Student Health Services 2019-2020

1. Student Health Services 2019-2020 • Together we make a difference

2. Bloodborne Pathogens Definition: Organisms in blood and other body fluids that can cause disease. Examples: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Viruses (HIV). BBP Exposure Control Plan Provides details about bloodborne pathogens, protective measures, training requirements, and what to do, if an exposure occurs. Located in main office and online. Know where the plan is located. If we had an OSHA inspection, employees would be randomly asked whether we have an Exposure Control Plan and how to locate it.

3. Protective Measures Universal Precautions: Considerallblood and bodily fluids as infected. Handwashing • Immunization against HBV Wear gloves. Do not recap needles. Use sharps containers. Call custodian for clean-up. Solutions that kill BBP must be used. Cover cuts/wounds.

4. Workplace Transmission Bloodborne pathogens are transmitted by: • Non-intact skin: through cuts, abrasions, dermatitis, or hangnails. • Mucous membranes of eyes: blood splashes into unprotected eyes. • Mucous membranes of nose: wiping nose with a contaminated glove. • Skin penetrated by a contaminated needle or other sharp. • Direct contact with materials, linens, or surfaces contaminated with infected blood or bodily fluids. Bloodborne pathogens arenot transmitted by: • Sweat. • Coughing or sneezing. • Touching an infected person. • Using the same equipment, materials, toilets, showers, or water fountains as an infected person.

5. BBP Exposure:What to do Steps Wash exposed area immediately! Notify supervisor. Contact school secretary for forms. Complete BBP Exposure Report and WC Form 19. Go to FastMed Urgent Care in RockyMount (either location).

6. Red Bag/First Aid Kit • Located in each classroom. • School staff only may access and carry the bag. • School nurse only may approvemedications that may be placed in the bag. • What goes in the bag? • Gloves and Band-Aids. • Emergency Action Plans. • Emergency medications only such as an inhaler or epi-pen. • Medication and supplies for students with diabetes. • Take bag to cafeteria, playground/gym, and on field tripsand fire drills with students.

7. Each school has first responders, certified in CPR/AED & First-Aid. [Identify and have first responders to stand.]. If you would like to get certified or recertify, you may register on-line. [Contact school nurse for more information/assistance.] Location of our AEDs: [Identify locations.] First-Aid & Emergencies Departments Student Services Nurses Staff Training

8. Diabetes The body is unable to use glucose normally. Glucose levels in the blood are controlled by insulin, a hormone made by the pancreas. In diabetes, the pancreas does not make enough insulin (Type 1 diabetes) or the body can’t respond normally to the insulin that is made (Type 2 diabetes). This causes glucose levels in the blood to rise. Type 1 diabetes requires insulin injection to treat. Both types require blood glucose monitoring. Students with diabetes allowed to: • Carry diabetic supplies at all times, including testing situations. • Check blood sugar anytime they feel symptomatic. • Have a snack when needed. Emergency Action Plans • Provides medical directions for individualized care, insulin administration, carb counting, and blood glucose monitoring. • Provided to teachers, first responders, and diabetic care managers. • Kept in EAP notebook in health room. • Contact school nurse with questions.

9. Diabetic Care Managers • Schools with diabetic students are required by NC law to have a minimum of 2 Diabetic Care Managers (in addition to the school nurse) who are available to assist students with their daily diabetes care. • This includes any school sponsored activity. • Skills taught include: using a glucometer to check blood sugar, administering insulin, counting carbohydrates and calculating insulin dosage, and administering glucagon in an emergency. • Additionally, NC law requires all staff to be trained to recognize the signs of low and high blood sugar and know what to do. • Identify Diabetic Care Managers.

10. Low Blood Sugar Early Signs & Symptoms Sweaty • If in doubt, treat as low blood sugar. • These early signs are caused by a release of epinephrine which triggers the body’s fight or flight response. • They are meant to get the diabetic’s attention for treatment. Nervousness Pallor

11. Low Blood Sugar Late Signs and Symptoms Irritable Sleepy Uncoordinated Stubborn Pass out Angry Sad Seizure • The symptoms of low blood sugar have gone untreated or unrecognized. • The brain is reacting to the lack of sugar or fuel to ensure proper functioning. • Treatment must happen now !

12. Treating Low Blood Sugar Fast-acting carbohydrates are the treatment of choice for low blood sugar. These foods are quickly absorbed into the blood stream and available for use by the body. • Examples of fast-acting carbohydrates • 2-4 glucose tablets • 4 ounces of apple or orange juice • 4-6 ounces of regular soda • 2 tablespoons of raisins • 3-4 teaspoons of sugar or syrup • 1 cup of low fat milk • 1 tube of cake gel or 2 packets honey (if unable to swallow or unconscious) • Parents are responsible for providing snacks and diabetic supplies. • Students should carry a juice or other snack with them at all times.

13. Treating Low Blood Sugar – Other Measures If glucometer available, check blood sugar. If low, give a snack. After 15 minutes, recheck blood sugar. If still low, give another snack. After another 15 minutes, recheck blood sugar. If still low, give another snack. If blood sugar does not come up, after 2 snacks, call parent. If no glucometer available, assume blood sugar is low, and give a snack. Follow with carbohydrate/protein snack –such as, peanut butter crackers, cheese, or sandwich with meat.

14. HighBlood Sugar Signs and Symptoms Drowsy Thirst Frequent urination Blurred Vision Nausea Mood Changes

15. Treating High Blood Sugar • Check emergency action plan for orders. • Administer insulin per doctor’s orders. • If no care plan is in place, contact parent/guardian. • Student needs to drink clear non- calorie liquids. • Do not exercise if the blood sugar is over 300. • Student may need to go to the ER for IV fluids, if blood sugar remains too high. Insulin is the only way to lower the blood sugar. Exercise will notdecrease the blood sugar!

16. Diabetic Emergency!Loss of consciousness • CALL 9-1-1. • Stay with student. • Send for nurse, diabetic care manager, or first responder. • Administer glucagon, if ordered. • Call parent/guardian.

17. Asthma Rescue Inhaler • Must have Medication Administration Authorization Form completed by healthcare provider, even if student self-carries and self-administers. • Must be easily accessible and available, especially for PE and recess, field trips, and after-school activities. • Must have accompanying emergency action plan, completed by the school nurse. • The EAP indicates where inhaler is kept and how/when to administer. • Complete the EAP log when the inhaler is used. • If student self-medicates, parents are responsible for providing an extra, back-up inhaler. Refer students to School Nurse who: • Have multiple and/or severe asthmatic episodes. • Have chronic cough, wheezing, or breathing issues. • Sit out PE/ recess. • Abuse, misuse, overuse, and/or frequently use rescue inhaler. • Need/do not have a rescue inhaler at school.

18. Seizures What to do: • Follow instructions in the student’s Emergency Action Plan. • Notify school nurse/first responder and parent as directed in the EAP. • During a seizure: • Protect from injury. • Remove other students from scene. • Lay student on floor, if possible. • Turn on left side, when seizure is over • TIME the seizure - how long seizure lasts. Call 9-1-1 if: • Seizure lasts more than 5 minutes. • Student doesn’t arouse after a seizure. • First time student has ever had a seizure.

19. Severe Allergies & Epi-Pens Symptoms • Swelling – lips, eyes, face • Tightening of throat / Hoarseness • Hacking / Repetitive cough • Shortness of breath / Wheezing • Weak pulse / Fainting • Pale / Bluish skin color Emergency Action Plan • Follow instructions in the EAP. • EAP provides location of student’s Epi-Pen. Administer the Epi-Pen • If in doubt, administer an epi-pen. • Use student’s epi-pen, if provided. • Use the stock epi-pen: [located: ______] • Diagnosed/known allergy; but, individual has no Epi-Pen. • Undiagnosed/unknown allergy. Blue to the sky. Orange to the thigh.  May be administered through clothing.  Administer in outer thigh.  Hold for 3 seconds.  Must call 9-1-1, immediately after injection.  Must be transported to Emergency Room.District policy – no exceptions.

20. Student Accidents • Contact parent/guardian. • Accident Report Form must be completed by the staff member who saw the accident and ASAP after the accident. • Refer to the school nurse, if on campus. • Refer to a first responder, if the school nurse is not on campus. • Give the original Accident Report Form to the Principal and make a copy for the school nurse. • Principal must sign and forward to the Central Office contact. Health Alerts: PowerSchool • Students with health conditions, emergency action plans, emergency medication at school, etc. are identified with the red symbol to the right of their name. • Click on red symbol to view students in your classes with medical conditions.

21. Concussion Policy / Traumatic Brain Injury • A concussion is caused by a bump, blow, or jolt to the head and alters how the brain normally functions. • Effects are usually temporary but can include headaches and problems with concentration, memory, balance, and coordination. • Symptoms may present hours or days after the injury. • The district has a Return-to-Learn policy/procedurefor students (athletes and non-athletes) diagnosed with a concussion. • The guidance counselor, school administrator, and teachers must initiate/monitor the RTL protocol. • Athletes diagnosed with a concussion must follow the Return-to-Play policy/procedure. • Contact School Nurse or Guidance for assistance.

22. Updated Medication Policy • NRMPS Medication Administration Authorization Form: Required for ALL medications • Self-Carry and Self-Administration of Medication: Allowed for Emergency Medications only [Inhalers, Epi-Pens, and Diabetes Medications]. • Over-the-counter medications must be ordered by the healthcare provider and administered by school staff. Students are not allowed to carry/administer. Notes from parent/guardian no longer accepted. • Controlled medications – e.g., Adderall and Ritalin must be kept in a locked, secure location. • Medication Record/Log: Required for dailyand prn medications • Initial when med is given. • Code reason, if omitted.

23. Stop the Bleed-Save A Life Life-Threatening Bleeding Yes Is a Trauma Kit available? No Whereis the wound?  Use any clean cloth.  Apply steady direct pressure directly on the wound. Neck, shoulder, groin Arm or leg Is a tourniquet available?  Pack the wound with bleeding control gauze (preferred), any gauze, or clean cloth.  Apply steady direct pressure. Yes No  Apply above the bleeding site.  Tighten until the bleeding. Combat Application Tourniquet

24. Refer to the School Nurse Examples: • Chronically ill student. • Excessive absences due to illness. • Asthmatic student with continued complaints, frequent coughing, wheezing, or difficulty breathing. • Diabetic with frequent symptoms of high, low, uncontrolled blood sugars. • Vision/Hearing concerns. • Medication questions / medication brought to school (unauthorized). Email referrals / consultations. Call before sending to the health room. • Make sure nurse is in / not with another student. • Minimizes time out of class. • Allows you a chance to describe situation / concerns. • Allows the nurse to give appropriate care to student. • School Nurse Schedule: _________________

25. Questions? Be sure you sign the roster for this training!