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nursekoll BSN, RN

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nursekoll has 15 years experience as a BSN, RN.

15 years as a nurse, 7 years as a school nurse.

nursekoll's Latest Activity

  1. nursekoll

    Lice/rant

    I have found out the hard way that mentioning things like shampooing and combing for head lice might not be specific enough. I now use very specific questions like "What kind/brand of LICE -killing shampoo are you using?" (had one family just use regular hair shampoo) and "What does your NIT COMB look like? Is it plastic or metal, are the comb tines very close together and longer than an inch? How long did it take you to comb through her hair last night?" (had one family just combing daily with a regular hair comb). I have also asked for the empty box of treatment upon return to school so I know they didn't just use mayonaise or olive oil or something like that. Maintain an attitude that you're only trying to be helpful and work together to eliminate the head lice. Good luck with your meeting!
  2. nursekoll

    Lice found, but not on head

    Interesting. I'd ask more questions such as where did they find it? I have been checking the affected elementary grades this week due to several cases and was surprised to find 2 students (siblings) with a few nits that were likely empty due to being grown out more than 1/2 inch from the scalp. I found no live lice or any nits closer to the scalp. I asked them both and the parent separately if that had already treated at home in the last month or so, they all denied it. (Parents are encouraged to notify the school if they find lice/ treat at home so we can be aware and check classmates.) Hmm, okay. Back to class it is! Seemed strange though.
  3. nursekoll

    what to do if you disagree with PA's treatment

    This is the only solace I can offer the teacher at this point! Thanks!
  4. nursekoll

    what to do if you disagree with PA's treatment

    I know it's not in my scope to diagnose or treat. The PA did diagnose the ringworm- not me. It is in my scope to follow rules/regs of infection control and school health is my priority. Our policy is to exclude for ringworm until treated appropriately and it must be covered at school until cleared. I'm so tempted to call to clarify or question the treatment as appropriate though. I'm worried that next week I'll have a whole classroom full of kids with pinkeye and ringworm. . . I'm waiting to hear back from my state school nurse consultant for advice. This is a difficult family to work with as is- poor hygiene, poor resources, etc. I really don't think it will get better with this treatment. Thanks all for your comments and advice, I really do appreciate it!
  5. nursekoll

    what to do if you disagree with PA's treatment

    I really want to call the clinic charge nurse or clinic manager and ask her if SHE considers topical treatment appropriate for scalp Ringworm. And not say student's name as to not violate confidentiality. Mid level providers are the only ones who do walk-in clinic/urgent care around here. It takes 1-2 moths to see an MD. sad.
  6. Hi all, I would like your opinion on what you would do if you thought (knew) that the treatment recommended by a PA was not appropriate? I have a kinder student with tinea captitis (ringworm of scalp) and the PA's note to the school states that Ringworm is not contagious due to treatment with topical antifungal cream. It is my understanding that when ringworm gets into the hair follicles, the topical creams are ineffective treatment because they do not penetrate deep enough. In the case of scalp ringworm a prescription for an oral antifungal is required. This is what I told the parent (twice, a week apart), and when they finally took the kid into be seen, the PA did nothing! Said keep treating with the otc athletes foot cream. School policy is exclude until appropriate treatment is started and keep ringworm covered at school. Hard to do that- have student wear a hat?? Also same kid had irritated left eye, red sclera, cloudy exudate in inner canthus and crusted matter in lashes and skin surrounding eye. When I sent home to be evaluated for both possible pinkeye and ringworm without appropriate treatment, mom is not happy. Student returns next day with note from PA that says "ringworm not contagious- treated with topical agent, left eye not conjunctivitis, may atttend school." What would you do?????? Help.
  7. nursekoll

    ringworm on eye

    Kindergartner. Ugh. I did urge student to refrain from touching the area and reminded about frequent hand washing especially if the area is touched. Technically it's somewhat covered with the nail polish?!
  8. nursekoll

    ringworm on eye

    Hey fellow nurses, I have a student with ringworm on the eyelid. Normally we don't exclude for ringworm, but ask that it be covered while at school and treat with anti-fungal cream at home. There's really no way to put a band-aid on the eyelid, so would you exclude until proper treatment is initiated? Side note: Mom says "grandma is a nurse" and put fingernail polish on this kid's eyelid! Glitter nail polish, in the eyelashes, on the eyelid. Not sure how this kid can even open the eye very well with NAIL POLISH on it! SMH Anyway, mom agreed to pick up some lotrimin and start using that. I did send the kid back to class, but wonder if y'all would have done the same?
  9. nursekoll

    Allergies

    I'm having the opposite issue- A student's physical lists no allergies, but the asthma form has a place for allergies/triggers to be listed by parents. I think the student filled out the form because of a language barrier for the parents. Student listed peanuts, cashews, tree nuts, and seeds as an allergy. When I asked student about what symptoms occur when nuts are ingested, she replied, "Oh, my throat gets itchy, I cough, and I get these weird red blotches all over my face and neck." Me, shocked: "That sounds pretty serious, do you have an epi-pen?" Student: "No, I just don't eat nuts anymore." (shrugs) I don't even know what to do with that. Send a release form to the parents so I can talk to the provider?? Student has been at this school for more than 2 years. This is the first I've heard of it.
  10. I'm glad my state has an emergency response protocol with standing orders to give epi-pen followed by albuterol neb to anyone with a life threatening breathing emergency. This is a valuable tool for school nurses in Nebraska in order to save lives. If a student has an action plan, but that plan fails, we go to the protocol, if there is no plan or history of asthma/anaphylaxis, we go to the protocol. I wish more states had this and would stock epi and albuterol in their schools. I have known a young person who died in ambulance en-route from status asthmaticus even after seeking help, so the sooner we can get meds on board the better. So sad.
  11. nursekoll

    Exclude for vomiting

    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.
  12. nursekoll

    Field Trips

    I send emergency medications (ie: Seizure meds, diabetes meds, Epi-pens) with the school staff that have been trained in their administration. I also have some first aid materials in the "emergency bag".
  13. nursekoll

    drug exposure symptoms??

    Ain't that the truth!
  14. nursekoll

    drug exposure symptoms??

    Thanks. It's hard sometimes being the only nurse around! I'm so glad for the sounding board. The student was not showing anything abnormal as far as vitals or neuro assessment. Wanted to go home, so not avoiding that. Not much history, as the family is new to the district. Counselor was unaware of the reported concern, but will now keep an eye out for anything more concrete as far as needing reported to HHS. Administration and all involved staff are now keeping a watchful eye for this kid. This job is heartbreaking sometimes.
  15. nursekoll

    drug exposure symptoms??

    I don't like the idea of acting on heresay, but also don't want the kid to be in an unsafe situation.
  16. nursekoll

    drug exposure symptoms??

    Hi, I'm hoping someone can help. What kind of symptoms would you see in an elementary student that was/ is exposed to meth second-hand at home? And what do you do when you suspect this situation? I saw a 3rd grader with general malaise, headache, nausea, no fever, no vomit, no diarrhea. Other staff members told me the parent is "on a bender" and is known in the community for being a meth user. Now I don't know what to do next, please advise.
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