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Pennsylvania Training and Technical Assistance Network
Medical Issues
Rosemary Moyer, CRNPDiv. of School Health
PA Department of Health
Medical Issues
District, IU, Preschool Agency Policy
Your local district’s policies regarding Paraeducator job
descriptions, duties, and
responsibilities provide the final word!
Agenda1. Welcome – Opening
Activities2. Confidentiality and
Communication3. Standard
Precautions/Hand washing
4. Chronic Health Conditions in Schools
5. Medical Equipment6. Medications7. First Aid
Learner Outcomes
•Participants will:–Discuss potential medical situations Paraeducators may encounter when working with students with a variety of disabilities –Discuss roles and responsibilities of Paraeducators in supporting the medical needs of students with disabilities –Examine a checklist of medical/physical factors to consider when working with students with a variety of disabilities
Learner Outcomes
•Participants will:–Describe the steps to follow in using Standard (Universal) Precautions–Examine basic first aid procedures and responsibilities –Examine characteristics of chronic health conditions and medications–Describe how to respond when students exhibit specific physical or behavioral symptoms related to medications or specific health conditions
Jargon Page
What does the “alphabet soup” really mean?
Activity
ADD
CP
IHP
Type of health conditions of students that you have worked with?
What is your most challenging experience on the job?
Type of health conditions of students that you have worked with?
Sharing Experiences
Confidentiality
• Classroom Teacher
• Certified School Nurse
Confidentiality
• FERPA - Family Educational Rights and Privacy Act
• HIPAA – Health Insurance Portability and Accountability Act of 1996
Two Laws frequently referred to:
Confidentiality
• What is student health information? • What student health information may
be shared? • When may it be shared? • With whom may it be shared? • And who should consent to such
sharing?
Confidentiality
There needs to be adequate
communication between
the teacher, the nurse and you
to ensure the safety
and health of the student
Confidentiality
Remember:Do not discuss any medical information about ANY student
except as necessary to ensure the health
and safety of the student
Confidentiality
• Think about where you are when discussing students’ health problems– Not in the elevator– Not in the faculty room– Not in the cafeteria
Confidentiality
Where else might you have overheard someone else discussing a student?
Confidentiality
Discussions
require
privacy
Communication
• Classroom Teacher
• Certified School Nurse
• Other Professional Staff
• Student and Family
Communication
The Paraeducator’s
greatest contribution is
observation&
reporting
what is seen
Communication
Reporting what is seen
to the teacher and/or school nurse
or other health professional
according to school procedures
Student Plans
•Individual Education Plan – IEP
•Individual Health Care Plan – IHP
•Emergency Care Plan – ECP
Blood borne Pathogens (& Diseases)
• Blood borne = found in blood
• Pathogen = disease-producing microorganism.
Blood borne Pathogens (& Diseases)
Video Presentation of Poem by
Jacki O’Donnell, RN
Standard (Universal) Precautions
CDC recommendation: Blood and/or body fluid precautions should be observed for all patients (students)
Individualized guidelines set up for specific settings
HospitalDentistDay Care/School
Blood borne Diseases
HIV
Hepatitis B
Hepatitis C
Blood borne Diseases
Protecting yourself
from blood and other body fluids
is essential
To Avoid Exposure To Someone’s Blood You Should Wear A. A girdle B. Wool mittens C. Latex or
hypoallergenic gloves
Blood borne Pathogens (& Diseases)
Donning Gloves
Demonstration
Glove Removal
• Grip one glove near the cuff and peel it down until it comes off inside out, cupping it in the palm of your ungloved hand
• Place 2 fingers of your bare hand inside the cuff of the remaining glove
• Peel that glove down so that it also comes off inside out and over the first one
• Properly dispose of the gloves
• Wash your hands with soap and water
Removing Gloves
Demonstration
How Would You Clean Up Broken Glass?
A. With paper towels
B. Broom and dustpan
C. Tell one of the kids
If You Think You Have Had an Exposure You Should
A. Call an ambulance B. Tell an
administrator and school nurse
C. Call the cafeteria
Blood Borne Pathogens (& Diseases)
Remember !
If it’s wet,
and it isn't yours,
don’t touch it!
When to Wash ?
• After going to bathroom• Before eating or preparing food• After coughing or sneezing• After playing outside• After playing with pets• After diaper changing
Hand washing 101
• Use warm running water, soap and friction
• Rub for at least 20 seconds– Between fingers– Underneath fingernails
• Rinse• Dry hands with paper towel• Turn off water with paper towel• Dispose of towel in
wastebasket
Why don’t we do it in our sleeves?
Play DVD
http://www.coughsafe.com/media.html
Chronic Health Conditions
Contributions by Andrea Dale,
Northcentral District Office School Health Consultant
Medical Issues to Consider
When Working With Students Who Have Disabilities
CHECK LIST
Medications
• What you need to know– Only licensed nurses (registered
nurses, licensed practical nurses as well as certified school nurses) may administer medications in Pennsylvania (Law-Nurse Practice Acts)
– All school age children in Pa must have school nurse services in the school where they attend (Law-School Code)
Medications
• What you need to know (continued)– When administrators make School
Nurse assignments they must take into consideration •Distance and travel time between
buildings•The health needs of the area
– Medications, their side effects, and special considerations
Medications
• What you need to know (continued)– All medications should be kept in a
locked area– Some medications must be kept
extremely secure•ADD medications are a good example
Medications
•What to do in an emergency:
– There should be an emergency care plan made by the school nurse with input from the medical provider and the parents
– You should be told what is expected of you in an emergency and what emergencies may be expected
Epilepsy/Seizure Disorders
• Epilepsy is a chronic disorder that is characterized by recurrent seizures, most often requiring medications
• There are various types of seizure activity ranging from staring to muscle jerking involving the entire body
• Seizures can occur for many reasons: •Illness•Head injury
Epilepsy/Seizure Disorders
• Seizure – What is it?
•A surge in the brain’s electrical impulses that causes a change of consciousness
– How are seizures treated?•Medications
Classroom Treatment for Seizures
• Follow IHP / Recommendations– Stay calm– Do not crowd around student– Move furniture to prevent injury– Let the seizure run it’s course- observe how long
it lasts– Stay with the student– If student is incontinent, protect from
embarrassment– At end of seizure, turn on left side to prevent
aspiration from vomiting/secretions– Let sleep until awakens
Care for Seizures
• Follow the IHP• Call for the teacher or school nurse• Cushion the student’s head• Loosen any tight clothing• Turn on side• Do not give anything to eat or drink!• Do not hold the student down!• Do not put anything in the mouth!
Medical Emergency if:
•The seizure lasts more than five minutes
•The student is pregnant
•The seizure follows a head injury
•The student has no previous history of seizures
Medication Related to Seizure Disorders
• Medications: – Tegretal/ Dilantin/ Valium
• Considerations : – Change of consciousness
• Adverse Side Effects
Adverse Side Effects
Tegretol Dilantin Valium
Drowsiness Nistagmus (jerky movement of the eyes)*
Central Nervous System depression
Dizziness Slurred Speech Respiratory depression
Gastro Intestinal (GI)Upset
Decreased Coordination
Ataxia (inability to coordinate voluntary muscles)*
GI Upset Memory impairment
* Next slide
*Those Odd Medical Words:
• Nystagmus - jerky movement of the eyes– May be up and down, side to side, circular– The pupil of the eye is moving
• Ataxia - inability to coordinate voluntary muscular movements– Unsteady movements – Staggering gait
Diabetes
Diabetes is a chronic health condition
that results in a lack of insulin or the inability of the body to use
insulin
Diabetes-what is normal?• Insulin “unlocks” the cells so the
glucose can enter and power the cells• Food is eaten and broken down into
micronutrients, which are then sent out to the body’s cells
• Blood glucose (sugar) levels rise• Pancreatic beta cells make and
release insulin• Blood glucose levels go back to
normal level
Insulin Movie
http://www.metacafe.com/watch/1015642/insulin_the_movie/
Diabetes
• Types of Diabetes: Type I: Requires daily insulin since
the student has a complete or near lack of insulin production
Type II: Can usually be controlled by diet and exercise but student may need to take pills or insulin or both
Type 1 Diabetes
• Type 1– Absolute insulin
deficiency
• Causes:– Genetic
predisposition– Autoimmune
disorder– Viral infection– Pancreas injury
• Population– 5-10% affected– Children– Adults up to age 35
• Treatment– Insulin
injections/pumps– Blood glucose
monitoring– Meal planning– Exercise
Prevalence of Diabetes Among PA School Age Children
0.00%
0.05%
0.10%
0.15%
0.20%
0.25%
0.30%
0.35%
0.40%
1997-1998 1998-1999 1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008*
School Year
Perc
enta
ge
Type I Diabetes
Type II Diabetes
Diabetes (both types)
Hypoglycemia/Hyperglycemia• Hypoglycemia
– Shakiness– Decreased
concentration– Headache– Sweating– Irritable– Dizziness– Anxious– Problems following
directions
• Hyperglycemia– Extreme thirst– Frequent urination– Increased hunger– Drowsiness– Blurred vision– Weight loss– Classroom
performance may drop
Hypoglycemia
Hypoglycemia [or low blood sugar]is caused when the brain
doesn’t receive enough glucose and sends warning signals
Hypoglycemia• Teachers Must Know
– Student symptoms– Time most likely to occur– How to treat– Treatment response time– Parent notification
• Causes– Skipped meals/snacks– Exercise– Incorrect dose of insulin– Injection site problems
Hypoglycemia (continued)
• Treatment– Follow IHP/ECP– Intervene Promptly– Give sugar source– Response time- about 15 minutes
• Points to remember– Never leave student unattended– Sugar source should always be available– Buddy system– Attendance may be affected
Hypoglycemia
• Signals of hypoglycemia could be:– Shaking, sweating, hunger, dizziness– Paleness, or numbness of the lips– Irritability– Poor coordination– Confusion, headaches, blurred vision– Convulsions– Unconsciousness
Treatment of Hypoglycemia
• 1 small box of raisins
• 1 Fruit roll-up• ½ cup regular soda• 6 or 7 Lifesavers• ½ cup fruit juice• 5 small sugar cubes• 2 or 3 glucose
tablets
Diabetes Management
• Monitoring – Food and fluid intake – Activity output – Level of consciousness
• Should prevent the need for emergency medications
Addressing Student Needs
Hyperglycemia
• Causes– Missed insulin injection– Not enough insulin– Eating too much food– Impending or acute illness– Infection– Less exercise than normal– Emotional or physical stress
Hyperglycemia (Continued)
• Treatment– Follow IHP/ECP– Increase fluids( water, non-sugared liquids)
• Points to remember– Never leave student unattended– Buddy system– Attendance may be affected
Hyperglycemia
• High blood sugar• Can be caused by
– illness or stress – missing medication – over eating simple sugars
• The symptoms are increased thirst and increased urination
• Treatment for hyperglycemia is insulin and exercise and prevention
Blood Glucose Monitoring
• Who is responsible?– Nurse, teacher, student, sometimes the
paraeducator
• When:– As indicated in IHP – Always interpreted by a licensed nurse
• Where:– Designated area- usually the nurse’s
office
Meal Planning
• Snacks
• Lunches
• School parties
• Field trips
• After school activities
• Consistency is key
Psychological Issues
• Self esteem is important for each student
• At each stage of development, there will be different diabetes issues to deal with relating to food, insulin, and blood glucose testing
• A psychologist/counselor may be involved in the students plan of care
• These students do not wish to feel different than their peers
Summary
• Children with diabetes can do everything other children can do
• Remember they were a child before the diabetes
• Do not assume your student completely understands his/her condition
• Following an IHP will help the student gain control with managing his/her diabetes and will help the school staff involved with their care to effectively manage any situation
Hypoglycemia
• What is hypoglycemia?
Hyperglycemia
• What is hyperglycemia?
Medication Related to Diabetes• Medications
– Oral medication to lower blood sugar– Insulin injections – Glucagon injections
• Considerations– Checking blood sugar levels may prevent
over medication • Adverse reactions observe for signs of low
or high blood sugar
Diabetes Management
• Monitoring – Food and fluid intake – Activity output – Level of consciousness
• Should prevent the need for emergency medications
Addressing Student Needs
Asthma
• Asthma is a chronic disease in which the air passages overreact
• During an asthma attack the air passages become blocked
• Triggers: Infection, allergies, exercise
• Treatment: Take medications as ordered, avoid allergies that may trigger attacks, check asthma action plan
Medication Related to Asthma
• Medications Albuterol – Aerosol treatment – Metered dose inhalers (MDI)
• Considerations– MDI needs to be shaken up for a full
minute– If more than one puff is required a full
minute must be waited between puffs
• Adverse actions– Jitteriness, dry mouth, palpitations
Celiac Disease (CD)
• Also called “gluten
intolerance”
• Inherited autoimmune disease that affects the small intestines
Disease Process
• The intestines contain projections called villi
• The villi absorb nutrients
• Villi are damaged when individuals with CD eat gluten and other proteins found in wheat, barley, rye, and possibly oats
• Signs and symptoms vary for each individual
•Gastrointestinal•Non-intestinal
Celiac’s Disease
• Treatment–Gluten free diet
• Resources–Celiac Disease Foundation: www.celiac.org
–Celiac.com: www.celiac.com
Medical Equipment That May Be Used By Students In School
Examples of Medical Equipment
• Respiratory – Oxygen – intermittent or constant– Nebulizer – machine that puts
medication into moisturized air to be inhaled (Aerosol Treatment)
– Tracheostomy – Suctioning – nose and mouth– Mechanical ventilator
• Ostomies – colostomy, urostomy, ileostomy
Equipment Continued
• Feeding tubes – nasogastric, gastrostomy, feeding button
• Catheters – indwelling and external
• Medication administration devices – IV, ports, insulin pumps
First Aid
A student falls on the playground
A. Help the student into the school
B. Stay with the student and have someone get the school nurse
C. Check to see if she has a broken arm by bending her arm
Your action should be?
A student is bleeding severely
A. Apply direct pressureB. Use a barrier between
you and bloodC. Apply tourniquet
What’s wrong with this Picture????
You should Not…..
Consider Taking a First Aid Course
American Red CrossAmerican Heart Association
Allergic Reactions
• Food Allergies
• Allergies to bee stings
• Hay fever and other environmental triggers
How Familiar Are You With YOUR School?
