1. Welcome
Thank you for all the juggling you do!!!

2. Santa Rosa City Schools
Presented by District Nurses
Cheryl Closser, RN, MSN, PHN
Beth Munns, RN, BA, BSN
Emily Henke, RN, BSN, PHN
Jennifer Rodriguez, RN, BSN, PHN
October 23rd and 24th 2014

3. Contents Welcome and Introduction Health Tasks eSchools
Confidentiality
Medication Administration
Nose Bleeds
Head Injury
Anaphylaxis
Asthma
Diabetes
Vasovagal Syncope
Heart Conditions/AED
Seizures
Immunizations
Questions & concerns/evaluation
Skills Laboratory
CAIR

4. Important Health Tasks
Ensuring Confidentiality and Privacy
Entering Health Information into eSchools
Administering Medications
Maintaining the Health Office
First Aid
Verifying and Reporting Immunization Data

5. Ensuring Confidentiality
Awareness of surroundings when speaking about students and any medical conditions.
Keep paper work and files confidential; please do not post private information on walls. Do not allow student access.
Please review s before sending.
On s be aware when carbon copying, replying to one vs. all etc.

6. Entering Information in eSchools
Enter emergency card information ASAP! Do not drop information.
Consistency of entry of health problems. Example: Anaphylaxis vs. Allergies
Please add your initials and date to med alert entry.
Ask your nurse about any med alert doc. Questions.
Notify staff of any urgent matters i.e. PE restrictions, MD notes addressed to staff.
Generate health problem list and distribute to appropriate staff. Example: food allergy list for kitchen.
Notify nurse of any serious health conditions.

7. Medication Administration Six Critical Rights
Right Student
Right Medication
Right Dose
Right Route
Right Time
Right Documentation

8. Medication Administration Authorization Form
Fill Out Completely
Name of Student and Birth Date
Signatures from parent and doctor with dates.
5 of 6 Rights must be on form
Self administration or Self Carry?
Rights are 1. Right Student Right Medication Right Dose of Medication Right Route of Administration e.g. by mouth Right Time
And #6. Right Documentation

9. Important Considerations
Changes must be in writing from the physician
Notify School Nurse Immediately of Changes and New Medication Orders.
Label and Order must match, notify your school nurse if they do not.
Doctors orders must be brought into school by parent or faxed
All medications this includes over the counter, supplements, herbs and alternative treatments must be in original container and be accompanied by a medication authorization form and/or doctor’s order.
All doctors orders must be placed in health file, med book, with medication (disaster preparedness), & nurses mailbox
Any problems or questions….contact your school nurse!
Please post in health office “when accepting new medication, always check the following” handout. Also post in health office “steps in school medication administration” and go over the steps Reference Doctor’s order sheet (remind to make sure there is MD sig. and parent sig.)

10. Problems
To protect yourself: if you find an incomplete order, document and date what you are doing to resolve the problem.

11. Time
Initials
If student takes meds regularly, must mark reason for any missed dose
Explain the MAR:
-Top box for time and bottom for initial
-W: if med was dropped or tossed away and “*” and put the date/time/med that was ACTUALLY administered.
-If student takes meds regularly, need to mark reason (A or P or D) for missed dose
For meds dropped or tossed away. Document on reverse side. Then also document the medication was given.

12. Documentation
Complete log in ink, with time, and your initials, when you assist or observe student using medication.
Sign and initial bottom of medication log.
If student takes meds regularly, document reason for any missed doses.
You must have a list of the students who take medication at school

13. Counting Pills
All prescription medications must be counted and the number documented on the reverse side of the Medication Administration Record (MAR).
Two adults count the number of pills (without touching them) and both adults sign for the medications that have been brought in.
Call Nurse for Advice if needed

14. Count pills when medication is dropped off
-Drop off med, need to be logged in back, need to count pills, need 2 people to verify the number of pills
If student needs to take medication more than once, put “*” and write in date, time, med, and initial on the reverse side

15. Medication storage Must be stored in centrally located, locked cabinet
ALWAYS lock the med cabinet
No student access to med cabinet
Refrigerators for med storage must be locked & reserved only for meds!
If you do not have a locking refrigerator (for medications only) at your school site, notify your site administrator.

16. Errors and Discontinued Meds
Report errors immediately:
Site administrator
School nurse
Parent/ Guardian
Document error on MAR
Fill out incident report
Discontinued/ Outdated
Attempt to return
When disposing of medication place in sharps container.
Error: wrong time (or missed dose), wrong student, wrong dose, etc.
Write explanation on back of MAR next to “*” in regards to what happened

17. Medication Error Sheet
Please complete error sheet and give a copy to your school nurse and site administrator.
If an incident report is required, attach med error sheet to report and give to administrator.
Nurses will also complete reports as we check the medication binders and give a copy to the school’s administrators.
This is not meant to be punitive. We are working hard to improve safety at our school sites and we appreciate your help in making our schools a safer place.

18. Emergency Care Plan Forms
Please give a copy of the forms i.e. Seizure Disorder, Diabetes, Anaphylaxis to parents and/or students with known diagnosis.
Parents and physician must sign all care plan forms.

19. Medication Book Organization
A to Z by last name and include E Care Plans. Please use alphabetical file tabs.
If you have a separate emergency plan binder a copy of the plan must also be placed in the medication binder.
If you have a separate binder for diabetic students, have a reference in main binder.
Make a list of students taking daily medication and place in front of binder.

20. Staff Awareness
Elementary schools may have a red binder in the staff room with care plans and physician notes; staff should look at.
FYI: Teachers/staff should also have a red binder in their classroom for substitute teachers with emergency plans. This should also include a list of students with med alerts from eSchools. Teachers may ask you for this information.

21. Field Trips
Ask teachers to notify you 2 weeks in advance for field trips.
Give them a copy of the medication administration form and the medication before the trip.
Instruct teacher to document on back of form during the trip and assist with official documentation in med book on return.

22. Maintaining the Health Office
All equipment is functioning correctly
Supplies are stocked, organized and accessible.
Health office is clean, there should not be any food in the office. Example: Clean bed after every use.
Ensure Emergency First Aid bag is ready to go, along with student medications, logs and ecards for disasters.

23. First Aid Considerations
Provide as much privacy as possible.
Follow universal precautions.
Document all visits to the Health Office (in pen) may use paper or computer log.
Ensure 911 is called if situation warrants, and notify administration, parents and school nurse.

24. Universal Precautions
Wash hands before and after first aid treatment
Wear gloves when in contact with blood and other body fluids
Call janitorial staff for clean up of excess bodily fluids
Wipe down beds after each use, if blankets are used wash between uses.
Keep health office area clear of food and beverages.

25. Nose Bleeds FIRST AID - Sit upright, lean slightly forward.
Pinch soft part of nose above nostrils, 5-10 minutes, repeat if needed.
May use ice on bridge of nose if needed.
To prevent re-bleeding, advise students not to blow/pick nose or bend down for several hours.
If nosebleed lasts more than 20 minutes or follows an accident, fall or head injury don’t hesitate to call 911.

27. What is a Concussion?
A concussion is caused by a fall, bump, or blow to the head & can change the way your brain normally works.

28. Head Injury: Head injuries must be taken seriously.
May be difficult to determine whether mild or severe.
Call parents and give head injury form with signs & symptoms and when to seek care.
Severe symptoms usually develop within 24 hours but can occur several weeks later.
Doctor’s note required for students to return after a concussion.

29. Basic First Aid for a Head Injury:
Ice for head or neck
Keep still in a darkened room, not alone
Ask simple questions (what is your name, what day is today, where are you?)
Observe body language, personality, balance
Monitor student for worsening of symptoms, report to nurse and parent
Re-evaluate student at 15 and 30 minutes
A visit to the doctor is needed anytime mild symptoms persist.

30. Concussion Checklist
Concussion: Heads Up For Schools (More information & free resources).

31. Common Symptoms of Concussion
Appears dazed, stunned, and/or confused
Loses consciousness (even briefly)
Memory, behavior or personality changes
Balance problems or dizziness
Double or blurry vision
Headache and/or sensitivity to light or noise
Feels tired, sluggish, hazy, foggy or groggy
Nausea and/or vomiting
Just not feeling right or feeling down Requires a hospital visit! Need doctor’s note to return to school.

32. When is Head Injury a Medical Emergency? Call 911 if…
Difficulty breathing
One pupil larger than the other
Mood changes
Loss of balance
Weakness, numbness, and/or decreased coordination
Speech problems
Severe head/facial bleeding
Seizures
Blood or clear fluid in the ears or nose
Loss of consciousness
Increasing confusion
Worsening headache
Drowsiness or cannot be awakened
Persistent vomiting or nausea
Unusual behavior 32

34. In case of severe head trauma:
If found unconscious assume the neck is injured and stabilize. DO NOT MOVE! Call 911.
Stop any bleeding with pressure unless you suspect a skull fracture, no direct pressure.
Open airway, watch for breathing. CPR if needed.
If severe head trauma occurs:
Keep the person still. Until medical help arrives, keep the injured person lying down and quiet in a darkened room, with the head and shoulders slightly elevated. Don't move the person unless necessary and avoid moving the person's neck.
Stop any bleeding. Apply firm pressure to the wound with sterile gauze or a clean cloth. But don't apply direct pressure to the wound if you suspect a skull fracture.
Watch for changes in breathing and alertness. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR. 34

35. Anaphylaxis: Extremely serious form of an allergic reaction
Can occur within seconds or be delayed.
“Any respiratory system involvement, difficulty breathing, audible wheezing or difficulty swallowing”. -EMSA Definition
Act immediately, You can save a student’s life!
Students with asthma & allergies have a higher risk of complications with breathing.

36. Anaphylaxis Emergency Care Plan
See Handouts in English and Spanish:
Please distribute copies of this plan to students/families whom have serious allergies.

37. Common Anaphylaxis Triggers
Nuts
Shellfish
Latex
Bees
Variety of Foods
Some Chemical Exposures such as Sulfa
Plants
Other Unknowns

38. Symptoms of Anaphylaxis
After being exposed to the trigger, an anaphylactic reaction can develop within minutes or even seconds. The reaction is sudden, severe and involves the whole body. In some cases, the reaction can be delayed for up to 1 to 3 hours depending on the substance causing the reaction.
As shown in the asthma video the airways tighten making it difficult to breath. If the student has asthma the have a higher risk of complications with breathing.
Ref.

39. What Kids Could Say: Look I have small red bumps
I’m really itchy all over
I feel like throwing up
My stomach hurts
My heart is beating really fast
My throat hurts
I can’t swallow
I can’t breathe
I’m scared
I’m dizzy

40. What You May See: Change of Voice Coughing Wheezing Change of Color
Swelling of any body part
Fainting or Loss of Consciousness

41. What to do if Suspected Anaphylactic Reaction
 Determine if anaphylaxis is suspected. More of a danger not to give it than to give it.  If symptoms have occurred CALL 911 immediately, stay with student. Have student sit and stay calm.  Prepare to administer EpiPen. EpiPen acts immediately but effects last only minutes. Make sure 911 is called.
Link to video & link to training standards. If from stinger, remove with credit card

42. Two strengths:
Above 66 lbs. = 0.3 mg (yellow)
Below 66 lbs. = 0.15 mg (green)

43. How to Administer Epi-Pen:
 Form a fist around the Epi-pen. Pull off the Safety Cap.  Never put thumb, fingers, or hand over the black/orange tip.  Swing and jab the tip firmly into the OUTER THIGH at a 90 degree angle. (Can be injected through clothing.)  You will hear a click. Hold the EpiPen in place for 10 seconds. Remove & massage the injection area for several seconds. (After the injection, they may feel their heart pounding. This is a normal.)  Check the black/orange tip: If the needle is exposed the dose was delivered, if not repeat above steps.

44. Always Call 911:  Give epi-pen first if alone, then call 911.
 Know time you gave Epi-pen, may only last minutes. Do not give Benadryl first, takes min.  If symptoms return give 2nd Epi-pen minutes after initial dose.
 If insect sting, remove stinger/apply ice to sting area. Scrape stinger out, do not pull out.  Give used Epi-pen to paramedics
Some individuals will have an anaphylactic reaction that goes away and returns a few hours later. Therefore, after exposure or a serious reaction observation in the hospital is necessary.

45. Observe for signs of shock cover with blanket if cold.
Watch breathing. If stops breathing begin CPR.
Document the incident
Send a copy to your school nurse

46. Additional Epi-pen Info:
 School Personnel are required to have current CPR certification to administer an Epi-pen.
 Store at room temperature  Keep record of expiration date- solution must be colorless, replace if brown

47. Auvi Q Demonstration

48. SEIZURE TRAINING FOR SCHOOL PERSONNEL Information from Epilepsy Foundation
NOTES:
Introduce yourself.
Ask, “How many of you have experience with students or other people who have seizures? Would you be willing to briefly share your experience with the group?”
Keep total sharing time to about two minutes.
If implementing the optional certification process, notify participants that they will be tested on the training content. 48

49. Epilepsy = Seizure Disorder Objectives:
Discuss what a Seizure is.
Review types/signs of Seizures.
Seizure Triggers or Precipitants
What to do during a Seizure.
Recognize when a Seizure is a Medical Emergency. 49

50. What is a Seizure?
A brief, excessive discharge of electrical activity in the brain that alters one or more of the following:
Movement
Sensation
Behavior
Awareness
Most Seizures are NOT medical Emergencies!

51. Types and Signs of Seizures
Generalized Seizures: (seizures involving the entire brain)
*Tonic-Clonic (generally last 1 to 3 minutes, sudden, loss of consciousness, convulsions, stiffening and/or jerking of extremities)
*Absence Seizures(generally last 1 to 10 seconds, lapse of awareness, blank stare, pause in activity)
Partial Seizures: (seizures involving only part of the brain)
*Simple/Complex Partial (awareness maintained and/or impaired, psychic/sensory symptoms, inability to respond)

52. Seizure Triggers and Precipitants
Flashing lights and hyperventilation can trigger seizures in some students with epilepsy
Factors that might increase the likelihood of a seizure in students with epilepsy include:
Missed or late medication (#1 reason)
Stress/anxiety
Lack of sleep/fatigue
Hormonal changes
Illness
Alcohol or drug use
Drug interactions (from prescribed or over the counter medicines)
Overheating/overexertion
Poor diet/missed meals

53. What to do during a Seizure?
Remain calm
Time seizure
Ensure safety
Clear the area
Cushion head, remove glasses
Turn on side, loosen any tight clothing
Nothing in mouth; don’t hold down
Protect privacy
After: reassure and stay with them

54. When is a Seizure an Emergency? Call 911 When:
Convulsive (tonic-clonic) seizure > 5 minutes
Please refer to individual student health plan & consult with your nurse.
Repeated seizures without
regaining consciousness
Injured or other medical condition
First-time seizure
Breathing difficulties
Possible pregnancy

55. Epilepsy Foundation Information and Referral. (800) 332-1000
Contact Information
Epilepsy Foundation Information and Referral. (800)

56. What is Asthma?

57. Asthma Triggers Allergens (mold, dust, pollen, animals etc.)
Chemicals (sulfites, aspirin, etc.)
Emotions (stress, crying, excitement)
Exercise
Irritants (perfume, cleaning fluids, smoke)
Respiratory Infections (cold, flu, sinus)
Seasonal/Time (day vs. night)
Smoking
Image Retrieved from:

58. Asthma Symptoms Wheezing Frequent Cough Chest Tightness
Shortness of Breath
Difficulty Walking or Talking
Check their Peak Flow Meter
if they have one.

59. Asthma Medications
Three Types: Please call nurse if unsure of the type of inhaler provided.
Rescue
Maintenance
Steroid Reversing Medication

60. Rescue Inhaler Rescue Inhaler/Symptom Relieving: FOR SCHOOL
Example: Albuterol/Ventolin/Pro Air HFA

61. Maintenance Inhaler Maintenance/Preventative: Home Use
Example: Advair, Q Var, Dulera
No inflammation=no muscle irritation=no tightening of the breathing tubes.

62. Steroid Flare Up Reversing Medication Example: Prednisone

63. Asthma Medication Side Effects
Symptom Relieving:
Rapid Heart Rate
Tremors
Nervousness
Headache

64. 4 Steps for Asthma Episode
Help to sit upright; stay calm and reassure
Follow Emergency Action Plan &/or Doctors order for use of rescue inhaler
Get help from school nurse or notify parent if student has any of the following:
Inhaler not helping
Breathing hard and fast
Can’t walk or talk well
Call 911 if not breathing, unconscious, lips blue, struggling to breathe (hunched over or ribs show), or other signs of distress
Notify Parent or Guardian

65. Asthma Inhaler Use Remove the cap and hold the inhaler upright.
Shake the inhaler
Tilt your head back slightly and breathe out.
Press down on the inhaler to release the medicine as you start to breathe in slowly.
Breathe in slowly for 3 to 5 seconds.
Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.
Repeat puffs as directed. Wait 1 minute between puffs to allow the second puff to get into the lungs.

66. Six Ways to Administer Medication

67. Asthma Action Plan
Please have parents and/or doctor complete the plan for students that have significant difficulty with their asthma.

68. Vasovagal Syncope
Student faints in response to trigger (sight of blood, heat, lack of food or water, fear of injury, standing for a long time, etc.)
If a student loses consciousness call 911
Student should be checked by MD. especially if it is a first occurrence.
If known history and student uninjured he/she should rest for 15 to 30 minutes.
Hearbeat slows blood vessels in legs relax causing drop in BP leading to brief LOC

69. Heart Conditions and AEDs
AED can save a child’s life that has a heart condition.
AED awareness training annually at your school sites.
AT least one person on site at all times that is CPR certified.
Register at Coastal Valley EMS
Place device in visible location for anyone to use.

70. Monthly AED Readiness Check
Date
Functional(green light)
Adult Padpak Exp date
Ped Padpak Exp date
Signature

71. Diabetic Management in Schools

72. What is Diabetes? Body does not make or properly use insulin.
Insulin is needed to:
Move glucose from blood into cells for energy
If insulin isn’t working, high blood glucose results:
Energy levels are low
Dehydration
Complications
Retrieved from:

73. Types of diabetes Type 1 Type 2 Insulin dependent diabetes
Insulin producing cells (pancreas) destroyed by body
Must take insulin daily by injection or insulin pump.
Most common in adults.
Pancreas can still make insulin.
Diet, weight, lifestyle, and genetics causes.
Early diagnosis controlled with medications at home.
*Types of Diabetes:
Type 1 (Insulin dependent diabetes, Juvenile onset diabetes) - autoimmune disease meaning that the body has destroyed the insulin producing cells in the pancreas. People with type 1 must take insulin daily by injection or insulin pump.
Type 2 (adult-onset diabetes) – most common, body either does not produce enough insulin or does not use the insulin well, pancreas can still make insulin. 73

74. Signs and Symptoms of Diabetes
Increased urination
Increased thirst
Increased tiredness
Acanthosis Nigricans=dark pigmentation of skin around neck

75. Type 1 Management Medication/insulin Blood sugar monitoring
Carbohydrate Counting
Exercise
24/7 Job

76. Diabetes Medical Management Plan
Basis for all school-based diabetes care plans.
Developed by student’s personal health care team and guardian.
Signed by a member of student’s personal health care team.
Individualized

77. Terms Basal dose is the background insulin that works for 24 hours
Bolus dose is extra insulin given for carbohydrates
Correction dose is used to decrease high blood sugar
Ketones are acids produced by the body when it burns fat for fuel. Bad for diabetics.
I:C is the insulin to carbohydrate ratio

78. What affects blood sugar?
Insulin and Activity make blood sugar go down
Food makes blood sugar go up
Stress, illness, and injury affect blood sugar and it can go up or down.
*Things that can affect blood glucose levels:
insulin and activity can made blood glucose go down
food can raise blood glucose
stress, illness, injury and other things can also affect blood glucose 78

79. Levels of care Many older students are independent!
Some students will need school staff to observe or assist with care.
All students with diabetes will need help in the event of an emergency situation.
Always check the health plan
Never leave student alone
Many students are independent!
Some students will need school staff to perform or assist with care.
All students with diabetes will need help in the event of an emergency situation. 79

80. They have tested now what?
In Range (set by doctor)
Administer insulin per plan
Document
Back to class
Too high=
Hyperglycemia
Too low=
Hypoglycemia

81. Hyperglycemia Goal is to lower blood sugar within range
Check blood glucose
Allow use of the bathroom
Allow access to water
Insulin dose if stated in plan
Check ketones if in plan
Call home
May NOT PLAY or DO PE if ketones present
Ketones can lead to diabetic keto-acidosis emergency
*Hyperglycemia – Blood glucose too high
*review flow sheet
*Main actions are:
check blood glucose
check ketones (chemicals that your body makes when there is not enough insulin in the blood and the body must break down fat for energy) if written in the plan
allow free use of the bathroom and access to water
call home (do not allow them to go out and play if ketones are present).
Ketones can lead to a condition called DKA – this can be life threatening! 81

82. Ketones
Develop over time, usually one high blood sugar is not a cause for an alarm.
Pumpers can develop faster
Time to check can vary based on health care plan.
Always check if have
Nausea
Vomiting
Abdominal Pain
Flu like symptoms

83. Ketones continued Two ways to check ketones; blood or urine
Pee on a keto stick
Any color on the stick is a call home
Darker the color the more serious
Dark and vomiting call 911 if unable to reach parent this can become very dangerous and serious

84. Hypoglycemia Blood sugar too low – usually less than 80 Quick onset
Requires immediate treatment
May lead to unconsciousness if not
Most students will be able to recognize the signs and symptoms of hypoglycemia but not always…
*Hypoglycemia – Blood glucose too low (A low) (Usually defined as blood glucose fewer than 80)
Happens very suddenly and must be treated immediately, may progress to unconsciousness if not treated.
Most often students will be able to recognize the signs and symptoms of hypoglycemia but not always. *see sheet 84

85. Hypoglycemia Signs and Symptoms
Mild
Moderate to Severe
Extreme Hunger
Tremors
Lethargic
Increased heart rate
Pale skin
Sweating
Change in Personality
Shakiness
Dizziness
Headache
Dilated Pupils
Clammy Skin
Anxiety
Yawning Irritability/frustration
Behavior/personality changes
Extreme tiredness/fatigue
Sudden crying
Restlessness
Confusion
Inability to swallow
Dazed Appearance
Seizures, convulsions
Unconsciousness/coma jerking movements

86. Mild / Moderate Hypoglycemia
Blood sugar (BS) check
If no meter, treat for a low with…
Rule of 15
Student eats / drinks 15 grams of a fast acting carbohydrate
4 oz. of juice
3-4 glucose tablets
1-2 TBSP honey
6 oz. regular soda --NOT DIET SODA
3 tsp. sugar in water
Re-check BS in min
Repeat with 15 more grams if still low
Recheck in min
If symptoms continue, call home
Do Not Over Treat or allow student to over treat
*Mild/moderate:
Main actions are:
check blood glucose – if no meter treat for a low, rule of 15
Have the student eat or drink 15 grams of a fast acting carbohydrate (4 oz of juice, 3-4 glucose tablets, 1-2 TBSP honey, 6 oz regular soda, 3 TSP sugar in water)
Check blood glucose in 10-15min
Repeat treatment of 15g if blood glucose still low and recheck in 10-15min
If symptoms continue call home 86

87. Severe Hypoglycemia Student unable to swallow or unconscious
Inject glucagon ASAP! Call 911
Position student on side will vomit
Call parent or guardian and nurse
Stay with the student
Student should respond to the glucagon in minutes
When student is awake and able to swallow give juice while waiting for EMS
If student found unconscious assume low BS
*Severe Hypoglycemia (see sheet)
Place student on side
Lift chin to keep airway open
Inject glucagon – go over this in a minute
Do not give anything by mouth
Call 911 1st then the parent/guardian
Stay with the student
Student should respond to the glucagon in 10-20min
When student is awake and able to swallow then you can give juice while waiting for EMS 87

88. What Is Glucagon? Naturally occurring pancreatic hormone
It raises blood glucose level by releasing liver glycogen.
Treatment for severe hypoglycemia.
Can save a life!
Cannot harm a student – cannot overdose.
There are different doses, check the doctor’s order.
Glucagon for injection is a prescription medication.
Glucagon is a hormone that occurs naturally in the body. It is produced in the pancreas and raises blood glucose levels by causing the release of glycogen (a form of stored carbohydrate) from the liver that raises blood glucose levels.
Glucagon injections are used to treat serious hypoglycemia. If it is specified in the student’s Diabetes Medical Management Plan (DMMP), glucagon should be used when the student is unconscious, experiencing convulsions, or cannot eat or drink safely. Severe hypoglycemia can cause brain damage or death.
Although it may cause nausea and vomiting when the student regains consciousness, glucagon is a life-saving treatment that cannot harm a student. Cannot overdose. 88 88

89. Glucagon Kit Storage
Place: As designated in DMMP accessible to school personnel.
Store at room temperature
Expiration date: Monitor
After mixing, dispose of any unused portion within one hour.
The glucagon kit should be stored in a place designated in DMMP, accessible to school personnel, and may be kept with the student.
Glucagon should be stored at room temperature.
Expiration date should be checked. Do not administer if expired, discolored, or does not dissolve well.
After mixing the contents, dispose of any unused portion within one hour.
Expired glucagon emergency kits can be used for future training sessions. 89 89

90. Preparation Flip cap off glass vial containing dry powder
Remove cap from syringe
Put on gloves if available
1. Flip the plastic cap off the glass vial of powdered glucagon.
2. Remove the plastic cap off the syringe needle. Do not remove plastic clip from syringe as it prevents the rubber stopper from being pulled out.
3. Put on gloves if available 90 90

91. Mixing Solution
Inject entire fluid in syringe into the bottle containing powder
Shake gently or roll to mix until all powder is dissolved and solution is clear.
3. Take the fluid filled syringe in the glucagon emergency kit and inject the fluid into the bottle containing the glucagon powder.
4. Shake gently or roll to mix until all powder is dissolved and solution is clear. 91

92. Dosing and Drawing Out
Inspect. Solution should be clear and colorless.
Draw prescribed amount of glucagon back into syringe.
5. Inspect medication for color, clarity, and presence of lumps. Solution should be clear and colorless.
6. Draw a prescribed amount of glucagon back into syringe. Amount is per DMMP. General guidelines are as follows:
If child weighs > 45 lbs., inject the full vial of glucagon (1 cc) using the buttocks, thigh, or arm.
If child weights < 45 lbs., inject 1/2 of the solution.
Do not recap syringe. Discard sharp in appropriate container. 92

93. Injecting Clean site if possible.
Inject at 90° into the tissue under cleansed area (may administer through clothing as necessary
buttocks
thigh
arm
7. When possible, the injection site should be exposed and cleaned.However, glucagon can be administered without cleaning and through clothing if necessary.
8. Injection is given at a 90 degree angle into the tissue under the cleansed area in an area such as the buttocks, thigh or arm. Suggested sites include the outer thigh, upper outer buttock, or arm. 93

94. After Injecting
May take minutes for student to regain consciousness
Check blood glucose
Give sips of fruit juice or regular soda, once student is awake and able to drink
Advance diet as tolerated
Document as per DMMP
Do not recap syringe. Discard sharp in appropriate container
It may take minutes for student to regain consciousness.
Check blood sugar minutes after administering glucagon.
Give sips of regular soda or fruit juice once student is awake and able to drink.
Follow with concentrated sugar with snack containing proteins and carbohydrates such as peanut butter sandwich or cheese crackers to keep blood glucose levels elevated to normal levels and to prevent recurrence.
Document blood glucose level and glucagon dosage as per DMMP.
Do not recap syringe. Discard sharp in appropriate container. 94 94

95. Considerations
The time to complete recovery from a severe hypoglycemic episode varies according to how low the blood glucose level was and for how long prior to treatment
Some signs and symptoms, such as headache, may persist for several hours, although the blood glucose level is satisfactory
Continued monitoring is important
Student may need to be transported via EMS or go home with parent/guardian
The time to complete recovery from a severe hypoglycemic episode varies according to how low the blood glucose level was and for how long prior to treatment.
Some signs and symptoms, such as headache, may persist for several hours, although the blood glucose level is satisfactory. The student may be unable to participate in learning or school activities up to several hours after a severe hypoglycemia episode.
Continued monitoring is important, but is a challenge in the school setting. The student may need to be transported via EMS or sent home with the parent/guardian. 95 95

96. Don't Be Surprised If. . .
Student does not remember being unconscious, incoherent or has a headache
Blood glucose becomes very high (over 200)
Nausea or vomiting may occur
Don’t be surprised if …..
Student does not remember being unconscious, incoherent or has a headache.
Blood glucose becomes very high (over 200)
Nausea or vomiting may occur
Note: At this point, the instructor demonstrates administration of glucagon and participants practice. 96 96

97. Glucagon Training Documentation
Send copy to HR
Keep a copy for your own records

98. Diabetes Monitoring Log
For the supervision of diabetic students at school.
Let your nurse know if you have a student that requires supervision.

99. Legal Considerations
In the State of California unlicensed assistive personnel may administer insulin.

100. Maintaining and Reporting Immunization Information
Review immunization records and ensure requirements are met
Shots for School
Complete state reports for K and 7th grade
Annually send report to Public Health Dept. for K and notify your nurse when complete. Send proof to Special Services.
Notify nurse of any questions or concerns

101. Immunization Guidelines
Conditional vs Unconditional Admission
30 day grace period while waiting for records
Waiver Forms
Homeless may attend without immunizations.

102. CAIR Please review form; add email and school
Promise of CONFIDENTIALITY
Password and User Name
District Nurses to follow up
CAIR web information