What do you do when the evidence isn't there but you kind of think it will be eventually?

ruby_jane, BSN, RN · Nov 30, 2017

Someone talked about their Spidey Sense earlier. I agree - if it's an everyday, school-avoidant kid, 15 minutes rest and back to class you go. If it's someone I've not seen often then yes, come back after lunch/in 30 minutes/if it gets worse is warranted.

Also the closer it gets to the end of the day, the more likely I am to let them call home to see what parent would like to do. If parent was aware and told the student to "try to go to class" I figure if the student made it through lunch and still feels bad, then they gave it a good try!

JenTheSchoolRN, BSN, RN · Nov 30, 2017

See if it is a student that I never see and appetite is affected, I will likely call home and dismiss. Especially if it after lunch, because student has likely given the day a good try and is really in my office because they feel terrible.

Now a FF, that is a case-by-case eval.

KeeperOfTheIceRN, ADN · Nov 30, 2017

Part of my policy to be in school includes "being clinically well to attend". I get a lot of kiddos who have been on abx for the 24 hour window that allows them to return to school, but they still don't feel well enough to be there. So, even if their s/s don't meet the criteria to go home (i.e.: fever, vomiting, etc. ect.) if I can tell they legitimately don't feel well, I do call home. Its not going to do them any good to stay in class if they're feeling miserable. Especially those that I rarely, if ever, see. Now, my FFs.....they have more hurdles to jump through before I call home! That's a monster they created though! But like others have said, trust your gut and call if you feel you need to. Even if its just to let the parent know what you're seeing.

SaltineQueen · Nov 30, 2017

If I have a temp that's up towards our "go home" level (100.0) I will have them rest for 10-15 and take it again. If it's still high, then my decision process is similar to yours. If I never see them, I may just call parents & give them the option to come get them. If they're a FF I try to talk to the teacher to see how they've been acting in class. It just kind of depends on how they're acting/looking & how nice I'm feeling that day. I've sent kids home that were borderline & ended up really being sick. And I've called for a pick up on kids who almost skipped out the door. Can't win for loosing sometimes.

Flare, ASN, BSN · Nov 30, 2017

if it's a kid that i never ever see and they've dragged them self into my office then that's further proof positive that they feel like crud and should go home before the downward spiral hits. But tbh with a lot of these kids it can take me so darned long to get anyone on the phone or to come and get them that by the time i look back over they are out cold and the fever has set in anyhow and the maybe?? has turned into definitely!!.

MrNurse(x2), ADN · Nov 30, 2017

Littles get a different criteria. They seem less able to deal with those pre-symptoms of illness that older students can forge through. Frequent flyers, well I know their personalities well enough to know if they are faking. I am very direct with my FFs. if I am sending them home, I go into exact detail why they received the golden ticket that day.

grammy1 · Nov 30, 2017

I will frequently have them come back to recheck temps. I've had them come in normal or low 99s and 2 hours later be 102 (or totally normal). Sometimes you just have that feeling.

moreoreo · Nov 30, 2017

I agree with others that there is a sense of how they are behaving the second they walk in (especially if it's someone who's never come in before vs. frequent flyer). Regardless of my sense I do have them sit and sip water for ten minutes and observe them secretly while working on paperwork. (Elementary kiddos are not the best fakers so some of them start swinging their legs or looking brightly out the window while waiting. Therapeutic boredom also helps differentiate between those who feel well enough and would rather go back to class than sit there doing nothing, and those who feel so badly that sitting in a quiet room is a relief.) I let that extended observation and the second temp check determine my course of action but I almost always call for temps over 99 so kid can be on parent's radar. If parent doesn't feel inclined to come pick up their child (or simply can't) I offer to recheck the child after lunch time and they usually take me up on that. Of course if a child looks/acts/feels completely dreadful I absolutely push for pick up even if the temp does not increase.

Like others I've had a mild temp turn out to be a legitimate fever, and I've also had a child who looked miserable in the morning feel completely fine in the afternoon. We can't always be right so it feels better to take the time to watch and be a team with the parent.

bgxyrnf, MSN, RN · Dec 7, 2017

Had a little one in the clinic not feeling well. Ate minimal lunch and went out for recess. Temp 99.6. Her little eyes looked tired though and like just maybe, she was beginning to brew a little something that was legit. Do you send them back, asking them to come back within a certain time frame, so you can assess them again, including another temp check, or do you just go ahead and call home? For me, it depends on the situation and the kid (frequent flyer vs a newbie). I sent a little one back to class this afternoon, asking her to come back to see me in 30 minutes, so I could see how she was feeling, how lunch settled on her belly, and if there was a change in her temp. Her teacher called to question me, which is whatever, I just wanted to see/hear your routine for this.

I'm not a school nurse but rather an ED nurse. Still, there's some overlap between our roles, at least in this context. First, the patient's general appearance is a legitimate part of the assessment; the docs generally address it under "constitutional." In your case, the appearance and the high-normal temp may reflect the late prodromal period of an infection. In my opinion, it doesn't warrant isolation and a call home but it does warrant a reassessment. Temperature: The 99.x temp isn't indicative of anything, except... that it might be. It is a high-normal temp that could mean nothing or, particularly if you have a baseline series of temps indicating that the kid normally runs low-normal, say 97.8. In the presentation that you describe, it doesn't warrant isolation and a call home but it does warrant a reassessment. Reassessment: Regular reassessment is a key component of ED care and as you decided, is appropriate in this case. Thirty minutes is probably too early based on my experience of watching ED patients over the last 10 years, but your strategy is sound. There's no reason not to have the kid back in class at this point but I'd look at 1-2 hours later depending on the presentation of the kid and perhaps a subtle obs over recess/lunch. In your presentation, I'd at least as interested in the HR and 60-sec RR because it turns out that legit infections can trigger elevated RR before any other objective sign. Again, I speak from a different perspective than you but I think your general approach is clinically sound.

kidzcare · Dec 7, 2017

I will frequently have them come back to recheck temps. I've had them come in normal or low 99s and 2 hours later be 102 (or totally normal). Sometimes you just have that feeling.

I had kid go from 97.8 to >102 in 45 minutes once! I was glad she came back!

As for the original question, it totally depends on the kid. A FF I take with a grain of salt. Others I may ask to return in an hour. I also will give parents a preemptive call along the lines of "So Snowflake was in not feeling well and is back in class now but I asked him/her to return so I can check him/her out again in an hour. If you don't hear back from me, assume all is well, but if there are changes I'll give you a call to pick Snowflake up." I've found parents more receptive to the second phone call when they have a warning. Plus I may get more insight from that call like "Oh, yeah. Snowflake had a headache last night so I'm not surprised. I'll come get him/her if you think I should!"

Amethya · Dec 8, 2017

If the kid looked bad, I would of called their parents to let them know and ask them what they would like to do. Even at 99, I let them know, but I let them know if the kid seems okay or not.