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 (Wednesday and Thursday)

Services of the health office:

  • 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. Wash hands with soap and running water for at least 15 seconds (long enough to sing happy birthday to yourself). This should be done:
  2. Before and after any physical contact even if gloves have been worn.
  3. After using the restroom.
  4. After providing care or first aid.
  5. Before and after handling any food.
  6. Immediately after cleaning up any body fluid, spills or tissues
  7. Wear disposable gloves for contact with body fluids
  8. Wear protective eyewear (prescription glasses are acceptable in emergency situations) when body fluids may come in contact with the eyes.
  9. Wipe up any blood or body fluids as soon as possible. Clean the affected area with the appropriate solution (contact the custodial staff).
  1. Send any soiled clothing home in a double- bagged plastic bag.
  2. Never touch your mouth, eyes, or nose while in contact with body fluids or when administering first aid.
  1. Complete a First Report of Injury regarding exposure to potentially infectious blood or body fluids within 24 hours after exposure.
  2. 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.
  3. All staff should have access to gloves and Band-Aids. Please inform health office personnel if you need either.

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:

Sponsoring teachers need to be aware of the following steps:

  1. Provide a list of students attending the field trip to the health office and get the field trip packets back from students at least two weeks in advance of your trip. If we have two weeks notice, we can assist you in planning for student health needs.
  2. For in-state trips, the need for a nurse depends on student health concerns and the tasks the sponsor is able to cover for students.
  3. We can review the health pages of the field trip packet for the sponsor and see who will need medications or a health plan on the trip. Teachers can be trained to follow student plans and understand when asthma or allergies are an emergency and 911 needs to be called.
  4. A first aid/CPR trained staff member should attend all trips.
  5. At secondary level, we try to get all parents to sign off on allowing their students to manage and administer their own daily medications if this can safely be done (the teacher/sponsor is then the holder of daily meds). This process keeps the demands on the teacher to a minimum and puts the responsibility back on the student to remember to ask for medications except for inhalers which we usually allow them to carry and self-administer. So,
  6. Remember that school plans change depending on what we learn from the field trip packets as parents will often supply health information in the packets that they do not provide to the school since these conditions and medications fall outside the school day but not outside an over night trip.
  7. Parents also have to be given enough time to get additional doctor orders to all prescription medications that students will need on the field trip.
  1. For out of state trips, we strive to have all students/parents sign off a contract for students to self-manage all concerns with the teacher acting as a holder of medications for safety reasons. If some families do not agree that their students can be independent, then a nurse must be hired to administer medications and cover health needs--as the law does not allow nurses to train an unlicensed person to cover this when you cross state lines.
  1. In these cases, the teacher/sponsor/group should plan for covering the expenses of a nurse.
  2. Ask students if they have a family member who is a nurse who would be interested in going. Otherwise, to bring in and pay an agency nurse is very expensive for your group.
  3. Nurses will have to complete sub back ground checks, finger prints and a contract stipulating their pay in accordance to what the sponsor has agreed to. (The district does NOT pay for this nurse).

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 self-administer 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: See Allergy/Anaphylaxis SOP (Universal Food Precautions) for specific steps all staff must take to help prevent allergic reactions to foods.

Some students have an intense, life-threatening reaction when exposed to certain foods, insect bites etc....

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: Any of the following:
LUNG: Short of breath, wheeze, repetitive cough
HEART: Pale, blue, faint, weak pulse, dizzy,
THROAT: Tight, hoarse, trouble breathing/swallowing
MOUTH: Significant swelling of the tongue and/or lips
SKIN: Many hives over body, widespread redness
GUT: Repetitive vomiting, severe diarrhea
OTHER: Feeling something bad is about to happen,
confusion
Treatment:
1. INJECT EPINEPHRINE IMMEDIATELY
2. Call 911 and activate school emergency response team
3. Call parent/guardian and school nurse
4. Monitor student; keep them lying down
5. Administer Inhaler (quick relief) if ordered
6. Be prepared to administer 2nd dose of
epinephrine if needed
*Antihistamine & quick relief inhalers are not to be depended upon to treat a severe food related reaction . USE EPINEPHRINE
Directions for use of Epi-Pen®:
  1. Pull off gray safety cap.

  1. Place black tip against upper outer thigh.

  1. Press hard into outer thigh, until it clicks.

  1. Hold in place 10 seconds, then remove.
  2. Carefully place the used auto-injector back in the storage tube and give to EMS personnel.

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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).

Websites to learn more about allergies and anaphylaxis in a school setting:

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:

  • Fatigue
  • Hunger
  • Weakness
  • Sweating
  • Headache
  • Dizziness
  • Blurred vision
  • Confusion
  • Tingling in arms or legs
  • Argumentative, defiant
  • Hyperactive
  • Irritable
  • Pale

Most, but not all, students with diabetes know when they have a high or low blood sugar.

Action:

  1. 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.
  2. 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.
  3. If the student appears disoriented, call the health aide/nurse to come to the student immediately.
  4. 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:

  • Always let the health office know when your class or this student is not in the expected location.
  • 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.
  • 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.
  • 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.
  • 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 school-sponsored 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.

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:

HeadachesChanges in comprehension

Fatigue, foggy feelingChanges in behavior, slowed processing

Vision problemsDecreased attention

Sleep disturbancesIrritability, increased emotional labiality

Balance issuesImpulsiveness

Memory lossChanges in mood

Noise and light sensitivityAggression

Upon return to school after MTBI (Concussion)

1. Student must have a health care provider order if activity restrictions for sports,