School Nurse:

Please contact for any student medical concerns, and/or questions about care plans.

Refer to WCPSS intranet Health Services for Policies and Procedures.

Brittany Weiss, School Nurse

MEDICAL EMERGENCIES

Asthma Attacks

Symptoms: Wheezing, coughing, feeling of tightness in chest, difficulty breathing with short inhalations and long exhalations, nostrils may flare, sweating may occur, restlessness, tired. May see bluish color in the lips and nail beds. Coughing may cause vomiting. An attack may be brought on by changes in temperature, irritating fumes, dust, or other substances to which the person is allergic - physical exertion, coughing may also cause an attack.

Interventions:

· Remain calm, stay with the student.

· Have the student rest in a sitting position, breathing slowly through the nose and exhaling by mouth with pursed lips.

· Offer reassurance - attempt to help the student breathe slower by breathing with him/her.

· Offer sips of water (room temperature-not cold). This helps to thin mucus.

· Administer any medication ordered by doctor. Individually prescribed inhalers are most commonly used.

· Notify an administrator if the medication doesn’t seem to work, if the attack is severe, or if a bluish color is noted around the lips and nail beds.

· An administrator will contact an emergency response unit (911) if further medical assistance is needed for the student.

· An administrator will contact the parent.

Note: If nebulizer treatments are prescribed for a student, the school nurse will provide staff training. A copy of this treatment will be on file in student services.

What to look for:

· anxious or scared look

· unusual paleness or sweating

· flared nostrils when child tries to get in some air

· pursed lips when breathing

· vomiting

· hunched-over body posture; the child can’t stand or sit straight and can’t relax,

· restlessness

· fatigue that isn’t related to working or playing hard

· the notch just below the child’s Adam’s apple may sink in as the child breathes during an asthma attack

· spaces between the ribs may sink in when the child breathes in

What to listen for:

· coughing when the child has no cold

· excessive clearing of the throat

· irregular breathing, wheezing, however light

· noisy, difficult breathing

What is it?

Asthma is a chronic obstructive lung condition characterized by an unusual reaction to a variety of stimuli producing difficulty in breathing, coughing, wheezing, and shortness of breath. Asthma attacks can be mild to severe. Asthma is not a psychosomatic disorder. Attacks can be triggered from many sources including infections, cigarette smoke, polluted air, stress, strenuous exercise, dust, pollen, animal hairs and feathers, and climate changes.

Cause:

There is no known cause for asthma, although a number of stimuli are known to trigger an attack. Each child has unique stimuli which provoke attacks. Attacks are caused by constricting of breathing tubes and build up of mucus, inducing wheezing, coughing, and shortness of breath. The child may become restless and anxious.

Treatment:

There is no cure for asthma. The goal of treatment is symptom management, which can be responsive to therapy. Therapy consists of three methods: prevention of contact with allergens and irritants that trigger attacks; use of medication to control symptoms; use of allergy shots to reduce sensitivity to known allergens when deemed necessary by a child’s physician.

Prognosis:

The prognosis for asthma is good. Treatments aimed at reducing the number and severity of asthma attacks have been successful. Many children with asthma recover after puberty with attacks less frequent or nonexistent.

Problems for children:

For the child with mild, intermittent symptoms, the impact of the disease can be negligible. The more severe forms can impair academic achievement due to absences, fatigue, and inattentiveness related to a lack of sleep. For acute attacks, the child may need to leave the classroom for treatment. Medication side effects can include lack of impulse control and short attention span. Other emotional problems may include fear, anger, resentment, and lack of self-esteem.

Problems for families:

Asthma can cause serious disruption of family routines. Loss of sleep is a frequent problem when attacks flare-up at night. Emotional and financial problems can occur as a result of environmental adjustments such as remodeling heating systems, stopping smoking, or giving away family pets. It can be terrifying to watch a child fighting to breathe, and parents may be reluctant to appropriately discipline their child for fear of provoking an attack.

Diabetic Emergencies

Hypoglycemia (low blood sugar)

Prevention of low blood sugar reaction:

· eating regular meals, never skipping breakfast, lunch, or dinner, eating mid-morning and mid-afternoon snacks provided by a parent

Symptoms:

Shaking, sweating, hunger, dizziness, confusion, irritability, lack of attention, dazed look, paleness, numbness, tingling of lips, poor coordination, headaches, double or blurred vision. Symptoms occur quickly, most often before meals, during or after exercise, and at peak action time of insulin.

Interventions:

· At first symptoms, assist the student with eating or drinking any of the following foods: 1 tablespoon of Cake Mate (icing), 2 or 3 glucose tablets, ½ glass of orange juice or regular soft drink (not diet), 6 life savers, 2 large sugar cubes, or 2 packets of sugar dissolved in water. Reaction should begin to resolve in 10-15 minutes. If it does not, continue to give some form of sugar as long as the student can swallow.

· Follow up reaction treatment with a glass of milk and a peanut butter or meat sandwich.

· If the student becomes unable to swallow, unconscious, or has a seizure, immediately contact an administrator.

· The administrator will call for the emergency response unit (911) and contact the parent.

· Only trained personnel should follow doctor’s orders for checking blood sugar or administering glucagon injection if ordered (training will have been provided by the nurse).

Note: If a student brings a glucogon injection to school, notify the school nurse.

Recognition of High Blood Sugar (Hyperglycemia):

Hyperglycemia comes on slowly and is generally not a concern to school personnel. If a student complains of abdominal pain, nausea, vomiting, blurred vision, notify an administrator immediately. This condition could progress to confusion, drowsiness, and coma. Immediate medical attention may be needed. Follow doctor’s orders for checking blood sugar if applicable for this student. The administrator will contact a parent.

Diabetes

(Type I: Insulin Dependent)

What is it?

Insulin dependent diabetes, also known as Type I or juvenile diabetes, is a condition that prevents the body from utilizing food (glucose) normally. When this form of diabetes occurs, the body no longer produces insulin. Insulin is a hormone produced by the pancreas and released in response to blood sugar levels. For children who have insulin dependent diabetes, daily injections of insulin must be taken in order to stabilize blood sugar levels. Diagnosis can occur any time. Common symptoms of insulin dependent diabetes are excessive urination, thirst, and hunger. Other symptoms include weight loss, abdominal pain, muscle weakness, and visual disturbance.

Cause:

The cause of insulin dependent diabetes is uncertain at this time, but present studies suggest that there is an inherited susceptibility to develop diabetes.

Treatment:

Treatment involves daily injections of insulin, a modified diet and an exercise program. Blood glucose (blood sugar) levels must be routinely monitored. Insulin dependent diabetes is currently irreversible, but it can be controlled. Most children, as they grow older, have little trouble learning to inject the insulin and monitor blood sugar levels.

Prognosis:

Prognosis is good with proper control. Children with diabetes grow up to be functioning, productive adults. Management of diabetes at the present time is lifelong.

Problems for children:

The daily management of insulin dependent diabetes is a constant reminder to the child of a chronic health condition. Insulin injections, blood glucose monitoring, diet modifications, and an exercise program are all required daily. The treatment regimen that must be followed can sometimes cause resentment in a child. A feeling of being different from peers can also be a source of stress for the child. Learning to live with diabetes can be difficult, but can be accomplished.

Problems for families:

Acceptance of the child’s condition, which requires daily management, can be stressful for many families. Treatment is expensive. Families need to promote independence for the child by teaching the child to be responsible for all aspects of daily management. Encouragement or peer support, such as summer camps for children with diabetes, can be helpful.

Epilepsy

Absence (Petit Mal) Seizures

Symptoms:

Sudden brief loss of consciousness usually lasting 1-10 seconds, often appears like a blank stare (day dreaming); may have some rapid blinking or chewing movements of the mouth.

Complex Partial Seizures

Symptoms:

Usually starts out with a blank stare, then chewing, followed by random activity. Person appears unaware of surroundings. May seem dazed and mumble. Unresponsive, actions are clumsy and not directed. May pick at clothes, pick up objects, and try to take off clothing. May run or appear afraid. May struggle or flail at restraint. Once pattern is established, same set of actions usually occurs with each seizure. Seizure lasts for a few minutes. Post-seizure confusion lasts substantially longer. There is no memory of what happened during seizure.

Generalized Tonic-Clonic (Grand-Mal) Seizures

Symptoms:

Loss of consciousness, followed by stiffening and then a period of jerking (usually lasts 1-3 minutes). May have irregular breathing, may drool, may lose bowel and bladder control. May be confused or sleepy after regaining consciousness.

Interventions:

· Stay with the student during and after the seizure. Remain calm.

· Be prepared to assist to the floor if the student starts to fall. Guide carefully away from hazards if any automatic behavior occurs. Turn head to side in case of vomiting.

· Monitor breathing.

· Contact an administrator immediately.

· Stay with the student until fully recovered, alert, and aware of surroundings.

· Allow the student to rest if he/she chooses or needs to.

· Offer reassurance and reorient the student, providing any needed information about what happened.

· If further medical help is needed, an administrator will call the emergency response unit (911).

It is rarely necessary to call 911 for help unless any of the following occur:

· Prolonged seizure activity (child specific or greater than 5 minutes).

· Falling and hitting head during the seizure.

· Not able to arouse after a seizure.

· Trouble breathing or cessation of breathing.

· Seizures continue one after another.

What is it?

Epilepsy and recurrent convulsive disorder are terms that are used interchangeably to describe seizures, convulsions, unconsciousness, or altered behavior. Seizures are caused by an unusual or sudden discharge of electrical energy in the brain. A seizure can take many different forms, such as a convulsion (tonic-clonic jerks), a loss of consciousness, a brief stare, or other altered behaviors.

Cause:

It is estimated that two percent of the population has epilepsy. There are many causes of epilepsy, including brain injury, viral infection, or a low inherited seizure threshold. Sometimes the cause of epilepsy cannot be determined.

Treatment:

Today, epilepsy can usually be treated successfully with consistent use of medication. The goal of treatment is to control the seizure activity with the least number of side effects from medication. Teachers and parents should be familiar with action and side effects of medication.

Prognosis:

With proper treatment most children with epilepsy can be expected to live full, productive lives.

Problems for children:

Seizure activity can be misunderstood to mean there are other problems, such as not being intelligent or in control of emotions. The behavior exhibited during seizure activity can be frightening to others. Due to these attitudes and fears, children with epilepsy may be harassed or shunned by peers. Self-esteem may be unstable as a child integrates feelings of body integrity and social acceptance with self-worth. Children with epilepsy can participate in most activities. Changes in medication may foster changes in attention and behavior.

Problems for families:

Two major problems for families are both related to a tendency to overprotect and to avoid limit setting and discipline due to fear of causing a seizure. These tendencies have a cumulative negative effect on the child’s academic competency and vocational potential in later years.

STUDENT ILLNESSES & MEDICATION

· A list of all students with chronic illnesses that require special instructions and precautions is maintained in the office.

· Appropriate staff are trained on emergency procedures necessary for chronic illnesses of students in their care.

· Student medications are secured in locked storage in the office.

· Student medication is dispersed according to safety rules and procedures with a written log maintained on each student with dates/times of medication dispersal.

· The school nurse notifies the staff in writing of any student whose illness requires special instructions and precautions.

A student accident or illness which occurs at school during school hours or at school-sponsored events should be reported as soon as possible to the parents or guardians of the student involved. The parents or guardians are then responsible for the welfare of the student except:

· When, in the judgment of the person in charge, a student is injured to the extent that, or becomes so ill that it is a critical situation requiring immediate attention, the person in charge who stands in loco parentis must act in a reasonable manner. The person in charge must render whatever aid or assistance is necessary in order to preserve the well-being of the student. Parents or guardians are to be notified as soon as possible.

· When it is impossible to locate or report to parents or guardians, the person in charge must use his/her best judgment as to the proper handling of the situation.

PROCEDURE FOR HANDLING EMERGENCIES/INJURIES

The teacher is responsible for carrying out the following procedures:

· Notify the principal yourself, send a student, or send an available teacher. Take necessary first aid measures.

· The principal will notify the parents. If the principal or designee is not available, the classroom teacher or physical education teacher will make the call.

· See that the remaining students are in the care of a responsible person.

· If an ambulance is needed, the principal will make the request. If the principal or designee is not available, the teacher in charge will make the request.

· If parents cannot be reached, the teacher will use his/her best judgment.

· It is the responsibility of the teacher to observe the student who has been injured, yet remains at school.

· The person responsible for the student at the time of injury must complete a Student Accident Report.