Macey Dossey BSN-RN
Roles and Responsibilities of School Nurses
School nursing is a specialized practice of public health nursing that promotes and protects individual student health, facilitates development, and advances academic success.
Mesquite ISD employs registered nurses to serve as school nurses and substitute school nurses in the clinic. School nurses work with students and their families, school personnel, the community, and health care providers to advocate for student health and a healthy school environment.
A full time RN is assigned to each Mesquite ISD elementary and secondary campus. A full time school nurse is assigned three days a week (Monday, Wednesday, Friday) to Mesquite Academy and two days a week (Tuesday, Thursday) to The Learning Center.
Nurses monitor student records for required immunizations, perform mandated health screenings, track communicable diseases, plan for health related emergencies, deliver direct care for students, teach disease prevention and health promotion, and engage students in self-management skills for a healthy life.
The practice of school nursing concerning the prevention and control of communicable disease is regulated by the State of Texas under Texas Administrative Code (TAC) Chapter 97.
Symptoms requiring exclusion from school
The major criterion for exclusion from school is the probability of spread of infection from person to person. A child may have a non-excludable illness that makes it difficult for the child to learn and/or requires the child be cared for at home or in a hospital. The school nurse is qualified to assess a student's symptoms and to determine when parent or guardian needs to be notified regarding the student's symptoms based inability to adequately engage in learning.
The first step in the control of communicable diseases is assessment of presenting signs and symptoms. A student exhibiting any of the following symptoms will be excluded from school:
- Temperature of 100.0° F or higher. According to the TAC, students must be excluded from school for a minimum of 24 hours until symptom-free and/or fever-free without the use of fever suppressing medications.
- Two or more episodes of diarrhea within 24 hours or any diarrheal illness. The student may be excluded from school until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
- Blood in stools not explained by dietary change, medication, or hard stools.
- Nausea and/or vomiting accompanied by a fever above 100.0 degrees Fahrenheit, or abdominal pain/tenderness upon palpation that lasts longer than 2 hours.
- Two or more episodes of vomiting within 24 hours.
- The definition of vomit being "ejection of matter from the stomach and out through the mouth"
- Red eye with purulent discharge or crusting.
- Scaly patches on scalp (possible ringworm).
- Open, purulent draining lesions.
- Signs of jaundice.
- Undetermined rash on torso or face with behavior change or fever, open wound and drainage, bruising without cause, joint pain, inability to participate, or increasing tenderness and redness at the site.
The 24 hour rule refers to and includes full school days, i.e. students excluded at 8:40 a.m. one day may not return to class the following day at 8:40 a.m.
Established by the Texas Department of State Health Services (DSHS) and located in the Texas Administrative Code, is mirrored in MISD Regulation FFAD and used to identify notifiable conditions and to determine readmission requirements for communicable diseases. The campus administrator shall exclude from attendance any child having or suspected of having a communicable disease designated by the Commissioner of Health as cause for exclusion until one of the criteria listed is fulfilled:
- Amebiasis - Exclude until treatment is initiated.
- Campylobacteriosis - Exclude until after diarrhea free without the use of antimotility medications and fever free without the use of fever suppressing medications.
- Chickenpox (Varicella) - Exclude until lesions are dry or if lesions are not vesicular, until 24 hours have passed with no new lesions occurring.
- Common Cold - Exclude until fever free for 24 hours without the use of fever suppressing medications.
- Conjunctivitis, viral or bacterial - Exclude until written permission and/or permit is issued by a physician or local health authority, or until symptom free.
- Diphtheria - Doctor’s release
- Fever - Exclude until fever free for 24 hours without the use of fever suppressing medications.
- Fifth’s Disease - Exclude until fever free for 24 hours without the use of fever suppressing medications.
- Gastroenteritis - Exclude until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
- Giardiasis - Exclude until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
- Hepatitis A - Exclude until one week after onset of illness
- Infections - Includes wounds, skin, and soft tissue. Exclude until drainage from wounds or skin and soft tissue infections is contained and maintained in a clean dry bandage; restrict from situations that could result in the infected area becoming exposed, wet, soiled, or otherwise compromised.
- Infectious mononucleosis - Exclude until physician decides or fever free for 24 hours without the use of fever suppressing medication.
- Influenza - Exclude until fever free for 24 hours without the use of fever suppressing medications.
- Measles (Rubeola) - Exclude until four days after rash onset or in the case of an outbreak, unimmunized children should also be excluded until at least two weeks (14 days) after the onset of the last rash.
- Measles (Rubella) - Exclude until seven days after rash onset or in the case of an outbreak, unimmunized children should be excluded for at least three weeks (21 days) after the onset of the last rash.
- Meningitis, bacterial - Exclude until 24 hours after start of effective treatment and approval by healthcare provider.
- Meningitis, viral - Exclude until fever free for 24 hours without the use of fever suppressing medications.
- Mumps - Exclude until five days after the onset of swelling.
- Pertussis (Whooping cough) - Exclude until completion of five days of antibiotic therapy.
- Ringworm - If the site can be completely covered by clothing or a bandage, the child is not excluded from school. Otherwise, exclude until treatment begins.
- Salmonella - Exclude until after diarrhea free for 24 hours without the use of diarrhea suppressing medications and fever free for 24 hours without the use of fever suppressing medications.
- Scabies - Exclude until treatment has begun.
- Shigellosis - Exclude until after diarrhea free for 24 hours without the use of diarrhea suppressing medications and fever free for 24 hours without the use of fever suppressing medications.
- Streptococcal sore throat/Scarlet fever - Exclude until 24 hours from the time antibiotic treatment has begun and fever free for 24 hours without the use of fever suppressing medication.
- Tuberculosis (Pulmonary) - Exclude until antibiotic treatment has begun and a physician’s certificate or health permit obtained.
The best method to prevent a severe case of flu is vaccination. Because the flu vaccine is not 100% effective, campuses take other actions to help reduce the impact of flu on learning and attendance.
Preventative measures taken on campuses include encouraging students and staff to cover coughs and sneezes, to wash hands with soap and water, to use hand sanitizer when soap and water are not available, and to avoid touching their eyes, nose and mouth. Campuses will also wipe down frequently touched hard surfaces using approved disinfectants.
As flu season nears and campuses experience increased flu numbers, other measures are implemented to separate sick people from well ones. To this end, campuses may restrict lunch time visitors. Students sent home with flu-like symptoms may not return to school until they are fever-free for 24 hours without the use of fever reducing medication . This includes the next full consecutive day of school. Examples of fever reducing medication include those containing acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Students who return with fever or who do not meet return to school criteria are sent home.
Parents can help by keeping students with flu or flu-like illness home from school until they are free of fever for 24 hours without the use of fever reducing medication. This 24 hour period of time includes the next consecutive school day. Parents are encouraged to keep in close contact with their child's campus attendance clerk whenever students are kept at home.
At the beginning of each school year, a few flu cases are reported randomly across the district. Flu is mainly spread by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or be inhaled into the lungs. Less often, a person may get the flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.
Symptoms of flu usually come on suddenly and include fever with a cough, sore throat, chills, head ache, muscle or body aches, and fatigue. Symptoms may also include vomiting or diarrhea; these are more common in children.
A fever is considered to be a temperature greater than 100 degrees Fahrenheit. According to the Centers for Disease Control and Prevention, it is important to note that not everyone with flu will have a fever.
When someone in your home is sick with flu or fever, it is important to prevent dehydration. Encourage them to drink non-caffeinated clear liquids, or to eat ice chips or frozen ice pops.
There are emergency warning signs related to flu that indicate the need for urgent medical care. In children, these include:
- Fast breathing or trouble breathing
- Bluish skin color
- Not drinking enough fluids
- Not waking up or not interacting
- Irritability-not wanting to be held
- Flu-like symptoms improve then return with fever and worsening cough
- Fever with a rash
In addition to those warning signs, get medical help right away for infants who are unable to eat, who have no tears when crying, and who have a lot fewer wet diapers than normal.
In adults emergency warning signs indicating the need for urgent medical attention include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Severe or persistent vomiting
- Flu-like symptoms improve then return with fever and worsening cough
West Nile, Zika, Dengue and Chikungunya are viruses spread by the bite of an infected mosquito.
Use the 4Ds to help reduce the chance of being bitten by a mosquito.
DEET All Day, Every Day: Whenever you’re outside, use insect repellents that contain DEET or other EPA approved repellents and follow instructions.
DRESS: Wear long, loose, and light-colored clothing outside.
DRAIN: Remove all standing water in and around your home.
DUSK & DAWN: Limit outdoor activities during dusk and dawn hours when mosquitoes are most active.
To best protect your child from insect bites, please apply insect repellent products before your child leaves for school, especially if your child walks or waits for a bus.
- Parent Notification of SB66 Regarding Epipens
- Guarding Against Influenza
- Meningitis Information for Students and Parents
In accordance with Chapter 38 Sub-chapter E of the Texas Education Code, Mesquite ISD has a policy in place allowing authorized, trained personnel to administer an epinephrine auto-injector to a person on campus who is reasonably believed to be experiencing a life threatening anaphylactic reaction.
All campuses have an emergency supply of epinephrine that may be administered in the event of an unexpected, undiagnosed life threatening (anaphylactic) allergic reaction.
All high school athletic trainers have an emergency supply of epinephrine that they may administer in the event of an unexpected, undiagnosed anaphylactic event occurring during an athletic event attended by the athletic trainer.
This program is not intended to replace student specific orders or medication. Parents of students with known life-threatening anaphylaxis are expected to provide the school with all necessary emergency medications and physician orders or emergency action plans at the beginning of each school year.
It's never too early or too late in the school year to think about flu prevention. Everyone can help reduce the impact of the cold and flu season in our community by following these simple tips:
- Get a flu shot! It is never too late to get a flu shot, but it is best to get one as soon as possible after the vaccine comes out each year.
- Wash hands often with soap and water for 20 seconds or more. If soap and water are not available, use alcohol-based hand rub/gel.
- Cough and/or sneeze into a tissue or your upper sleeve, not into your hand.
- Avoid touching your eyes, nose or mouth.
- Stay home for any fever of 100°F or more and once fever goes away (without use of fever reducing medication), stay home for 24 hours.
Visit the Department of State Health Services Flu site at the Texas Flu Information Page. Flu information for parents is also available through the Department of State Health Services. Families looking for flu vaccine providers may check the Texas Flu Vaccine locator at Texas Flu Vaccine Clinic Finder.
In compliance with Education Code 38.0025, the following information relating to bacterial meningitis must be be provided to students and parents:
WHAT IS MENINGITIS?
Meningitis is an inflammation of the covering of the brain and spinal cord. It can be caused by viruses, parasites, fungi, and bacteria. Viral meningitis is most common and the least serious. Meningitis caused by bacteria is the most likely form of the disease to cause serious, long-term complications. It is an uncommon disease but requires urgent treatment with antibiotics to prevent permanent damage or death.
Bacterial meningitis can be caused by multiple organisms.Two common types are Streptococcus pneumoniae, with over 80 serogroups that can cause illness, and Neisseria meningitidis, with 5 serogroups that most commonly cause meningitis.
WHAT ARE THE SYMPTOMS?
Someone with bacterial meningitis will become very ill. The illness may develop over one or two days, but it can also rapidly progress in a matter of hours. Not everyone with meningitis will have the same symptoms.
Children (over 1 year old) and adults with meningitis may have a severe headache, high temperature, vomiting, sensitivity to bright lights, neck stiffness, and drowsiness or confusion. In both children and adults, there may be a rash of tiny, red-purple spots. These can occur anywhere on the body.
The diagnosis of bacterial meningitis is based on a combination of symptoms and laboratory results.
HOW SERIOUS IS BACTERIAL MENINGITIS?
If it is diagnosed early and treated promptly, most people make a complete recovery. If left untreated or treatment is delayed, bacterial meningitis can be fatal, or a person may be left with permanent disability.
HOW IS BACTERIAL MENINGITIS SPREAD?
Fortunately, none of the bacteria that cause meningitis are as contagious as diseases like the common cold or the flu, and they are not spread by simply breathing the air where a person with meningitis has been. The germs live naturally in the back of our noses and throats, but they do not live for long outside the body. They are spread when people exchange saliva (such as by kissing; sharing drinking containers, utensils, or cigarettes) or when people cough or sneeze without covering their mouth and nose.
The bacteria do not cause meningitis in most people. Instead, most people become carriers of the bacteria for days, weeks or even months. The bacteria rarely overcome the body's immune system and cause meningitis or another serious illness.
HOW CAN BACTERIAL MENINGITIS BE PREVENTED?
Bacterial meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis may be prevented through vaccination. The vaccine which protects against Streptococcus pneumoniae is called pneumococcal conjugate vaccine or PCV. This vaccine is recommended by the Advisory Council on Immunization Practices (ACIP) for children in the first year of life. Neisseria meningitidis is prevented through two types of vaccines. The first is a meningococcal conjugate vaccine which protects against 4 serogroups A, C, W, and Y and is referred to as MCV4. The second is a vaccine against Neisseria meningitidis serogroup B and is referred to as MenB.
The ACIP recommends MCV4 for children at age 11-12 years, with a booster dose at 16-18 years. In Texas, one dose of MCV4 given at or after age 11 years is required for children in 7th-12th grades. One dose of MCV4 received in the previous five years is required in Texas for those under the age of 22 years and enrolling in college. Teens and young adults (16-23 years of age) may be vaccinated with MenB. This vaccine is not required for school or college enrollment in Texas.
Vaccines to protect against bacterial meningitis are safe and effective. Common side effects include redness and pain at the injection site lasting up to two days. Immunity develops about 1-2 weeks after the vaccines are given and lasts for 5 years to life depending on vaccine.
Do not share food, drinks, utensils, toothbrushes, or cigarettes. Wash your hands. Limit the number of persons you kiss. Cover your mouth and nose when you sneeze or cough. Maintaining healthy habits, like getting plenty of rest and not having close contact with people who are sick, also helps.
WHO IS AT RISK FOR BACTERIAL MENINGITIS?
Certain groups are at increased risk for bacterial meningitis caused by Neisseria meningitidis. These risk factors include HIV infection, travel to places where meningococcal disease is common (such as certain countries in Africa and in Saudi Arabia), and college students living in a dormitory. Other risk factors include having a previous viral infection, living in a crowded household, or having an underlying chronic illness.
Children ages 11-15 years have the second highest rate of death from bacterial meningitis caused by Neisseria meningitidis. And children ages 16-23 years also have the second highest rates of disease caused by Neisseria meningiditis.
WHAT YOU SHOULD DO IF YOU THINK YOU OR A FRIEND MIGHT HAVE BACTERIAL MENINGITIS?
Seek prompt medical attention.
FOR MORE INFORMATION
Your school nurse, family doctor, and the staff at your local or regional health department office are excellent sources for information on all infectious diseases. Additional information may also be found at the web sites for the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS)