Download Diabetes - Thompson School District

Thompson School
District:
Staff Guide
To Student Health
Issues
Revised 8/14
Part 1 General Health Information:
This guide reviews common school health issues. Please read it to familiarize yourself with your role in these instances. If you
have questions or if other health concerns come up for which you need guidance, please feel free to contact the health office.
Nurse’s Office Personnel:
(Health Tech)
Tiffany Rockwell
(School Nurse) Jennifer Buchmeier
Services of the health office:
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Provide simple first aid to students and staff as needed
Involve EMS personnel as needed for emergency situations that are outside the simple first aid
situation
Provide health education and encourage students to make “good health choices”
Manage and prepare for student health concerns
Give medication prescribed by a physician to students as needed
Perform physician prescribed procedures as needed for students
Provide the health component for Special Education students
Maintain student health records
Serve as the health consultant for the health needs of students in the school setting
Develop health care plans for students with health care needs
Train and supervise assistive personnel in the performance of nursing procedures
Universal Precautions:
Universal Precautions are a set of guidelines given to care providers that assume all body fluids are potentially infectious.
This assumption protects employees and students by removing the need to know about any particular individual’s health
information. Therefore universal precautions should be used when administering care to any student, teacher or support staff
within the school district.
Note: body fluids known to be potentially infectious for blood borne pathogens are any unidentified body fluid, blood, semen,
vaginal secretions or any other fluid containing visible blood. An evaluation by a health care provider is recommended for
anyone exposed to these fluids. Talk to your school nurse if you have questions.
Universal Precautions include:
1.
2.
3.
4.
Wash hands with soap and running water for at least 15 seconds (long enough to sing happy birthday to yourself).
This should be done:
a. Before and after any physical contact even if gloves have been worn.
b. After using the restroom.
c. After providing care or first aid.
d. Before and after handling any food.
e. Immediately after cleaning up any body fluid, spills or tissues
Wear disposable gloves for contact with body fluids
Wear protective eyewear (prescription glasses are acceptable in emergency situations) when body fluids may come in
contact with the eyes.
Wipe up any blood or body fluids as soon as possible. Clean the affected area with the appropriate solution (contact
the custodial staff).
5.
6.
Send any soiled clothing home in a double- bagged plastic bag.
Never touch your mouth, eyes, or nose while in contact with body fluids or when administering first aid.
7.
Complete a First Report of Injury regarding exposure to potentially infectious blood or body fluids within 24 hours after
exposure.
If students or staff are exposed to body fluids, immediately wash the affected site with soap and water or rinse the
eyes and mouth as indicated.
All staff should have access to gloves and Band-Aids. Please inform health office personnel if you need either.
8.
9.
Health Concerns and Confidentiality
It is the responsibility of the health office to make all pertinent health information accessible to all appropriate school staff when we
are given permission by the parent or guardian to do so.
This information is necessary to keep our students safe. It is highly confidential information and is only to be shared by school staff
on a “need to know” basis.
It is the classroom teachers’ responsibility to become familiar with students who have health concerns. Teachers will need to
provide classroom accommodations such as frequent bathroom privileges, increased visits to the health office, or other measures
as directed in the students’ health care plan.
Field Trips:
Please let the health aide know at least two weeks in advance of a field trip. If there are students in your class
or group who receive health services at school, and you are taking a field trip during regular school hours, the
school is required by law to provide those services on the field trip. Since the health aide or the school nurse
cannot go on most field trips, the teacher in charge of the student will be trained and delegated by the school
nurse to provide the health services that may be delegated. If your group is taking a trip outside school hours
or during the summer, planning needs to be done during the school year with the assistance of the school
nurse because your group has to cover all needed services and may need to hire a health assistant or nurse
to go with the group, depending on the extent of the need.
Medication:
(Primary) Most prescription medication should be given in the health office. The exceptions to this standard are
prescription inhalers, Epi-Pens or other emergency medications. Students who have a doctor’s order and permission for
the medication on file in the health office are allowed to carry the above medications on their person, but must be able to
self-administer it independently to meet the requirements of the law. Most primary students are not ready for this
responsibility.
(Secondary) Most prescription medication should be given in the health office. The exceptions to this standard are
prescription inhalers, Epi-Pens or other emergency medications. Students who have a doctor’s order and permission for
the medication on file in the health office are allowed to carry the above medications on their person, but must be able to
self-administer it independently to meet the requirements of the law.
Students are allowed to carry over-the-counter medication (Tylenol, Advil, Tums, etc.) on their person if they have it in the
original container, carry only a one day dose, and have written permission from their parents to take it. They can selfadminister as needed.
The law also says that the only staff members who can give medication to a student are those who have been delegated
by the School Nurse to do so. If a staff member gives medication to a student without being delegated to do so,
he/she is functioning on his own and assumes the personal liability associated with doing so, in addition to
potentially being in danger of practicing nursing without a license.
These regulations are difficult to enforce. If a staff member is aware of a student who is not following the medication
routine, please refer them to the health office.
Part 2: What to Do When Health Concerns Arise
Because of your proximity to students and because the health office is not always made aware of health concerns, you will need to
be prepared to handle the following emergency medical situations in the following manner.
Allergic Reaction to Insect Bites or Food:
Some students have an intense, life-threatening reaction when exposed to certain foods or insect bites.
Symptoms: hives spreading over the body, wheezing, difficulty swallowing or breathing, swelling of the face, neck or
tongue, tingling of the tongue, vomiting, or signs of shock (extreme paleness/gray skin, clammy skin, severe
lightheadedness, decrease in level of consciousness). Younger student may complain there is something in my mouth or
throat or my mouth feels or tastes funny. They may be grasping at or itching/rubbing their throat.
Action:
1.
2.
3.
4.
Do not leave the student alone.
Call the health aide to come to your location immediately.
Call 911 immediately for any of the above symptoms.
Stay with the student until the health aide or EMS personnel arrive.
Some students may have a mild or local reaction. Symptoms include several hives, itchy skin, or local swelling at the site.
This is not a serious reaction; send those students to the health office with an escort (secondary) or call the health office
staff to your location (primary).
Epi-Pens:
Teachers and/or others who work with students with life-threatening allergic reactions, may be trained by the school nurse to use
an Epi-Pen. The following diagram shows the steps for administering an Epi-Pen. Further training, demonstration, and practice
with the device will be provided to those in this position on a case-by-case basis. Addition staff who would like this training can
simply request it. See illustration.
Severe symptoms can cause a LIFE THREATENING REACTION:
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Wheezing, difficulty swallowing/breathing
Swelling (face, neck), tingling/swelling of tongue
Vomiting
Signs of shock (extreme paleness/gray color, clammy skin, etc.)
Loss of consciousness
Treatment:
1. Give Epi-Pen immediately, place against upper outer thigh,
through clothing if necessary.
2. Call 911 (or local emergency response team) immediately. EpiPen® only lasts 20-30 minutes. 911 (emergency response team)
should always be called if Epi-Pen® is given
3. Contact parents or emergency contact person. If parents are
unavailable, school personnel should accompany the child to
the hospital.
Directions for use of Epi-Pen®:
1.
2.
3.
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5.
Pull off gray safety cap.
Place black tip against upper outer thigh.
Press hard into outer thigh, until it clicks.
Hold in place 10 seconds, then remove.
Carefully place the used auto-injector (without bending the
needle), needle-end first, into the storage tube of the carrying
case that provides built-in needle protection after use. Then
screw the cap of the storage tube back on completely and give
to EMS personnel.
Websites to learn more about allergies and anaphylaxis in a school setting:
http://www.foodallergy.org/section/schoolchildcare
http://www.epipen.com/page/how-to-use-epipen-auto-injector-index
Asthma:
Some students have an intense respiratory reaction when exposed to “triggers”. Triggers cause the respiratory tract to
swell and produce increased amounts of mucus. Some triggers are exercise, cold weather, viral infections, chalk dust,
animal dander, and pollens or molds. The airway reaction is called an “Asthma Attack “. Some students can prevent an
asthma attack by using medication before they come in contact with a trigger. Students with asthma triggered by exercise
will pre-treat before they engage in physical education classes. Most emergency and pre-treating medication is given in the
form of inhaled medication. Primary school students usually have their inhaler in the health office. Middle and high school
students are encouraged to carry inhalers on their person for pre-treating or emergency treatment.
Symptoms of an Asthma Attack: complaining of chest tightness, shortness of breath, rapid or labored breathing,
wheezing, and coughing (any student exhibiting these symptoms should be asked if they have a history of asthma).
Action:
1. Stay with the student and encourage the student to rest.
2. Ask the student if he has emergency medication available. If yes, then encourage the student to use the
medication. Most students will recover within a few minutes of using medication.
3. If the student does not have emergency medication or the medication is not working, and if the student can walk
and talk without breathing difficulty, send him/her to the health office with an escort. If not, call the Health aide to
come to the student.
Diabetes:
Diabetes is a disease where there is a cellular resistance to insulin and/ or an insufficient amount of insulin required to
process and move blood sugar intracellularly. A person with diabetes must take injected insulin and monitor blood sugar
levels at various intervals during the day. Since this is all artificial, there can be problems. Too much or too little insulin
can result in high or low blood sugar. This can be life threatening.
Serious symptoms of low blood sugar include:
o Fatigue
o Hunger
o Weakness
o Sweating
o Headache
o Dizziness
o Blurred vision
o Confusion
o Tingling in arms or legs
o Argumentative, defiant
o Hyperactive
o Irritable
o Pale
Most, but not all, students with diabetes know when they have a high or low blood sugar.
Action:
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If the student carries a glucometer and snack, allow them to check their blood glucose level and treat
accordingly. (DO NOT leave the student alone). The student can return to class activity as soon as the blood
sugar has been treated and the student is feeling symptom free.
If the student does not carry a glucometer, is conscious, and does not appear in danger of losing
consciousness, send him to the health office with an escort (secondary) or call the health aide/nurse to get
the student (primary). If the student has a snack, encourage him to eat it.
If the student appears disoriented, call the health aide/nurse to come to the student immediately.
Call 911 immediately if the student appears to be losing consciousness.
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Students with diabetes have the right to be included in the same activities as students without diabetes and to
complete necessary testing and procedures in the classroom.
Teacher responsibilities:
o Always let the health office know when your class or this student is not in the expected location.
o Elementary level only—Parents should receive advanced notice about parties or activities which include
desserts, so that they can adjust insulin or send alternative foods for the student.
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Notify parents and the health office at least two weeks in advance of field trips or outings so that
arrangements can be made for family or staff to accompany the student. (These decisions will be made
on a case-by-case basis).
Be familiar with the classroom plan & emergency plan, specific to each individual with diabetes. These
will be sent to you to keep in a confidential place and provide this information to subs.
Be prepared to respond immediately to the signs and symptoms of hypoglycemia (low blood glucose)
and hyperglycemia (high blood glucose)
Recognize that a change in the student’s behavior could be a symptom of blood glucose changes.
Diabetes is a disease that requires added precautions and close monitoring during periods of illness or
stress. This monitoring may need to be done at home. For this reason, students with diabetes may miss
more school days than the average student. Provide instruction to the student if he or she misses school
and opportunities to make up missed classroom assignments or exams due to diabetes-related care or
illness.
o
Diabetic students who experience greater fluctuations in blood sugars, who are frequently ill, or who are
newly diagnosed may require classroom accommodations to meet their health and learning needs. In
these instances, a 504 plan may be appropriate.
o
Provide a supportive learning environment for students with diabetes to manage their diabetes safely
and effectively at school. This includes enabling students to monitor blood glucose, administer insulin
and other medications, eat snacks for routine diabetes management and for treatment of low blood
glucose levels, have bathroom privileges, access to drinking water, and participate in all schoolsponsored activities.
Recognize that eating meals and snacks on time is a critical component of diabetes management.
Communicate with the parents/ guardian and school nurse regarding the student’s progress or any
concerns about the student.
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HEAD INJURY:
Head injuries can range from a simple bump on the head to a massive brain injury.
Mild TBI/Concussion (may present with significant functional impairment)
Mild Traumatic Brain Injury (MTBI) is defined as a blow, or jolt to the head, with or without loss of consciousness, resulting in
one or more of the following conditions: temporary confusion, disorientation, or impairment of memory around the time of
injury.
Roughly 85% of people diagnosed with a MTBI recover. However, some continue to experience physical and behavioral
symptoms, each manifesting in ways as unique as the individuals themselves.
Signs and symptoms of concussion can show up right after an injury or may not appear or be noticed for hours or days after
the injury.
Signs and symptoms usually fall into the following categories:
Headaches
Fatigue, foggy feeling
Vision problems
Sleep disturbances
Balance issues
Memory loss
Noise and light sensitivity
Changes in comprehension
Changes in behavior, slowed processing
Decreased attention
Irritability, increased emotional labiality
Impulsiveness
Changes in mood
Aggression
Upon return to school after MTBI (Concussion)
1. Student must have a health care provider order if activity restrictions for sports,
athletic classes (fitness) and possibly recess (grade school) are needed. A release to
return to full activities will then be required.
2. Report unusual changes in a student’s behavior to parent , nurse and counselor.
3. Student may need more time to complete work and exams.
4. May require a modified homework load.
5. Student may need assistance with note taking.
6. Due to fatigue, may need rest periods in the health office or a modified school day.
7. Allow sunglasses as needed for visual disturbances or photosensitivity.
8. Refer for evaluation or 504 accommodations as appropriate beyond 6 months.
Liberal Bathroom Privileges:
Some students have health issues that cause them to need to use the bathroom frequently or at inconvenient times. Many
times these health issues are very confidential because of the nature of the concern. If you have a student requesting
frequent bathroom privileges, please check with the health office to validate the need.
Loss of Consciousness/Fainting:
There are many reasons that a student may faint or lose consciousness. The actual fall from the loss of consciousness
may cause a head or spinal injury in addition to whatever caused the initial loss of consciousness.
Action:
1. Stay with the student. If you are alone with the student, call for help first, then return to the student and
remain there until help arrives.
2. Stay calm and have the health aide/nurse come to your location.
3. Do not move the student.
4. Clear nearby furniture away from the student’s reach.
5. Clear secretions from around mouth, if necessary.
6. Loosen any tight clothing around the neck.
7. DO NOT restrain the student’s movements.
8. DO NOT place anything in the student’s mouth.
9. Call 911 if:
a. The student quits breathing
b. The student has a life threatening injury
c. The student has a seizure and it lasts more than 5 minutes, or
the student has never had a seizure before.
d. The student remains unconscious longer than 1-2 minutes.
10. Allow for the student’s privacy. (If possible, have the remainder of the class move out into the hallway or
encourage other students not to focus on the student and to continue with their class activity).
11. Debrief the class after the student is removed from the classroom.
If you need to call 911, please follow this procedure:
a.
b.
c.
Stay with the student and send a second person to call 911. If alone with the student, call 911 first, then
return to the student and remain there.
After calling 911, notify the building receptionist that you have called 911 and of your location.
The receptionist will post someone to meet the EMS personnel and will contact the health aide, campus
monitors, and administrators to come to your aid.
Migraine Headaches:
Migraines are unusual headaches that can be associated with visual disturbances, nausea/vomiting, and possibly mental
confusion. Migraines are best treated early, before the symptoms progress. If a student in your class has a migraine,
allow them to come to the health office immediately.
Pertussis:
The state of Colorado has been experiencing an outbreak of pertussis cases for several years.
Pertussis is a bacterial illness involving the respiratory tract that begins with cold-like symptoms and progresses to a
severe cough. Some cases can have severe coughing spells which may cause vomiting, breathlessness, a change in
facial color, and a whooping sound that follows the coughing fits. (Whooping is less common after infancy.) The
illness can last from six to ten weeks. Disease symptoms vary with age and vaccination status, with milder illness
generally seen among fully vaccinated persons. Pertussis is spread through sneezing and coughing and contact with
droplets from the respiratory tract of the person who is infected.
Clinical Pertussis Information
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Incubation period: after exposure to pertussis, symptoms typically begin in 7-10 days.
The illness typically progresses as follows:
o Initial symptoms can include a runny nose, sneezing, low-grade fever, and mild cough which
gradually become more severe over a period of 1-2 weeks.
o The cough is characterized by coughing fits which may be followed by a high-pitched inspiratory
whoop, vomiting, and/or a pause in breathing. This severe cough usually lasts 1-6 weeks and
then gradually improves over a few weeks.
o Note that young infants can present without classic cough symptoms and may present with
gasping or apnea only.
Infectious period: individuals with pertussis are contagious as soon as symptoms begin through the first
3 weeks of cough or until 5 full days of antibiotic treatment are completed.
Testing and treatment: special testing is available through a health care provider to diagnose pertussis.
The most common antibiotic used to treat pertussis is azithromycin, but several others are also effective.
Our primary goal is to prevent pertussis in infants and very young children and anyone with a medical
condition that would be complicated because of pertussis. Pertussis can be particularly severe in infants
under 12 months of age and in persons with any chronic respiratory disease such as asthma.
What to Do
 If you, your child or other individuals you provide care for have a respiratory infection with a cough
now or develops pertussis-like symptoms, do not expose others to the cough. Consult with your health
care provider and inform him/her that there may have been an exposure to pertussis so that appropriate
testing and treatment can be considered. This is especially true if you have children less than 1 year of
age living or being cared for in your household.
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Consult with your health care provider or your local health department to ensure immunizations
(DTaP/Tdap) of all members of your household are up to date. Vaccine is available from most private
physicians or your County Health Department.
Vaccination recommendations follow the Center for Disease control and Prevention
guidelines:
 DTaP vaccination of all infants at 2, 4 and 6 months (primary series)
 DTaP booster for all children at age 12-15 months
 DTaP booster for all children at age 4-6 years
 Tdap booster for all adolescents at age 11-12 years
 Tdap booster for adolescents 13-18 years who have never had a Tdap
 Tdap booster for all adults one time (including those 65 years and older)
 Tdap booster for all pregnant women with each pregnancy to increase protection for infants
who are too young for vaccination
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Household members and those with close face-to-face contact with a known pertussis case can be treated
preventively with appropriate antibiotics to stop further spread of the infection.
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Pertussis cases should stay home from daycare, school, or work until they have taken a prescribed
antibiotic for 5 days.
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Staff role: School staff should help identify students exhibiting symptoms and send them to the
school health office or child’s health care provider for evaluation.
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If you have questions about Pertussis, call your health care provider or the Larimer County Department
of Health and Environment at 970-498-6700. The Larimer County Department of Health and
Environment holds vaccination clinics. Please call the Larimer County Health Department for further
information.
Pediculosis (head lice):
Head lice are usually transmitted from one infested person to another by direct contact with the hair or by sharing personal
items like combs, brushes, hats, hair ribbons, towels, and bedding. Head lice do not observe any class distinction; they
can infest anyone. Head lice are insects, flattened in shape and very small; they have no wings and do not jump or fly.
People who are infested with head lice persistently scratch the scalp. If you suspect a student has pediculosis, refer them
discretely to the health office. Never perform an examination of a student’s head in your classroom or single out a student
in any way. The health office staff will take care of checking the student, informing the parents, and finding out if others
may have been infected.
The Thompson School District R2J “Lice” policy, addresses the specifics of when a student must be dismissed from school
with head lice and when that student can return. Health office staff will determine that the student has been appropriately
treated and when they can return to class. Health office staff are not at liberty to discuss the specifics of individual cases
with other school personnel. Please be assured that if a student has been released to resume class attendance, that the
student has complied with the guidelines of the policy and other students are not a risk of contracting lice.
Seizure Disorders:
There are several different types of seizures. The seizures that pose the most threat to life are Grand Mal or Generalized
Clonic-Tonic seizures.
The student may have an aura (a feeling just before the seizure that it is about to happen). An aura may include a buzzing
sound, unpleasant odor, visual disturbances, a feeling of numbness or brief sensation in the stomach or head or leg pain.
The student may be able to communicate that he is about to have a seizure.
Symptoms of Grand Mal Seizure: loss of consciousness, large muscle jerking with loss of balance, possible incontinence
of urine or bowel, rapid breathing, staring, verbal noises, or vomiting.
Action:
Stay calm and call the health aide to come to your location.
Stay with the student.
Help the student to the floor in a position lying on their side to prevent choking.
Clear nearby furniture away from the student’s reach.
Provide protection for the student’s head.
Clear secretions from around the mouth if necessary.
Loosen any tight clothing around the neck.
DO NOT restrain the student’s flailing movements.
DO NOT place anything in the student’s mouth.
Document seizure activity (date, time, duration and objective facts about the seizure).
Call 911 if:
a. The student quits breathing
b. The student has a life threatening injury
c. The seizure lasts more than 5 minutes
d. The student has never had a seizure before
12. Allow for the student’s privacy as much as possible. Encourage the other students not to focus on the seizure and to
continue with their class activity.
13. Most students will be very tired after the seizure and will have no recollection of what happened. The student will be taken
out of the classroom after the seizure is over and until fully recovered.
14. Debrief the class after the student is removed from the classroom.
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2.
3.
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6.
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8.
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11.
There are other seizures that do not require emergency treatment. Some of these seizures are called absence, simple
partial and complex partial seizures.
Symptoms of Other Seizures: Staring (may appear to be daydreaming), repeated movement of a body part or parts,
and/or repeated verbal noises.
Action:
1. Observe.
2. Call health aide if help is needed.
3. Document seizure activity (date, time, duration, and objective facts about seizure behavior).
4. Notify the Health office (if not done before) who will communicate with the student’s parents.