From the desk of Nurse Donna ....: Enterovirus (EV-D68) Tips from Dr. Will's

Thursday, September 18, 2014

Enterovirus (EV-D68) Tips from Dr. Will's

The T Zone: Your First Line of Defense to Prevent Contraction of Enterovirus! The outbreak of Enterorvirus D68 (EV-D68) that's suspected of sickening children in a dozen states most likely will get worse before it gets better. "Respiratory infections like this can spread quite quickly across the U.S.," according to CDC's Anne Schuchat, M.D. Join Henry the Hand Foundation's campaign for "T Zone Teaching Moment" and help others in your community (family, friends and work place) understand the importance of not touching your T Zone. It is your second line of defense preventing infectious diseases including Enterovirus as proper hand washing is still the #1 prevenative! The T Zone is a common area that people touch throughout the day "unconsciously" and we are trying to help put an end to this unhealthy habit! Risky behavior puts you at risk for unintended consequence! What many do not realize is that you are inoculating YOURSELF with whatever germs are on your hands. This is the time for YOU to discover the "T Zone Teaching Moment" and help others to break this unhealthy habit. Remember it is Back to School time when many infections are brought into the classroom to be shared with others! The 4 Principles of Hand Awareness 1. Wash your hands when they are dirty and BEFORE eating 2. DO NOT cough into your hands 3. DO NOT sneeze into your hands 4. Above all, DO NOT put your fingers into your eyes, nose or mouth Special thanks goes out to Dr. Will's healthful tips! Nurse Donna

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The 3 Best Ways to Avoid the Flu

There are three primary actions you can take to protect yourself and others from the flu:

Vaccination
This is your best defense against the flu. There are two types of vaccines: the "flu shot," an inactivated vaccine (containing killed virus) that is administered by needle, and the nasal-spray flu vaccine, made with live, weakened flu viruses that do not cause the flu.
Good Health Hygiene
Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick. This includes staying home from work, school, and errands. When coughing or sneezing, cover your mouth and nose with a tissue. Washing your hands often will help protect you from spreading germs on your hands to your eyes, nose, and mouth. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
Antiviral Drugs
Four antiviral drugs (amantadine, rimantadine, zanamavir, and oseltamivir) are approved for use in preventing the flu. Because the flu virus changes each year, your doctor will know which medication is recommended for fighting this year's bug. Antivirals are effective only if taken within two days after becoming sick. When used in this manner, these medications can reduce influenza symptoms and may shorten your illness by one or two days. They may also make you less contagious.

Why do we have School Nurses?

School Nurses are the primary health care provider within the educational environment. It is our job to promote each student's attainment of optimum health status, physical and mental, so that they achieve their fullest potential as a learner and as a person.

What do school nurses provide that no one else in the school district can?

1)Oversee your child's health needs
2)Promote health practices within the school
3)Provide primary health care, emergency care, assist in crisis management, and referrals at school
4)Provide communicable disease control
5)Access community resources
6)Perform mandated health screenings

School nurses strengthen and facilitate the educational process by improving and protecting the health status of children and by identification and assistance in the removal or modification of health-related barriers to learning in individual children. The major focus of school health services is the prevention of illness and disability, and the early detection and correction of you childs health problems.

We serve as a resource person to teachers and administrators, and act as a participant in implementing any section or sections of a comprehensive health instruction curriculum for students by providing current scientific information regarding nutrition, preventive dentistry, mental health, genetics, prevention of communicable diseases, self-health care, consumer education, and other areas of health.

Most importantly...we comfort and care for your children when they become ill or injured at school.

Asthma; Parents must be their child's advocate.

Communication with the parents is important at every grade level. It is critical when a child's medical condition needs monitoring at school by your childs teachers and myself as the school nurse. Please take time to share any information that you as a parent feels may be pertinent to your childs well-being. Do you have a specific plan of action at home that works best? Is so, let us know. Especially with cold & flu season just around the corner.

Did you know....

Nationally, nearly 11 percent of all schoolchildren have asthma, and the American Lung Association recently issued tips and a checklist for parents to prepare for the coming school year.

Here's what parents should do to keep their children well:

1) Schedule asthma checkups.
2) Confirm that medications are up-to-date, and fill prescriptions.
3) Know about prescription assistance services. Two organizations help provide asthma medications to those in financial need. The Partnership for Prescription Assistance can be reached at 888/477-2669, pparx.org, and Rx Outreach provides information at rxoutreach .com.
4) Have an asthma action plan. All students with asthma should have a written asthma action plan detailing personal information about symptoms, medications and physical activity limitations as well as instructions about what to do if an attack doesn't improve with prescribed medication.
5) Visit your child's school nurse and teachers. Discuss specific triggers and typical symptoms to help school personnel be prepared to help.
6) Advocate for your child. Find out what needs to be done to allow your child to carry and use an inhaler, for example.
7) Know your school's asthma emergency plan. Parents should know a school's history of dealing with asthma episodes and confirm that school staff members have been trained in responding to asthma emergencies.

For more on asthma and children, visit lungusa.org or call 800/586-4872.

Attention Deficit Disorder

There is a growing awareness in the education community that attention deficit disorder (ADD) and attention deficit hyperactive disorder (ADHD) can result in significant learning problems for children with those conditions. While estimates of the prevalence of ADD vary widely, we believe that three to five percent of school-aged children may have significant educational problems related to this disorder. Because ADD has broad implications for education as a whole, I believe we should clarify school site responsibility for addressing the needs of children with ADD.

Ensuring that these students are able to reach their fullest potential is an inherent part of the National education goals and AMERICA 2000. The National goals, and the strategy for achieving them, are based on the assumptions that: (1) all children can learn and benefit from their education; and (2) the educational community must work to improve the learning opportunities for all children.

Frequently Asked Questions:

What is an attention deficit disorder?
An attention deficit disorder is a medical condition which affects a person's ability to concentrate and maintain attention to tasks.

What is the difference between ADD and ADHD
Passive inattention (drifting off, daydreaming, etc.) is generally referred to as ADD (attention deficit disorder). When inattention is combined with significantly heightened activity level and impulsiveness, ADHD (attention deficit hyperactivity disorder) may be a more appropriate term. Often the two terms are used interchangeably and the combination term "AD/HD" is frequently used.

How is AD/HD diagnosed?
As previously mentioned, AD/HD is a medical condition which requires a medical diagnosis. Although it is a medical condition, AD/HD cannot be diagnosed by any type of neurological or laboratory test. The diagnosis is based upon a set of behavioral characteristics, and as such, can be a rather subjective process. Often a pediatrician, psychologist, or psychiatrist makes the diagnosis based upon observation of the child and interview of the parent about behavioral characteristics which are observed at home or at school. Frequently the school will also be involved in the process either as part of an evaluation for possible special education services or simply through behavior ratings which are completed by teachers. There are also various types of computerized performance "tests" which are designed to directly measure a student's ability to maintain attention to a computer task. However, this type of assessment is most useful and appropriate in a medical setting which can often provide a more controlled evaluation and allows the option of trial medication. This can be especially beneficial to help determine the potential effectiveness of medication if a diagnosis is made. It is very important to remember that AD/HD is not diagnosed by the school, but the school can take a very active role in once a child IS diagnosis.

How common is AD/HD?
Depending on the source, it is estimated that somewhere between 2% and 10% of the population is experiencing some form of attention deficit disorder (AD/HD). But since the condition involves behavioral characteristics which can range from very mild to extremely severe, many undiagnosed students may exhibit behaviors very similar to those of students who are diagnosed with ADD or ADHD. And since the diagnosis itself is very subjective, it is not possible to accurately determine the actual size of the AD/HD population.

Is AD/HD a "learning disability" or other special education issue?
Technically, an attention deficit disorder, by itself, is not considered a specific learning disability or other special education handicap as defined by Federal Special Education regulations. However, since AD/HD students experience many, if not all of the same processing difficulties that are experienced by LD students, they often are found eligible for special education services under the SLD (specific learning disability) classification. In other words, it really depends on how well the student is able to cope with his or her attention deficit disorder. If the AD/HD "severely" impacts the student's academic skills and classroom achievement, then an SLD diagnosis may be appropriate. If the AD/HD has not severely impacted the student's skills (i.e. he/she scores well on standardized achievement tests) but does interfere significantly with their ability to cope with daily classroom expectations (staying focused, understanding assignments, completing homework, etc.) then another category of special education called OHI (other health impaired) may be considered. OHI is an appropriate diagnosis when a student has any type of health/medical condition which severely interferes with his or her ability to cope with daily classroom expectations. For any type of special education services, the school must determine if the student's needs are severe enough to meet State and/or Federal requirements.

What other support is available for AD/HD students in school?
First of all, the vast majority of mainstream teachers are very sensitive to the special needs of individual students and will frequently provide modifications and accommodations when a legitimate need is presented. Unfortunately, many AD/HD students may appear lazy, disinterested, unmotivated, or are even disruptive within the classroom. Teachers are sometimes reluctant to provide help to someone who either doesn't seem to care or creates a difficult teaching environment. In these cases it is especially important for the student (with parental support) to realize and admit to his or her difficulties and try to work with the teacher to come up with an appropriate plan of intervention. There also may be tutorial services available within the school which could help strengthen lagging skills. But again, the student must be willing to admit the need for help. If a student is actually "diagnosed" with a "disability" or "handicap" of some form (including AD/HD) but is not eligible for "special education" services he or she may be eligible for a mainstream alternative called a "Section 504" plan. Section 504 of the Rehabilitation Act of 1973 guarantees the right to an appropriate education (including necessary accommodations) for any student with a disability. School personnel can help to determine if a student meets the requirements of Section 504. This can be especially helpful for AD/HD students who may need a quiet space for testing or other classroom supports to help maintain attention and reduce disruption.

What about medication?
When a child is diagnosed with an attention deficit disorder, often one of the most difficult decisions is whether or not to treat the condition with medication. Typically, the medication prescribed is some form of "stimulant" - most commonly ritalin. Although this type of medication is quite safe and usually highly effective, parents are wise to at least consider the potential side effects which can include loss of appetite, sleep disturbance, and very rarely "tics". There have been some (extremely few) cases in which children developed "tics" after initiating medication and later were diagnosed with Tourette Disorder. Although that may suggest a cause and effect relationship, it has not been established that the medication actually caused the Tourette Disorder. It is quite possible that the behavioral characteristics which were first diagnosed as AD/HD in these children were actually the early symptoms of Tourette's, and the medication simply helped to progress the disorder to the next inevitable stage. Again, these potential negative reactions to medication have been extremely rare. On the positive side, stimulant medication, when introduced at an early age and combined with positive behavioral interventions, has proven to be highly effective for treating both ADD and ADHD. When introduced at later ages, medication has been somewhat less effective primarily because negative behavioral patterns have often already been firmly established by this time. While the medication may "allow" a student to make better behavioral choices, the choices are still his or hers to make. And as we all know, negative habits are especially hard to break.

If a child starts on medication, do they need it for the rest of their life?
Studies have suggested that approximately 50% of students who required medication in elementary grades are able to cope without medication by high school. This may be due to a combination of neurological development and learned behavioral changes. The other 50% of these students may benefit significantly from the medication for most of their adult lives.

Can the effectiveness of the medication be used to "officially" diagnose AD/HD?
Although some professionals previously made such a claim, recent studies have shown that virtually all children react favorably to stimulant medications such as ritalin. In other words, almost all students in such studies were better able to maintain attention to tasks and control impulsive tendencies when taking the medication. So, simply because a child responds favorably to medication, this does not definitely prove that the child has AD/HD.

Can someone help if I have questions?
After discussing any classroom problems with your student's teachers, the next resource is your family doctor.

Related resources:

https://research.tufts-nemc.org/help4kids/default.asp

http://www.chadd.org/

Colds and Flu

The Difference between the Flu and a Cold

Influenza (flu) and a cold are both respiratory (breathing) system infections caused by viruses. Initial symptoms of flu and colds are similar, and it can sometimes be difficult to tell if you have the flu or a very bad cold. The flu can cause more serious illness than a common cold.

Colds usually begin slowly, two to three days after infection by the virus. They last between 2 days and 2 weeks. You will first notice a scratchy, sore throat, followed by sneezing and a runny nose. You may get a mild cough several days later. If there is a fever, it is usually mild, (higher in young children). On average a young child will get 7 colds per year. There is no reasonable way to keep from getting at least some colds.

If you have the Flu, you will have a sudden headache and dry cough, and you might have a runny nose and a sore throat. Your muscles will ache, you will be extremely tired, and you can have a fever up to 104°F (40°C). Most people feel better in a couple of days, but the tiredness and cough can last for two weeks or longer.

Preparing For Flu Season

Flu Vaccine: Flu vaccine is the best protection against flu. For children who suffer from asthma, lung disease, or other respiratory conditions, diabetes, heart disease, and kidney disease, flu vaccine is especially important. Those who receive flu vaccine may get flu anyhow, but it is frequently milder than without the vaccine. Flu vaccine will not protect you or your child from cold viruses.

Wash hands after touching others and after touching objects that others handle.

Keep your fingers away from your nose and eyes. This is the most common way cold viruses are transferred into your body.

If Your Child Has the Flu or a Cold

Protect others. Teach children to cover their nose and mouth with a tissue when sneezing and coughing, to throw the tissue away, and then to wash their hands.

Do I send my child to school?

Do not send your child to school if your child has a fever (measured greater than 100 degrees with a thermometer) or is too ill to pay attention in class.

Your child does not need to recover completely before returning to school. You can send your child to school with a cough and a runny nose. Even runny noses that have a green color are not good enough reasons to keep a child home. These symptoms can go on for 10 days to two weeks after a cold begins – and the school is able to teach your child, even when he or she is feeling less than perfect because of a cold.

Be sure school staff know how to reach a child’s parent during the school day.

Is there Treatment for the Flu?

Speak to your doctor’s office to determine what the best medicine is for your child. Most medicines (Acetaminophen, Ibuprofen, and decongestants) are given to relieve symptoms.

There are now anti-viral drugs that can reduce the symptoms of the flu. These must be prescribed for your doctor. Although any child can get these medications, if your child has an underlying illness (such as asthma or another lung disease) AND has symptoms of the flu, reach your doctor early.

These drugs work only on flu (not colds) and only if given within the first two days of flu symptoms.

Measles...understanding a bit about this disease

What exactly is measles?

Measles is a viral infection known as rubeola, or “red measles”, or “ten-day measles”. It presents with a runny nose, red eyes, cough, fever (that goes up), rash and sometimes spots inside the mouth. Some children are sensitive to light when they have measles. More information about the contagious periods of measles is provided on the bottom of the page.

Is getting measles dangerous?

Measles was once a very common childhood infection. Measles is now uncommon because almost all older adults have already had the disease, and younger adults and most children older than age 1 year have been vaccinated.

Although most people with measles recover without further problems, it is more common for children younger than 5 years of age and adults 20 years of age and older to experience complications. Diarrhea and ear infections are the most common complications.

Pneumonia occurs in 6% of those with measles. Measles in pregnancy increases the risk of premature labor, miscarriage, and low-birth-weight infants. Measles is most life-threatening among young children and adults. The most common cause of death in children is pneumonia; in adults it’s encephalitis (infection of the brain).

How can a parent know if their child is at risk for developing measles?

Any child is at risk for developing measles if they meet these two conditions: (1) The child has not been vaccinated, and (2) The child has been exposed to someone who is in the contagious stage of measles.

Here is more information on those two conditions:
(1) All children should get their first measles vaccine at age 1 year and then again just before kindergarten (usually at age 4 or 5 years). If your child is between age 1 and age 5, he or she is considered protected from the disease. If your child is older than age 5 and has not been vaccinated since his or her first birthday, a second vaccine is recommended. But, your child is likely (better than 95% chance) protected and is not likely to get measles, even if exposed. Most children get the measles vaccine in combination with mumps and rubella (German measles) in a vaccine known as “MMR”.

(2) It is impossible for us to know if your child has been at a public place or walking on the street near a child contagious with measles. That is why it’s important for every parent to be sure that all their children older than age one year have been immunized.

How can we keep measles from spreading if your child gets them?

By reminding parents to vaccinate their children. All children with measles and all unvaccinated children thought to have been exposed to measles are asked to remain at home (known as quarantine) until the risk for measles has passed or the child has recovered.

Is the vaccine safe?

Some parents are worried that the vaccine is not safe. The truth is that the vaccine is very safe. Parents who want to learn more about the vaccine and its safety should contact their pediatrician or family doctor, call the County’s Health Dept., or visit www.cdc.gov/vaccines/vpd-vac/measles/

Should children continue to go to school?

Yes, unless you have been instructed by the School or County health department to keep your child at home. Otherwise, your child should go to school as usual. If a child is older than age 12 months, parents should be sure he or she is vaccinated.

More about the contagious periods of measles

Prodrome stage (the period before the rash): Lasts 2-4 days (range 1-7 days). It is characterized by a high fever, often as high as 103°-105°F, followed by cough, runny nose and/or conjunctivitis. Koplik spots, a rash on the mucous membranes, may appear 1-2 days before the rash up to 1-2 days after the rash.
Rash stage: Occurs 2-4 days after prodrome stage and persists for 5-6 days. The rash begins on the face and head then proceeds downward and outward to the hands and feet. The rash fades in the same order it appeared, head to feet.
Period of contagion: Measles is highly contagious and may be transmitted from 4 days before the rash to 4 days after rash onset. It is spread by droplets (from coughs and sneezes). It is easily spread, so that an unvaccinated child in the same room as someone who is contagious, can catch measles.This is true even in large rooms.

MRSA (Methicillin-Resistant Staphylococcus Aureus

Staphylococcus aureus ("staph") infections have been around for many years, causing mild to severe illness. MRSA stands for methicillin-resistant Staphylococcus aureus, a form of staph infection that does not respond to routine treatment with some commonly used antibiotics, although other antibiotics are effective. Early detection and medical care are paramount to the success of MRSA treatment

Healthy people often carry staph bacteria on the skin or in the nose; most of the time these bacteria do not cause a problem. Staph is passed from person to person through direct contact with skin or through contact with contaminated items. Staph can enter the body through breaks in the skin and can sometimes cause infection.

Proper personal hygiene is the best defense against staph infection. The key ways to prevent the spread of staph bacteria are through frequent and thorough hand washing and through proper wound care. Hands should be washed after toileting, before eating, and before and after changing bandages. Additionally, avoid sharing razors, towels, bars of soap, or other objects that could pass bacteria from one person’s skin to another’s. Wounds should be cleaned and covered with bandages.

If you have any questions about you or your family's personal health, ask you doctor.

Related Resources

MRSA Information Sheet: English Spanish
MRSA Fact Sheet
Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools (Centers for Disease Control)
What Athletes Should Know About MRSA