Cyclic Vomiting Syndrome Care PLan

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					                                 Catawba County Public Health Department
                                         School Health Program
                        CYCLIC VOMITING SYNDROME CARE PLAN
      NAME: _____________________________________DATE OF BIRTH: _____________
      SCHOOL: __________________              GRADE/TEACHER:____________________
      Parent/Guardian: _______________________________ Ph. (H) _________________
      Emergency Phone Contact__________________________ _______________ _______________
                                       Name                    Relationship       Phone
      Physician treating condition: _______________________________ Ph.___________
      Other physician:__________________________________________ Ph. __________
                                   General Information About Cyclic Vomiting Syndrome
      Cyclic vomiting syndrome (CVS) has no known cause and causes severe vomiting, nausea and gagging –
      sometimes as often as 12 times an hour. Episodes usually last 1-2 days and complications can include
      dehydration, injury to the esophagus and tooth decay. Episodes typically begin at night or first thing in
      the morning. There is no cure for CVS. Children tend to outgrow this condition when they become
      teenagers. During childhood however, there are several medications that often help stop or prevent
      episodes of cyclic vomiting.Other symptoms may include pallor, exhaustion, headache, fever, dizziness,
      diarrhea, abdominal pain.
                     The cause of CVS is unknown, but the bouts of vomiting can be triggered by:
              Colds, allergies, sinus problems                        Hot weather or physical exhaustion
              Emotional stress or excitement                          Menstruation
              Foods such as chocolate or cheese                       Motion sickness
              Overeating, or eating before bed
      Self Care
      Many people know what triggers their vomiting episodes. Avoiding those triggers can reduce the
      frequency of episodes. People with CVS generally need to get adequate sleep. Once vomiting begins, it
      may help to stay in bed and sleep in a dark, quite room. When the vomiting phase has stopped, it’s very
      important to drink water and replace electrolytes. Some people feel well enough to resume a regular diet
      right away, while others need to start with clear liquids and slowly continue to solid food.
                                               CVS ACTION PLAN
      My child, ____________________ (student’s name) has the following symptoms:
      ______________________________________________________________________________
      ______________________________________________________________________
      His/her triggers are: _________________________________________________________
      __________________________________________________________________________
      He/she is on the following medications:
      ____________________            ___________       ___________             _________
               (Medication)                (Dose)        (Frequency)           (Home/School)
      ____________________            ___________       ___________             _________
               (Medication)                (Dose)         (Frequency)          (Home/School)
      Medication side effects to watch for include:
      ______________________________________________________________________________
      _____________________________________________________________________________
      Call parent immediately if: ______________________________________________________
      _________________________________________________________________________

Care Plan discussed with parent: _______________________              Date: _________________

      School Nurse signature: ______________________________                   Date: _________________



      Updates/Changes:
      K: _____________________ 3: ___________________                         6: ___________________
      1: _____________________ 4: ____________________                        MidSch:________________
      2: _____________________ 5: ____________________                        HiSch: _________________

				
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posted:11/14/2011
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