Audience: Nurse

Skin cancer can develop anywhere on the skin. Ask someone for help when checking your skin and scalp, specifically in hard to see places. If you notice a mole different from others, or that changes, enlarges, itches or bleeds, you should see a dermatologist.


Nearly 1.5 million people in US are diagnosed with skin cancer annually. This common form of cancer also causes more than 12,000 deaths a year. Individuals with blond or red hair are two to four times more likely of developing melanoma, the deadliest form. Excessive exposure to the sun’s harmful ultraviolet rays – leading cause of skin cancer – can harm you even when you are in the shade, so always were sunscreen. Although UV radiation is one source of Vitamin D, it is recommended that you safely get Vitamin D eating a healthy diet or vitamin supplements.


The first 5 letters of the alphabet are a guide to the early warning signs of melanoma. These signs are not proof of melanoma but to be on guard and monitor these areas. Melanoma can develop anywhere, even in places that are exposed to the sun, such as your nasal membranes, the soles of your feet or even under your nails.

A – Asymmetry. Mole that is not equal in sides when you “draw” a line through it may be a warning sign of Melanoma

B - Border. The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

C - Color. Having a variety of colors is another warning signal. Different shades of brown, tan or black could appear. A melanoma may also become red, white or blue.

D - Diameter. Melanomas usually are larger in diameter than the eraser on your pencil tip (1/4 inch or 6mm).

E – Evolving or changing. When a mole is evolving, see a doctor. Any change- in size, shape, color, elevation, or another trait, or new symptom such as bleeding, itching or crusting- points to danger.


Wearing sunscreen every day is one of the most important steps you can take to protect your skin from the harmful effects of the sun. The FDA has standardized the definition of a broad spectrum sunscreen – one that has a SPF of at least 30, and that it provides protection from both UVA and UVB rays.


Have a Wonderful Summer!


Schedule your child for a physical and immunizations if new to Pre-K, entering Grades K and Gr 7, Gr 8 and/or new to Jamestown Schools, and if your 6th graders are planning on Fall Sports. All exams and series must be up to date for school entry. Feel free to mail in the forms to either school and please ensure your child’s FULL NAME and GRADE are written on exam forms.

Posted by: Jennifer Romph
Published: 6/1/17

Audience: Nurse

Children generally do not complain about problems with their vision. Eye problems that are not corrected may lead to a permanent loss of sight. Many vision problems in children cannot be seen, but sometimes there are signs of a vision problem. Strabismus often called “cross-eyed or squint”; Leukocoria, a pupil that looks white when light reflects on the eye or Ptosis, a drooping eyelid that blocks part of what the eye can see. Children who need to sit close to the television screen, hold books close to their face, or do not see objects in the distance, may need an eye examination.


What can you do?

  1. Watch your child while at play, and while looking at books, pets, or other people. If something doesn’t seem right, discuss this with your child’s provider.
  2. Talk with your doctor about any family history of vision problems (such as ‘lazy eye”, a “crossed eye”, use of an eye patch to correct vision or need for eyeglasses with strong prescription.
  3. Have a vision screening at every well child visit and as needed. During the school ages, children have vision screenings in K (if not done at their provider’s office), Grades 1-5 and 7th, and once during high school years.
  4. If your child is referred after 2nd vision screening, follow up and submit copy of the results to the school.

Protect your eyes from the sun by wearing sunglasses that block 100% of UVA and UVB rays from the sun. Recommend that your child to wear safety eye wear for sport activities with hard balls and safety eye wear if they have limited or no vision in one eye to protect the eye with vision.


Screenings: May 26th – RI Hearing Center will be screenings students in Grades K-3.

Posted by: Jennifer Romph
Published: 5/1/17

Audience: Nurse

T1DM can occur at any age but peaks at ages 2, 4-6, and 10-14 years of children. 70% of T1DM are diagnosed by age of 30. T1DM accounts for 5-10% of all diabetes, affects 1.4 million in USA and Caucasians are more susceptible.


How does T1DM present? The classic symptoms are extreme thirst and urination. Urination comes first then thirst, these children are awake all night. Other symptoms are weight loss, fatigue which may progress over months, and symptoms progress with acute illnesses; flu, appendicitis, extreme stress that increases cortisol levels which increases the blood glucose levels. In children, insulin is needed for proper growth and insulin needs increase during times of physiological stress (illness or puberty).


The history of insulin can be traced back to 1916 to now. More commonly used insulin for T1DM are Humalog, Regular, Lantus, and Levemir. Modern dosing is based on schedule of meals and bedtimes and dose is related to blood glucose for younger children and as they grow older, calculate insulin for blood glucose and their carbohydrates. Children ages 1-4 years, doses are lower for

safety and their unpredictable level of activity. School age child factors in carbs as their activity level is usually consistent in the school day. Young adolescents may begin managing insulin pump but their bodies are changing with puberty, may sneak extra snacks and activity level changes with after school programs/sports.


Hypoglycemia is a special situation that requires immediate intervention. This occurs when individual has low blood glucose level <80 and continuous to drop. It can happen when individual has taken too much insulin, has not eaten enough food or excessive exercising. The treatment is following the 15-15 rule. Look at the individual, are they confused, sweating, feeling shaky, pale, and

drowsy, verbalizing feels low, and hungry. Give 4 oz of juice (15gms) and recheck blood glucose in 15 minutes. Always send an adult with young child to be cared for. Repeat if blood glucose remains less than 80.


Technology is increasing with new meters that are web based; bionic

pancreas pumps and CGM (continuous glucose monitoring meter) that help the individual and families better manage the T1DM condition. Dexacom is one of companies that develop the CGM. Having the continuous reading sent to close proximity of IPOD and cell phone of the school nurse-teacher allows school to keep tabs on students with Diabetes during the day. When low/high alarms settings

go off, the student must always check their blood glucose for accuracy.


There are summer camps for T1DM individuals that are offered through Joslin: Camp Joslin for boys/Camp Clara Barton for girls and in RN- Camp Surefire. Camp Surefire is held at Alton Jones during week of June 25-30, 2017. Students can meet other individuals with T1DM and gain confidence and knowledge with their diagnosis.

Posted by: Jennifer Romph
Published: 4/1/17

Audience: Nurse

What are the common signs of a heart attack? Persistent pain or discomfort in the chest that feels like an elephant sitting on your chest, lightheadedness, nausea with/without vomiting, jaw, neck or back pain, discomfort that increases in pain in arm or shoulder, sweating, skin pale or grayish hue to skin, and shortness of breath. With any of these signs CALL 911.


What are the common signs of a stroke? Sudden slurred speech, confusion or understanding, difficulty speaking, facial droop, and numbness or weakness on one side of body, sudden dizziness, loss of balance or coordination, loss of vision in one or both eyes, and a sudden severe headache with no known cause. The acronym FAST for caring for someone who may be experiencing a stroke is FACE

drooping, ARM weakness, SPEECH difficulty and TIME to call 911. Time is of the essence for getting to a hospital to treat the symptoms within 90 minutes and may prevent long-term disability.


What to do – first and foremost call 911. Remain calm. Obtain all medications; get detailed description of the time when symptoms began (very important with stroke like symptoms) and keep the individual in a position of comfort. Stay with that person. Individuals with any medical history, it is a recommendation, that an index card is attached to your refrigerator door for information that can be given to EMS on arrival. Listed on that card should be allergies, all medications scheduled and as needed (include vitamins), immunization history, living will, and all health care providers names/phone numbers.


New EMS Guidelines which will be enacted is CPR for a full thirty minutes on the scene before transporting to the hospital. First responders will be able to assess pulse, airway, bleeding, and need for intervention: AED/defibrillator, CPR, initiating an intravenous access, and airway management. This may be difficult for families and others to watch and wonder why are they not transporting to nearest ED. Studies have shown that on scene 30 minute resuscitation improves the outcomes for the individual.


Upcoming Screening: March 21 st – Dental Screenings with Coastal Dental

Posted by: Jennifer Romph
Published: 3/1/17

Audience: Nurse

The CDC has released the latest AICP recommendations that adolescents, who begin the HPV vaccination series before the age of 15, will only require two doses of the vaccine.

HPV vaccine recommendations for target age groups remain the same as before. Routine HPV vaccination is recommended at 11 or 12 years of age. The vaccination series can be started as early as 9 years of age. The vaccine is recommended through ages 26 for females and through age 21-26 for males not previously vaccinated.

The new dosing schedule for those initiating vaccination from:

Ages 9-14 - receive 1st dose with a minimum of 5 month interval before 2nd dose.

Ages 15-26 - initiating vaccine at age 15, receive total of 3 doses: 1st one, 2nd one within 1-2 months and 3rd dose 6 months after the 2nd dose.

Impact on RI school Immunization Regulations:
The new recommendations have no effect on the immunization requirements for 7th and 8th grade students. Students entering Gr 7 will need one dose and those entering 8th grade will need two doses. The recommendation will affect some 9th graders.

  • Adolescents 14 year old upon entering 9th grade who have already received 2 doses of HPV vaccine at least 6 month apart, per the recommendation , will not be required to have a 3rd dose.
  • Adolescents 14 years old upon entering the 9th grade who have already received 2 doses of HPV given less than 5 months apart, will be required to have a third dose.
  • Adolescents 15 years old upon entering the 9th grade will be required to have 3 doses.


Posted by: Jennifer Romph
Published: 2/2/17

Audience: Nurse

The heroin epidemic that has been taking the lives of young adults for years is creeping into even younger age groups. This epidemic pushed RI legislators to enact a law that schools have a fast-

acting antidote available in schools from grades 6-12. Although overdoses are rare at middle school level, the drug Naloxone is becoming part of the first responder treatment. Required are nasal spray Naloxone, and when administered to someone with known or suspected opioid overdose, Naloxone aids in that individual breathing again and it does not have major side effects. To allay concerns that school employees could be sued for giving a life-saving drug, the RI law states no one can be held liable for using it or be disciplined for refusing training.  


Naloxone is known by the brand name, Narcan, and was first approved by FDA in 1971.  Advocates say it could save child, parent or school employees who overdose on heroin or prescription painkillers. It is now recommended to be given should an individual present with no respirations or poor respiratory effort in the CPR algorithm. School doses are 2mg at the present time with one repeat dose and are intended for use in the nose only. Naloxone is intended for immediate administration as emergency therapy.


Health care providers are being monitored for painkiller prescriptions. The new recommendation is less than 30 day prescription. This is due to study that reports 4 out of 5 heroin users first abused prescription painkillers, which are chemically similar to heroin. CDC reports that 44 people die every day due to overdose and those individuals who are addicted to opioid painkillers are 40 times

more likely to try heroin.  


A survey of 81 RI School Nurse-Teachers who participated in a Naloxone training program last year found that 43% of high school nurses reported that students in their schools ere abusing opioids and that 15 called 911 at least one in three years for suspected use or overdose. Since the law passed, Jamestown Lawn Avenue School does have required antidote if needed and at this time has not administered it to any individual.


Welcome Back and Happy 2017!


Upcoming Screenings – Scoliosis in students Grades 6, 7 and 8.

Vision screening in Grade 1 / Color Vision screening in K.

Posted by: Jennifer Romph
Published: 1/3/17

Audience: Nurse

Epinephrine auto-injectors (Epi-Pens) are simple to use and come with clear instructions. The devices are equipped with a needle and medication protected inside the device until time of use. Removal of a safety cap allows the medication to be delivered relatively easily by individuals who have been trained on how to recognize the signs and symptoms of a severe allergic reaction, including anaphylaxis. An Epi-pen should be properly dosed based on weight or length of individual.


The U.S. Food and Drug Administration (FDA) recently announced changes to safety labeling for

Epi-pens. The changes include:

  1. Holding the leg firmly during the injection , especially with children
  2. Avoiding administration of the medication in the buttocks, the preferred site remains intramuscularly or subcutaneously in the anterolateral (outer) aspect of the thigh midway between the knee and the hip.
  3. An additional recommendation of reducing the “hold time” for the injection from 10 seconds to 3 seconds for a leading brand of Epi-pens.

The rationale for these changes includes the occurrence of rare cases of serious skin and soft tissue infections at the injection site following administration of an Epi-pen. Individuals should seek medical care if the following signs occur at the site of injection: persistent redness, warmth, swelling and/or tenderness.


The administration of Epi-pen remains the same:

  1. Check the date and that liquid epinephrine is still clear in appearance.
  2. Follow the instructions on the pen taking care you do not accidentally inject yourself.
  3. The Epi-pen needle is designed to go through clothing if necessary. Hold the leg and keep it steady during the injection.
  4. Hold for 3 seconds (for new pens) until all epinephrine is delivered.
  5. Remove the device and massage the thigh. Be careful if your device does not retract the needle; carefully put the used pen back in its case.
  6. Call 911. Individuals should be monitored for the next 4 hours at a minimum.
  7. Give the used injector to EMS for disposal.


December screenings – VISION beginning with Grade 4 first. Kindergarten will have color vision screened.


Happy and Healthy Holidays to ALL!

Posted by: Jennifer Romph
Published: 12/1/16

Audience: Nurse

Why is getting the influenza (flu) shot annually highly recommended?


CDC reports up to 1 in every 5 people in the USA get influenza every

season. Each year, approximately 226,000 people are hospitalized with complications from influenza, and between 3,000-49,000 die from influenza.  Pneumonia and influenza combined are the nation’s 8th leading cause of death.  The goal of the Wellness Company and I, is to promote the clinic and hopefully increase number of Jamestown students and community by 5% annually.


The biggest change this year is that the CDC is recommending only

injectable flu shots be given during the 2016-2017 season due to concerns about the effectiveness of the nasal spray vaccine. Recommendations for people with egg allergies have been updated. People who experience only hives after exposure to eggs can receive any licensed flu vaccine that is appropriate for their age and health.


The following screening criteria if present and documented would deem the individual ineligible for the flu vaccine:

  • Allergy to latex NOT contraindicated 2016-17
  • Documented anaphylaxis to EGGS
  • Individual who underwent an organ transplant
  • Bone marrow transplant within past 6 months
  • History of Guillian-Barre syndrome within 6 weeks after a previous fluvaccine

Registration online closes on Friday, November 4th for Monday, November 7th flu clinic but you can register that night. The clinic will begin @ 4pm and ends @ 6:30pm. Bring an insurance card as well.


Hope to see you there.

Posted by: Jennifer Romph
Published: 11/1/16

Audience: Nurse

Kids Eat Right, the Academy of Nutrition and Dietetics have listed few tips/ideas for setting a healthy lifestyle for you and your child.  They are all basic topics, eat right, move more but their recent fact sheets include healthy tips for Meatless Meals and how to talk to your child about weight. These are recommendations on how to be role model for healthy lifestyle and to give some ideas.


Setting a good example for your child by making healthy eating a family value; include the kids in food planning and/or shopping. Make time to eat together with cell phones or TV. Have a bowl of fruit on the counter and other healthy snacks encourages making healthier choices. Don’t use food as a punishment or a reward.  


Physical activity is an opportunity to have family fun, focusing on playing together vs. winning. Make up games you can all play and fit activities to your child’s interest e.g.; if child loves reading – walk or bike to the library. Engage family in planning family outings and explore new places. When adding more physical activity into family routine, consider ways to decrease TV times. The fall season is great time to be outdoors.


New movement is Meatless Mondays and replacing chicken or beef with beans, tofu or plant-based meat alternatives is a challenge. Mornings try a fiber-rich meatless breakfast with oatmeal and fruit. A website for ideas is .  Many of us are trying to become healthy eaters on a limited budget. URI has great ideas on their free website


The final topic from Kids Eat Right is how to talk to your child about weight. Anyone who is overweight is well aware of this fact. The challenge is to talk about being healthy, and not focusing on weight and appearance. Keep food positive and not forbidding certain foods; eliminate stocking foods you want your family to avoid. Avoid negative body talk and offer non-food rewards based on age and gender – get to pick after school trip to library or park, jump rope or bubbles, sleepover, movies, new clothes or shoes.


Being healthy is a life time commitment and not always easy. Do the best you can and aim to feel good about you.


October Screenings –

Gr 4/ 6 Hearing Screenings  Heights/Weights - during PE

Vision screenings @ Lawn Grades 5 & 7

Posted by: Jennifer Romph
Published: 10/3/16

Audience: Nurse

In a recent article in NASN School Nurse magazine, the NASN issued a statement on preparing for a sudden cardiac arrest (SCA) in schools. School’s primary mission is to educate the children, but mandates drills to prepare for emergencies. This article discusses schools implementing cardiac emergency response plan (CERP).


On any given day, 63.6million students are in school settings (US Dept of Education 2015) and in 2014 360,000 suffered a SCA in community setting. Prompt CPR and use of an automated external defibrillator (AED) can double or triple the chance of survival. SCA most often results from a disruption in the heart’s electrical system that causes the heart to beat rapidly and ineffectively, accompanied by the loss of a pulse. While SCA and heart attacks are both life threatening, SCA occurs abruptly and without warning; while a heart attack may have signs of pending onset. SCA requires intervention immediately to avoid death or permanent neurological damage. Without immediate CPR to help maintain blood flow to vital organs and the shock of an AED to reset the heart’s natural rhythm, individuals usually die.


In older children and adolescent, SCA is more often form underlying condition including hypertrophic cardiomyopathy and coronary artery abnormalities. One exception is commotio cordis, where an irregular heart rhythm results from a blow to the chest directly over the heart at a critical time during a cardiac cycle. Not fully developed, the chest of a child is more prone to this as compared to an adult. This type of blow leads to a SCA (in an otherwise normal heart) and requires cardiac defibrillation – AED as soon as possible.


Chest pain, nausea, or light-headedness may occur right before a SCA, but most often there are no warning signs. The individual collapses, is unresponsive, is not breathing or abnormally. It must be assumed that a SCA has occurred. Seizure-like activity and abnormal gasping/irregular breathing occur in 30-40% of SCA individuals. Loss of consciousness typically happens within seconds of the onset of chaotic heart rhythm (most often ventricular fibrillation) and suddenly they collapse.


In June and in September 2016, staff in Melrose, teaching assistants, and administration have been trained in CPR (Child/Adult), AED and First Aid. CERP procedures have been implemented. In RI, the Good Samaritan laws provide immunity to laypersons that voluntarily provide care during any emergency. Melrose and Lawn school each have an AED in place, Melrose is outside the RN office and Lawn is outside the Gymnasium. The AEDs are maintained every six months and checked monthly.  


Welcome back to a new school year.


K, 7th Gr, 8th Gr are reminded to submit all immunizations and physicals to Nurse Sullivan.

Posted by: Jennifer Romph
Published: 9/19/16