School Nurse » From Nurse Jami

From Nurse Jami


Please review the information below regarding viruses, policy guidelines for sending students home and returning to school, and prevention tips.

COVID-19: Covid-19 symptoms may closely resemble other viruses and allergy symptoms. If you know that your student has been in direct contact with a Covid-19 positive case, you will need to contact Nurse Jami and await further instruction before your student can return to school. 

STUDENTS WITH FEVER, VOMITING, DIARRHEA: Any student with a fever of 100 or more will need to be picked up from school. Any student who has had an episode of vomiting or diarrhea will need to be picked up from school.  The child is not to return to school until he or she has not had a vomiting or diarrhea episode for 24 hours, and or is fever-free for a minimum of 24 hours without the use of fever-reducing medication such as Tylenol (Acetaminophen) or Ibuprofen. If a parent discovers at home that a child has a fever, the same guideline applies. If a student returns to school within the initial 24-hour period, a parent will be notified that the student will need to be picked up from school. 

HEAD LICE: Students will only be check for head lice if there is a concern or request by a teacher or the student’s parent. Per USD 509 policy: only children with live lice will be sent home, and the parent requested to initiate lice removal treatment. I will request receipt or label information of the treatment with readmission to school. Kansas regulations no longer require children to be nit free before returning to school. Encourage your child to not share personal items or allow their hair to touch another child’s. Head lice are spread most commonly by direct head-to-head (hair-to-hair) contact.

FIFTH DISEASE: The first symptoms of fifth disease are usually mild and nonspecific and include fever, runny nose, and headache. After several days a distinctive red rash appears on the face called a "slapped cheek" rash. Some people will get a second rash a few days later on their chest, back, buttocks, arms, and legs that can vary in intensity, is itchy, and can come and go for several weeks. (KDHE Website) Children are not excluded from school unless temperature is over 100 due to nonspecific symptoms. Some children may just not feel well and symptoms mimic seasonal allergies. Children are most contagious prior to having a rash, are no longer contagious by the time the rash appears. The rash may last 1-3 weeks and come and go throughout that time. Hand washing and covering the nose and mouth during sneezing and coughing are the most effective ways to stop the virus from spreading. Exposed pregnant women should follow up with their doctor for any risk factors that may apply to them.

HAND FOOT, AND MOUTH DISEASE: Hand, foot, and mouth disease usually starts with a fever, reduced appetite, general discomfort, and sore throat. One to two days after the fever starts, painful sores can develop in the mouth. A skin rash, flat or raised red spots and sometimes blisters, will develop over one to two days. The rash usually appears on the palms of the hands and soles of the feet: it may also appear on the knees, elbows, buttocks or groin area. Children with a fever and rash should stay at home. Children should not return to school until they have been fever-free for 24 hr as the policy above states. Prevention: Washing hands often with soap and water, especially after changing diapers and using the toilet. Cleaning and disinfecting frequently touched surfaces and soiled items, including toys. Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease. 


Now is a good time to review and explain how illness and fever affect school attendance.  In the fall of 2009, the school board approved certain policies regarding fever in students.  If a student is determined to have a fever at school, that student will be sent home and needs to remain out of school until the student is free of fever for 24 hours without the use of fever-reducing medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin).  This also applies if parents discover their child has a fever at home outside of school hours.  Since normal body temperature can vary widely from person to person,  the temperature measurement which the school uses to automatically send a student home is 100.0 degrees and higher, and parents should use this same guideline. Fever is only one criteria for determining that a child is ill, but it is a crucial one in determining that a child may have an illness that is contagious and more serious than a common cold.

At times a decision is made to send a student  home with a temperature lower than 100.0 degrees because of other symptoms of illness reported by the student or observed by the school nurse or other staff.  Examples of this would be a student who is constantly coughing---not just an occasional cough--- and vomiting by a student.   There are also situations in which a parent is notified because a teacher has observed that the student is not unable to do his school work in the classroom because of illness. Examples of such behavior in the classroom are a child who doesn't want to play at recess, eat lunch, or sits with his or her head down on the desk for a long period of time.   There are many times when a student can start out the day appearing to feel well enough to be at school, and then his or her condition deteriorates as the day progresses---which is normal with illness---especially fever.

We understand that many students will experience cold-type viruses, and we do not expect parents to always keep their children home because of these.  However, when it is determined that a student may be showing signs or illness more severe or incapacitating than a cold or is unable to adequately function in the classroom, parents will be notified that their child needs to go home or to a place outside school designated by the parent.


Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by a type of bacteria called Bordetella pertussis.   Pertussis can cause illness in babies, children, teens, and adults.   It is spread from person to person.  People with pertussis usually spread the disease to another person by coughing or sneezing or when spending a lot of time near one another where you share breathing space. Many babies who get pertussis are infected by older siblings, parents, or caregivers who might not even know they have the disease.  Infected people are most contagious up to about 2 weeks after the cough begins. Antibiotics may shorten the amount of time someone is contagious.

Symptoms of pertussis usually develop within 5 to 10 days after being exposed, but sometimes not for as long as 3 weeks. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. In babies, the cough can be minimal or not even there. Babies may have a symptom known as "apnea." Apnea is a pause in the child's breathing pattern. Pertussis is most dangerous for babies. About half of babies younger than 1 year who get the disease need care in the hospital.

Early symptoms can last for 1 to 2 weeks and usually include: runny nose, low-grade fever (generally minimal throughout the course of the disease), mild occasional cough, and apnea---a pause in breathing (seen in babies usually).  Because pertussis in its early stages appears to be nothing more than the common cold, it is often not suspected or diagnosed until the more severe symptoms appear.

After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may appear and include:

  • Paroxysms (fits) of many, rapid coughs followed by a high-pitched "whoop"
  • Vomiting (throwing up) during or after coughing fits
  • Exhaustion (very tired) after coughing fits

Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to throw up and be very tired. Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and bad as the illness continues, and can occur more often at night. The coughing fits can go on for up to 10 weeks or more.   However, the "whoop" is often not there for people who have milder (less serious) disease. The infection is generally milder in teens and adults, especially those who have been vaccinated.

Persons with pertussis are infectious from the beginning of the catarrhal stage (runny nose, sneezing, low-grade fever, symptoms of the common cold) through the third week after the onset of paroxysms (multiple, rapid coughs) or until 5 days after the start of effective antimicrobial treatment.  Pertussis is a disease easily missed in older children, adults, and children who have been immunized because they have a less severe form of the disease.  This leads to more widespread exposure of the disease to others around that person.

While pertussis vaccines are the most effective tool we have to prevent this disease, no vaccine is 100% effective. If pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious disease. If you have been vaccinated but still get sick, the infection is usually not as bad.

This information is from the Center for Disease Control website


Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it sometimes occurs in older children and adults.  It usually starts with a fever, reduced appetite, sore throat, and a feeling of being unwell (malaise). One or two days after the fever starts, painful sores can develop in the mouth (herpangina). They begin, often in the back of the mouth, as small red spots that blister and can become ulcers. A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.  Not everyone will get all of these symptoms. Some people, especially adults, may show no symptoms at all, but they can still pass the virus to others

Some people, especially young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.

Transmission of hand, foot, and mouth disease

The viruses that cause hand, foot, and mouth disease can be found in an infected person’s nose and throat secretions (such as saliva, sputum, or nasal discharge0, bister fluid, and feces.  An infected person may spread the viruses that cause hand, foot, and mouth disease to another person through: close personal contact, the air (through coughing or sneezing, contact with feces, and contact with contaminated objects and surfaces.

For example, you might get infected by kissing someone who has hand, foot, and mouth disease or by touching a doorknob that has viruses on it then touching your eyes, mouth or nose.  Hand, foot, and mouth disease is not transmitted to or from pets or other animals.

Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the virus to others. This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.


There is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.

A person can lower their risk of being infected by

  • Washing hands often with soap and water, especially after changing diapers and using the toilet. Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
  • Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

Treatment and Care

If a person has mouth sores, it might be painful to swallow. However, it is important for people with hand, foot, and mouth disease to drink enough liquids to prevent dehydration (loss of body fluids

There is no specific treatment for hand, foot, and mouth disease. However, some things can be done to relieve symptoms, such as

  • Taking over-the-counter medications to relieve pain and fever (Caution: Aspirin should not be given to children.)
  • Using mouthwashes or sprays that numb mouth pain

School Attendance

According to the Kansas state epidemiologist, there are no specific rules for excluding children with hand, foot, and mouth disease beyond keeping a child out of school until he or she has been fever-free for a minimum of 24 hours without the use of a fever-reducing medication.  A child is not required to remain home until all lesions in the mouth are gone.


           A concussion is a traumatic brain injury!The Center for Disease Control estimates that 1.6 million to 3.8 million sports related traumatic brain injures (TBIs) occur each year. Estimates indicated that 85 % to 90 % of sports concussions are not recognized or reported.High school football players often do not report concussions for several reasons.

           The majority of concussions in competive sports were attributed to basketball, baseball, football and soccer. Girls competing in sports like basketball are more susceptible to concussions than boys are in the same sports. Female concussion rates in HS basketball are almost 3 times higher than boys rates.

           BRAIN INJURY CAN OCCUR EVEN IF THERE IS NO LOSS OF CONSCIOUSNESS. Loss of consciousness occurs in approximately only 10% of all concussions. Amnesia is 10 times more predictive than loss of consciousness predicting outcome following a concussion.

          Concussions are caused by a direct blow to the head, face, neck or elsewhere ti the body with a force transmitted to the head.

Research shows that it may take days, weeks, or even months to be symptom free following a concussion. Even when physical symptoms, such as headache, are gone, neurocognitive problems may remain!Fiction: The most pronounced symptoms following a concussion are usually seen within the first 24 hours following the injury. FACT: SYMPTOMS OFTEN INCREASE THE SECOND DAY FOLLOWING THE INJURY. Girls take longer than boys to recover from a concussion. An athlete with prior history of headaches or brain injury is more susceptible to concussion and a more prolonged recovery from concussion. Athletes with a previous concussion are more susceptible to another concussion.

Athletes who sustain a concusssion during play should never return to play during that game.

For more information on concussions and sports, please see the attached presentation given by Janet Tyler, PHD with the Kansas Instructional Support Network at the University of Kansas Medical Center. 


One of the most important tasks of the school nurse is vision screening.  By Kansas state law, schools are required to provide vision screening to all enrolled students every 2 years, as a minimum interval.   Vision screening guidelines for school nurses also emphasize the importance of doing such screening annually for all children 8 years and younger.  After the vision screening is done,  the person doing the screening is required to encourage  the parents of students who failed screening to have their child receive an eye examination by an optometrist or ophthalmologist---this is known as a vision referral.  The school nurse is also required to follow-up on referrals made.

An initial vision screening for a student 4 years and older at our school includes: 

  • Distance acuity (far vision)---each eye is tested separately and then with both eyes together
  • Near acuity (near vision))---each eye is tested separately and then with both eyes together 
  • Depth perception--using stereoptic glasses
  • Color vision
  • Fusion testing (only up to age 8)

* For preschoolers and kindergarteners new to the school, the screening also includes fixation, tracking, pupil response, corneal light reflection and near point of convergence.  

* Near acuity is not tested for preschoolers under the age of 4.

Each year, all students in preschool, kindergarten, 1st grade, 2nd grade, 3rd grade, 5th grade, 7th grade, 9th grade and 11th grade receive vision screening.  In addition, each student new to the school that year and all students receiving special services through special ed and the gifted program receive vision screening.   Vision screening is usually done in the fall before Christmas break to ensure that any child who has undetected vision problem will receive the necessary treatment to help him/her in his academic performance through the rest of the school year.   Although children's near acuity remains pretty much the same after the age of 8, distance acuity can begin to change for the worse around the age of 9--sometimes sooner.  

Criteria for referring to an optometrist or opthalmologist are as follows for children 4 years and older: 

  • Distance acuity (far vision) and/or near acuity  of 20/40 or worse (higher numbers indicate a worse condition such as 20/50, etc.) in one or both eyes.
  • Two or more lines difference between the 2 eyes in either distance or near acuity.  An example would be a child having 20/20  distance or near acuity in the right eye and 20/30 in the left eye.   The lines checked are 20/20, 20/25, 20/30, 20/40, 20/50, etc. going as high as needed to find where a child's vision is at.
  • With the Worth 4 dot test for fusion, the child counts an incorrect number of dots
  • Inability to track properly with eyes, inability to fixate on an object or fixation with one eye only----such as in 'crossed eyes'
  • With corneal light reflection, the reflection of a penlight does not appear in the same position in each pupil.
  • With the near point of convergence, there is poor fixation of eyes to object beyond 3 inches of nose or asymmetrical response between the eyes.
  • For depth perception, inability to detect butterfly in stereoptic book
  • For children 3 years old, the criteria for referring for distance vision is 20/50 in one or both eyes.

Vision screening at school should not replace having regular eye examinations for children.  There are eye conditions which can only be detected with the more sophisticated equipment and knowledge of an optometrist or opthalmologist.   At times, a child may pass the vision screening done at school but still have a vision problem.  Some examples of such vision problem areas are teaming of the eyes, ability of the eyes to remain focused,  and visual perceptive processing disorder.  In that situation, the eyes can see but the brain and eyes are not working properly together to process what the child is seeing. 

It is recommended that children begin having eye examinations at the age of 3 and in Kansas, all children age are eligible for free eye examinations under a program called See to Learn.  There are a large number of optometrists who participate in this program, including optometrists in Wellington and Arkansas City as well as other local communities.   Vision is crucial to all areas of academic learning so the sooner children have an eye examination, the better!  

For anyone who has questions about the See to Learn program or vision screening at school, you are welcome to contact our school nurse,  Jami Kuchar, R.N. at 620-892-5215 Monday through Friday between 9 AM and 3 PM.


Over-the Counter Medications:

Students are not allowed carry over-the-counter medications with them at school. The school nurse has a variety of over-the-counter medications on hand in her office which can be given to students whose parent/guardian has signed an over-the-counter medication consent form. These medications will only be given at the discretion of the school nurse or in her absence, a designated school staff person. Parents may send in additional over-the-counter medications but they must be accompanied by a written note with the name of the medication and directions for amount to give and time to give signed by the parent. If over-the-counter medication(s) are requested by a student during school hours, the medication(s) may only be given if an over-the-counter medication consent is on file in the school nurse's office. New forms have to be completed each school year. To download the over-the-counter medication consent form, click below.

Prescription Medications:

All prescription medications to be taken at school must be accompanied by a written statement signed by the physician/health care provider and a written note signed by the parent/guardian. The written statement from the physician can be a note written on a prescription pad. All medication must be sent in the original container from the pharmacy with the prescription label on it.  To download the prescription medication form, click here.

All Medications:

Students in grades PreK through 5th grade bringing any medication to school should give the medication to their classroom teacher upon arrival at school. Teachers will give all medications to the school nurse or delegated staff person unless the teacher has been delegated by the school nurse to administer the medication. Students in middle school and high school bringing any medication to school should give the medication to the high school secretary upon arrival at school. The high school secretary will then give that medication to the school nurse.  Medications may only be administered by the school nurse or those school staff who have been delegated by the school nurse.


As school nurse, my goal is to help our students maintain optimal health so they can fully take advantage of the educational opportunities offered to them.  

The school nurse provides the following services:

  • Vision and hearing screenings at various grade levels. Parents will be contacted if their child does not pass any screening.
  • Dental screenings performed by a local dentist.   Parents will be notified of results of dental screenings.
  • Management of prescription medications and over-the-counter medications administered during school activities
  • Maintain individual health record for each student, including immunization records.
  • Notification of required immunizations for each school year.  Parents will be notified each spring of required immunizations for students. 
  • Injury and illness assessment.
  • Basic first aid measures for injuries..
  • Identification of health concerns and individualized health care plans as needed.
  • Baseline cognitive computerized testing for athletes prior to each sport season.
  • Health information resource for students, parents, and faculty
  • Health promotion activities.
  • Chronic disease monitoring.

Parents are encouraged to contact me with any health concerns that may affect your child during the school day.  I appreciate the opportunity to work with students and parents to provide a safe, healthy environment for learning. 

Jami Kuchar, RN