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School Nurse & Health Services

Welcome To The School Nurse & Health Services Page!
If you have any questions about anything you see here, please feel free to contact:

Monica Porras, BSN, RN

TLCA District Nurse

San Angelo Elementary Campus Nurse

Phone: 325-653-3200, ext 7104

Fax: 325-223-0020

Email: monica.porras@tlca-sa.com

TLCA's School Health Advisory Council (S.H.A.C.) is a group of individuals consisting of parents, teachers, school staff, and community leaders who are appointed at a District level to provide advice on coordinated school health programming and its impact on student health and learning. This group will meet at least four times a year and reports directly to the TLCA School Board.


The S.H.A.C. has a variety of roles addressing components of a comprehensive school health program.

These include but are not limited to: Health Instruction, Health Services, Healthy School Environment,

Physical Education, Schooling Counseling, Food Service Program, Physical Activity Opportunities and

Physical Education, and Integrated School & Community Programs.


If you are interested and willing to participate in the S.H.A.C.

please contact Monica Porras, BSN, RN (TLCA District Nurse)





ILLNESS AT SCHOOL  |  Children should only be in school when they can fully participate in their educational program. Therefore, children with the following should stay at home and or will be referred home by the nurse or other school personnel:


  • Fever (100 degrees Fahrenheit or higher) - or any condition that presents with a fever must be kept home until they are fever free for 24 hours without the use of fever suppressing medications.
  • Vomiting - must be vomit free for 24 hours. 
  • Diarrhea - must keep kept home until diarrhea free for 24 hours without the use of diarrhea suppressing medications.  
  • Conjunctivitis - (bacterial and/or viral) must be kept home until physician permission has been given to return to school or until symptom-free.


Under state and local Health Department regulations, if your child has certain medical conditions, he/she must be excluded from school for a period of time. The school nurse or principal can provide parents with a complete list of conditions and periods of exclusion. All communicable diseases must be reported to the school office, who will, if the disease is reportable, report it to the Health Department. Some of these diseases include but are not limited to: Amebiasis, Meningitis (specific types), Hepatitis, Polio, Pertussis, MRSA, Chickenpox, Novel Influenza, and Tuberculosis. 


CHRONIC ILLNESS/HEALTH CONDITIONS  |  Because your child may have a medical condition (including severe or life-threatening food allergies) that requires extra attention/care from the school personnel, it is important the parent/guardian visit with the school nurse. The school nurse will then inform others of care as needed. It is imperative that addresses and telephone numbers are kept up-to-date with the school as an emergency can arise at any time during school hours.


COMMUNICABLE DISEASES  |  The school requests that parents of students with a communicable or contagious disease telephone the school nurse or principal so that other students who have been exposed to the disease can be alerted. A student with a communicable disease is not allowed to come to school while the disease is contagious. These diseases include but are not limited to the following: chicken pox, measles, mumps, and hepatitis. Most communicable diseases require a doctor’s release for the student to return to the classroom. Students with a temperature of 100·F or above must not be sent to school.


HEAD LICE  |  Children shall be screened by the school nurse or other school official with consideration for privacy and confidentiality. Screenings may be scheduled or conducted at random throughout the year. When a student is suspected of having head lice, the school nurse or other school official shall inspect the child. When live lice and/or viable nits are found, the school nurse or other school official shall check the student’s siblings and all known household contacts on campus. Parents will be contacted and/or a letter will be sent to the parents of students with active infestations.


When a student is examined by the school nurse or other school official and found to have head lice, the teacher and office personnel shall be notified. The parent shall be notified, and the student shall be sent home with head lice treatment information.  The school nurse or other school official shall provide instruction to the parent and/or guardian regarding identification of active infestation, treatment procedures, and readmission guidelines.


Re-admission: Children who are sent home for head lice infestation must be free of live lice before the student may return to school. When a student has missed five consecutive days of school related to lice infestation, a warning letter shall be sent to the parent to notify them that the student is immediately required to be at school. With excessive absences, both the student and parent can be subject to truancy laws. 


When the student returns to school (presumably on the next day), the student shall be re-examined. If the student is free of lice, the student may return to class. If lice are found, the office and teacher shall be notified. The parent shall be notified and the student shall be sent home again for treatment, if it cannot be determined that treatment was done or with instructions for alternate treatments. When the student returns to school for the second time, the student shall be re-examined. If the student is free of lice, the student may return to class. If lice are found, the office and teacher shall be notified and a referral shall be made to the nurse. The parent shall be notified, and the student shall be sent home with instructions from the nurse.


MANAGEMENT OF DIABETES IN SCHOOL CHILDREN  |  The Texas Health Safety code provides for unlicensed diabetes care assistants to be trained to assist school children who need help with their diabetes management while at school or participating in a school activity. If a school nurse is assigned to a campus and is available, then the nurse shall assist the student with diabetes. If a nurse is not available, an unlicensed diabetes care assistant shall help with student only if the parent or guardian of the student signs an agreement that authorizes the assistant to assist the student and a release of liability for civil damages. School children with diabetes are allowed to self-manage their own diabetes, if capable. The law provides immunity from liability for school employees and school nurses.


MEDICATION ADMINISTRATION IOF MEDICATION AT SCHOOL  |  Often, students have to take a prescription and/or over the counter medications at school for a certain period of time as treatment for a medical condition. Prescribed medication must come to school in the original pharmacy bottle, labeled correctly, with the instructions for dosage on it. This also includes inhalers. If medication is only given 1-3 times per day or time released, it can usually be given at home unless specific times are ordered by the doctor. Parents must sign a medication consent form before medication can be given at school. The parent’s written request must not conflict with the label instructions.


Any increase or decrease in dosage must be stated in writing by a physician until a new prescription bottle is provided. Otherwise, school personnel must administer medication as it is stated on the container label, or parents may choose to come to the school and dispense the medication to their student.


Over the counter medication must be purchased in the United States and it must be in its original container stating directions and dosage. If school personnel reading the label directions find that the medicine is contraindicated for that student, a parent must come to school and administer the medication (ex: if a student is younger that the recommended age on the label directions, school personnel cannot administer the medicine without a physician’s order).


If over the counter medication is given for three (3) consecutive days, a physician’s order is required.

Herbal or dietary supplements will not be administered unless the medication will benefit the student’s educational achievement as stated in the student’s individualized education program (IEP) or Section 504 Plan and is prescribed by a physician.  


All medication must be turned in to the office upon arrival on the campus. We do not permit students to carry their own medications and self-administer without prior approval from the physician and the school nurse. A student with asthma or severe allergic reaction (anaphylaxis) may be permitted to possess and use prescribed asthma or anaphylaxis medication at school and school-related events only if he or she has written authorization from his or her parent and a physician or other licensed health-care provider.  Self-administration must be done in compliance with the prescription or written instructions from the student's physician or other licensed health care provider.


The student must also demonstrate to his or her physician or health-care provider and to the school nurse the ability to use the prescribed medication, including any device required to administer the medication.  The physician’s statement must be kept on file in the office of the campus the student attends. A person standing in parental relation to a student or the student himself, if over the age of 18, may give permission to use an asthma inhaler under these guidelines.


Only designated employees may administer prescription medication, non-prescription medication, and herbal or dietary supplements to students. Exceptions apply to the self-administration of asthma medication (with the physician and parents consent), medication for anaphylaxis (e.g., EpiPen®), and medication for diabetes management, if the medication is self-administered in accordance with policy and procedures. A student who must take medication during the school day must bring a written request from his or her parent and the medicine, in its original, properly labeled container. Contact the school nurse for information on procedures that must be followed when administering medication to students. 


SAFETY TRAINING  |  School employees who serve as nurses, licensed health care professionals, head coach, or chief sponsor for extracurricular athletic activities, including cheerleading, sponsored or sanctioned by the school must maintain and submit proof of current certification or training in first aid and cardiopulmonary resuscitation (CPR) issued by the American Red Cross, the American Heart Association, or another organization that provides equivalent training and certification. Employees subject to this requirement must submit their certification or documentation to Human Resources in the Administration Office. 


BACTERIAL MENINGITIS  |  Information can be found at the Texas Department of State Health Services website, found HERE


Meningitis is an inflammation of the covering of the brain and spinal cord. It can be caused by viruses, parasites, fungi and bacteria. Viral meningitis is the most common and the least serious.  Bacterial meningitis is the most common form of serious bacterial infection with the potential for serious, long term complications.


It is an uncommon disease, but it requires urgent treatment with antibiotics to prevent permanent damage or death.  Someone with meningitis will become very ill. The illness may develop over one or two days, but it can also rapidly progress in a matter of hours. Not everyone with meningitis will have the same symptoms. Children (over 1 year old) and adults with meningitis may have a severe headache, high temperature, vomiting, sensitivity to bright lights, neck stiffness or joint pain, and drowsiness or confusion. In both children and adults, there may be a rash of tiny, red-purple spots. These can occur anywhere on the body. The diagnosis of bacterial meningitis is based on a combination of symptoms and laboratory results.  If it is diagnosed early and treated promptly, the majority of people make a complete recovery. In some cases it can be fatal or a person may be left with a permanent disability.  


Fortunately, none of the bacteria that cause meningitis are as contagious as diseases like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been. The germs live naturally in the back of our noses and throats, but they do not live for long outside the body. They are spread when people exchange saliva (such as kissing, sharing drinking containers, utensils or cigarettes). The germ does not cause meningitis in most people. Instead, most people become carriers of the germ for days, weeks, or even months. The bacteria rarely overcome the body’s immune system and cause meningitis or another serious illness. Do not share food, utensils, toothbrushes, or cigarettes. Limit the number of persons you kiss. While there are vaccines for some other strains of bacterial meningitis, they are used only in special circumstances. These include when there is a disease outbreak in a community or for people traveling to a country where there is a risk of getting the disease. Also, a vaccine is recommended by some groups for college students, particularly freshmen living in dorms or residence halls. The vaccine is safe and effective (85%-90%). It can cause mild side effects, such as redness and pain at the injection site lasting up to two days. Immunity develops within 7 to 10 days after the vaccine is given and lasts for up to 5 years. Seek prompt medical attention if you think you may have Meningitis. Your school nurse, family doctor, and the staff at your local or regional health department office are excellent sources for information on all communicable diseases. You may also call your local health department or Regional Texas Department of Health office to ask about meningococcal vaccine.


STAPH INFECTIONS  |  Most people have heard of terms like “staph infection,” “antibiotic-resistant bacteria,” and “MRSA” (pronounced mersa). Staphylococcal bacteria often referred to as “staph” are commonly occurring bacteria found on the skin, under fingernails, and in the noses of all people. Most staphylococcal species never cause infection. However, when infection does occur due to staph, Staphylococcus aureus—one of these species of staph—is usually the cause. While all people have some staphylococcus species on their skin and in their noses, only three or four people have S. aureus. Even if they have S. aureus on their skin or in their noses, most people are not ill. Since staph is spread primarily by direct (skin-to-skin) human contact or with direct contact to wound drainage of someone who is carrying or infected with the bacteria, anyone with a break in his or her skin is at risk.


“MRSA” stands for methicillin-resistant S. aureus. Initially, MRSA strains were resistant to the antibiotic methicillin, a form of penicillin. Now they are resistant to many antibiotics and are sometimes called “multi-resistant” S. aureus. MRSA is not the only antibiotic-resistant bacteria. Initially, infection with MRSA was associated with exposure to health care environments, such as hospitals. However, other MRSA strains have evolved that affect previously healthy persons who have not had contact with health care facilities. MRSA causes the same types of infections as S. aureus that is not resistant to methicillin; however, MRSA may be more difficult to treat and can be rapidly fatal.

Staph infections begin abruptly. Symptoms may include a large area of redness on the skin, swelling, and pain followed by a pustule or abscess, boils and carbuncles (red, lumpy sores filled with pus). If left untreated, staph can infect blood and bones, causing severe illness that requires hospitalization.


We cannot eliminate staph because it is everywhere. However, because staph is everywhere and has the potential to cause infection, everyone—not just health care workers—must be involved in prevention. Students and their family members should take the following precautions to help prevent skin infections:

  • Encourage frequent hand washing with soap and warm water.
  • Encourage students to keep their fingernails clean and clipped short.
  • Avoid contact with other people’s wounds or anything contaminated by a wound.
  • Avoid sharing personal items such as razors, towels, deodorant, or soap that directly touch the body.
  • Clean and disinfect objects (such as gym and sports equipment) before use.
  • Wash dirty clothes, linens, and towels with hot water and laundry detergent. Using a hot dryer, rather than air-drying, also helps kill bacteria.

STATE MANDATED SCREENINGS  |  TLCA addresses state-mandated screening procedures by conducting screenings for vision, hearing, spinal (scoliosis and kyphosis) and Acanthosis Nigricans (AN).


Vision and hearing screening:

  • Any student referred by a teacher, principal, parent, and physician.
  • Students referred by Special Education.
  • All students in Kindergarten, 1st, 3rd, 5th, and 7th grades.
  • All students new to the state of Texas.
If a child requires prescription eye wear or hearing aids, please be sure they have these prior to screening dates.


SPINAL SCREENING  |  Students must be screened at least twice during the growth years-ages 10-14. TLCA provides spinal screening to 5th and 7th grade girls as well as 8th grade boys.


ANCANTHOSIS NIGICANS SCREENING  |  Acanthosis Nigricans (AN) serves as an indicator of Risk for Type 2 diabetes and other chronic health problems. All students in the 1st, 3rd, 5th, and 7th grades are screened for acanthosis nigricans. Parents may exclude their child from the screenings by providing the school in advance with written notification or the results of a screening done by a medical doctor.  If the exclusion is due to religious reasons the religious affiliation of which the student attends is required to submit on or before the day of the risk assessment process, an affidavit stating the objections to the risk assessment.


STUDENT ILLNESS OR INJURY AT SCHOOL  |  We will attempt to promptly notify the parent or guardian (or a person you have authorized us to notify) if we have knowledge that your child has been injured or becomes ill at school. We will, of course, call the parents/guardians in such a situation and will also call for emergency assistance. We cannot and will not use public funds to pay individual student medical expenses.


At the beginning of each school year, we offer you the opportunity to purchase low-cost student accident insurance. The school district is not the policy-holder for this insurance; if you decide that additional protection would be a benefit and protection to you and your family, the contract is between you and the insurance company.

In accordance with the Texas Department of Health immunization schedule, recommendations and adopted by the Texas Board of Health and published in the Texas Register annually, a child or student shall show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child care facility or public or private elementary or secondary school, or institution of higher education. Exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. Children and students in these categories must submit evidence for exclusion from compliance as specified in the Health and Safety Code, 161.004(d), Health and Safety Code 161.0041, Education Code, Chapter 38, Education Code, Chapter 51, and the Human Resources Code, Chapter 42.


For Information About Immunizations in a Parent-Friendly
and Easy-To-Read Schedule, please see these links:


To claim an exclusion for medical reasons, the child or student must present a statement signed by the child’s physician, duly registered and licensed to practice medicine and state that in the physician’s opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well being of the child or any member of the child’s household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.


To claim exclusion for reasons of conscience, including a religious belief, a signed affidavit must be presented by the child’s parent or guardian, stating that the child’s parent or guardian declines vaccinations for the reasons of conscience, including a person’s religious beliefs. This type of affidavit is only valid for two years. Affidavit MUST BE obtained by submitting a written request to the Texas Department of State Health Services, 1100 West 49th Street Austin, Texas 78756 (Rule 97.62 Title 25 of the Texas Administrative Code).


A student may be provisionally enrolled for 30 days if the student has an immunization record that indicates the student has received at least one dose of each specified age-appropriate vaccine. If at the end of the 30 day period, a student has not received a subsequent dose of vaccine, the student is not in compliance and the school shall exclude the student from school attendance until the required dose is administered (Rule 97.66, Title 25 of the Texas Administrative Code).


In the event that office personnel or the school nurse finds a student is lacking an immunization, the parent will be contacted and will only have the number of school days specified to immunize their child. After that, the student will not be allowed to return to school until proof of immunization is given to the school. Proof of immunization may be in the form of personal records from a licensed physician or public health clinic with a signature or rubber stamp validation.