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Managing Students with Chronic Conditions

Management of Students with Chronic Health Conditions


ADHD

Planning for Care of Students with ADHD

  • Identify students diagnosed with ADHD
  • Obtain medical authorization to administer medications for students receiving medications at school.
  • Establish medication plan for those students receiving medications at school.
  • If student is receiving medications from school nurse they may need an IHP.
  • Consider nonpharmacological interventions as needed in the classroom.
  • Consider evaluation for 504 or IEP.
  • Evaluate for any side effects of medication, educate staff as needed.
  • Consider referrals for students not diagnosed (refer to school psychologist)

Accommodations:

Students with diagnoses learning disabilities (LDs) are eligible for an IEP under IDEA; however, many students with ADHD are not.  ADHD students are covered under Section 504 of the Rehabilitation Act, thus making them eligible for an Accommodations Plan.  The student suffering from severe ADHD may be eligible under IDEA under “other health impaired.”.  The nurse can collaborate with other team members, including but not limited to, the school principal, counselor, and teacher to establish the students eligibility and best suited plan.  The school nurse should consider developing and IHP for these students. 


Reference: School Nursing, A Comprehensive Text. 2nd edition. Selekman. (20013)

Asthma

Asthma

Planning Care for Students with Asthma

  • Identify students with asthma
  • Obtain proper forms for medications at school.   Student may self-carry their inhaler if MT Authorization to Self-Carry Emergency Medication form is signed by medical provider.
  • Develop an Emergency Action Plan or Asthma Action Plan for student.
  • Consider developing Individualized Healthcare Plan
  • Assess student’s ability to self-administer as indicated; teach proper technique if needed
  • Assess student’s ability to identify triggers and their self-compliance with medical regimen
  • Allow students easy access to inhalers and other equipment (i.e. spacers, peak-flow meter, nebulizers)
  • Consider developing school wide protocol for handling asthma episodes.
  • Educate staff, parents, and students about asthma
  • Collaborate and advocate for students with asthma
  • Research your schools air quality policies. 
  • Assess school for possible triggers (i.e. perfumes, air fresheners, cleaning agents, etc.)
  • Communicate with administrator(s), coaches, and other staff re: outdoor air quality concerns.

Assessment Tools/Interventions

 Refer to respiratory protocols for guidelines in using the following:

  • Pulse Oximetry 
  • Peak Flow Meter
  • Nebulizer Treatment

Forms (attachments):

MT Sever Allergy and Medication Authorization Form (insert doc. link)

Asthma Action Plan (insert doc. link)

Example teaching tool for inhaler use (insert doc. link)

Asthma Programs

See these websites for more resources including educational materials, grant funding, and referral sources regarding asthma.

MTDPHHS Asthma Friendly Schools

Mt Asthma Project-home visiting nurse program

MTDPHHS School Mini-Grant

American Lung Association

CDC Asthma Site: School and Childcare Providers

Laws/Regulations

MCA 20-5-420 allows students to carry and self-administer their rescue inhaler as long as there is a Medication Authorization Form on file.

Reference

 

 

Diabetes

Diabetes

Definitions

Type I Diabetes:  When the pancreas fails to produce insulin.  This diabetes is more common in children and adolescents (formerly referred to as Juvenile Diabetes).

Type II Diabetes:  Defined by the American Diabetic Association as, “a type of diabetes that occurs primarily as a result of insulin resistance, characterized by diminished liver, muscle, and adipose tissue sensitivity to insulin…” (2011c)

Diabetic Medical Management Plan (DMMP):  Provider orders outlining daily care of diabetic students.  DMMP should address blood glucose monitoring, insulin orders (for blood sugar correction and carb coverage)  and treatment for high and low blood sugar (see appendix for MT DMMP).

Hyporgylcemia:  Low blood glucose, typically less than 300 70mg/dl.

Hypergylcemia:  High blood glucose, typically over 300 70mg/dl.

Continuous Glucose Monitor (CGM):  A way to measure glucose levels in real-time throughout the day and night. A tiny electrode called a glucose sensor is inserted under the skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. (www.medtronicdiabetes.com/treatment-and-products/continuous-glucose-monitoring)

Students with Type I Diabetes

Considerations in Planning Care

  • The school nurse should work with student’s family and provider to obtain a DMMP for each Diabetic student. 
  • All diabetic students should have an Emergency Care Plan that addresses actions to take if the student is hyperglycemic or hypoglycemic.
  • Diabetic students should have an IHP and be considered for a 504 plan.
  • The school nurse needs to assist in establishing meetings for all staff involved with student to review care plans and emergency procedures.  School nurse oversees training and possible delegation of diabetes care tasks.

Elements of Care Plan for Diabetes

  • Where will supplies be kept?  Can they keep extra supplies in the classroom or office?
  • Blood glucose testing:  When/where will student test?  Do they need supervision or assistance?  If so, who will that person be and who will train them?
  • Blood glucose monitoring:  What blood sugar range is acceptable?  When and how do parents want to be notified.
  • What are the student’s typical symptoms of hypo/hyperglycemia?  Can they identify when they have high or low blood sugar?  Can they communicate this to an adult?
  • If the student cannot self-administer insulin, who will be assisting?
  • Snacks for the students:  who will provide the snacks and where will they be kept?
  • Dietary concerns:  Type I Diabetics may also have celiac considerations.  If the student is eating school lunch will you be able to provide carb counts?
  • Recess accommodations:  Does the student need to test their blood glucose prior to recess.  What training will the recess aids need?
  • Fieldtrip accommodations: What supplies will the student need?  Do they need a UAP, licensed person, or parent to accompany them?
  • Who will be trained to assist student with daily needs and/or administer glucagon.
  • Accommodations during classroom parties:  Does the student provide their own snack?  Can they participate in the party as long as they cover carbs eaten with insulin?
  • Physical activity:  discuss with family the effects that exercise has on the student’s blood glucose levels.  Consider if BG testing should be done prior to or after PE if necessary.
  • After school and extracurricular activities:  Identify if the student needs support during extracurricular activity time and discuss your role in supporting this process.

Training School Staff

  • Review ECP with at least all staff that have daily contact with student.  You may want all staff to be familiar with a student if they are a young child in elementary school.
  • Some staff may need an overview of Diabetes if they will be assisting with care in any way.  See example training record under “Forms”.
  • Glucagon:  Please refer to MCA 20-5-412, otherwise known as “the Glucagon law.”  The nurse may facilitate in teaching staff to use glucagon after they have been designated by the diabetic student’s parents.  .  Under this law the nurse is not delegating injection of Glucagon, but is identified as teaching the skill. See “Forms” for glucagon related resources

Students with Type II Diabetes

Students with Type II Diabetes may not require as much daily assistance as students with Type I Diabetes, but it is still recommended that the school nurse have these students identified as students with a chronic condition.  It is advisable to discuss their potential needs with the child’s parents and develop an emergency care plan and any other plans deemed appropriate by the school nurse.

Considerations in Planning Care

  • Dietary concerns:  Does this student have  any prescribed dietary plan that requires accommodations in the school day?
  • Treatment plan support:  If the child’s medical provider has them on a treatment plan discuss with the family if there are ways that you can support this plan at school.

Legislation

MCA 20-5-412 Definition -- parent-designated adult -- administration of glucagon -- training.

Forms

  • MT Diabetic order set (upload and insert links to form)
  • Diabetes Training Record from MT Kids with Diabetes: School Collaborative (upload and insert links to form)
  • Glucagon training record from MT Kids with Diabetes Collaborative. (upload and insert links to form)

Resources

  • “Pink Panther book”: “A First Book for Understanding Diabetes”  from the Children’s Diabetes Foundation of Denver.
  • The National Diabetes Education Program school guide, Helping the Student with Diabetes Succeed: A Guide for School Personnel (free), http://ndep.nih.gov/media/Youth_NDEPSchoolGuide.pdf
  • Diabetes Care at School: Bridging the Gap.3rd edition.  Salus Education, LLC (2013).
  • American Diabetes Association, (sample 504 available) www.diabetes.org
  • Colorado Kids with Diabetes website (nurse files): www.coloradokidswithdiabetes.org
  • The Calorie King Calorie, Fat, and Carbohydrae Counter (2009). A Borushek. Costa Mesa, CA: Family Health Publication.  (Also available as a mobile app)
  • The Diabetes Carbohydrate and Fat Gram Guide (Lea Ann Holzmeister)
  • Glucagon Instructional Training:  www.lillyglucagon.comn (also available as mobile app)

 

Epilepsy/Seizures

Seizure Classifications:

  • Partial: onset is within one cerebral hemisphere
    • Simple partial: Most commonly presents as sensory or motor involvement without impairment to consciousness.  Symptoms usually confined to one side of body.
    • Complex partial: Sensory and/or motor seizure with alteration in awareness  May progress into a secondary generalized tonic-clonic seizure.
  • Generalized: seizures involving both cerebral hemispheres simultaneously
    • Include absence, atonic, myoclonic, tonic, and tonic-clonic

Reference: Individualized Healthcare Plans for the School Nurse.  Arnold, Harrigan, Silkworth, Zaiger. (2005)

Nursing tasks

  • Identify students with Epilepsy/history of seizures
  • Speak with family and medical provider as needed to obtain history (is the student on medication?  How often do they experience seizures?  What type of seizures do they have?  What is the typical duration of a seizure?)
  • Establish Emergency Care Plan/Seizure Plan
  • Establish Individualized Healthcare Plan if needed
  • Possible evaluation for 504
  • Provide first aid training for staff
  • Provide teaching regarding emergency care plan and any procedures specific to the student (i.e. administration of emergency medications or use of Vagus Nerve Stimulator)

Considerations in Planning

  • Most seizure ECPs need to include guidelines for seizure first aid and how to keep the student safe during a seizure.
    • Assist the student to the floor, provide a safe area
    • Do no restrain or put anything in the student’s mouth.
    • Turn the child to their side if possible.
    • Time the start/stop of the seizure.
    • Plan should identify when to call parents and 911.
  • Emergency medications:
    • Diastat
    • Intranasal versed
      • **Note: Requests are often made to have unlicensed staff trained in the administration of these medications. 
  • Use of Vagus Nerve Stimulator (VNS)
  • Side effects of seizure medication
  • Students may experience learning disability/difficulties related to type of seizures, severity and duration of seizures, medications side effects, or various other reasons related to their diagnosis (could lead to possible IEP or 504 evaluations).

*For more information on how to delegate the administration of emergency medications please refer to delegation section of this resource manual. 

Food Allergies