Life-Threatening Health Conditions

1. Life-Threatening Health Conditions Fall 2005 sponsored by Nursing Services

2. This self-paced module • Designed to meet the state law requirements in RCW 28A.210.320 – education to all who work with students diagnosed with a life-threatening condition. • Press the space bar to continue and the backspace bar to move back to a previous frame.

3. Life-Threatening Health Condition A life-threatening health condition means a condition that will put the child in danger of death during the school day if a medication or treatment order providing authority to a registered nurse and a nursing plan are not in place.

4. Life-Threatening Health Conditions • Prior to attendance at school, each child with a life-threatening health condition shall present a medication or treatment order addressing their health condition. • Following submission of the medication or treatment order, an Individual Health Plan (IHP) shall be developed for the student.

5. Life-Threatening Health Condition • RCW 28A.210.320 states that……….. Students who have a life-threatening health condition and no medication or treatment order presented to the school shall be excluded from school.

6. Who are these Children with Medical Needs? • Students with known medical conditions such as: Severe Asthma Life-threatening Allergies Diabetes Unstable Seizures 504 Accommodations must be established for all these medical conditions!

7. Section 504 Prohibits discrimination against any individual because of a disability. • Requires schools to make reasonable accommodations for the disability. • Students with health care needs have the right to attend school.

8. So, What Will This Student Look Like? • Many times classrooms will have students with various health care needs. It is likely that a student with severe asthma maybe sitting next to a student with life-threatening allergies, and in the next row there may be a student with a seizure disorder.

9. Allergies Let’s discuss the impact of allergies on the student that you may have in class.

10. What is an Allergy? An allergy is an abnormal response to a “normal” substance (allergen). The allergic person has an altered immune response to substances which normally are not harmful to most people. A reaction may be mild or severe.

11. What Causes Allergic Reactions? • Substances “allergens” that cause allergies can vary from child to child. • Potential allergens: • Substances used to diagnose and treat disease • Medications • Latex • Foods (cross contamination) • Stings or insect bites • Snake venom

12. Eight foods cause 90% of food allergy • reactions: • Milk • Peanuts • Soybeans • Eggs • Wheat • Tree Nuts • Fish and • Shellfish Food Allergies Food is the leading cause of anaphylaxis in children.

13. Anaphylaxis Anaphylaxis is a sudden,severe allergic response that produces breathing difficulties, circulatory problems and possible death. Anaphylaxis is always considered a medical emergency.

14. Symptoms of Anaphylaxis • Tingling lips, mouth or tongue • Flushing of the face and body • Itchy eyes, nose, face • Eyes and face swelling • Hives • Diarrhea • Wheezing

15. Treatment • Allergy symptoms are controlled by a licensed health care provider through: • An individually tailored routine of medications • Diphenhydramine HCL (Benadryl) • Fexofenadine HCL (Allegra) • Loratadine (Claritin) • Dietary manipulations • Allergen-free area by environmental control

16. Emergency Medication Epinephrine is the medication to treat severe allergic reactions. Epinephrine’s effects will last for only about 15 minutes. Symptoms of the reaction can recur 4 to 8 hours after the initial reaction.

17. How to Use the Epi-Pen® 1. Pull off gray safety cap. 2. Place black tip on outer thigh. Stabilize the thigh. You may inject through clothing. 3. Press forcefully to active mechanism. Hold pen in place for 10 seconds. 4. Dispose of Epi-Pen ® as a contaminated sharp. 5. Massage the injection area for 10 seconds. 6. NOTE: You must demonstrate this skill using the Epi-Pen Trainer to your School Nurse.

18. Where is the Epi-Pen Kept? • There is always one available in the Health Room. • The student may be wearing/carrying one. • Review each student’s Individual Health Plan (IHP) to identify the exact location of the medication.

19. Asthma Basics • What is asthma? • Chronic lung condition that causes breathing problems (asthma attacks) • Manageable disease • Who has asthma? • 4.8M US, 150K (1 in 10) Washington children • Level of severity varies from student to student

20. Normal Breathing Process • Inhalation causes air to travel through the nose &/or mouth through the trachea. • From the trachea air enters a series of smaller airways that branch off the trachea, called bronchi and then divide into even smaller airways – bronchioles. • It is in the bronchi and bronchioles that asthma has its effect.

21. Asthma Basics (cont.) • What happens during an asthma attack? • Airways in the lungs become smaller; extra mucus in airways can further block air • Symptoms include: coughing, wheezing, chest tightness, shortness of breath • What can trigger an asthma attack? • Respiratory illness, allergens, weather, irritants, emotions, exercise • Students may have different triggers

22. Asthma Basics (cont.)

23. What Causes an Attack? • Respiratory Illness • Allergens • Weather • Irritants • Emotions • Exercise

24. Symptoms of Asthma • Shortness of breath • Coughing • Wheezing • Chest Pain • Chest Tightness

25. Management of Asthma • Minimizing contact with triggers • Management of asthma uses two basic approaches: • Use of medications

26. Medications • Rescue Meds provide quick relief by relaxing the muscles around the bronchial tubes • bronchodilators • Long-term control medications reduce inflammation of the airways • Reduce inflammation

27. Where is the Asthma Medication Kept? • Student medication is kept Health Room in the elementary schools. • The student may be wearing/carrying an inhaler in the secondary schools. • Review each student’s Individual Health Plan (IHP) to identify the exact location of the medication. • Note: if the student has an inhaler and no IHP, please notify the school nurse.

28. Diabetes Another medical condition on the rise!

29. Diabetes A chronic illness that results from failure of the pancreas to make the hormone called insulin. Without insulin, sugar accumulates in the blood stream and will cause symptoms.

30. Diabetes is a Chronic Illness • Most children have Type 1 Diabetes (requires Insulin) • Diabetes is not contagious • Diabetes cannot be cured, but can be managed and treated • Treatment includes: • Frequent blood testing • Administration of insulin • Dietary control • School Accommodations

31. Diabetic Training • In-service Training: as required by RCW 28A.210.320 • In schools attended by diabetic students, all school employees must undergo an in-service training on symptoms, treatment, and monitoring of students with diabetes and any additional observations that may be needed during the school day.

32. Diabetic Training • Specific Training as required by RCW 28A.210.320 • All school employees who have responsibility for diabetic students must complete training in proper procedures for care of students with diabetes. Such training must include information of individual student’s IHP requirements, as well as information on symptoms, treatment, and monitoring of student with diabetes.

33. Blood Sugar Testing • Hypoglycemia– too much insulin & too little glucose • Hyperglycemia- too little insulin & too much glucose

34. Hypoglycemia • Too much insulin and too little glucose • Causes: too little glucose, missed food, too much exercise, and/or growth spurts • Symptoms: hunger, shakiness, paleness, headache, behavior change, blurred vision, dizziness, seizures • Treatment: Prescribed by medical care provider and parent to self-treat with juice, soda, glucose, snacks • Accommodations: may be needed related to lunch, snacks and/or physical exercise

35. Hyperglycemia • Too little insulin and too much glucose • Causes: too little insulin, infection/illness, injury, undiagnosed diabetes • Symptoms: increased thirst, frequent urination, nausea, blurry vision, fatigue • Treatment: Prescribed by medical care provider and parent to self-treat with water, and diet soda • Accommodations: frequent bathroom privileges, extra water

36. Insulin • Taken by injections • Lower blood sugar • Different types of insulin have different peaks or onset of action

37. Another Medical Condition……for you to know and understand. Seizures

38. Seizures • Epilepsy is a chronic disorder of the brain characterized by the tendency to have recurrent seizures. • Seizures are sudden uncontrolled episodes of excessive electrical discharges in some nerve cells in the brain, with associated sensory, motor, and/or behavioral changes. • There are over 30 different types of seizures.

39. Types of Seizures Generalized Seizures • Tonic/Clonic (grand mal) seizures • Absence (petit mal) seizures • Partial Seizures • Complex Partial • Simple Partial

40. Treatments • Medications-often students will be on 2-4 different medications. • KetogenicDiet-foods high in fat and low in carbohydrates and protein. • Surgery • Vagus Nerve Stimulator

41. First Aid for Seizures • Stay Calm • Protect person from injury • Do not restrain person • Do not put anything in mouth • Roll person to their side • Allow person to rest once seizure is over.

42. Call 911 IF: • The seizure is a first time seizure or you don’t know if the person has epilepsy. • The seizure lasts more than 3-5 minutes. • The seizure is followed by another seizure. • There are signs of breathing difficulty. • The person is pregnant.

43. One More Thought … • If you have a student with any of the previously discussed medical conditions, and the student complains of illness – always accompany the student to the Health Room. • Provide care and notify the nurse. • The School Nurse is your resource, • support and a friend. Refer to them!

44. Test Time • There are five test questions for you to answer. • Please print out the test, identify the correct answer and submit your completed test to your administrator. • Make sure your name and employee number are on the test. • Good Luck!