HUMBOLDT COUNTY SCHOOL DISTRICT
SCHEDULE OF SCREENING BY GRADE
Vision/Dental Screening: Kindergarten, 2, 4, 6, 8, and 10
Hearing Screening: Kindergarten, 2, 4, 6, 8, and 10
Scoliosis Screening: 7
Height/Weight Screening: Kindergarten, 1, 2, 3, 4, 6, 8, and 10
All new students will be screened regardless of grade level
SEE: NEVADA STATE LAW: HEALTH SCREENINGS
Cardiovascular appraisal in the school setting includes assessment of the radial and apical heart rate and measurement of blood pressure. Recognition of risk factors and knowledge of principles of heart disease prevention are important to the assessment process.
Any student who presents with signs or symptoms of cardiac concerns needs screening assessment. Cardiovascular assessment is also part of the routine physical examination. Blood pressure screening may be a part of physical fitness programs.
1. Chest Pain
4. Shortness of Breath
6. Urinary Tract Problems
8. Family History of Hypertension
1. Proper cuff size is critical to accurate blood pressure measurement. For both adults and children, cuffs that are too wide will underestimate blood pressure, and those that are too narrow will give an artificially high measurement. The correct cuff size ensures that equal pressure will be exerted around the artery resulting in accurate measurement.
Cuff size considerations for children and adolescents: Bladder width should not exceed 2/3 the length of neither the upper arm nor less than ½ the length. Bladder length should not completely wrap around or overlap the extremity being used to take the measurement. Ideally, it should cover ¾ the circumference of the extremity.
Obese children for whom accuracy in pressure reading is especially important may need measuring with an adult cuff.
2. Slow or repeated inflation of the cuff can cause venous congestion and result in inaccurate readings. Elevating the arm for one minute and retaking the blood pressure can relieve venous congestion.
3. Activity, apprehension, and anxiety increase blood pressure. A five-minute rests and calmness prior to measurement is important.
Hypertension is a condition established and diagnosed over time. A single reading or several readings on the same day may not be conclusive EXCEPT in situations of malignant hypertension. An elevated single reading needs follow-up for a week with measurement at approximately the same time each day. Use "Classification of Hypertension by Age Group" and "Normal Blood Pressure Values at Various Ages" charts as referral guides. Blood pressure curves for boys and girls age 2-18 present another type of guideline. Follow-up on any reading that is above the 95th percentile.
Many lay persons still think that the "normal" body temperature is 98.6 and anything higher is abnormal or fever. Actually, a person's temperature varies with the time of day (lower in the morning, higher in the afternoon) and with the room temperature.
Most doctors feel that unless a temperature is over 100degrees F, it is not in itself a sign of illness. Children with temperatures between 99-100 needed other signs of illness to be sent home.
Dental screening is based on a professional understanding and competency in dental appraisal techniques. It includes principles of dental health and nutrition, oral hygiene, and plaque control techniques.
1. The school nurse/designee will conduct dental inspections, counsel students, record and report recommendations to parents as indicated.
2. A Nevada State Dental clinic is available for those who qualify through the Community Health Nursing Service. Qualifications change periodically and current information can be obtained from Community Health.
3. For emergency dental problems or if a student's family does not have a dentist, referrals can be made to the Emergency Room of the Humboldt General Hospital.
4. For minor dental problems refer to Dental First Aid Guidelines. (See Appendix J)
5. All findings and recommendations are documented in the student's health record.
Special alerts in dental screening:
1. Inflammation of gums-red, swollen, tender to touch, bleed easily.
2. Stains on teeth.
3. Breath odor.
4. Hard deposits of tarter on teeth.
5. Obvious cavities.
6. Missing teeth or extra teeth.
7. Noticeable protrusion of upper or lower jaw.
8. Sores in the mouth.
9. Irregular alignment of the teeth.
10. Thumb sucking.
11. Tongue thrust.
1. Determine the age of the student and date of last visit to the dentist.
2. Observe the mouth and the teeth for special alerts as listed above. Note the color and appearance of lips, mucosa, tongue, palate and floor of the mouth.
3. Count the number of teeth. Compare number with the tooth eruption schedule.
4. Observe the chewing surfaces of the teeth.
5. Note the bite of the teeth; observe for lower teeth outside the upper teeth, overlapping of teeth or two teeth in the space for one.
Proper occlusion is apparent when the upper molars rest directly on lower molars and the upper incisors slightly override the lower incisors. Protrusion of the upper or lower incisors, failure of the upper incisors to overlap with the lower incisors and back teeth that do not meet are indication of malocclusion.
3. Fistulas or gum boils at root tip
4. Irregularity in alignment
5. Missing permanent teeth-depending on age of the student
6. Inflamed and/or swollen gum tissue
Height and weight measurement is recommended each year for students in the elementary grades, students who are referred for health concerns, and students who are referred for Special Education health Appraisals.
1. An elementary student who fails to grow heavier and taller over time.
2. Change in growth pattern from the norm for the student.
3. Significant differential between height and weight percentile.
4. Unusual increases or decreases in weight.
5. Unusual largeness or smallness of the student.
1. Balance scale before weighing the student.
2. Have student REMOVE SHOES, JACKET, OR HEAVY SWEATER prior to measurement of height and weight.
3. An adult with calculation of the weight could hold physically disabled students who are unable to stand by the subtraction method.
4. Calculation of the height of the physically disabled student who is unable to stand can be obtained by measurement of the head to heel length while the student is positioned on the back.
5. Students who are overweight, "too" tall, "too" short, or "too" thin need to be treated with sensitivity and kindness. Individual circumstances will call for creativity on the part of the nurse or designee to avoid embarrassment to the student.
Students who are anorexic or bulimic or in recovery may be sensitive to measurement of weight. Nursing judgement is important at this time.
6. Compare measurement results with previous recordings noting any questionable findings so that measurement errors can be eliminated.
7. Record results in the student health record.
Recording and use of Growth Curves:
Physical growth is one of the best markers of a child's general health status. When height and weight measurements are obtained on a regular, at least yearly basis, the growth pattern of the child can be determined. Plotting of the results on a growth curve enables the tracking of height and weight measurements through continuous and possibly uneven growth patterns. The resulting individual curve becomes more reliable as an index of the child's growth pattern than individual numeric measurements.
Therefore, if height and weight results are included in health reports, the numeric measurement should be accompanied by the corresponding percentile reading from the growth curve. If deviations from normal are noted, previous measurements with the corresponding percentile readings should be included in the report or referral.
Judgement and evaluation of genetic background, that is parental stature, is important in the evaluation of a student's growth. Cultural differences and race specific standards need to be taken into consideration.
Investigate further any growth measure that:
1. Falls below the 5th or above the 95th percentile with no genetic explanation.
2. Indicates a greater than 20 percentile spread between height and weight when the weight is at the higher percentile; (i.e. 50%tile for height, 75%tile for weight). Conversely, significant discrepancy between height and weight percentiles with the height percentile higher than the weight; (i.e. 50%tile for height and 5%tile for the weight).
3. Shows that growth has suddenly stopped when it had been steady on the curve. Persistent plateauing of weight loss needs a more detailed assessment.
HEARING SCREENING PROGRAM
Nevada School Law for school age children mandates hearing screening. It is designed for early identification and intervention for children with hearing disorders. In addition, a hearing screening program provides for follow-up of identified students with permanent hearing impairment. The student is assisted in obtaining individual educational interventions that will help to maximize the student's academic performance.
Students to Be Screened:
B. Grades 1, 2, 3, 5, 8, and 10.
C. All students new to the school system.
D. Students with a known hearing loss. (Including high frequency losses).
E. All students who are repeating a grade.
F. All students referred or enrolled in a Special Education Program.
G. A student with a health history of recurrent upper respiratory or middle ears infections.
H. Any student who failed a hearing screening in the previous year and did not receive follow-up evaluation.
I. Any student referred by a parent or a teacher.
SPINAL SCREENING PROGRAM
Scoliosis screening is mandated by Nevada School Law (N.R.S. 392.420) for school age children. It is designed to identify children with spinal deformities, physical symptoms of scoliosis, and to refer involved children for further evaluation.
Students to be screened:
A. Students in the seventh grade.
B. Siblings of an identified student with diagnosed scoliosis.
C. Previously identified students who have not received follow-up intervention.
D. Students confined to wheelchairs.
E. Previously identified students who are under treatment or regular follow-up need not be rescreened.
An information letter is sent to parents of students who will be screened for scoliosis. Parental permission is not needed for screening. Some parents may request that their child be excused from the screening. This request will be honored.
1. History and External Observations
Purpose: To detect any physical or obvious abnormalities.
Grade: Should be spontaneous on-going observation of students by the nurse and the teachers.
Procedure: Provide teachers with a list of suspicious signs and symptoms associated with scoliosis. Classroom education of students prior to scoliosis screening will provide information for both the teacher and the students.
II Classroom Instruction of Students Includes Information On:
A. Definition of scoliosis, lordosis, and kyphosis.
B. Identification of scoliosis.
C. Importance of early identification and screening programs.
D. Components of the screening procedure-Privacy provisions and body positions.
E. Required dress to facilitate observation during the screening (Shorts, no shirts, no shoes; bra, halter, or swim suit top permitted for girls).
III Screening Procedure
A. Location for separate screening areas for boys and girls needs to be arranged. The area needs to be well lighted and large enough for movement to allow visualization of the back as the students moves