Post on 26-Dec-2015
transcript
Illinois EMSC 1
Medical Objectives
Upon completion of this lecture, you will be better able to:
Accurately assess a change in the health status of a student who has a chronic condition
Respond appropriately to an exacerbation of the student’s condition
Work with the student to prevent recurrences of medical emergencies
Help these students cope with their conditions and maintain optimum wellness
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INITIAL ASSESSMENT
RECOGNIZE SIGNS AND SYMPTOMS INCLUDING:- Itching- Throat tightness- Hives - Edema
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HISTORY OF ANAPHYLAXIS
- ALLERGENS- Latex Allergies
- CURRENT MEDICATIONS AND AVAILABILITY
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INTERVENTIONS FOR ANAPHYLAXIS
-Maintain ABCs- Administer epinephrine (EPIPEN)- Administer antihistamine or bronchodilator- Transport to ED
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TRIAGE AND TRANSPORT FOR ANAPHYLAXIS
EMERGENT - Symptomatic with known history, evidence of respiratory distress or shock
URGENT - Generalized mild symptomsNON-URGENT - Localized reaction
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EXPECTED OUTCOMES FOR ANAPHYLAXIS
Decreased symptoms Decreased respiratory
distress Decreased anxiety
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EVALUATION AND FOLLOW-UP
Record treatment on school health record
Review with student foods or allergens to avoid
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PREVENTION OF ANAPHYLAXIS
Teach students to read package labels carefully
Have epinephrine available in school
Have student allergies documented
Have an IEMP for students with severe reactions
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DIABETES MELLITUS
Type 1 most common, although Type 2 is on the rise in children and adolescents
Goal is to maintain adequate blood glucose levels
Hyperglycemia or hypoglycemia can occur
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HISTORY OF DIABETES
CHIEF COMPLAINT-abdominal pain, headache
MEDICATIONS-insulin type, dose, frequency
DIET-last meal, amount, type of food
EVENTS-exercise, stress, infection
SYMPTOMS-cool clammy skin, hot dry skin
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INTERVENTIONS FOR DIABETES
Assure ABCs Determine blood glucose level Use IEMP Hypoglycemia
Glucose tablets/snack
Hyperglycemia Insulin administered as ordered
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TRIAGE AND TRANSPORT FOR DIABETES
EMERGENT Severe dehydration, seizures, Kussmaul
respirations, lethargy URGENT
Abdominal pain, nausea or vomiting, tachycardia, fruity breath
NON-URGENT Polyuria without dehydration, minimal
distress
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EXPECTED OUTCOMES FOR DIABETES
Adequate ABC’s
Normal blood glucose level
Compliance with medication regimen
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EVALUATION/FOLLOW-UP
Documentation of care/contact with health care provider
Reassess ABCs, neuro status, and blood glucose levels
Identify trends if poor compliance is suspected
Refer for health counseling
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IMMUNOCOMPROMISED CANCER
Survival rates for children are increasing Chemotherapy temporarily suppresses
RBCs, WBCs, and platelets Venous access devices are common Monitor for increased ICP Varicella exposure can be devastating
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IMMUNOCOMPROMISED HIV/AIDS
Increased risk for opportunistic infections Progression of disease varies
significantly Antiretroviral and prophylactic
medication regimens available Monitor for early signs of infection and
developmental delays or loss of milestones
Student may not know diagnosis
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ORGAN TRANSPLANT RECIPIENTS
More common Transplanted solid organs include:
heart, liver, kidney, bowel and lung Incisional scars identify transplant
location Immunosuppressive agents needed
to prevent rejection
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INITIAL ASSESSMENT
ABCDsRespiratory distressFirst time seizure, severe HAUncontrolled bleeding
Oral bleeding, lymph node tenderness, abdominal pain, weakness, skin integrity, temperature, HA, nausea/vomiting, and lethargy
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TRIAGE AND TRANSPORT
EMERGENT ABCD compromise
URGENT Fever, malaise, vomiting or diarrhea,
bleeding
NON-URGENT Consider all changes in status as urgent
until diagnosed
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HISTORY
Chief complaint (fever, pain, bleeding) Isolation/immunizations Medications (immunosuppressive,
regimen, last dose) Past history (diagnosis, acute
episodes) Events (infection, recent rejection
episode)
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EXPECTED OUTCOMES
ABCs will be maintained Infection/rejection determined
and treated Psychosocial support will be
maintained
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EVALUATION AND FOLLOW-UP
Document all care and health care contacts
Follow-up to determine if rejection or infection is present
Update the IEMP as necessary
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PREVENTION
Avoid unnecessary exposure to infectious diseases
Follow immunosuppressive regimen to avoid rejection episode for transplant student
Avoid contact sports to decrease chance of organ injury or bleeding episodes
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SICKLE CELL ANEMIA
SICKLE CELL ANEMIA A hereditary disorder that is
inherited as an autosomal recessive trait
Caused by an abnormal type of hemoglobin called hemoglobin S
Occurs primarily in students of African decent
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SICKLE CELL CRISIS
SYMPTOMS OF CRISIS Pain (usually severe) Tenderness and edema over
the bony infarcts which are producing the pain
Moderate to severe abdominal pain
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INITIAL ASSESSMENT OF SICKLE CELL ANEMIA
ABC’s
Level of consciousness
Presence of pain or fever
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HISTORY OF SICKLE CELL CRISIS
Chief complaint feverjoint/back pain
Past health history last crisiscauseduration
Events recent infection or stress
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SICKLE CELL DISEASE
COMPLICATIONS OF SICKLE CELL DISEASE:Orthopedic abnormalitiesDelayed growth and sexual
maturationEye problemsLiver dysfunctionStrokePriapism
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TREATMENT FOR SICKLE CELL DISEASE
TRANSFUSIONS PROPHYLACTIC PENICILLIN FOLIC ACID IMMUNIZATIONS OXYGEN HYDROXYUREA ADMINISTRATION
NOTE: Studies are still being done with this medication
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TRIAGE AND TRANSPORT
EMERGENTStudent with sickle cell disease presenting
with fever, severe pain, seizures/neurologic deficits or dyspnea
URGENT Fever, mild to moderate pain
NON-URGENT Mild pain, no dehydration
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EVALUATION AND FOLLOW-UP WITH SICKLE CELL CRISIS
Recurrent care and contact with health care provider
Revise IEMP as necessary
Follow-up with the cause of crises
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Students with Special Health Care Needs
When managing special needs students, remember to utilize "age appropriate" guidelines. In addition the following tips are helpful:
Concentrate on the student’s abilities, not disabilities. Promotes self-esteem and a positive self-image.
Communicate in a manner appropriate to the student’s ability. Presence of a physical disability does not mean that the student is also cognitively impaired.
Meet with the parent or caregiver and obtain a careful detailed history. Their assistance in interpreting behaviors and responses can give a better understanding of the student’s needs.
Develop an individualized health care plan for these students. Become familiar with respiratory emergency adjuncts and
interventions. Respiratory problems are the most common emergency encountered with these students.
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PREVENTION
Assure adequate nutrition and hydration
Avoid exposure to infections or stress
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SUMMARY
Thanks largely to improved treatment modalities, more children with significant health problems are living in the community and attending school.
Through your understanding of their unique health conditions, you can help these students accept and adapt to medical challenges they may face at school.