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School Nurse/ Medical Forms/ Attendance Forms

Welcome to the St. Joseph School Nurse page.  This new addition to the St. Joseph web site will provide information about varied topics related to children’s health issues. It is my hope that this information will assist you in caring for your child.

The health topic/topics covered at this site will be changed periodically. Other health links for parents/children for health topics will also be included for further exploration.

Therese M. Hoehn, R.N., B.S.N., C.R.N.
School Nurse
St. Joseph School

Not responsible for information found by linking beyond this page.

Dr. David Grossman from the Lucas County Health Department has issued a memo concerning the use of water bottles that I believe is important to pass along to you. He recommends that students not share drinking containers, such as water bottles, since many diseases can be passed through infected saliva.

Students involved in extracurricular activities such as sports may share drinking containers during practices and games, either accidentally or knowingly.  Teachers, coaches and parents should discourage this behavior since illnesses such as viral meningitis, enteroviruses, rotaviruses, and influenza can be easily transmitted from one student to the next.

The Health Department encourages teachers, coaches, and parents to take the following steps to reduce the likelihood of illness:

  1. Label drinking containers with the student’s name.
  2. Ensure that drinking containers are filled regularly during practice and games to discourage sharing of drinking containers.
  3. Wash drinking containers regularly.
  4. Exclude ill students from practice and activities.
  5. Encourage regular hand washing, especially after bathroom breaks and before meals.

Varicella (chickenpox) is an acute, contagious disease caused by varicella zoster virus.  Individuals with chickenpox develop a rash of lesions that look like blisters over their body.  The lesions usually begin around the neck, scalp, face, trunk, and then to the extremities.  The highest concentration of lesions are found on the trunk (chest and back).  Lesions are usually 1-5 mm in size (size of a pencil eraser).  Once the rash appears, it progresses fairly rapidly over 1-2 days.  The number of lesions varies.  Some people get just a few lesions while others can be covered from head to toe.  The lesions develop vesicles which are delicate and contain clear fluid.  The vesicles may rupture or become cloudy before they dry up and crust over.  This process of “crusting over” usually takes about a week.  Children will in addition to developing a rash also have a general malaise (not feeling well), mild fever and itching.

Chickenpox is transmitted either indirectly by the respiratory tract (airborne) or by direct contact with the fluid from a lesion.  Children are most contagious 1-2 days prior to development of their rash.  Many times children spread the virus before they even realize they have it.  Children will continue to be contagious until the last of the lesions have crusted over.  This “crusting over” process usually takes from 7-10 days.  The incubation for chickenpox is from 10-21 days ( usually 14-16 days) from the time the child was exposed.

With the availability of the varicella vaccine since 1995, many children have been immunized against this virus.  This vaccine has resulted in a greatly decreased number of chickenpox cases seen in school.  While most children (99%) have immunity once they receive the vaccine, there is a 1% occurrence of what is referred to as “breakthrough infection”.  If a child does develop chickenpox after they had been immunized, their breakthrough infection is much milder than unvaccinated children.  It has been my experience that the lesions tend to be smaller in size and number.  These Children experiencing a “breakthrough infection” are also considered contagious until the last lesion has crusted over.  This process of crusting over takes about a week.

Skin Cancer is the most prevalent cancer in the United States.  It is linked to sun exposure in youth and is preventable.  St. Joseph School would like to promote practices which help protect our children from the sun.  Sun protection measures can include:

  1. Wearing appropriate clothing.  Covering up the skin by wearing long sleeves or hats can provide a practical barrier to the effects from the sun.  Sun glasses can also protect the eyes from harmful UV rays. 
  2. Using Sun Protection (SPF) sunscreens.  While some people are at greater risk to damage from the sun due to factors such as skin type and family history, everyone benefits from the use of sunscreen.
  3. Skin cancer is the most common and preventable type of cancer in the United States.  Since 1973, new cases of melanoma have increased 150%.
  4. Research indicates that most people receive as much as 80% of their total lifetime UV exposure during their first 18 years.
  5. Protection from UV exposure during childhood and adolescence reduces the risk for skin cancer.
  6. Using sunscreen is one of the most commonly practiced and easiest behaviors for preventing skin cancer.
  7.  The American Academy of Dermatology suggests that everyone should use a sunscreen of SPF of at least 15 year round.
  8. Sunscreen should be applied if you are going to be exposed to the sun for more than 20 minutes.
  9. 80% of the sun’s ultraviolet rays pass through the clouds.  Sunscreen should be used even on cloudy days.   
  10.  SPF stands for Sun Protection Factor.  SPF numbers can range from 2-60.  These numbers refer to the product’s ability to block the sun’s rays.  The SPF is calculated by comparing the amount of time needed to produce sunburn on protected skin to the amount of time needed to cause sunburn on unprotected sun.  For example, a person who would normally burn after 10 minutes in the sun will take 20 minutes to burn if using SPF 2 product.  If a person uses SPF 15, he/she has 150 minutes before he/she will burn.
  11. Sunscreen should be applied to dry skin 15-30 minutes prior to going outside.
  12. One ounce (enough to fill a shot glass) is considered the amount needed to cover the exposed areas of the body properly.

While sunscreens are not strictly classified as a medicine, it is a product that has guidelines which should be followed for effective and safe use.  Therefore, St. Joseph School has created a Sun Safety/Sunscreen Use Policy.  Parents or guardians have the prime responsibility for their child’s health.  Parents also know if their child is of greater risk to sun damage and the needs of that child for sun protection.  St Joseph’s goal is to ensure that parents decide on the sun protection needs of their children.

Although St Joseph skin safety guidelines are intended for school use, they are a guide for children and adults whenever they spend time in outdoor settings.  These practices, if adopted as healthy habits throughout life, can have an important impact on the prevention of skin cancer.

St. Joseph School wishes to encourage students to protect themselves from the sun.  One way of doing this is to use sunscreen at the appropriate time.    If a student is to use sunscreen at school, parents are asked to:

  1. Provide the sunscreen product for school use.  The sunscreen must be:
    Clearly marked with the child’s name.
    Replenished by the parent as needed.
  2. The sunscreen product will be stored in the child’s book bag or other location designated by the teacher.
  3. The child must be able to apply his or her own sunscreen.
  4. It will be the child’s responsibility to determine when to use sunscreen during the school day.  Parents should instruct their child as to when to apply sunscreen.
  5. For kindergarten parents:  You are asked to apply sunscreen at home before a typical school day.  If the school day is extended for your child ( i.e.- all day field trip or Extended Day use) you are asked to:
    Discuss with your child’s teacher if your child is too young and unable to apply his/her own sunscreen. 
    If it is considered necessary for teachers/staff to assist with the application of sunscreen, the sunscreen will only be applied to face, neck, arms, hands and lower legs.  Parents are asked to provide written instruction to teachers for their child’s individual needs.

Pertussis, also referred to as Whooping Cough, has been mentioned recently in both national and local news.  This vaccine preventable disease has been reported on because of a rise in the number of confirmed cases recently.  I would like to provide some information about Pertussis (Whooping Cough) that you may find helpful.

Pertussis, better known as Whooping Cough, is highly contagious an is one of the most commonly occurring vaccine-preventable diseases in the United States.  Many infants who get Pertussis are infected by older siblings, parents or other caregivers who might not even know they have the disease.  In 2010, several states, including Ohio, have reported an increase in Pertussis cases as compared to the same time in 2009.  This year in Lucas County there were over 12 cases reported during July and the first half of August.  This compares with 5 cases for all of 2009 for Lucas County.  It is thought that the immunity developed from the vaccine fades in 5-10 years, and that boosters are needed for teens and adults to prevent spread to children.  The updated Ohio requirements for a Pertussis booster (Tdap) for 7th grade entry are expected to reduce the number of cases.

Common symptoms of Pertussis include a gradual onset that initially resembles the common cold with sneezing, a low grade fever, and cough for 1-2 weeks.  The cough gradually becomes more severe with paroxysms, gasping, and a characteristic whooping sound.  The individual may not have a fever at this stage.  The paroxysmal cough may last 4-10 weeks.  Older children and adults may not necessarily exhibit whooping.  Individuals with Pertussis usually spread the disease by coughing or sneezing while in close contact with others who then breathe in the Pertussis bacteria.  Incubation is commonly 5-10 days after exposure.  Communicability is greatest in the first several weeks and lasts for approximately 21 days after onset of cough.  Young infants are at the greatest risk fro complications from Pertussis.
While we have not had any confirmed cases of Pertussis at St. Joseph School, I encourage parents of children with an ongoing cough to follow up with their physicians.  At times, families may assume a cough is due to asthma or other respiratory conditions, delaying diagnosis and resulting in spread among family, friends, and classmates. 

Confirmation of Pertussis is through culture of a nasal swab.  Antibiotics are prescribed for confirmed cases and prophylactic antibiotics for those family and friends with close contact to the confirmed case.  Children with confirmed cases should not attend school or extracurricular activities until 5 days after beginning antibiotic therapy. 

Adults, including new mothers and healthcare personnel, are encouraged to get the recommended booster to help reduce the risk of illness for themselves and their families.  According to the Center for Disease Control (CDC), in 2008, 40% of individuals aged 13-17 had coverage fro Pertussis through the Tdap vaccine and only 6% of adults had coverage.

If your child should experience the symptoms as described, it would be advisable to contact your child's doctor for further evaluation/care.  Please feel free to contact me with any questions/concerns you have.

Sincerely,
Therese Hoehn, R.N. B.S.N., P.C.N.

St. Joseph School follows diocesan guidelines and Ohio School Law regarding medication administration.  Medication will be given to students by school personnel only when written permission is obtained from the physician and the parent.  A medication administration form (Form A) can be obtained from the school clinic or the St. Joseph School web site.  Medication should be brought to the school clinic by the parent/guardian.  Students may not carry medication during the school day.  All medication must be given to the school nurse.  If, however, it is medically necessary for a student to store a medication in the classroom, then a special two page form (Form B) must be completed by the parent and physician.  This may be indicated for older, responsible students using inhalers or for students carrying Epi-Pens.  It is advised that if the student is to carry his own inhaler, a duplicate inhaler be made available to the clinic   in case the student can not find his/her own inhaler or if he presents in the clinic in distress.

For students having an order to carry their own Epi-Pen or keep their Epi-Pen in the classroom, a duplicate Epi-Pen must be kept in the clinic at all times.  In addition to having an Epi-Pen order, a two page Allergy Action Plan (Form C) is to be completed by Parent/Physician.   

Medication must come to school in a pharmacy-labeled container including doctor’s name, student’s name, drug, time to be given and amount.  If the medication needs to be given at school, the pharmacy needs to divide the amount into separately labeled bottles for school and home.  Medications are forgotten when they are brought back and forth daily, meaning an important dosage is missed at home.

Medication guidelines noted above apply to prescription as well as over-the-counter medications.  If you feel your child may need Tylenol or other over-the-counter medications during the school year, you should have a medication form completed by your family physician and supply a container of medication to the clinic.

With the increasing number of school aged children having food allergies, I would like to share some information about food allergies as well as ways we can assist these children during the school day.

Food Allergy Facts

  1. Approximately 11 million Americans suffer from food allergy. 
  2. Approximately 2 million school-aged children have food allergies.
  3. All of these individuals are at risk for anaphylaxis, a potentially life-threatening allergic reaction.
  4. Eight foods account for 90% of all reactions in the U.S.:  milk, egg, peanuts, tree nuts (walnuts, almonds, cashews, pistachios, pecans, etc), wheat, soy, fish, and shellfish.
  5. Trace amounts of a food allergen can cause a reaction.  This may be from traces left on someone’s hands, cross contamination when preparing food, or from traces left on a table.  Some individuals are so sensitive that they can react to traces being in the air.


Frequently Asked Questions

Whatare the common symptoms of a reaction?
An allergic reaction to food can involve the skin, respiratory tract, gastrointestinal tract, and cardiovascular system. 
Symptoms can vary from one person to another, but these are some common symptoms of an allergic reaction:

Skin symptoms

Respiratory symptoms

Gastrointestinal symptoms

Cardiovascular symptoms

hives 

itchy, watery eyes

diarrhea

reduced blood pressure

swelling 

runny nose

cramps

lightheadedness

itchy, red rash  

stuffy nose

nausea

increased heart rate

eczema flare-up 

sneezing

vomiting

shock

 

coughing

 

 

 

itching or swelling of lips, tongue

 

 

 

difficulty swallowing

 

 

 

tightness of chest

 

 

 

wheezing

 

 

 

shortness of breath

 

 

Can an allergic reaction be serious?
Some reactions are mild, and only result in hives or gastrointestinal problems.  Other reactions are very serious, and can be life threatening.  Symptoms can appear immediately or appear over a number of hours after an exposure.  Some reactions can cause anaphylaxis.

What is anaphylaxis?
Anaphylaxis is a sudden, severe allergic reaction which involves several body systems.

Can someone die from anaphylaxis?
Yes, anaphylaxis can be fatal.  That is why it is so important to act quickly to identify and treat an allergic reaction.

What foods should be avoided?
Individuals with food allergies need to avoid all food containing the foods they are allergic to.  This may seem simple but it is quite confusing and time consuming.  Careful reading of all food labels becomes vital for these individuals. 

Home-baked and non-packaged items are particularly difficult because they could have “hidden” ingredients or traces of an allergen due to “trace elements”. 
For those individuals with food allergies to peanuts or tree nuts, they need to avoid foods such as anything containing nuts, including most baked goods and chocolate.  They also need to avoid certain foods which have a higher incidence of containing nuts. This would include foods such as soups, sauces, certain international foods, and sunflower seeds.  As you can see, some of the foods may not be thought of as an “unsafe food”.

What can school parents do to help?

  1. Never take food allergies lightly!
  2. Be aware of children in your child’s classroom who have a food allergy.  Your child’s classroom teacher, with permission from the allergic child’s parent, will notify parents if there is a child in a classroom with a food allergy. 
  3. Ask your child’s teacher for guidelines on safe birthday treats as well as safe foods when planning parties or any offered food items during the school day.  This includes special celebrations that include food.
  4. Teach your children about food allergies and the seriousness of potential allergic reactions.  Teach them to not share food with their food-allergic friends.

What can school children do to help?

  1. Never take food allergies lightly!
  2. Don’t share food items with food-allergic friends.
  3. Wash hands after eating an item which is a known allergen to their classmate.
  4. Ask what their friends are allergic to and help them avoid it.
  5. If an allergic schoolmate becomes ill, get help immediately!

For further information about food allergies, please feel free to contact me at  419 882-6670.  You may also want to do further research by visiting The Food Allergy and Anaphylaxis Network at www.foodallergy.org.

Therese Hoehn, R.N., B.S.N., P.C.N.
School Nurse

During the early spring months I have occasional reports of a student reporting symptoms of or being diagnosed with Fifth’s Disease.  This is usually followed by questions surrounding this disease.

Fifth’s Disease is a viral infection caused by Parvovirus 19 and is characterized by mild viral symptoms.  Symptoms are brief and mild consisting of fever, malaise, headache, slight runny nose and sore throat followed by a distinctive rash.  This can be such a mild disease that it is possible to have no symptoms at all and then develop the distinct rash.  The rash usually appears approximately 7 days after the other viral symptoms and by the time the rash appears the child is typically feeling better.  The rash is a very red rash on the face giving a “slapped cheek” appearance.  A symmetrical lacelike rash can also appear on the trunk.  The rash tends to fluctuate in intensity and can recur with changes in the environment such as changes in temperature or sunlight for up to several weeks.  I typically see a reoccurrence of the rash after children have been running around during recess when they become overheated.

Treatment involves supportive care.  Typically no other treatment is necessary.  This distinctive rash is harmless and causes no symptoms that need treatment.  Because the disease is contagious during the week prior to the presence of a rash, a child who has the rash is no longer contagious and does not need to stay home from school.  Parents should notify their child’s physician if the rash becomes itchy, their child develops a fever over 101 degrees, they feel their child is feeling worse, or they have concerns or problems.