Health Room Supplies
You asked for it: Here is a rundown of supplies you may need or want in your health room.
Bandages/First aid:
- Adhesive bandages – varying sizes: In addition to the regular 1″x3″ bandaids, you also need a supply of 2″x4″, 7/8″ spots, and if you have the budget you can also have the fingertip and knuckle bandaids. If desired you can also find the multi skin tone bandaids.
- Butterfly closures: I use these sparingly for wounds that need further closure in the ER. If you use a butterfly closure make sure to tell the parent that it is not a permanent solution and they need to seek medical care to address the wound.
- ACE bandages multiple sizes: elastic bandages with the velcro closure are better than the ones with the little metal teeth to hold them closed. Similar to the butterfly closures, be sure to let the parent know that an ACE wrap is not to replace seeking medical evaluation if that is required, it’s a temporary solution to get them through till they can get to the doctor.
- Wound cleaner/saline/antiseptic: I like the BZK antiseptic towelettes because they are individually packaged, they travel easily in first aid kits, and they don’t sting wounds.
- Petroleum jelly: I prefer the small individual packets of petroleum jelly for sanitary purposes.
- Splints – varying sizes: Mainly finger splints are needed but I like to keep some cardboard arm and leg splints available also in case of emergency. They are simple to place on an injury and wrap with ace bandage or tape.
- Slings: I like the fabric triangle slings for the purpose of immobilizing the arm so the student can get to the hospital to be evaluated.
- Tape
- Splinter-out/needle nose tweezers: either is fine for removing splinters. Splinter Out are basically just lancettes.
- Gauze: Stock with 2×2 and 4×4 gauze for wound cleaning, dressing, and applying ointments.
- Cotton balls: You can substitute gauze for cotton balls if desired.
- Cotton tipped applicators: I use these for everything – applying lip balm, petroleum jelly in the nose, hydrocortisone, and cleaning the outside of the ears.
- Alcohol prep pads
- Gloves
- Tissues
- Tongue depressors
- Ice bags/ice packs: I prefer to use ice bags and fill them from my ice machine as opposed to reusable ice packs. While it’s not the green way to go they are easily thrown in the trash when they are done instead of trying to keep track of the reusable ones.
Assessment & Tools
- Thermometer(s): I love the Kinsa Smart Thermometer! It is the easiest to use and the most accurate. It links up to an app also so you can have a record to show parents. Alternatively, oral thermometers are best if possible – Welch-Allyn is the recommended brand to go for.
- Stethoscope(s)
- Otoscope: A regular otoscope is best but I also have a really cool digital one that I’m still learning how to use. FYI, you will NOT be using the ear wax removal feature in a school setting.
- Sphygmomanometer: Have multiple sizes of blood pressure cuffs available for different size students and staff.
- Scale: The Health-O-Meter is a popular scale/stadiometer combo.
- Stadiometer: The Health-O-Meter is a popular scale/stadiometer combo.
- Pulseoximeter: you don’t need anything fancy but I have this one that bluetooths to my phone for a readout.
- Eye wash station: It’s very important to have some sort of eye wash available in case of anything in the eyes – I regularly have kids splashing hand sanitizer in their eyes, or getting dirt and pollen in their eyes. I like the sink mounted ones like the one I have linked but if you don’t have a sink that lends itself to this then the wall mounted ones are great also.
- Vision screening tools: You will need various eye charts for different age groups and abilities, near vision, and depending on your state requirements you might need stereo vision, color vision, and the plus lens. All of this can be found on Schoolhealth.com or the other supply companies listed.
- Audiometer: You need an audiometer, more specifically a pure tone audiometer. MAICO is a popular brand. The OAE hearing screener is not meant for children over 5 years old but can be used for children who are disabled and unable to participate in a pure tone hearing screen. These can be purchased through the dealer or from the school health supply websites.
- Flashlight/pen light: Needed for checking throats, pupils and other concerns.
- Woods lamp/blacklight: See my post about Woods Lamps, these can be helpful in assessing for head lice, and some rashes.
- Wheelchair
- Gooseneck lamp: a bright light is often needed for things like splinter removal or assessing for lice.
- Magnifier lamp: often comes as the gooseneck lamp.
- AED(s): AED can be purchased through the school health supply companies or from direct dealers.
- Ice machine: Ice machines are a must, especially in elementary. It’s far easier to have the ice machine than it is to make ice in ice cube trays every day!
- Privacy screen: If you don’t already have a curtain or privacy areas in your health room then these are helpful.
- Ring cutter: The manual ones are generally the best ones but you can also get the Dremmel one. Remember with a ring cutter you usually need two pairs of needle nose pliers to open the ring once cut.
- Air purifier: I like the Levoit brand but any one with a HEPA filter will do.
Miscellaneous:
- Salt (regular table salt): for rinsing mouths from lost teeth, loose teeth and sore throats.
- Tooth holders: For lost teeth. I absolutely hate the necklace ones because the strings will definitely get tangled, plus the strings are never long enough to wear around the neck. I cut the strings off usually or buy ones that do not have strings.
- Ammonia inhalant: These are rarely used anymore but I like to have some on hand in case of emergency.
- Lice combs/screening sticks: little wooden sticks that help you assess someone’s hair for head lice. Pro-tip: they also work as coffee stirrers.
- Nosebleed clips: Helpful for pinching the nose for nosebleeds, especially for other staff and kids.
- Cups: paper cups in varying sizes if possible for water and med administration. I accidentally bought one sleeve of tiny ones (I thought I was getting a whole case and it turned out to be one sleeve of tiny cups).
- Ziplock bags – varying sizes: I store everything in ziplock bags – all meds go in a bag with students name on it, bandaid kits for classrooms go in quart size bags, lots of supplies are organized in them.
- Peppermints: Optional, I prefer the pillow mints that are melty because the risk of choking is decreased.
- Baby wipes: Again used for everything from wiping butts to cleaning faces.
- Cotton rolls: needed for nosebleeds or lost teeth that bleed a lot.
- Air freshener: Self explanatory. Try to go for the ones that are not heavily scented or the medical grade “odor eliminator” type sprays.
- Braces wax: for braces injuries and pokey wires.
- Trauma shears/bandage scissors: Have multiple pairs available, I include trauma shears with my AED to remove clothing or sports equipment.
- Emesis bags/basins: Optional, I like to keep the bags for field trips in case of motion sickness.
- Backpacks for field trip meds: helpful to pack meds and first aid supplies.
- Go-bag: For drills (fire, lockdown, evacuation, etc) to hold supplies like meds, first aid etc.
- Batteries: Everything needs batteries. Otoscopes, pen lights, label makers etc.
- Ginger-ale: For upset tummies or low blood sugar.
- Menstrual care: menstrual pads and/or tampons – you may be able to work with some companies like Always to get free pads or with the department of health.
- Condoms: Again, you may be able to work with the health department or planned parenthood for free condoms.
- Cleaning supplies: Lysol wipes, paper towels, etc. Your maintenance people might supply this or it is supplied by the school budget and not health room budget so check with admins if you need to invest in any disinfecting supplies.
- PPE: Again, PPE may be provided by the district/school and you don’t have to supply it from your budget.
Medications
All medications suggested are based on your district/states guidelines. Some may be able to stock lots of things and others may not be allowed to have anything. Check your guidelines before investing in any meds.
- Acetaminophen/Tylenol
- Ibuprofen/Motrin
- Hydrocortisone
- Tums
- Stock Epi-pens
- Stock Albuterol
Unnecessary but helpful:
- Robicomb for lice: Comb with small electrical current that zaps lice and nits.
- Reli-a-light: a flashlight that fits a tongue depressor for looking in throats.
- Digital otoscope: Allows better ear assessment, and the kids can see their ear on the screen!
- Mindfulness toys/items: For when kids need a time out or a personality break.
- Vision SPOT screener: So incredibly helpful for vision screens if your state/district allows it. They are expensive but worth it. This can be purchased from school health supply companies or a dealer.
- Laminator: I love to make signs and bulletin boards and laminate it all! I have n Amazon one and it works perfectly.
- Kinsa bluetooth thermometers: They come in ear, forehead, and oral thermometers. It connects to an ap on your phone to log temperatures. Kinsa has a Flu prevention program where you can get free thermometers for the students for home, found here: https://home.kinsahealth.com/kinsa-for-schools
- Stop the Bleed kit: These are for bleeding trauma injuries like gunshots, stabbing etc. You can have the Stop the Bleed company come out and give a PD for you as well or do online training for the kits.
- Prepackaged first aid kits: Perfect for field trip bags and storing in the main office or around the school for just in case.
- CPR pocket masks & face shields: These can be kept with the AED or in visible locations in case of emergency.
- CPR chest wrap: a cover for the chest that assists in placement of hands and stickers for CPR and AED usage.
- Stickers/rewards: For after eye exams, hearing screens, or even to work with kids behavior if you’re involved with that.
- Personal printer/scanner: I can not live without mine! I have an HP all in one printer/scanner/copier and it’s a lifesaver.
- Vomit absorbent: Your maintenance people might already have this but if they don’t it’s helpful for cleaning up vomit from the floor.
- Snacks: I keep some snacks like little bags of goldfish, saltines, and pringles on hand in case of emergency. I do NOT advertise that I have goodies though. Always keep snacks in closed bags to prevent mice.
- Spacers for MDI: The students should be bringing their own but it’s helpful to have some extras on hand. Schoolhealth.com carries disposable ones.
- Life-vac choking device This is not FDA approved yet so many do not choose to use it but it exists and some swear by it. It’s kind of like a plunger with a mask on it that you can use to get an item out of a choking person’s mouth/throat.
- Label maker: This helps to keep your stuff neat and tidy and organized. I label the drawers of my med cart, and anything else I might need to be organized.
- Ear lavage kit: This is more than likely something you would not be using in a school setting depending on your policies as far as what procedures you can do but in a pinch having this can help wash out an ear that has a foreign body.
- Self care items: Deodorant, toothbrushing, soap/shower wipes, chapstick, pads/tampons
- Extra clothes and underwear: Students should have their own in their bags but we all know they don’t always. I keep spare underwear and I have a closet full of hand me down uniform clothes. This isn’t convenient for everyone to manage though, and often can be managed by the counsellor or another school staff member.
Most things on this list are linked on Amazon but you may have a contract with one or more of these vendors to get your supplies:
- http://www.schoolhealth.com
- http://www.amazon.com
- http://www.schoolnursesupplyinc.com
- http://www.macgill.com
You can check out my TPT for printable supply lists including what to pack in your emergency bags: https://www.teacherspayteachers.com/Product/School-Nurse-Supplies-Checklist-9114441
Do you have any supplies that I didn’t mention that are life savers for you? Email or message me and let me know!
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Energy Drinks
Thanks, Logan Paul for creating this Prime drink and marketing it to kids who don’t know that it’s not safe for them. We have been noticing an uptick in students bringing various energy drinks to school and we are worried.
They make them in flashy cans and bottles, with awesome flavors like cotton candy or jolly rancher, they advertise them on TikTok and with influencers who are targeting younger people and kids. Most of them are marketed as “safe” because they “just have vitamins” in them but what many don’t realize is that the “natural” ingredients might be just as dangerous as the chemical ingredients, especially for kids.
Most energy drinks are NOT regulated by the FDA because they are marketed as “dietary supplement” and not “food”. They tend to have excessive amounts of caffeine and other chemicals in them. Because they are not regulated by the FDA the manufacturer does not have to print the breakdown of these ingredients on the labels.
These ingredients can cause heart palpitations, anxiety, panic attacks, headaches, high blood pressure, behavior changes, kidney damage, liver damage, and even lead to stroke, heart attack or cardiac arrest. Everyone is at risk of these effects but children have a higher risk of negative health effects due to their immature developing bodies and brains.
Ingredients in most energy drinks:
- Caffeine: According to the FDA, soda manufacturers cannot have more than 71 mg of caffeine per 12‐ounces; currently there is no regulation for caffeine content in energy drinks. Many “energy drinks” do not state their caffeine content; some have as much caffeine as 14 cans of soda!!!
- Sugar: the same thing as sucrose, glucose, fructose, corn syrup or high fructose corn syrup. Sugar is known to give an instant boost but after very little time will cause a crash in both energy and alertness. Additionally, sugar has 4 calories per gram, a 8.3 ounce Red Bull has 27 grams of sugar; that’s 108 non‐nutritional calories!
- Guarana: a South American plant that produces seeds with 4‐5% caffeine content, while a coffee bean has the caffeine content of 1‐2%. Guarana in a 16‐ounce energy drink ranges from 1.4 mg to as much as 300 mg. It is unclear how much guarana is in each drink because many companies do not list a milligram amount. The safety of guarana in higher levels remains unknown, but these high levels could be easily achieved by consuming multiple drinks
- Ginseng: an extract made from the root of the ginseng plant. Ginseng may increase brain power but since ginseng is not regulated by the FDA it is difficult to know what else you may be getting in your drink! The amount of ginseng in most drinks is minimal and therefore harmful effects are unlikely, but check with your doctor first if you are taking any medications.
- Taurine: one of the most abundant amino acids in the brain, which can act as a neurotransmitter, a chemical messenger that allows cells to communicate with one another. Most energy drinks have anywhere from 20 mg up to 2,000 mg of taurine in a 16‐ounce beverage. When taurine is dumped into the bloodstream, via consuming an energy drink, it cannot pass through the membranes that protect the brain. But even if it could, scientists believe taurine would behave more like a sedative than a stimulant. Taurine is likely safe in small doses, but currently there is little research on taurine consumption in humans.
- L-Isoleucine: Side effects may include fatigue, nausea and muscle incoordination. Several groups of people should talk to their doctors before taking BCAAs: Pregnant or breastfeeding women.
- L-Leucine: Very high doses of leucine may cause low blood sugar (hypoglycemia). It may also cause pellagra. Symptoms of this can include skin lesions, hair loss, and gastrointestinal problems. People who are pregnant or breastfeeding shouldn’t use leucine supplements.
- L-Valine: L-valine is a natural substance that is necessary for our health. As such, it generally does not have any side effects. However, taking large quantities of L-valine can cause fatigue, nausea, and a lack of muscle coordination. Extremely high doses of L-valine can be dangerous.
- D-Alpha Tocopheryl Acetate (Vitamin E): a vitamin that is not specifically dangerous.
- Retinyl Palmitate (Vitamin a): Another vitamin that is not specifically dangerous.
- Zinc Aspartate : an amino acid, often taken as a supplement. Zinc supplementation up to the tolerable upper intake level is generally considered safe. High doses are sometimes used in children with moderate to severe deficiencies or in acute cases of diarrhea. In these instances, the high doses should be limited to a short period of time (10-14 days) in order to prevent gastrointestinal distress, copper deficiency, anemia, or genitourinary complications.
- Pyridoxine Hydrochloride (Vitamin B-6): Another vitamin that we do need, B vitamins can increase energy and often the purpose of the combination of B vitamins in products is to increase energy. High doses of vitamin B6 may be harmful to your child’s health depending on how much they consume. The side effects of excess vitamin B6 include: Nerve damage showing up as numbness. Nausea and heartburn.
- Cyanocobalamin (Vitamin B-12): Vitamin B12 deficiency can have distressing neuropsychiatric symptoms. It can have an etiological role in clinical presentations like depression, anxiety, psychosis, dementia, and delirium, requiring screening of at-risk populations. B-12 supplementation can improve energy and mood. Often the purpose of the combination of B vitamins in products is to increase energy.
Some of these ingredients are in fact vitamins and ones that we need to have, however, consuming them in the quantities that are in these energy drinks can be extremely dangerous, especially to younger people.
Some examples of the energy drinks that kids might try:
Red Bull
Monster
Bang
Rockstar
Prime Energy AND Prime Hydration
5-hour energy
NOS
Celsius
Prime Hydration is a sports drink, not an energy drink and does not have caffeine but it does contain something called BCAA’s which stands for branch chain amino acids (L-Isoleucine, L-Leucine, L-Valine) which are not really studied as to the effects on children but they are known to potentially cause fatigue, nausea, muscle discoordination, and decreased liver and kidney function. It also contains fake sweeteners like Aspartame and Sucralose that can lead to diabetes due to the way it is metabolized plus also lead to inflammatory illness such as arthritis, joint pain and degenerative joint disease. Not to mention that it contains coconut water which is likely to trigger a tree nut allergy which is something I think a lot of kids don’t realize.
Prime Hydration actually has a warning label on the bottles manufactured for Canada stating that people under 15 years old should not consume it. The US bottles do not bear this warning due to different FDA regulations in the US versus regulations in other countries (US is allowed to have a LOT more leeway for ingredients than many other countries but that’s another post).
The bottom line is that children (and adults) should NOT consume energy drinks due to the very dangerous side effects they could experience. Parents should be monitoring what their children are consuming and checking labels if they aren’t familiar with the product. Pregnant and nursing women should avoid these and consult with their doctor about the safety of the hydration drinks.
https://kidshealth.org/en/parents/power-drinks.html
https://www.arthritisfoundationasia.com/foods-avoid-if-you-have-arthritis.html
https://www.cdc.gov/healthyschools/nutrition/energy.htm
https://www.healthylincoln.org/what-we-do/bevinit/energy-drinks-and-kids.html
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Vaping: They Thought It Was Supposed To Be Safer.
Remember when vaping and e-cigarettes came on the scene and everyone was thrilled that they could now “smoke” with virtually NO ill effects? So healthy! People indoors, “smoking” fruity flavored, cotton candy, apple pie flavored oils because it’s a healthy alternative to getting your nicotine in AND you can do it indoors right in people’s faces!
Later came new laws regarding marijuana legality in various states, dispensaries, and people vaping marijuana. It seemed like a great idea at the time for sure as there can be many benefits to using THC for various ailments from cancer pain, nausea from chemo, relaxing Parkinson’s tremors, relaxing tourette’s tics, managing severe autism, stimulating eating in a person with dementia, other pain like migraines and arthritis, to anxiety and PTSD.
So let’s get into it: the good and the bad of vaping. Yes, there is some “good” but in reality, after all the research that is being done, all the physical injuries related to vaping nicotine or THC the bad outweighs the good and it’s just not worth it.
Pros:
People started vaping oils and e-cigarettes as a way to cut down on the many many chemicals found in cigarettes. Smoking cigarettes expose you to literally thousands of dangerous cancer causing chemicals, puts you at risk for many forms of cancer aside from just lung cancer, and puts you at risk for heart disease, lung disease like COPD, stroke, and diabetes just to name a few.
- Vaping exposes you to fewer chemicals than smoking cigarettes. This is also a con because vaping still exposes you to other different dangerous chemicals.
- Vaping does not expose you to tar or carbon monoxide like cigarettes do.
- If you’re vaping THC you get a better product delivery than smoking dry flower because it is more concentrated THC. This is also a con because a person who is new to using THC is more likely to have greater effects from vaping and is more likely to have greater side effects.
- That’s all the pros I’m gonna give because the reality is that there are no pros to vaping or smoking.
Cons:
- Vaping exposes you to different dangerous chemicals than smoking including Diacetyl, Formaldehyde, and Acrolein. These chemicals when ingested in the vaping oil can lead to severe lung damage and even death. In addition, the vape pens themselves often offer exposure to other dangerous chemicals and metallic compounds from the heating coils that can cause irreversible lung damage such as something called Bronchiolitis Obliterans aka Popcorn Lung.
- Many vape products contain propylene glycol and glycerin, which, alongside many other polycyclic hydrocarbons, are linked to the development of cancers and lung and cardiovascular diseases.
- Vaping with cartridges that are not from either a regulated dispensary or made in one’s own home have the potential to have other additives like vitamin E oil which can lead to permanent lung damage. Vitamin E is often used as a thickening and delivery agent in e-liquid. And, while it’s safe when taken orally as a supplement or used on the skin, it’s likely an irritant when inhaled. It’s been found in the lungs of people with severe, vaping-related damage.
- Teens’ brains are not fully developed yet. Teens who are exposed to chemicals such as THC, Nicotine, Alcohol or other illicit substances are highly susceptible to cognitive deficits like memory problems, poor coordination, poor reflexes, poor decision making skills.
- Because of the lack of full brain development, teens are more likely to develop marijuana use disorder or addiction to marijuana. They are also more likely to develop poorer academic success, poorer career success, lower life satisfaction and increased relationship problems.
- Marijuana use as a teen can lead to increased depression, anxiety and increased risk for developing schizophrenia.
- It is a myth that the second hand “smoke” from vapes does not affect those around you. The people that you are vaping in front of are now breathing in the same harmful chemicals that you are breathing in and putting them at risk. So all those people who think it’s ok to vape indoors in front of people are putting everyone else at risk as well as themselves.
- Research has proven that switching to vaping does not in fact help anyone quit smoking.
What is in the vape juice/oil?
E-liquid, also called e-juice or vape juice, is what vaping devices use to make the vapor you breathe in. E-liquids aren’t just water. They usually contain:
- Flavoring. Each flavoring has its own set of ingredients.
- Nicotine, the addictive and harmful substance in cigarettes and other tobacco products.
- Propylene glycol and glycerin, used to create vapor.
E-liquids and flavorings sometimes have other ingredients, including:
- Chemicals that can cause cancer (carcinogens), like acetaldehyde and formaldehyde.
- Chemicals known to cause lung disease, such as acrolein, diacetyl and diethylene glycol.
- THC (tetrahydrocannabinol), the chemical in marijuana that gets you “high.”
- Vitamin E acetate, linked to lung injury caused by vaping (EVALI, see below).
- Heavy metals like nickel, tin, lead and cadmium.
- Tiny (ultrafine) particles that can get deep into your lungs.
Health problems associated with vaping
- Popcorn lung: Diacetyl, a chemical used in some flavorings, can cause bronchiolitis obliterans (“popcorn lung”). Bronchiolitis obliterans causes permanent scarring in your lungs. Popcorn lung gets it’s name from it’s discovery in people who worked in a popcorn factory who were breathing in Diacetyl and developed this permanent lung scarring.
- EVALI (e-cigarette, or vaping, product use associated lung injury). EVALI is a serious lung condition that vaping causes. It causes widespread damage to your lungs and gives you symptoms like coughing, shortness of breath and chest pain. EVALI can be fatal.
- Cancers: lung cancer, bowel cancer, many many forms of cancer can be caused by smoking or vaping.
- COPD: Asthma, emphysema, chronic lung disease. This is permanent.
- Heart attack/stroke: The increase in adrenaline and the decrease in oxygen flow can lead to heart attacks and strokes. You can literally die from this.
- Addiction: Many people think that marijuana is not addictive but it most certainly can lead to marijuana use disorder. Also nicotine is highly addictive.
- Injury from vape devices exploding or burning: Yep, that’s right, the devices can explode! They can also malfunction and burn you.
Alternatives:
- Quit. If you are vaping nicotine then quit. I know that’s not as easy and it sounds but there is no physical need for nicotine in any form. For help to quit smoking you can look here: https://www.lung.org/quit-smoking/i-want-to-quit
- If you are vaping THC or smoking flower for medical reasons, there are other methods of delivery for it than vaping or smoking such as edible, RSO, tinctures, creams and others. If you are using THC for recreation, it is legal for recreation where you live and you are of an appropriate age to use THC safely then again, there are other methods of delivery aside from vaping or smoking.
Additional facts about vaping
- The smell from THC vapes is extremely short lived. Be aware that teens can more easily take a few hits from a THC oil vape and go undetected than if they smoked whole flower.
- The devices for vaping have developed into things that look like other things. They might look like a USB drive, a cell phone case, an actual pen, or even a smart watch. Some of the paraphernalia might be disguised as other items also such as lip balm (dabs are stored in little jars that could be mistaken for other things).
- 60% of young people think that vapes are mostly just flavoring while the reality is that 98% of them have nicotine.
- Researchers disagree on the statement that marijuana is a “gateway drug” as we were always taught in the 80’s and 90’s. There is little evidence suggesting that people who use marijuana continue on to using harder drugs although it is not impossible to imagine. That being said, marijuana use in teens is dangerous in itself anyway.
- Even if you have a high quality THC product, the vape devices themselves can cause chemical exposure from the internal workings of the heat coils and chemicals used to heat them up.
- It’s really expensive. Average cost to vape a JUUL – $1,008 PER YEAR; Average cost to vape refillable e-cigarettes – $1,512 PER YEAR. The average yearly cost of healthcare for e-cigarette users is $1.3 BILLION. Average cost of vape cartridges at a dispensary: $30-$50 and up!
Conclusion
It’s just not worth it. Vaping anything as a teen can seriously mess up your body and brain and affect the rest of your life. Vaping anything as an adult can seriously mess up your body and brain and also affect your life. For help and information about substance abuse visit https://www.samhsa.gov/.
Please like and follow my blog and comment with your thoughts on this topic!
References
https://leafwell.com/blog/are-all-cannabis-oil-cartridges-safe-when-vaped/
https://www.healthline.com/health-news/teens-and-disguised-vaping-devices
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Assessment Basics for the School Nurse: Hearing Screens
Screenings are one of the most important jobs school nurses do. We are often the first to determine that a student may need glasses or hearing assistance to improve their education.
The who and the when of screenings will depend on the state and district in which you are working. To find out who needs what screenings and when you can Google “mandated school screenings x state name” It will usually take you to your state department of health where you can see the information regarding mandated screenings. Here is an example of my state department of health website regarding screenings: https://www.health.pa.gov/topics/school/Pages/Mandated-School-Health-Programs.aspx
For now I want to narrow it down to just hearing screens (vision screens are in another post). For my state (PA), I do hearing screens on kindergarten, 1st grade, 2nd grade, 3rd grade, 7th grade, 11th grade, anyone new to the district, and any students needing an IEP evaluation/renewal. If they had a hearing screen already at their yearly checkup then they can be exempt unless there is a concern.
Types of hearing tests
- Pure-Tone Testing: You might remember putting earphones on and raising your hand whenever you heard the “beep.” This is pure-tone testing. It is sometimes referred to as “air conduction testing” since the sounds go through your outer and middle ear. This test helps find the quietest sound you can hear at different pitches, or frequencies. Having earphones on lets the sounds go to one ear at a time. This is sometimes done in a sound booth at the ENT or audiologists’ office. This is generally what you will find in a school setting as well.
- Speech Testing: Speech testing is a test to assess how well a person can listen and repeat words. This is often done in a sound booth with headphones on by a speech therapist. It sometimes is done in a noisier place to assess if you can separate background noise from other sounds. The Pilot audiometer is a type of speech testing.
- Tests of the Middle Ear: Tympanometry, acoustic reflex and static acoustic impedance measure the workings of the outer, middle and inner ear. These usually involve a probe in the ear canal to measure muscle response, eardrum movement and air levels in the ear canal. These will usually be done at the pediatrician or ENT/audiologist.
- Auditory Brainstem Response (ABR): Measures the brainwaves associated with hearing and cochlear function. This can be done on younger children who are unable to actively participate in a hearing test (like newborns in the hospital), or to assess if the hearing loss is due to a brain pathway issue vs a structural ear issue. This is performed by audiology usually
- Otoacoustic Emissions (OAEs): The OAE test is used to find out how well your inner ear, or cochlea, works. It measures otoacoustic emissions, or OAEs. These are sounds given off by the inner ear when responding to a sound. There are hair cells in the inner ear that respond to sound by vibrating. The vibration produces a very quiet sound that echoes back into the middle ear. This sound is the OAE that is measured. This is often used for the newborn hearing screens in the hospital and for pre-school students. OAE is not as useful for people over 5 years old but can be used if needed for someone who is unable to participate in a hearing screen.
Equipment
- Audiometer: There are tons of brands and styles of audiometers. The MAICO is the most popular that you will see. They range in price from about $1000 up to $3000 depending on which model you choose. The Pilot is also made by MAICO but performs the speech test as opposed to the pure tone test – it is around $3400 on schoolhealth.com. Welch-Allyn is also a popular manufacturer of audiometers.
- OAE machine: Usually for pre-k hearing testing, costs approximately $5000+ depending on the model and type of kit purchased.
- Small toys or blocks and a bucket to drop them into (optional): Some audiologists and/or nurses like to use small toys to drop in a bucket instead of the raising hands for the hearing tests on the kinder or pre-k kids. I have a set of small colored blocks and a bucket to use if I think it will work better.
- Otoscope: You may want to look in the student’s ears to assess for wax occlusion or abnormalities. This is optional as some states or districts do not allow school nurses to assess ears in this manner.
- A very quiet space: It is extremely important to have the quietest space possible to perform hearing screens. Sometimes even the noise of the refrigerator humming or the air conditioner will interfere. This is why audiologists usually have a sound booth for optimal testing environment. If you have a little noise just be aware that the student may be unable to hear the quietest tones during the test.
- A comfortable seat: You should have a chair and preferably a desk for the student to sit at during the test when they can feel comfortable and relaxed but also be able to turn away from you so the don’t see you pushing the buttons on the machine.
Procedures
Basic procedure for pure tone hearing “sweep” test (aka “rapid” test):
- Allow the audiometer to warm up for 15-20 min
- Have the student sitting comfortably in a position where they can not see you working the machine and giving inadvertent clues to the sounds but the tester can also observe their face for responses.
- Instruct the student prior to placing headphones that they should hear a “beep” and when they do they should raise their hand then put it back down. Alternatively, they can drop a toy into the bucket if they hear the beep.
- Place the headphones on the student with the red earpiece on the right and the blue earpiece on the left.
- Set the frequency to 1000 Hz and the decibels to 55 dB then deploy a tone.
- Decrease the dB to 40, then 25 giving one tone for each.
- Once at 25 dB test the frequency at 2000, 4000, 250, 500
- Repeat process for the other ear.
Basic procedure for threshold test
- Begin with frequency at 1000 Hz and decibels at 50 dB
- Decrease decibels by 10 until the student no longer indicates they can hear the tones.
- Increase decibels by 5 until they hear the tone again.
- At 25-30 dB start increasing the frequency to 1000, 2000, 4000, then 250 and 500.
- Note if the student does not indicate that they hear the tone.
- Repeat procedure for the other ear.
Pass/Fail criteria
Per the Pennsylvania Department of Health (your state or district may have different criteria):
- For the sweep test, a child not hearing two or more tones at 25 dB in one or both ears should be given a threshold test that day or within one month.
- For the threshold test, a student whose threshold test shows a hearing level of 30 dB or more for two or more tones in one or both ears, or 35 dB or more for one tone in either ear, shall be referred to the family’s provider or usual source of care for a complete ear examination. A complete ear examination means otologic assessment and audiometric tests. It is the family’s responsibility to arrange this examination.
Tips & Tricks
- According to the PA Dept. of Health instructions, you should allow the audiometer to warm up for 15-20 min.
- Always make sure you have the quietest space possible for hearing screens. My personal office is not in a quiet location but I scouted the school for the best spot and an admin is kind enough to loan his office for my hearing screens. I also have set up shop in the kindergarten closets because they are large, insulated, and fairly quiet.
- Before beginning the test make sure that the student fully understands the instructions. If there is a language barrier use your translating services or interpreter to ensure they understand what to do.
- Red = right ear, blue = left ear
- As mentioned, you can either have the student rise a hand when they hear the tones or make it fun and have them drop toys or blocks in a bucket when they hear the tone.
- Be careful because the student might see you pushing the buttons on the machine and know when to raise their hand even if they didn’t hear the tone.
- You can often observe the student’s face and mannerisms and tell when they hear a sound but are unsure. They may look questioning, or look around or stop to try and listen harder.
- If you are permitted in your district, you can look in a student’s ears and determine if they have excessive or occluding wax that might be interfering with the hearing screen, or possibly fluid in the ear that could affect it. If they do then they would then need to be referred to their doctor for further evaluation as we are not able to remove the wax nor are we able to diagnose an ear infection or abnormality.
- Clean the headphones between students with a lysol wipe.
- Audiometers should be calibrated yearly. Ours usually go out for calibration at the end of the school year and we get them back in september/october. You would make arrangements with the dealer of the audiometers for calibration.
Are any of you hearing screening experts? I would love to hear some tips and tricks if you know of any! Please follow my blog and comment with any thoughts!
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Resources
refehttps://www.health.pa.gov/topics/Documents/School%20Health/Pennsylvania%20School%20Health%20Procedures%20Hearing.pdfrences
https://www.asha.org/public/hearing/types-of-tests-used-to-evaluate-hearing/
https://www.asha.org/public/hearing/otoacoustic-emissions/
https://www.health.pa.gov/topics/school/Pages/Hearing-Screen.aspx
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Assessment Basics for the School Nurse: Vision Screens
Screenings are one of the most important jobs school nurses do. We are often the first to determine that a student may need glasses or hearing assistance to improve their education.
The who and the when of screenings will depend on the state and district in which you are working. To find out who needs what screenings and when you can Google “mandated school screenings x state name” It will usually take you to your state department of health where you can see the information regarding mandated screenings. Here is an example of my state department of health website regarding screenings: https://www.health.pa.gov/topics/school/Pages/Mandated-School-Health-Programs.aspx
For now I want to narrow it down to just vision screens (hearing screens will be in another post). For my state, I do vision screens on all students yearly. All students require a far & near visual acuity, 1st graders also get the convex lens test (more about that later), and 1st & 2nd also get color vision and stereo tests. Students that are newly enrolled in the district should have all the tests also.
Equipment
- Eye charts: there are multiple kinds of vision screening charts we can use for students of varying ages and abilities. More on those below.
- Light box: A holder for the screening charts that has a backlight. Not everyone has access to a light box but they are useful to get the best screening.
- Eye occluder: I generally have the student use their own hand to occlude one eye but you can also use the handheld eye occluder paddles if desired. Just be sure to clean them between each student.
- Stereo glasses and cards: The stereo vision test is a test of the ability to see 3D images and test for amblyopia, strabismus and poor ocular alignment. This test requires the stereo vision (3D) glasses and the stereo vision (3D image) cards.
- Color chart book: to test for color blindness we have a book of shapes made with varying color dots.
- Convex lens kit: Convex lens kit usually consists of a pair of +2.25 glasses to pair with the regular far vision charts.
Eye Charts
- Snellen: This is the regular letter chart usually used for students who are able to read and recognize letters. The Snellen chart originally consisted of hooked letters as opposed to the Sloane chart that has block letters. The current day Snellen chart now is called a Snellen/Sloane chart as they have changed the letters to all block letters. Snellen is the one with single rows of letters and the red and green lines.
- Sloane: The letter chart similar to Snellen but made with block letters instead of hooked letters. It is just a more modern version of the Snellen chart and sometimes called the Snellen/Sloane chart.
- Near vision cards: Near vision cards are (as you probably guessed) to perform the near vision test. They are smaller, handheld cards with either letters, shapes or sentences on them. They are meant to be held approx 13-16 inches away to read.
- LEA symbols: A chart for younger students who may not be fluent with their letter recognition. This chart has a series of shapes instead of letters. Sometimes it comes with corresponding cards or a single page with the shapes for the student to point to.
- HOTV: a simpler letter chart consisting of just the letters H, O, T, and V. This is sometimes used for the younger kids or people who are not fluent in reading.
- Tumbling E: Another chart for those who are not fully literate, an alternative to the LEA chart or the HOTV chart featuring “E” in different positions along the lines. The tumbling E chart has a capital letter E in varying positions and sometimes comes with a card or a plastic E so the student can demonstrate the position of the E.
- Hands: Similar to the tumbling E chart, the hands chart has a series of hands in different positions. The student can demonstrate with their own hand what position the hand they are looking at on the chart is.
Vision Tests
- Far acuity: The most common vision test used to assess for nearsightedness (difficulty seeing things at a distance).
- Near acuity: Used to assess for farsightedness (difficulty seeing things that are close up).
- Convex lens: A further assessment of nearsightedness, convex lens assesses for severe nearsightedness.
- Stereo: To assess for amblyopia, strabismus and poor ocular alignment. This test uses 3D images and 3D glasses to test how the two eyes work together.
- Color: tests for color blindness by looking at a series of shapes created from dots of varying colors.
Automated Vision screener: the automated vision screener devices are machines that will perform the vision screenings for you. These are sometimes known by brand names such as the Spot Screener, the Optec Screener, the Pulseoptix, or a few other brand names. They all have varying abilities to test different types of vision. They can be very expensive but if you can afford one for your district they are really helpful. The only caveat is that not all districts legally allow them and require physical vision screens to be performed. Check with your district heads and state health department for your specific state.
Procedures
Check with your state department of education and your district to check for any specific guidelines for screening student’s vision. This information is based on my state’s guidelines and instructions for screening.
Every vision exam should start with a visual inspection of the student’s eyes. Do they exhibit any nystagmus (shaking/movement of the eye), esotropia/exotropia (misalignment of one or both eyes inward or outward), drifting of one or both eyes, squinting, or any abnormal appearance of the eyes. Do they have any history of eye or vision problems?
Are there any language concerns? If so is there a translator available to assist? My teachers are kind enough to send the students with less english down with a student who can translate for them but I also have some in person translators available in my building.
Assess if the student already has glasses or contacts. If they do then they should perform the test with them on. Far vision should be performed with glasses for distance, near vision should be performed if their glasses are for near vision. If they forgot them then they should return at a later time with the glasses. If they are prescribed them but they don’t have any then consult the parent about getting a new pair of glasses. Offer assistance if there is a need.
Far Vision:
- Determine the appropriate chart for the student based on age, grade, and ability.
- Have the student stand either 10 feet or 20 feet away depending on which chart you are using (I have a premeasured spot marked on the floor for 10 feet away).
- Have the student cover the left eye first – if you routinely start with the same eye for every student it makes it easier to record the results correctly.
- Begin with the 20/40 line. If they pass 20/40 move down to the 20/30, 20/20 and so on. If they can not see the 20/40 line then move up to the larger lines instead.
- Failure to read more than half the letters/symbols on a line requires moving to the line above until they can read everything on the line.
- Repeat with the right eye.
- If you are using the hands or tumbling E chart, instead of asking them to state the letters you will have them use the hand they aren’t covering their eye with the demonstrate the position of the hand or the E you are pointing to.
- Refer: Any kindergarten or grade 1 student who’s acuity is greater than 20/40 or has greater than a 2 line difference between eyes should be retested and if same results should be referred. Any grade 2 and above student who’s acuity is greater than 20/30 or has a 2 line or greater difference between eyes should be retested and/or referred.
Convex lens
- While the student is still standing 10/20 feet away for the far acuity test, have them wear the convex glasses, occlude left eye.
- Starting with the 20/20 line ask them to read the letters/symbols. move up as far as the 20/40 line.
- If the student can NOT see the lines with the convex lens glasses on that means they PASS the test.
Near vision
- Have the student occlude the left eye first.
- Hold the near vision testing card approximately 13-16 inches away from the student and ask them to read the smallest line they can see without squinting or leaning in to the card.
- Repeat for the right eye.
- Refer: Any kindergarten or grade 1 student who’s acuity is greater than 20/40 or has greater than a 2 line difference between eyes should be retested and if same results should be referred. Any grade 2 and above student who’s acuity is greater than 20/30 or has a 2 line or greater difference between eyes should be retested and/or referred.
Stereo
- Have the student wear the polarized stereo vision testing glasses.
- Show the student the raised “E” figure on the demonstration card at 16 in (40 cm).
- Tell the student that the raised figure is popping off the card. Show the student the raised “E” paired with the blank card. Ask the student to point to the raised “E”.
- Repeat this process until you are certain that the student understands and can correctly identify the raised “E”. Once the student understands, start the screening test.
- Present the cards six times at 16 in (40 cm) and ask the student to point to the “E” on each presentation (shuffle the cards behind your back between each presentation).
- Refer: Refer if the student cannot identify the “E” correctly in four of six attempts.
Color vision
- Holding the pseudoisochromatic test cards approximately 30 in (75 cm) away, instruct the student to identify the number, symbol or trail seen on each of the designated cards, allowing for 3 seconds per card.
- Refer: If the student does not correctly identify the manufacturer’s suggested number of cards, he/she has failed the test.
Resources
- Local Lions club: one of the service projects the Lions Club does is to work with vision screening and obtaining glasses for kids and adults. Some school nurses have been able to schedule vision screening events with their local Lion’s Club.
- Vision to Learn: Helps students in low income communities obtain eye exams and glasses.
- Local association for the blind: I’ve linked the Pennsylvania Association for the Blind here but Most states also have a chapter.
- Local ophthalmology colleges: I’ve linked here a local ophthalmology school that my district uses as an example. You most likely have something similar in your area as well. The local one to me can schedule vision exam events at my school with the ophthalmology students.
For special needs students it can sometimes be difficult to complete the vision screenings depending on their level of disability but don’t neglect them! You can try various things such as the hands and E charts, meet them where they are – literally – if you have to sit on the floor and coax them into trying the exam then do that. If you’ve tried and they are unable then they can be referred to their doctor for evaluation if there are any concerns.
If anyone is an expert in vision screens in school or has any great resources or info to add please follow and message me or comment here and let me know what you think!
References
https://www.health.pa.gov/topics/school/Pages/Vision-Screen.aspx
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Assessment Basics for the School Nurse: Sore Throats
Sore throats: everyone seems to have them at the same time. What’s causing them, what are we looking for and what can we do about it?
Sore throats can be benign much of the time – from post nasal drip, too much talking, allergies, environmental irritation, or random unnamed viruses. But at times they can be worse than a run of the mill cold – strep throat, tonsillitis, mono, Coxsackie/hand-foot-mouth, flu, Covid, or even chickenpox or epiglottitis.
Equipment needed
- Tongue blades
- Flashlight/pen light
- Table salt/water/cup
Throat assessment
- Asses external appearance: do they have any injuries, swollen glands, drooling/difficulty managing their own saliva, swelling of the mouth or face?
- How does their voice sound? scratchy, hoarse, whispering, muffled “hot potato” voice?
- Assess for fever.
- Using light and tongue blade, have the student open their mouth and stick their tongue out. Gently push down on the tongue to visualize the back of the throat and tonsils. It helps if the student can say “ahhhh” as this causes the tongue to lower giving better visibility to the back of the throat.
Things you may see on exam
- Enlarged tonsils: tonsils appear swollen. In some cases they are so swollen they are touching.
- Tonsillar exudate/white patches/pus: With certain tonsillar ailments the tonsils can have white patches, white spots, pus, and have a “raw hamburger” appearance (sorry for the visual).
- Post nasal drip: I have never been good at spotting post nasal drip but doctors seem to see it all the time. Post nasal drip can cause a sore throat, especially in the morning when you first wake up and the mucus has been sitting there all night.
- Deviated uvula: The uvula is not hanging in the middle like it is supposed to. This can be an indicator of a peritonsillar abscess which is an emergency. In a peritonsillar abscess the uvula will deviate away from the side where the abscess is. Deviated uvula can also be an indicator of cranial nerve damage which is also potentially an emergency.
- Erythematous tissue: Redness in the throat and tonsils. This is an indicator of an inflammatory process like tonsillitis, irritation from increased coughing, or a viral process.
- Red spots to throat and/or roof of mouth: Petechiae in the mouth can be an indicator of a blood disorder or mono; red spots can also be an indicator of strep, hand foot and mouth, or oral thrush.
- Ulcers or canker sores: These look like a whitish concave area inside the mouth or around the throat. can be caused by minor injury (like getting poked with a pointy chip), eating too much salt or sugar, hand foot and mouth disease, or even a herpes simplex outbreak.
- Dental: The student may have some dental caries or fractured teeth that is referring the pain backward to the throat or causing general mouth pain.
Images of throat exams
Scroll by fast if these might gross you out!
In the health room
- While there isn’t a whole lot we can do about sore throats at school, there are a few things you can try like gargling with warm salt water, popsicles or freezies, sucking on ice.
- In some schools/districts Halls or throat lozenges are permitted to be given by the nurse. Check your district guidelines before dispensing throat lozenges or allowing self carry of throat lozenges.
- If sore throat is accompanied by fever then the student should be sent home.
- If exam shows any of the above issues, or any other concerns, call parent to report.
- Symptoms of strep throat can include not only a sore throat with swollen tonsils and exudate but also stomachache, headache, nausea, vomiting, fever, and a red “sandy” rash on the trunk. The student should be evaluated as soon as possible.
Tips and tricks
- gargling with salt water is often very helpful. Try adding 1/4 teaspoon or so of table salt to some warm water, mix it up and have the student gargle a little bit with it.
- Cold liquids, popsicles or freezies are great for temporary sore throat relief.
- Tea and honey can relieve a sore throat. Honey has antiviral and antibacterial properties and can help fight illness. Remember to never give honey to anyone under 12 months old due to the potential for infant botulism.
- Allergy medicine or decongestants: If the sore throat is caused by post nasal drip or a cold then trying something that will dry up excess mucus might help. This wouldn’t be given at school but the parent can consider this for home.
- Motrin or Tylenol: I prefer to use these sparingly and try other things first but they can certainly help with a sore throat. Ibuprofen is better than Acetaminophen for inflammation.
When is it an emergency?
- When there is difficulty breathing: If the student has a sore throat and difficulty breathing this could be a sign of anaphylaxis. Check a pulseox, auscultate lungs for wheezing, assess for swelling in the mouth, assess for known allergies. If anaphylaxis is suspected use your anaphylaxis action plan and give Epi and call 911.
- When there is real difficulty swallowing or managing saliva: Tonsils are so swollen that the student can not swallow their saliva. This can be an indicator of mono, peritonsillar abscess, strep throat and causes the risk of aspiration and compromised airway.
- Deviated uvula: The uvula is not hanging in the middle like it is supposed to. This can be an indicator of a peritonsillar abscess which is an emergency. In a peritonsillar abscess the uvula will deviate away from the side where the abscess is. Deviated uvula can also be an indicator of cranial nerve damage which is also potentially an emergency.
At the end of the day, we of course can’t diagnose anything but we must know when to refer out for further assessment and treatment.
Please feel free to follow for more assessment tips and comment if you have anything to add!
References
https://www.medicalnewstoday.com/articles/324876#prevention
Your Favorite School Nurse 