Flu without fever?

[Purple_Scrubs, BSN, RN]

OK, this is sort of a cross post, because I started a similar thread on the pandemic forum, but I wanted to get my school nurse buddies' input on this. Please forgive!

I have read that up to 50% of H1N1 cases present without fever. What are you doing to catch and exclude these kids to keep this from spreading? My district has no set policy on this, so I am on my own to decide who gets excluded for mild to moderate respiratory symptoms and who does not. My thinking is that if you have 2 out of 3 of these s/s (cough, sore throat, runny/stuffy nose/congestion) then you go home. But for how long and what do I do if a parent questions it - I have no policy to back me up on this! We do not even have a standard policy that says kids must stay home until fever free for 24 hours. We used to say in our literature that we recommend that they stay home 24 hours, then at the start of this year the form was revised and even this recommendation was taken out!!!

How are you handling this to keep your school and yourself healthy and safe?

[tleigh7097]

Contact your local public health office. The epidemiologist could be helpful.:

[SchoolNurseBSN]

That is a tough one. Personally, the kids I have seen have all had a fever - most above 101. I would have to base it on severity of symptoms. I personally would not exclude kids with mild symptoms and no fever. Otherwise - the school may be empty.

I would step up my staff, student, and parent education on handwashing and cough etiquette. Prevention is still your best offense!

Check your state health web site and your local health department for their recommendations.

[luvschoolnursing, LPN]

I saw one today. Temp normal. Main c/o was dry cough, chest tightness, achy. No hx asthma or resp problems.Lungs clear, color good but kid was clammy and "looked sick." Home he went. I will be following up with this one to see how it goes. We have no real policy about this, not sure how we could. Another good reason to have a nurse and not just go by specific criteria. How can you describe "looks sick" but I'm sure all my nurse friends know what I mean.

[Needsmorechocolate, ASN]

Please keep us posted on your student. I am curious to hear the outcome. I agree, as nurses, we can understand the phrase "looks sick."

[Purple_Scrubs, BSN, RN]

I'm glad I'm not alone in my concerns about this. Yes, the "looks sick" criteria is a big one for me too. Bearing in mind that the teacher's interpretation of "looks sick" (usually in correlation to how much complaining they do) is vastly different!

[SchoolNurseBSN]

No fever, mild symptoms, wiggly and talking.......back to class.

No fever, "looks sick"............going home. If they stay, temp will usually start to climb as the day goes by!! It is true, we "just know" that look. It comes from experience.