24 hours vomit free. I think that can be excessive especially since we are quick to exclude. One afternoon of upset stomach with vomiting x 1 shouldn't necessarily mean out the next day (in the absense of signs/symptoms of contagious illness.)

We have a 24 hr vomit-free policy also, but I feel (and admin backs it) that nursing judgment supersedes this rule if needed. I see a lot of period-cramp pukers in my MS/HS. Yeah, it hurts and they lose it with the pain. Go home, take some midol, rest a bit and come back after lunch if you feel better. I always tell the secretaries of the exemptions I'm making so there's no questioning upon return though.

[jess11RN]

We have a few that can just vomit on command. They don't get excluded ?

[ruby_jane, BSN, RN]

1 hour ago, Margaret K. Stephen said:

I'm in charge. But I've been here 5 months and she's been here umpteen years... ?

Good feedback here, everyone. Thank you. I agree exclusion should depend on assessment.

What's your readmission criteria? We do 24 hours vomit free. I think that can be excessive especially since we are quick to exclude. One afternoon of upset stomach with vomiting x 1 shouldn't necessarily mean out the next day (in the absense of signs/symptoms of contagious illness.)

AHHHH.

So, moving forward for next year - you can reassess this policy, no? Especially if it takes kids out of school before they are "counted" for the day.

24 hours vomit free makes sense if the kid is power puking....but not so much with food poisoning or excess of hot cheetos. However - you may have to keep it simple. For the folk that like to KISS.