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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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MEDICAL EMERGENCIES

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ANAPHLAXIS

SUDDEN, SEVERE ALLERGIC REACTION

- Can be systemic- Can be fatal

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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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INITIAL ASSESSMENT

ABCs LOC related to metabolic process

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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.

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ANY QUESTIONS??