School Nurse & Health Services
Katy Burnup, RN
San Angelo Elementary Campus Nurse
Phone: 325-653-3200, ext 7190
Sabrina Meares, LVN
San Angelo Middle & High School Nurse
Phone: 325-653-3200, ext 7212
GENERAL SCHOOL HEALTH GUIDELINES AND INFORMATION
ILLNESS AT SCHOOL | Children should only be in school when they can fully participate in their educational program. Therefore, children with the following should stay at home and or will be referred home by the nurse or other school personnel:
- Fever (100 degrees Fahrenheit or higher) - or any condition that presents with a fever must be kept home until they are fever free for 24 hours without the use of fever suppressing medications.
- Vomiting - must be vomit free for 24 hours.
- Diarrhea - must keep kept home until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
- Conjunctivitis - (bacterial and/or viral) must be kept home until physician permission has been given to return to school or until symptom-free.
Under state and local Health Department regulations, if your child has certain medical conditions, he/she must be excluded from school for a period of time. The school nurse or principal can provide parents with a complete list of conditions and periods of exclusion. All communicable diseases must be reported to the school office, who will, if the disease is reportable, report it to the Health Department. Some of these diseases include but are not limited to: Amebiasis, Meningitis (specific types), Hepatitis, Polio, Pertussis, MRSA, Chickenpox, Novel Influenza, and Tuberculosis.
CHRONIC ILLNESS/HEALTH CONDITIONS | Because your child may have a medical condition (including severe or life-threatening food allergies) that requires extra attention/care from the school personnel, it is important the parent/guardian visit with the school nurse. The school nurse will then inform others of care as needed. It is imperative that addresses and telephone numbers are kept up-to-date with the school as an emergency can arise at any time during school hours.
COMMUNICABLE DISEASES | The school requests that parents of students with a communicable or contagious disease telephone the school nurse or principal so that other students who have been exposed to the disease can be alerted. A student with a communicable disease is not allowed to come to school while the disease is contagious. These diseases include but are not limited to the following: chicken pox, measles, mumps, and hepatitis. Most communicable diseases require a doctor’s release for the student to return to the classroom. Students with a temperature of 100·F or above must not be sent to school.
HEAD LICE | Children shall be screened by the school nurse or other school official with consideration for privacy and confidentiality. Screenings may be scheduled or conducted at random throughout the year. When a student is suspected of having head lice, the school nurse or other school official shall inspect the child. When live lice and/or viable nits are found, the school nurse or other school official shall check the student’s siblings and all known household contacts on campus. Parent/guardian of students with active infestations will be contacted immediately.
Children identified with live lice shall be sent home immediately or excluded from the classroom until an initial treatment is completed. The school nurse or other school official shall provide instruction to the parent and/or guardian regarding identification of active infestation, treatment procedures, and readmission guidelines.
Re-admission: Children who are sent home for head lice infestation must be free of live lice before the student may return to school. When a student has missed five consecutive days of school related to lice infestation, a warning letter shall be sent to the parent to notify them that the student is immediately required to be at school. With excessive absences, both the student and parent can be subject to truancy laws.
When the student returns to school (presumably on the next day), the student shall be re-examined. If the student is free of lice, the student may return to class. If lice are found, the office and teacher shall be notified. The parent shall be notified and the student shall be sent home again for treatment, if it cannot be determined that treatment was done or with instructions for alternate treatments. When the student returns to school for the second time, the student shall be re-examined. If the student is free of lice, the student may return to class. If lice are found, the office and teacher shall be notified and a referral shall be made to the nurse. The parent shall be notified, and the student shall be sent home with instructions from the nurse.
Management of Diabetes in School-Aged Children
Medication Administration at School
MEDICATION ADMINISTRATION AT SCHOOL | Often, students have to take a prescription and/or over the counter medications at school for a certain period of time as treatment for a medical condition. Prescribed medication must come to school in the original pharmacy bottle, labeled correctly, with the instructions for dosage on it. This also includes inhalers. If medication is only given 1-3 times per day or time released, it can usually be given at home unless specific times are ordered by the doctor. Parents must sign a medication consent form before medication can be given at school. The parent’s written request must not conflict with the label instructions.
Any increase or decrease in dosage must be stated in writing by a physician until a new prescription bottle is provided. Otherwise, school personnel must administer medication as it is stated on the container label, or parents may choose to come to the school and dispense the medication to their student.
Over the counter medication must be purchased in the United States and it must be in its original container stating directions and dosage. If school personnel reading the label directions find that the medicine is contraindicated for that student, a parent must come to school and administer the medication (ex: if a student is younger that the recommended age on the label directions, school personnel cannot administer the medicine without a physician’s order).
If over the counter medication is given for three (3) consecutive days, a physician’s order is required.
Herbal or dietary supplements (including Hemp or CBD oil) will not be administered unless the medication will benefit the student’s educational achievement as stated in the student’s individualized education program (IEP) or Section 504 Plan and is prescribed by a physician.
All medication must be turned in to the office upon arrival on the campus. We do not permit students to carry their own medications and self-administer without prior approval from the physician and the school nurse. A student with asthma or severe allergic reaction (anaphylaxis) may be permitted to possess and use prescribed asthma or anaphylaxis medication at school and school-related events only if he or she has written authorization from his or her parent and a physician or other licensed health-care provider. Self-administration must be done in compliance with the prescription or written instructions from the student's physician or other licensed health care provider.
The student must also demonstrate to his or her physician or health-care provider and to the school nurse the ability to use the prescribed medication, including any device required to administer the medication. The physician’s statement must be kept on file in the office of the campus the student attends. A person standing in parental relation to a student or the student himself, if over the age of 18, may give permission to use an asthma inhaler under these guidelines.
Only designated employees may administer prescription medication, non-prescription medication, and herbal or dietary supplements to students. Exceptions apply to the self-administration of asthma medication (with the physician and parents consent), medication for anaphylaxis (e.g., EpiPen®), and medication for diabetes management, if the medication is self-administered in accordance with policy and procedures. A student who must take medication during the school day must bring a written request from his or her parent and the medicine, in its original, properly labeled container. Contact the school nurse for information on procedures that must be followed when administering medication to students.
BACTERIAL MENINGITIS | Information can be found at the Texas Department of State Health Services website, found HERE
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 the most common and the least serious. Bacterial meningitis is the most common form of serious bacterial infection with the potential for serious, long term complications.
It is an uncommon disease, but it requires urgent treatment with antibiotics to prevent permanent damage or death. Someone with 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 or joint pain, 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. If it is diagnosed early and treated promptly, the majority of people make a complete recovery. In some cases it can be fatal or a person may be left with a permanent disability.
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 casual contact or 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 kissing, sharing drinking containers, utensils or cigarettes). The germ does not cause meningitis in most people. Instead, most people become carriers of the germ for days, weeks, or even months. The bacteria rarely overcome the body’s immune system and cause meningitis or another serious illness. Do not share food, utensils, toothbrushes, or cigarettes. Limit the number of persons you kiss. While there are vaccines for some other strains of bacterial meningitis, they are used only in special circumstances. These include when there is a disease outbreak in a community or for people traveling to a country where there is a risk of getting the disease. Also, a vaccine is recommended by some groups for college students, particularly freshmen living in dorms or residence halls. The vaccine is safe and effective (85%-90%). It can cause mild side effects, such as redness and pain at the injection site lasting up to two days. Immunity develops within 7 to 10 days after the vaccine is given and lasts for up to 5 years. Seek prompt medical attention if you think you may have Meningitis. Your school nurse, family doctor, and the staff at your local or regional health department office are excellent sources for information on all communicable diseases. You may also call your local health department or Regional Texas Department of Health office to ask about meningococcal vaccine.
STAPH INFECTIONS | Most people have heard of terms like “staph infection,” “antibiotic-resistant bacteria,” and “MRSA” (pronounced mersa). Staphylococcal bacteria often referred to as “staph” are commonly occurring bacteria found on the skin, under fingernails, and in the noses of all people. Most staphylococcal species never cause infection. However, when infection does occur due to staph, Staphylococcus aureus—one of these species of staph—is usually the cause. While all people have some staphylococcus species on their skin and in their noses, only three or four people have S. aureus. Even if they have S. aureus on their skin or in their noses, most people are not ill. Since staph is spread primarily by direct (skin-to-skin) human contact or with direct contact to wound drainage of someone who is carrying or infected with the bacteria, anyone with a break in his or her skin is at risk.
“MRSA” stands for methicillin-resistant S. aureus. Initially, MRSA strains were resistant to the antibiotic methicillin, a form of penicillin. Now they are resistant to many antibiotics and are sometimes called “multi-resistant” S. aureus. MRSA is not the only antibiotic-resistant bacteria. Initially, infection with MRSA was associated with exposure to health care environments, such as hospitals. However, other MRSA strains have evolved that affect previously healthy persons who have not had contact with health care facilities. MRSA causes the same types of infections as S. aureus that is not resistant to methicillin; however, MRSA may be more difficult to treat and can be rapidly fatal.
Staph infections begin abruptly. Symptoms may include a large area of redness on the skin, swelling, and pain followed by a pustule or abscess, boils and carbuncles (red, lumpy sores filled with pus). If left untreated, staph can infect blood and bones, causing severe illness that requires hospitalization.
We cannot eliminate staph because it is everywhere. However, because staph is everywhere and has the potential to cause infection, everyone—not just health care workers—must be involved in prevention. Students and their family members should take the following precautions to help prevent skin infections:
- Encourage frequent hand washing with soap and warm water.
- Encourage students to keep their fingernails clean and clipped short.
- Avoid contact with other people’s wounds or anything contaminated by a wound.
- Avoid sharing personal items such as razors, towels, deodorant, or soap that directly touch the body.
- Clean and disinfect objects (such as gym and sports equipment) before use.
- Wash dirty clothes, linens, and towels with hot water and laundry detergent. Using a hot dryer, rather than air-drying, also helps kill bacteria.
- Encourage students who participate in contact sports to shower immediately after each practice, game, or match.
- Keep open or draining sores and lesions clean and covered. Anyone assisting with wound care should wear gloves and wash their hands with soap and water after dressing changes.
We encourage you to be vigilant in looking for signs and symptoms of staph infections. If you or any family member(s) exhibit symptoms as described above, you are encouraged to contact your family doctor or health care provider.
All information contained in this section as well as more detailed information is available at the Texas Department of State Health Services website at www.mrsaTexas.org
State Mandated Screenings
STATE MANDATED SCREENINGS | Texas Leadership addresses state-mandated screening procedures by conducting screenings for vision, hearing, spinal (scoliosis and kyphosis) and Acanthosis Nigricans (AN).
Vision and hearing screening:
- Any student referred by a teacher, principal, parent, and physician.
- Students referred by Special Education.
- All students in Kindergarten, 1st, 3rd, 5th, and 7th grades.
- All students new to the state of Texas.
Girls are screened two (2) times: Age 10 (or fall semester of grade 5) and Age 12 (or fall semester of grade 7). Boys are screened one (1) time: Age 13 or 14 (or fall semester of grade 8). TLCA provides spinal screening to all students in the 6th and 9th grades.
Student Illness Or Injury At School
STUDENT ILLNESS OR INJURY AT SCHOOL | We will attempt to promptly notify the parent or guardian (or a person you have authorized us to notify) if we have knowledge that your child has been injured or becomes ill at school. We will call the parents/guardians in medical emergency situations and will also call for emergency assistance. We cannot and will not use public funds to pay individual student medical expenses.
Texas Leadership holds a supplementary STUDENT ACCIDENT INSURANCE POLICY which covers student accidents on school grounds or at school sponsored functions. This policy is secondary or supplementary to the student's primary insurance policy.
What is Acanthosis Nigricans?
Acanthosis Nigricans (AN) serves as an indicator of Risk for Type 2 diabetes and other chronic health problems. All students in the 1st, 3rd, 5th, and 7th grades are screened for acanthosis nigricans. Parents may exclude their child from the screenings by providing the school in advance with written notification or the results of a screening done by a medical doctor. If the exclusion is due to religious reasons, the religious affiliation of which the student attends is required to submit a notarized letter stating this screening is against their belief.
Information About IMMUNIZATION
In accordance with the Texas Department of Health immunization schedule, recommendations and adopted by the Texas Board of Health and published in the Texas Register annually, a child or student shall show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child care facility or public or private elementary or secondary school, or institution of higher education. Exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. Children and students in these categories must submit evidence for exclusion from compliance as specified in the Health and Safety Code, 161.004(d), Health and Safety Code 161.0041, Education Code, Chapter 38, Education Code, Chapter 51, and the Human Resources Code, Chapter 42.
To claim an exclusion for medical reasons, the child or student must present a statement signed by the child’s physician, duly registered and licensed to practice medicine and state that in the physician’s opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well being of the child or any member of the child’s household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.
To claim an exclusion for reasons of conscience, including a religious belief, a signed affidavit must be presented by the child’s parent or guardian, stating that the child’s parent or guardian declines vaccinations for the reasons of conscience, including a person’s religious beliefs. This type of affidavit is only valid for two years. Affidavit MUST BE obtained by submitting a written request to the Texas Department of State Health Services, 1100 West 49th Street Austin, Texas 78756 (Rule 97.62 Title 25 of the Texas Administrative Code).
For a student to be afforded Provisional Enrollment for the first thirty (30) days the following criteria must be met:
- The student has an immunization record that indicates the student has received at least one (1) dose of each specified age appropriate vaccine.
- The student is homeless or is in foster care
- The student is a dependent of a person who is on active duty with the Armed Forces of the United States and is transferring schools.
Should a student be admitted under Provisional Enrollment and office personnel or the school nurse find that a student has become delinquent, at the end of the thirty (30) day period, the parent will be contacted and given ten (10) days to provide the school with an updated record. If a parent fails to meet this deadline, the student will be excluded from school until an updated record is provided.
The ten (10) days given past the thirty (30) day Provisional Enrollment is a courtesy as Rule 97.66, Title 25 of the Texas Administrative Code, requires a student to be excluded from attendance should they become delinquent at the end of the thirty (30) day period, until an updated shot record is provided to the school.
Since many types of personal immunization records are in use, any document will be acceptable, provided a physician or public health personnel has validated it. The month, day, and year that the vaccination was received must be recorded on all school immunization records.
Asthmatic Students Who Are Exposed To COVID-19
People with moderate to severe asthma may be at higher risk of getting very sick from COVID-19. COVID-19 can affect your respiratory tract (nose, throat, lungs), cause an asthma attack, and possibly lead to pneumonia and acute respiratory disease.
The CDC recommends the following for asthmatic students:
Please refer to the below link for guidance on the District
2020-2021 "Back to School Plan"
Texas Leadership's School Health Advisory Council (S.H.A.C.)
Texas Leadership's School Health Advisory Council (S.H.A.C.) is a group of individuals consisting of parents, teachers, school staff, and community leaders who are appointed at a District level to provide advice on coordinated school health programming and its impact on student health and learning. This group will meet at least four times a year and reports directly to the Texas Leadership School Board.
The S.H.A.C. has a variety of roles addressing components of a comprehensive school health program.
These include but are not limited to: Health Instruction, Health Services, Healthy School Environment,
Physical Education, Schooling Counseling, Food Service Program, Physical Activity Opportunities and
Physical Education, and Integrated School & Community Programs.
If you are interested and willing to participate in the S.H.A.C.
please contact your school nurse.
Health Services Guidelines