8:45 am: Buses arrive, doors open. 3 students arrive together.

Student #1: “I just threw up in the parking lot”. Temp 99.7 – not really high enough for exclusion but together with vomiting, I'll call mom.
Student #2: “I was coming in from the bus and I was talking to my friend and I didn't see that another boy stopped so I ran into him and fell down and scraped my knee and it's really bleeding and I need a band-aid.” Wash scrape with soap and water, bandage, off to class. 
Student #3: “I was feeling bad all weekend so my mom told me to come see you if I still don't feel good today and she would pick me up.”
Me: “Did you tell your mom you were feeling bad this morning?”
Student #3: “Yes, and she told me to go to school and give it a try and if I didn't feel good I can come home.”
Me: “Honey, I think your mom meant for you to give it more of a try than just walking into the school. Let me check your temperature. 97.5 – that's ok. Go on to class and if you still feel bad at lunch come back and see me again.”
Student #3: “Ok...” Trots off to class.

8:55 am: Diabetic student (#4) arrives, eats breakfast, calculates carbohydrates and insulin, gives himself insulin and goes to class (about 9:10).
AM medication student (#5) hasn't shown up yet, so I call his teacher and she sends him down. Pill given. “See you tomorrow – have a good day!”

9:00 am: Bell rings, morning announcements commence.

9:04 am: Student #6: “I hurt my finger this weekend playing softball. My dad said I should come and let you look at it to see if I need to go to the doctor.” Ugh. Ok. Let's see – no bruising, moves it easily, no swelling.  
Me: “Has it gotten worse or better or stayed the same since you hurt it?”
Student #6: “It's gotten a little better but it still hurts.”
  Me: “Ok. Let's get you an ice pack. If it still hurts bad in another day or two, then you should get it checked out. I'm not a doctor and I don't have x-ray vision, so I can't say for sure, but I think you may have just sprained or jammed it a little.” Back to class.

9:10 am: Student #7: “I have a canker sore again.”
Me: “Again? You need to tell your doctor or your dentist about that the next time you go. Let's give you some numbing stuff for now.”

9:12 am: Student #8: “I need a cough drop.”
Me: “Ok. You can come back for another one in 2 hours – that's about 11:15, all right? Drink lots of water.”
Student #8: “Ok.” Back to class.

9:15 am: Student #9: “I broke my glasses, and I was trying to fix them and I got super glue on the lenses this morning.”
Me: “Uh oh... that's a bad spot to break them in, right there at the nose piece. I'll see if I can fix it for now, but it won't hold past today. You need to get a new pair of glasses. If that's a problem, have your parents give me a call.” Twenty minutes of string, super glue, acetone and multiple incidents of me gluing myself to the frame later, back to class with very temporarily fixed glasses.

9:25 am: Student #10: “I have a stomach ache and I feel like I'm going to throw up.”
Me (immobilized by super glue and glasses): “Ok. Did you eat breakfast today? When did your tummy start to hurt? When was the last time you pooped? Was that normal or diarrhea?”
Student #10: “I didn't eat any breakfast because I didn't feel good. My tummy started to hurt when we were doing math. I don't remember when I pooped – no, not today. Not yesterday either.”
Me: “All right. Why don't you lie down for a few minutes and rest. I'll check your temperature as soon as my hands are free. I really would like you to drink some water and try to poop for me, ok? Sometimes our tummies hurt because they're full of poop.”
Student #10: “Ewww. I don't like to poop at school. That's gross.”
Me: “Ok, just rest for a little bit and then you can use MY bathroom. See, it's right here.”
Student #10: “All right.” Lies down.

9:30 am: Student #11: “I'm going to gym and I need my inhaler.”
Me: “Here you go. Remember, with these new inhalers you need to spray one or two puffs into the air before you use them, or you won't be sure you are getting any medicine. Don't you have a spacer?”
Student #11: “No, I don't use that anymore. I'm not a little kid anymore.”
Me: “Spacers aren't just for little kids. Especially with the HFA inhalers you need to use one so you are sure you're getting your medicine into your lungs instead of on your tongue. Do you still have one?”
Student #11: “Yeah, I have one at home.”
Me: “Well, you should start using it again. Try it and see if it helps.”
Student #11: “Ok.”

9:35 am: Student #10: “Hey, Mrs. Nurse, I went to the bathroom and I feel better. Can I go back to class now?”  
Me: “Sure, if you feel all right. If you start feeling bad later come back and let me check you again.”

10:05 am: Student #12: “I need a belt. My pants keep falling down.”
Me: “I don't have any belts. Let me see – if we tie two of your belt loops together it might tighten your pants enough to keep them up. How's that?”
Student #12: “Cool, that feels better. Thanks.”

11:00 am: Diabetic student comes to check his blood sugar: “352”  
Me: “Well, drink lots of water. We're running out of test strips – I need to call your mom and let her know again.”

11:10 am: Before lunch medication students come for their medications – one digestive (#13), three ADHD (#14, 15, 16), one schizophrenia (#17). S#8 returns for second cough drop.

11:40 am: Student #18: (sniffling) “I was going out to the playground and I hurt my hand in the door.”
Me: “Looks like you got a blood blister on your hand. Let's clean it off and bandage it, and we'll get you an ice pack so it doesn't bruise more.”

11:45 am: Student #19: “I was swinging on the monkey bars and I got a blister on my hand.”
Me: “Ouch! Go wash your hands off and we'll put a bandage on that blister so it doesn't pop. I really hate the monkey bars. Everyone gets hurt on them.”
Student #19: “Ow! My hand hurts!”
Me: “Well, let's get you fixed up and I'll give you an icepack so it'll feel better.”
Student #19: “Ok.”

11:50 am: Student #20: “I threw up on the playground.”
Me: “When did you start feeling sick?”
Student #20: “When I was playing on the playground.”
Me: “What were you playing?”
Student #20: “We were playing tag.”
Me: “How do you feel now? Do you feel like you're going to throw up again?”
Student #20: “I feel ok.”
Me: “Sometimes when you run around too much after lunch you can throw up, because your body is still trying to digest the food. Why don't you lie down for awhile, and then we'll try some crackers and water and see how you do.”
Student #20: “Ok. Can I go back out after that?”
Me: “I think your grade is almost done with recess, but we'll see.”

11:55 am: Four students arrive together.  
Me: “Ok... what are you all here for?”
Student #21: “I fell in a puddle.”
Student #22: “I was running and didn't see my friend and we ran into each other and my head hit her head and now my head hurts.”
Student #23: “My head hurts too.”
Me: “Are you the one she ran into?”
Student #23: “Yeah.”
Student #24: “My friend and I were playing and she scratched my neck.”
Me: “Let me see. Wow, you've got some bad scratches there. Does the playground supervisor know that this happened?”
Student #24: “Yes, I told her about it.”
Me: “Ok. You – what size of pants do you wear? Let's see – here you go. Try this one. Here's a bag for your wet ones. You two – are you dizzy? Did you pass out? Do you feel sick? Let me see where you bumped heads. No bruises or swelling. Let's get you some ice packs.”
Student #20: “I'm done with my crackers. Can I go back out now?”
Me: “All right, but take it easy. Don't run too much.”
Student #20: “Fine.” Runs out.
Me: “Ok, let's get those scratches cleaned up. I'll put some antibiotic ointment on them. Let me check them again tomorrow to make sure they don't get infected.”

12:00 pm: Playground supervisor hurries in carrying Student #25 who is crying.
PS: “He fell off the monkey bars.”
Me: “Ok, where does it hurt? Your arm? I see. Hold that real still, ok? I'm going to put some ice on that and call your mom. I think it might be broken. Hi. This is the school nurse. Your son fell off the monkey bars and his right forearm is swollen and may be broken. I think he needs to get checked out right away. Can you come and take him to the ER? Ok, thanks. I'll splint it, and I've got some ice on it. He should be all right until you get there.”
I splint the arm and make a sling. Mom arrives and we put Student #25 in the car.

12:10 pm: Student #26 (crying): “I was on the playground by the trees and I got stung by a bee. It really burns!” 
Me: “Let me see. Hold still – I'll scrape the stinger off. There. Now we're going to make it feel a little better. Here's an ice pack; hold it on there while I make some stuff to put on it.”
Student #26: “What's that?”
Me: “Baking soda. If you mix baking soda with a little bit of water so it's a paste it takes some of the sting out of bee stings. Meat tenderizer works too.”
Student #26: “Wow. Weird. I didn't know that.”

12:15 pm: Diabetic student stops in for his before lunch blood sugar test. “298”

12:20 pm: Student #27: “My tooth is loose and it hurts.”
Me: “How about we put some numbing medicine on it and then I'll give you some gauze so you can wiggle it better.”
Student #27: “All right. Do I stay here until I get it out?”
Me: “No, no. Go on back to class and come back when you get it out so you can put your name on my big tooth on the door.”

12:25 pm: Student #28: “My teacher sent me down here so you can check my head. It's really itchy.”
Me: “Ok, let me see. Well, I see lots of dandruff but no bugs. Maybe you need to talk to your mom about getting a dandruff shampoo.”

12:35 pm: Kindergarten teacher calls: “I have a little fellow who had an accident in my bathroom and is standing in there without any pants. Bring some wipes too, please.” I gather up assorted small underwear and pants as well as baby wipes and head to the kindergarten classrooms. A small, dejected boy (#29) with a mess on his rear end and no pants is standing in the bathroom. I clean him off and dress him, and wrap his soiled clothes up in several plastic bags, which go into his backpack.

2:50 pm: Diabetic student returns for after lunch carbohydrate calculation and insulin injection. “This lunch menu says we're supposed to have sausage pizza today but it was cheese. What do I do now? I don't know how many carbs that is.”
Me: “Well, let's look through these menus from last month. Here you go – this one has cheese pizza.”
Student calculates carbs and insulin for lunch. “6.3 units, so 6 units.”
Me: “Ok, what else do you need to do now?”
DS: “Oh, my corrective bolus. 298 minus 120 is 178. 178 divided by 38 is 4.38, so 4 units.”
Me: “Make sure you add them before you round them though.”
DS: “Oh, I see. 11 units.” Gives himself insulin and leaves.

12:55 pm: Playground supervisor pokes her head through the door: “Did you see that girl I sent in with the scratches?”
Me: “Yes, I did. They were pretty nasty. What happened?”
  PS: “Her friend was pretending she was a cat and clawed her.” We giggle.

1:00 pm: Case conference for student with severe seizure disorder; emergency plan and health care plan made (about 1 hour). Secretaries take care of Student #30 (toileting accident), Student #31 (scraped knee), Student #32 (contact lens problem), Student #33 (bruise), Student #34 (needs inhaler for gym) and Student #35 (cough drop). S#8 also returns for another cough drop.

2:00 pm: Student #36: “My teacher sent me down here so you can check my head. It's really itchy.”
Me: “Ok, let me see. All right – I do see some eggs and some baby bugs. I don't see any grown up bugs. Has your mom treated you for this already?”  
Student #36: “Yeah. She used that shampoo stuff this weekend.”
  Me: “Ok. You need to be re-treated 7 to 10 days after the last treatment, so if you were treated on Saturday then you need to be re-treated between Saturday and Tuesday. Since you were treated and don't have any grown up bugs, go on back to class. Don't share any hats or combs and such with your friends, and no hugging until after you get treated again, ok? I'll call your mom and let her know what's going on.”  
Student #36: “Ok.”

2:10 pm: Students #37, 38 and 39 come in together. “Our teacher wants you to check our eyes.”
  Me: “Ok. Two of you sit down over there. You stand right here. Put on these glasses – I know, they're weird. They cover one eye. This other pair covers the other eye. Now – can you read this line? No? What about this one? Ok, what's the lowest line you can read? Good. Switch glasses. Which line can you read? All right. Next!”

2:20 pm: Student #40 comes in clutching a bundle of paper towels to her nose.  
Me: “Right. Sit down over there. Let me see how bad it is. Hmm, looks like it's almost stopped bleeding. Here is some gauze. Pinch your nose with this and hold it tight for 5 minutes. Don't let go and don't check to see if it's still bleeding.”
Student #40: “Ok. I got some on my shirt too.”
Me: “Well, we'll change your shirt after we get your nosebleed stopped.”

2:25 pm: Me: “Let me see. Looks like your nose has stopped bleeding. Why don't you go wash your hands and face and when you're done I'll check to see if it's really done. Don't blow your nose, pick your nose, rub your nose or sniff really hard for about an hour. There is a kind of clot in there that needs to turn into a scab. If you knock it off it'll start bleeding again. Here's a new t-shirt – let me put some peroxide on that blood so it'll come out.”

2:30 pm: Student #41 comes in for afternoon medication.

2:40 pm: Student #42: “I've got a sore throat.”
Me: “Let me check your temperature. No fever – let me take a look in your throat. Looks a little red, but not too bad. You have some drainage in the back of your throat. That can make it hurt really bad. Do you want to try a throat lozenge or some throat spray?”
Student #42: “Uck. I hate that throat spray stuff.”
Me: “Do you want to try a lozenge? It kind of numbs up your throat so it doesn't hurt so bad. Drink lots of water too.”

2:50 pm: Diabetic student doesn't show up for afternoon blood sugar check. I go to classroom and check his sugar – 130. “I'll check it again at 3:15 to make sure you don't get too low.”

3:00 pm: Parent calls with questions about immunizations. I pull the child's record and check it against the CHIRP database.
Me: “Looks like all she needs right now is the second chicken pox shot. Other than that she's ok until 5th grade. Would you bring us a copy of the shot record after she gets updated? Thanks.”

3:15 pm: Diabetic student comes in saying he feels low. Blood sugar is 68.  
Me: “Ok, let's give you 15 carbs and recheck right before 3:30 to make sure you're ok.”
DS eats 8 glucose tablets and returns to class.

3:28 pm: I recheck diabetic student – 140.
“Ok, you're fine. Have a good day. Don't forget your notebook so your mom knows what your sugars were today.”

3:30 pm: Bell rings, students are dismissed.


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