Welcome to Nurses Notes! I will use this Wiki page to keep you informed and up to date on important medical information that I feel will benefit your students. You will not be given specific health information regarding your students on this site.

Medications You Need To Be Aware Of:

Naloxone (Narcan)  is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing on heroin or prescription opioid pain medications. The nurses are allowed to administer this. The police officer and our administrators are also trained in giving this medication.  It is located on the Nurse emergency cart in her office - in a blue bag taped to the cart. Our version is to be given up the nose. If you have been trained to give this - you are permitted to administer this medication to a suspected overdose victim.  This medication will not hurt someone if the underlying problem is not an overdose. It is better to give it than withhold it.

Asthma Inhalers: (If the student doesn't have the spacer (clear tube) you still follow all the same steps.)

Mild Food Allergy Reaction

Another good video that will also link you to others.
What Happens During Anaphylaxis?

Epinephrine Auto-Injector (used to treat severe allergic reactions) The only thing I would like to point out is that some Epi pens (brand or generic) come in a hard protective case, so you DO need to remove the pen from the case - on the video at the beginning it shows the case lying behind the actual medication pen. Children weighing under 66lbs are prescribed "Epi Pen Jr" and those above 66lbs are prescribed an "Epi Pen" I DO have an Epi Jr and and a reg adult Epi Pen here to use for anyone that would be having a severe allergic reaction. It is required that if a student has been prescribed an Epi Pen they must bring one in to my office - I mainly have the extra ones here for a "surprise" reaction or 1st time allergic response. If the Epi Pen or Jr Epi is EVER used, 911 must be called for that person - rebound allergic responses occur so even though the Epi possibly worked that patient MUST be taken via ambulance to the ER. All student prescribed Epi Pens are in my inner office (where my desk is) on the wall in a clear organizer - accessable to anyone needing them.

As you may be aware, the School Health Division also requests that schools look at field trip lists to see when it is necessary and appropriate to send a nurse. Administration and I look at particular health concerns of students involved and make a decision as to when a nurse is needed. It is not necessary to send a nurse on a trip for the sole purpose of observing asthma inhaler usage or for the administration of an autoinjector medication. It is very important for you to review the above-mentioned videos in case you need to intervene with these two medications.

Health Issues That May Require Your Intervention:

Severe Food Allergies, Diabetic Emergency, Besting Allergies, Heat Sensitivity, Asthma, Choking, Seizures, Cardiac Arrest, and Bleeding.

If you have been informed you have a student with the above issue(s) please take the time to review the following information. Please also remind your substitutes who in your class has a serious medical condition.

Severe Food Allergies

Comprehending food allergy basics.

The following six statements provide a simple yet comprehensive introduction to the basic medical facts:

• A food allergy is an overreaction of the immune system that can affect any system of the body, including the respiratory, cardiovascular, gastrointestinal, and skin systems.
• Ingestion of even a minute amount of the allergen can trigger this overreaction and cause a variety of symptoms ranging from mild nausea or itching to anaphylaxis (a systemic allergic reaction that can kill within minutes).
• There is no cure for food allergies. Strict avoidance of allergenic food is the only way to prevent a potentially life-threatening reaction.
• An allergic reaction can occur up to two hours (and sometimes, though rarely, up to four hours) after ingestion.
• The severity and progression of an allergic reaction is unpredictable: a seemingly mild reaction can turn fatal within minutes.
• Anaphylactic reactions are treated by prompt administration of epinephrine. Time is of the essence and may mean the difference between life and death. Transport to an emergency room must follow. Repeat administration of epinephrine may be required.

Avoiding the Allergen.

Because strict avoidance of the allergen is the only way to prevent reactions, it is crucial to make the classroom/lunchroom/playground safe for food-allergic students.

• Read food ingredient labels.
• Check the ingredients in art supplies and in other products that may contain allergens, such as soaps or hand lotions.
• Prevent cross-contamination by using proper cleaning methods for tables and other surfaces.
• Teach students to wash their hands before and after contact with food.

Recognizing a Reaction.

Early recognition of symptoms saves lives. Every allergic reaction is different. It is critical to know that a child experiencing anaphylaxis may show no skin symptoms whatsoever. The symptoms of an anaphylactic reaction include:

• Mouth - Itching, tingling, or swelling of lips, tongue, mouth
• Skin - Hives, itchy rash, swelling of the face or extremities
• Gut - Nausea, abdominal cramps, vomiting, diarrhea
• Throat - Hacking cough, tightening of throat, hoarseness
• Lung - Shortness of breath, repetitive cough, wheezing
• Heart - Thready pulse, low blood pressure, fainting, pale, blueness

Enacting Emergency Action Plan!

Students identified as having a known severe food allergy and have submitted a physician approved emergency plan will have their own emergency protocols in the nurses' office with their prescribed Epi Pen. Homeroom teachers of elementary students will be given a copy of the plan. Student's Epi pens are in the inner portion of the nurse's office in a clear hanging organizer on the wall - accessible to anyone if an emergency would arise. There is also a "General Use" Epi pen adult and an Epi pen Jr. available to anyone experiencing a life threatening allergic reaction in the Epi Pen boxes (note locations - mentioned above). There is always a "first" and maybe someone has not been diagnosed yet. If an Epi Pen was used - 911 MUST be called - rebound symptoms are very common and 911 must be called to transport student/staff to the emergency room. If a student happens to ingest a food they have a known allergy to - please call for the nurse immediately. The nurse will come to the student.

If a student is identified as having a nut allergy - strict avoidance of any and all nuts is required. If a student is only allergic to tree nuts,please review the following list to assure strict avoidance of tree nuts.

Quick reference to common tree nut names
Almond
Beechnut
Brazil nut
Bush nut
Butternut
Cashew
Chestnut
Coconut
Filbert
Ginko nut
Hazelnut
Hickory nut
Lichee nut
Macadamia nut
Nangai nut
Pecan
Pine nut
Pistachio
Shea nut
Walnut

Complete list of tree nut names, botanical names and derivative names for tree nuts:
Almond
Almond paste
Anacardium nuts
Anacardium occidentale (Anacardiaceae) [botanical name, Cashew]
Artificial nuts
Beech nut
Brazil nut
Bertholletia excelsa (Lecythidaceae) [botanical name, Brazil nut]
Bush nut
Butternut
Butyrospermum Parkii [botanical name, Shea nut]
Canarium ovatum Engl. in A. DC. (Burseraceae) [botanical name, Pili nut]
Caponata
Carya illinoensis (Juglandaceae) [botanical name, Pecan]
Carya spp. (Juglandaceae) [botanical name, Hickory nut]
Cashew
Castanea pumila (Fagaceae) [botanical name, Chinquapin]
Castanea spp. (Fagaceae) [botanical name, Chestnut (Chinese, American, European, Seguin)]
Chestnut (Chinese, American, European, Seguin)
Chinquapin
Coconut
Cocos nucifera L. (Arecaceae (alt. Palmae)) [botanical name, Coconut]
Corylus spp. (Betulaceae) [botanical name, Filbert/hazelnut]
Filbert
Fagus spp. (Fagaceae) [botanical name, beech nut]
Gianduja
Ginko nut
Ginkgo biloba L. (Ginkgoaceae) [botanical name, Ginko nut]
Hazelnut
Heartnut
Hickory nut
Indian nut
Juglans cinerea (Juglandaceae) [botanical name, Butternut]
Juglans spp. (Juglandaceae) [botanical name, Walnut, Butternut, Heartnut]
Karite (shea nut)
Lichee nut
Litchi chinensis Sonn. Sapindaceae [botanical name, Lichee nut]
Lychee nut
Macadamia nut
Macadamia spp. (Proteaceae) [botanical name, Macadamia nut/Bush nut]
Mandelonas
Marzipan
Mashuga nuts
Nangai nuts
Natural and artificial flavoring
Natural nut extract (for example, almond extract)
Nougat
Nu-Nuts®
Nut butters (e.g., Almond butter, Hazelnut butter, Brazil nut butter, Macadamia nut butter, Pistachio nut butter, Shea nut butter, Karike butter, as well as other nut butters)
Nut meal
Nutella ®
Nutmeat
Nut oil (e.g., Walnut oil as well as other nut oils)
Nut paste
Nut pieces
Pecan
Pesto
Pigñolia
Pili nut
Pine nut
Pine nut (Indian, piñon, pinyon, pigndi, pigñolia, pignon nuts)
Pinon nut
Piñón or Piñon nut
Pinus spp. (Pineaceae) [botanical name: Pine nut/piñon nut]
Pistachio
Pistacia vera L. (Anacardiaceae) [botanical name, Pistachio]
Pralines
Prunus dulcis (Rosaceae) [bontanical name, almond]
Shea nut
Sheanut
Vitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut]
Walnut (English, Persian, Black, Japanese, California)
May contain tree nuts:
Natural and Artificial flavoring
Mortadella

Diabetic Emergencies

What is type 1 Diabetes?
Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death. It's important to note that everyone is insulin-dependent. People without diabetes make insulin in their pancreas. People with type 1 diabetes must inject insulin.

High and Low Blood Sugars

Children with diabetes face two problems that teachers need to understand: hypoglycemia and hyperglycemia. You should learn the symptoms and how to treat each.

• Hypoglycemia, or low blood sugar, occurs when the blood sugar level is too low, due to too much insulin, too little food, or too much exercise. Children with low blood sugar sometimes behave erratically or act sleepy, and are often very hungry and shaky. Low blood sugar must be treated immediately by giving the child foods with simple sugars, such as glucose tablets, fruit juice or regular (NOT diet) soda. If you suspect that a child has low blood sugar, do not leave the child unattended because the child can lose consciousness. Never send a child who you suspect has a low blood sugar to the nurse alone.
• Hyperglycemia, or high blood sugar, occurs when the blood sugar level is too high, due to too little insulin or too much food. Children with high blood sugar sometimes act lethargic and sleepy, and are often very thirsty and need to go to the bathroom a lot. High blood sugar is treated by giving additional insulin and sugar-free drinks, such as water or diet (NOT regular) soda. Children with diabetes must be given free access to water and the bathroom whenever they feel the need. Prolonged hyperglycemia due to insufficient insulin can lead to a very serious condition called diabetic ketoacidosis, which can lead to coma and death.

Signs that indicate blood sugar may be too high or too low are:
Increased Thirst, Headache, Blurred vision, Difficulty Concentrating, Frequent Urination, Weakness, Nausea, Extreme Hunger, Feeling Nervous or Jittery, Cold, Clammy Skin, Sweating not Caused by Exercise, Rapid Heartbeat, Numbness or Tingling of fingers or lips, Trembling, Confusion, Difficulty walking or talking (staggering or slurred speech).

Insulin Injections
Children with type 1 diabetes are treated with insulin taken via injections or using an insulin pump, blood sugar monitoring, a carefully managed diet, and exercise. Frequent blood glucose tests help determine the correct amount of insulin to take and help identify low and high blood sugars.

Many kids with diabetes use an insulin pump instead of taking injections. An insulin pump is about the size of a pager. Kids can wear it on their belt or carry it in their pocket. A thin tube connects the pump to a small canula (thin tube) inserted under the skin that delivers insulin continuously. Kids who use an insulin pump give themselves extra insulin to cover each meal that they eat. Sometimes their pump will alarm - please let your student address this alarm. Some students now are able to monitor their blood sugar continuously and their cell phones may alarm, indicating an issue. Again, please know who your diabetic students are and let them address their pump or phone and go to the nurse if they request that need with an escort.

Blood Sugar Monitoring
Children with diabetes check their blood sugar many times per day. A blood sugar check involves pricking a finger with a lancet and placing a drop of blood on a special test strip. A blood sugar meter analyzes the test strip and reports the blood sugar level, usually in less than one minute. This process is called blood sugar testing, blood sugar checking or blood sugar monitoring. They all mean the same thing.
Some children with diabetes are required to do blood sugar checks during the school day. Many do a check before lunch.

Meal Planning
Children with diabetes usually follow a meal plan. Meal plans come in many varieties, and is usually tailored specifically to the needs of each child. Parents should also provide morning and afternoon snacks for those children with diabetes who require them. These snacks usually consist of protein and carbohydrates, such as crackers with peanut butter.

Exercise
Exercise is important for all kids, and kids with diabetes are no exception. Diabetes does not prevent a child from participating in any exercise or outdoor activity. Gym class (physical education) and recess can, however, be a challenging time for kids with diabetes, since exercise, like insulin, works to lower blood sugar. Teachers should know if a child has diabetes so they can provide help if needed. If a student is having high glucose readings and has ketones present in their urine they will need excused from exercise until these variables normalize. 

Children with diabetes often eat an additional snack before participating in strenuous exercise. A good rule of thumb is 15 grams of carbohydrates for each 30 minutes of exercise.

If gym or recess is immediately before lunch, for example, kids with diabetes should be allowed to eat a snack before participating.

Some teachers think that kids with diabetes sometimes pretend to feel low or high to get out of the classroom, or to get out of an activity that they do not like. This is very unlikely. Most kids with diabetes don't want to be different, and they don't want their diabetes to cause them to be treated differently. If you think this is a problem, speak with the child's parents, but do not deny the child's request for water or a blood sugar test.

Beesting Allergies

A severe allergic reaction (anaphylaxis) to bee stings is potentially life-threatening and requires emergency treatment. About 3 percent of people who are stung by a bee or other insect quickly develop anaphylaxis. Signs and symptoms of anaphylaxis include:

• Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis)
• Difficulty breathing
• Swelling of the throat and tongue
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting
• Loss of consciousness

People who have a severe allergic reaction to a bee sting have a 30 to 60 percent chance of anaphylaxis the next time they're stung. Students identified as having a known severe bee sting allergy and have submitted a physician-approved emergency plan will have their own emergency protocols placed with their Epi Pen in the nurse's office. Homeroom teachers of elementary students will be given a copy of the plan. Student's Epi pens are in the inner portion of the nurse's office on the wall - accessible to anyone if an emergency would arise. There is also a "General Use" Epi pen adult and an Epi pen Jr. available to anyone experiencing a life threatening allergic reaction. If an Epi Pen was used - 911 MUST be called - rebound symptoms are very common and 911 must be called to transport student/staff to the emergency room. If a student with a noted bee sting allergy is stung - please call for the nurse immediately. The nurse will come to the student.

Heat Sensitivity

If a child is identified as having a heat sensitivity, please ensure that the student rests and rehydrates with water as soon as the student mentions they are feeling affected. The child should be accompanied by an adult or responsible student to the nurse's office.

Asthma

Asthma is a chronic, or long-term, disease that inflames and narrows the airways of the lungs. Asthma causes a variety symptoms that can worsen at any time, making breathing difficult. Unfortunately, there is no cure for asthma. The main components of asthma are inflammation and constriction. Both components affect the airways of your lungs, making it more difficult to breathe. When exposed to a trigger, one may feel changes in the airways. At the same time, there may be changes to the airways that one doesn't feel. The more severe the inflammation and constriction get, and the longer they go untreated, the worse asthma symptoms may be and the harder they may be to control.

Asthma Symptoms

WHEEZING - A whistling sound is usually heard when breathing in or out.

COUGHING - A cough that may not go away and often occurs or worsens at night.

CHEST TIGHTNESS - Feeling as if something is squeezing or sitting on the chest.

SHORTNESS OF BREATH -Feeling as though one can't catch their breath. One may feel breathless, out of breath, or can't                            get enough air out of the lungs.

What to do in case of an attack
1. Any activity the student is performing must be stopped immediately.
2. Seat the student comfortably and try to calm them down.
3. Call for the nurse. If the inhaler is in the classroom and the child has permission to administer the inhaler independently, give the medication according to his or her medication plan. The parents will also be notified immediately for further discussion of appropriate interventions. 911 will be notified if the medication gives no relief (or there was no medication available) and respiratory compromise continues (see symptoms above).

   Choking 

This video helps you understand how this device can be life-saving

Seizures

A very informative website I suggest visiting is Epilepsy First Aid 

Seizures happen when the electrical system of the brain malfunctions. Instead of discharging electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of energy through the brain, causing unconsciousness and contractions of the muscles. If only part of the brain is affected, it may cloud awareness, block normal communication, and produce a variety of undirected, uncontrolled, unorganized movements. Most seizures last only a minute or two, although confusion afterwards may last longer. If seizures are prolonged, or occur in a series, there is an increased risk of status epilepticus. The term literally means a continuous state of seizure. If a seizure lasts longer than 5 minutes, there is a risk of it progressing to status epilepticus. Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control.

There are many different types of seizures. People may experience just one type or more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures. Sometimes a person has an "aura" or has a feeling that a seizure is about to happen. Some people smell something, a headache may come on quickly, some feel a tingling in an arm or leg. If a student mentions they feel a seizure could happen, either send the student to the nurse with a reliable student or call the nurse to your classroom.

A child who has partial seizures that affect his emotions or sense of the world around him may be intensely frightened by the episodes. Children with this type of epilepsy need lots of reassurance and an adult to keep track of how often the seizures occur. If they become prolonged and frequent, emergency treatment may be necessary.

If you have a student having a seizure/convulsions, call for the nurse immediately and state who and what the issue is. Some students have medicine prescribed to them for seizures and the nurse needs to retrieve the medication from the locked box to bring it along.  This is very important - please state who the person is having the seizure and ask another person to mark down the time the seizure started.

Managing complex partial seizures(convulsions) requires gentle monitoring during the seizure, keeping hazards out of the way, reassuring the child in a calm voice and keeping track of how long the seizure lasts. Move any objects out of the way to prevent further injuries. If possible, cradle the seizing person's head in your lap, ask two reliable students to alert the nurse immediately. During a seizure, urinating and vomiting can occur so for privacy please ask the other students to step out into the hall or remove the other students from the close vicinity of the patient. Do not try to restrain the seizing person, do not put anything near the mouth, after the seizure ends place the student on their side. Stay clam. The student will be very drowsy afterward. The nurse will come to you and your student.

Special Considerations:

When providing seizure first aid support to a student in a wheelchair:

• protect the student from falling from the chair, secure seat belt where available and able
• make sure the wheelchair is secure
• support the student's head if there is no head rest
• do not try to remove the student from the wheelchair
• carefully tilt the student’s head into a position that keeps the airway clear

What do you do if someone has a seizure in the pool?

Here are steps to follow if someone is having a seizure in water:

1. Support the person in the water with the head tilted so the face and head stay above the surface.
2. Remove the person from the water as quickly as possible.
3. Check to see whether the person is breathing. If not, begin CPR immediately. Call 911.
4. Whenever there is a seizure in water, an ambulance must always be called.

Cardiac Arrest:

AED's Are you ready to save a life?