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Nash-Rocky Mount Schools June 2019

Emergency Preparedness A training module for staff. Nash-Rocky Mount Schools June 2019. All p ersonnel are encouraged to review this module. Once you have viewed the module you will complete a quiz.

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Nash-Rocky Mount Schools June 2019

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  1. Emergency Preparedness A training module for staff Nash-Rocky Mount Schools June 2019

  2. All personnel are encouraged to review this module. • Once you have viewed the module you will complete a quiz.

  3. Students with certain conditions, such as diabetes, asthma and/or anaphylactic reactions, may need to possess and self-administer medication on school property. These medications would be considered emergency medications. • For students using emergency medications (inhalers or epinephrine autoinjectors) or diabetes medications (insulin, glucagon) the School Nurse will : • Verify that the student understands, has been instructed in self-administration of the medication, and has demonstrated the skill level necessary to use the medication and any accompanying device.

  4. Students with asthma may have a rescue inhaler to be carried/used at school. • Follow the guidelines and actions on the Asthma Emergency Action Plan (This plan should be kept with the student’s rescue inhaler) • Indications for rescue inhaler use are: • Coughing continuously • Difficult, shallow, rapid breathing • Longer time exhaling than inhaling, whistling or wheezing noise with breathing • Unable to speak more than 1-2 words without taking a breath • Flaring nostrils • Neck/chest muscles pull in (retract) with breathing • Cyanotic (turning blue) • Only rescue inhalers should be used at school Examples are: Albuterol, Alupent, Atrovent, Combivent, Maxair, ProAir, Proventil, Ventolin, Xoponex

  5. How to administer the inhaler • Start breathing in slowly through mouth and press down one time on the inhaler. Keep breathing in slowly as deeply as possible. • Hold breath as count to 10 slowly. • If using a spacer- first press down on inhaler and breathe in for 5-10 seconds. Hold breath for count of 10. • Wait 30-60 seconds between doses if 2 puffs are ordered • Contact the school nurse if a student frequently uses the inhaler or has any breathing problems.

  6. Method of administering rapid acting (rescue) medication for students with asthma. • Nurse must provide individual training on nebulizer machine; as all are different. • Contact the school nurse if a student’s parent requests nebulizer use at school.

  7. Epi-Pen, Epi-Pen Jr. or Twinject are used for students who have a severe allergic reaction to a food or other allergen. • These medications should always be readily accessible to the student. • Follow the student’s Emergency Action Plan for when to administer.

  8. Shortness of breath, wheezing, repetitive cough • Pale skin, blue lips, dizziness • Trouble breathing or swallowing • Significant swelling of tongue, lips • Many hives over the body or widespread redness • Repetitive vomiting, severe diarrhea • Feeling of impending doom, anxiety, confusion • These symptoms will come on very rapidly after exposure to the allergen

  9. CALL 911, SCHOOL NURSE AND PARENT • Remove medication from cylinder. • Pull off BLUE activation cap. • DO NOT TOUCH THE ORANGE TIP. THAT IS WHERE THE NEEDLE IS! • Hold ORANGE tip near outer thigh (always apply to thigh) Administer through clothing. • Swing and jab firmly into outer thigh until Auto-injector mechanism functions. • It dispenses very quickly and loudly

  10. Hold in place and count to 3 • Remove Epi-Pen unit. Place back in storage cylinder and send with emergency personnel to hospital. • Massage injection area for 10 seconds

  11. Adrenaclick and Generic Epinephrine Autoinjectors • Call 911, SCHOOL NURSE AND PARENT • Remove from cylinder • Pull off GREEN end cap first--- then pull off RED end cap • FIRMLY press down GRAY cap on outer thigh till needle penetrates. • May administer through clothing. • Hold for 10 seconds then remove.

  12. Students with diabetes are allowed to carry their treatment supplies with them during the school day. • The School Nurse will determine if the student is capable of self- testing and self-administering medications during the school day. • All staff should be aware of what to do for a student experiencing a low blood sugar. This can be a life threatening situation. Prompt recognition of signs of low blood sugar and appropriate treatment can save a life!

  13. Diabetes is a chronic disease that impairs the body’s ability to use food properly. • Insulin helps convert food into energy, in people with diabetes either the body doesn’t make insulin or it can’t use it properly. • Without insulin, glucose (sugar)- the body’s main energy source- builds up in the blood. • Insulin is a hormone produced in the beta or islet cells in the pancreas. • It is necessary to move the sugar or glucose from the bloodstream to the cells. • Glucose is necessary to keep the cells in the body healthy.

  14. Meals that are late or missed • Extra exercise or activity • An insulin dose which is too high • Unplanned changes in schedule • Lock down, assembly, field trip

  15. It is important to recognize a low blood sugar as soon as possible so that it does not progress to a severe reaction. • Early signs are caused by the release of a hormone named epinephrine. • People make this hormone when they are excited. Early Signs and Symptoms of Low Blood Sugar • Hunger Shakiness • Dizziness Sweatiness • Fast heartbeat Drowsiness • Nervousness Pallor • Feeling irritable, sad or angry

  16. Later Signs and Symptoms of Low Blood Sugar • Feeling sleepy • Being stubborn • Lack of coordination • Tingling or numbness of the tongue • Personality change • Passing out • Seizure

  17. If possible always do a blood sugar check first. • If meter is unavailable and child feels sick, go ahead and treat. • Eat or drink about 15 grams of fast-acting carbohydrate. • Wait 15 minutes and test blood sugar. • If blood sugar remains lower than 70 or below target for individual child, repeat fast-acting carbohydrate. • If it has returned to normal- give a small snack (ie. 2-3 cheese or peanut butter crackers) Hypoglycemia Busters- fast acting carbohydrates * 2-4 glucose tablets * 4 ounces of apple or orange juice * 4-6 ounces of regular soda * 4-8 Lifesavers * 2 tablespoons of raisins * 3-4 teaspoons of sugar or syrup * 1 cup of low fat milk * 1 tube of cake gel(if unable to safely swallow)

  18. When severe hypoglycemia occurs, this indicates that not enough sugar is getting to the brain. • The student may lose consciousness and/or have convulsions (seizures). • At this time the student will need the assistance of someone else. • Glucagon injection may then be necessary. • *If the student does not have glucagon- a tube of cake gel can be used. Squirt the gel between the cheek and gum and gently massage. • Drinking soda or eating glucose tablets is not possible and would be dangerous when the child is unconscious.

  19. There are different types of seizures. It is important to understand what type of seizure the student has and if there are any triggers or warning signs that a seizure may be coming. • All of this information will be found on the seizure plan. • For a student who is experiencing a gran mal or tonic/clonic seizure there are certain actions that must be taken to keep the student safe. • Signs of a gran mal seizure • Jerking, twitching movements of the head, body, arms or legs • Loss of posture • Sudden collapse • Rigid or stiff arms and/or legs • Not responsive to verbal commands • It is normal for the lips to turn blue during a seizure

  20. IF you observe a student having a seizure do the following • Stay calm! • Call for the nurse or first responder • If the student is seated or standing- lower the student to the floor • Turn the student on his side and place a small pillow or folded jacket under the head • Do NOT restrain or hold the student down • Move furniture and other objects out of the way • Remove other students from the area • Do NOT put anything in the student’s mouth • Time the seizure (look at a watch or clock- how long does it last?) • When the seizure is over, the student will be tired. • Check for any injuries • Check the mouth to make sure there is no bleeding • Check for cuts, scrapes, bruises etc

  21. Call the parent/guardian and inform of the seizure • Record observations on the seizure log • For seizures lasting longer than 5 minutes • Administer emergency seizure medication if ordered by the doctor • Call 911 and the parent/guardian • If the child has another seizure immediately following the last seizure • Call 911 and the parent/guardian • If the child has more than one seizure at any time on the same day • Call the parent/guardian

  22. Indications for use: seizure lasting more than 5 minutes. • Position the person on their left side • Assemble syringe and supplies ( an instructional sheet accompanies the med) • Put on disposable gloves, pull protective cover from syringe • Expose buttocks, bend the upper leg forward to expose rectum • Lubricate syringe tip, gently insert tip into rectum • Slowly count to 3 while pushing plunger in until it stops • Slowly count to 3 again before removing syringe from rectum • Repeat count of 3 while holding buttocks together to prevent leakage of med • Replace clothing and keep student on side facing you

  23. Note time given and monitor student. Document on seizure log. • If unable to locate parent or emergency contact person(s) call 911. • If seizure activity continues 15 minutes after Diastat- call 911 • If student is on bus when seizure occurs, contact parent to transport student. If no parent can be contacted- DO NOT transport- call 911. Other emergency seizure medication- Midozolam Physician will indicate when to use for prolonged seizure Given nasally either with syringe or ampule

  24. Severe Bleeding and Tourniquets In the event that bleeding cannot be stopped by packing the wound and applying direct pressure, it will be necessary to apply a tourniquet. • The tourniquet is applied above the site of bleeding on the extremity (arm/leg). • Tighten the tourniquet until the bleeding stops. • Record the time the tourniquet was applied. • Once applied, a tourniquet is never removed.

  25. School personnel assume no liability for complications or side effects of medication when administered in accordance with the instructions provided by the parent/guardian, physician or healthcare practitioner. • Your School Nurse will provide you with any additional training specific for your student population. Complete the quiz

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