2Santa Rosa City Schools Presented by District NursesCheryl Closser, RN, MSN, PHNBeth Munns, RN, BA, BSNEmily Henke, RN, BSN, PHNJennifer Rodriguez, RN, BSN, PHNOctober 23rd and 24th 2014
3Contents Welcome and Introduction Health Tasks eSchools ConfidentialityMedication AdministrationNose BleedsHead InjuryAnaphylaxisAsthmaDiabetesVasovagal SyncopeHeart Conditions/AEDSeizuresImmunizationsQuestions & concerns/evaluationSkills LaboratoryCAIR
4Important Health Tasks Ensuring Confidentiality and PrivacyEntering Health Information into eSchoolsAdministering MedicationsMaintaining the Health OfficeFirst AidVerifying and Reporting Immunization Data
5Ensuring 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.
6Entering Information in eSchools Enter emergency card information ASAP! Do not drop information.Consistency of entry of health problems. Example: Anaphylaxis vs. AllergiesPlease 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.
7Medication Administration Six Critical Rights Right StudentRight MedicationRight DoseRight RouteRight TimeRight Documentation
8Medication Administration Authorization Form Fill Out CompletelyName of Student and Birth DateSignatures from parent and doctor with dates.5 of 6 Rights must be on formSelf administration or Self Carry?Rights are 1. Right Student Right Medication Right Dose of Medication Right Route of Administration e.g. by mouth Right TimeAnd #6. Right Documentation
9Important Considerations Changes must be in writing from the physicianNotify 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 faxedAll 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 mailboxAny 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.)
10ProblemsTo protect yourself: if you find an incomplete order, document and date what you are doing to resolve the problem.
11TimeInitialsIf student takes meds regularly, must mark reason for any missed doseExplain 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 doseFor meds dropped or tossed away. Document on reverse side. Then also document the medication was given.
12DocumentationComplete 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
13Counting PillsAll 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
14Count 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 pillsIf student needs to take medication more than once, put “*” and write in date, time, med, and initial on the reverse side
15Medication storage Must be stored in centrally located, locked cabinet ALWAYS lock the med cabinetNo student access to med cabinetRefrigerators 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.
16Errors and Discontinued Meds Report errors immediately:Site administratorSchool nurseParent/ GuardianDocument error on MARFill out incident reportDiscontinued/ OutdatedAttempt to returnWhen 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
17Medication 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.
18Emergency 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.
19Medication 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.
20Staff AwarenessElementary 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.
21Field TripsAsk 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.
22Maintaining the Health Office All equipment is functioning correctlySupplies 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.
23First 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.
24Universal Precautions Wash hands before and after first aid treatmentWear gloves when in contact with blood and other body fluidsCall janitorial staff for clean up of excess bodily fluidsWipe down beds after each use, if blankets are used wash between uses.Keep health office area clear of food and beverages.
25Nose 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.
27What is a Concussion?A concussion is caused by a fall, bump, or blow to the head & can change the way your brain normally works.
28Head 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.
29Basic First Aid for a Head Injury: Ice for head or neckKeep still in a darkened room, not aloneAsk simple questions (what is your name, what day is today, where are you?)Observe body language, personality, balanceMonitor student for worsening of symptoms, report to nurse and parentRe-evaluate student at 15 and 30 minutesA visit to the doctor is needed anytime mild symptoms persist.
30Concussion ChecklistConcussion: Heads Up For Schools (More information & free resources).
31Common Symptoms of Concussion Appears dazed, stunned, and/or confusedLoses consciousness (even briefly)Memory, behavior or personality changesBalance problems or dizzinessDouble or blurry visionHeadache and/or sensitivity to light or noiseFeels tired, sluggish, hazy, foggy or groggyNausea and/or vomitingJust not feeling right or feeling down Requires a hospital visit! Need doctor’s note to return to school.
32When is Head Injury a Medical Emergency? Call 911 if… Difficulty breathingOne pupil larger than the otherMood changesLoss of balanceWeakness, numbness, and/or decreased coordinationSpeech problemsSevere head/facial bleedingSeizuresBlood or clear fluid in the ears or noseLoss of consciousnessIncreasing confusionWorsening headacheDrowsiness or cannot be awakenedPersistent vomiting or nauseaUnusual behavior32
34In 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
35Anaphylaxis: 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 DefinitionAct immediately, You can save a student’s life!Students with asthma & allergies have a higher risk of complications with breathing.
36Anaphylaxis Emergency Care Plan See Handouts in English and Spanish:Please distribute copies of this plan to students/families whom have serious allergies.
37Common Anaphylaxis Triggers NutsShellfishLatexBeesVariety of FoodsSome Chemical Exposures such as SulfaPlantsOther Unknowns
38Symptoms 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.
39What Kids Could Say: Look I have small red bumps I’m really itchy all overI feel like throwing upMy stomach hurtsMy heart is beating really fastMy throat hurtsI can’t swallowI can’t breatheI’m scaredI’m dizzy
40What You May See: Change of Voice Coughing Wheezing Change of Color Swelling of any body partFainting or Loss of Consciousness
41What 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
43How 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.
44Always 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 paramedicsSome 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.
45Observe for signs of shock cover with blanket if cold. Watch breathing. If stops breathing begin CPR.Document the incidentSend a copy to your school nurse
46Additional 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
48SEIZURE 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
49Epilepsy = Seizure Disorder Objectives: Discuss what a Seizure is.Review types/signs of Seizures.Seizure Triggers or PrecipitantsWhat to do during a Seizure.Recognize when a Seizure is a Medical Emergency.49
50What is a Seizure?A brief, excessive discharge of electrical activity in the brain that alters one or more of the following:MovementSensationBehaviorAwarenessMost Seizures are NOT medical Emergencies!
51Types 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)
52Seizure Triggers and Precipitants Flashing lights and hyperventilation can trigger seizures in some students with epilepsyFactors that might increase the likelihood of a seizure in students with epilepsy include:Missed or late medication (#1 reason)Stress/anxietyLack of sleep/fatigueHormonal changesIllnessAlcohol or drug useDrug interactions (from prescribed or over the counter medicines)Overheating/overexertionPoor diet/missed meals
53What to do during a Seizure? Remain calmTime seizureEnsure safetyClear the areaCushion head, remove glassesTurn on side, loosen any tight clothingNothing in mouth; don’t hold downProtect privacyAfter: reassure and stay with them
54When is a Seizure an Emergency? Call 911 When: Convulsive (tonic-clonic) seizure > 5 minutesPlease refer to individual student health plan & consult with your nurse.Repeated seizures withoutregaining consciousnessInjured or other medical conditionFirst-time seizureBreathing difficultiesPossible pregnancy
55Epilepsy Foundation Information and Referral. (800) 332-1000 Contact InformationEpilepsy Foundation Information and Referral. (800)
58Asthma Symptoms Wheezing Frequent Cough Chest Tightness Shortness of BreathDifficulty Walking or TalkingCheck their Peak Flow Meterif they have one.
59Asthma MedicationsThree Types: Please call nurse if unsure of the type of inhaler provided.RescueMaintenanceSteroid Reversing Medication
60Rescue Inhaler Rescue Inhaler/Symptom Relieving: FOR SCHOOL Example: Albuterol/Ventolin/Pro Air HFA
61Maintenance Inhaler Maintenance/Preventative: Home Use Example: Advair, Q Var, DuleraNo inflammation=no muscle irritation=no tightening of the breathing tubes.
62Steroid Flare Up Reversing Medication Example: Prednisone
63Asthma Medication Side Effects Symptom Relieving:Rapid Heart RateTremorsNervousnessHeadache
644 Steps for Asthma Episode Help to sit upright; stay calm and reassureFollow Emergency Action Plan &/or Doctors order for use of rescue inhalerGet help from school nurse or notify parent if student has any of the following:Inhaler not helpingBreathing hard and fastCan’t walk or talk wellCall 911 if not breathing, unconscious, lips blue, struggling to breathe (hunched over or ribs show), or other signs of distressNotify Parent or Guardian
65Asthma Inhaler Use Remove the cap and hold the inhaler upright. Shake the inhalerTilt 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.
67Asthma Action PlanPlease have parents and/or doctor complete the plan for students that have significant difficulty with their asthma.
68Vasovagal SyncopeStudent 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 911Student 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
69Heart 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 EMSPlace device in visible location for anyone to use.
72What is Diabetes? Body does not make or properly use insulin. Insulin is needed to:Move glucose from blood into cells for energyIf insulin isn’t working, high blood glucose results:Energy levels are lowDehydrationComplicationsRetrieved from:
73Types of diabetes Type 1 Type 2 Insulin dependent diabetes Insulin producing cells (pancreas) destroyed by bodyMust 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
74Signs and Symptoms of Diabetes Increased urinationIncreased thirstIncreased tirednessAcanthosis Nigricans=dark pigmentation of skin around neck
76Diabetes 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
77Terms Basal dose is the background insulin that works for 24 hours Bolus dose is extra insulin given for carbohydratesCorrection dose is used to decrease high blood sugarKetones are acids produced by the body when it burns fat for fuel. Bad for diabetics.I:C is the insulin to carbohydrate ratio
78What affects blood sugar? Insulin and Activity make blood sugar go downFood makes blood sugar go upStress, 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 downfood can raise blood glucosestress, illness, injury and other things can also affect blood glucose78
79Levels 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 planNever leave student aloneMany 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
80They have tested now what? In Range (set by doctor)Administer insulin per planDocumentBack to classToo high=HyperglycemiaToo low=Hypoglycemia
81Hyperglycemia Goal is to lower blood sugar within range Check blood glucoseAllow use of the bathroomAllow access to waterInsulin dose if stated in planCheck ketones if in planCall homeMay NOT PLAY or DO PE if ketones presentKetones can lead to diabetic keto-acidosis emergency*Hyperglycemia – Blood glucose too high*review flow sheet*Main actions are:check blood glucosecheck 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 planallow free use of the bathroom and access to watercall 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
82KetonesDevelop over time, usually one high blood sugar is not a cause for an alarm.Pumpers can develop fasterTime to check can vary based on health care plan.Always check if haveNauseaVomitingAbdominal PainFlu like symptoms
83Ketones continued Two ways to check ketones; blood or urine Pee on a keto stickAny color on the stick is a call homeDarker the color the more seriousDark and vomiting call 911 if unable to reach parent this can become very dangerous and serious
84Hypoglycemia Blood sugar too low – usually less than 80 Quick onset Requires immediate treatmentMay lead to unconsciousness if notMost 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 sheet84
85Hypoglycemia Signs and Symptoms MildModerate to SevereExtreme HungerTremorsLethargicIncreased heart ratePale skinSweatingChange in PersonalityShakinessDizzinessHeadacheDilated PupilsClammy SkinAnxietyYawning Irritability/frustrationBehavior/personality changesExtreme tiredness/fatigueSudden cryingRestlessnessConfusionInability to swallowDazed AppearanceSeizures, convulsionsUnconsciousness/coma jerking movements
86Mild / Moderate Hypoglycemia Blood sugar (BS) checkIf no meter, treat for a low with…Rule of 15Student eats / drinks 15 grams of a fast acting carbohydrate4 oz. of juice3-4 glucose tablets1-2 TBSP honey6 oz. regular soda --NOT DIET SODA3 tsp. sugar in waterRe-check BS in minRepeat with 15 more grams if still lowRecheck in minIf symptoms continue, call homeDo 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 15Have 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 10-15minRepeat treatment of 15g if blood glucose still low and recheck in 10-15minIf symptoms continue call home86
87Severe Hypoglycemia Student unable to swallow or unconscious Inject glucagon ASAP! Call 911Position student on side will vomitCall parent or guardian and nurseStay with the studentStudent should respond to the glucagon in minutesWhen student is awake and able to swallow give juice while waiting for EMSIf student found unconscious assume low BS*Severe Hypoglycemia (see sheet)Place student on sideLift chin to keep airway openInject glucagon – go over this in a minuteDo not give anything by mouthCall 911 1st then the parent/guardianStay with the studentStudent should respond to the glucagon in 10-20minWhen student is awake and able to swallow then you can give juice while waiting for EMS87
88What 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.8888
89Glucagon Kit StoragePlace: As designated in DMMP accessible to school personnel.Store at room temperatureExpiration date: MonitorAfter 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.8989
90Preparation Flip cap off glass vial containing dry powder Remove cap from syringePut on gloves if available1. 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 available9090
91Mixing SolutionInject entire fluid in syringe into the bottle containing powderShake 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
92Dosing and Drawing OutInspect. 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
93Injecting Clean site if possible. Inject at 90° into the tissue under cleansed area (may administer through clothing as necessarybuttocksthigharm7. 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
94After InjectingMay take minutes for student to regain consciousnessCheck blood glucoseGive sips of fruit juice or regular soda, once student is awake and able to drinkAdvance diet as toleratedDocument as per DMMPDo not recap syringe. Discard sharp in appropriate containerIt 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.9494
95ConsiderationsThe 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 treatmentSome signs and symptoms, such as headache, may persist for several hours, although the blood glucose level is satisfactoryContinued monitoring is importantStudent may need to be transported via EMS or go home with parent/guardianThe 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.9595
96Don't Be Surprised If. . .Student does not remember being unconscious, incoherent or has a headacheBlood glucose becomes very high (over 200)Nausea or vomiting may occurDon’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 occurNote: At this point, the instructor demonstrates administration of glucagon and participants practice.9696
97Glucagon Training Documentation Send copy to HRKeep a copy for your own records
98Diabetes Monitoring Log For the supervision of diabetic students at school.Let your nurse know if you have a student that requires supervision.
99Legal ConsiderationsIn the State of California unlicensed assistive personnel may administer insulin.
100Maintaining and Reporting Immunization Information Review immunization records and ensure requirements are metShots for SchoolComplete state reports for K and 7th gradeAnnually 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
101Immunization Guidelines Conditional vs Unconditional Admission30 day grace period while waiting for recordsWaiver FormsHomeless may attend without immunizations.
102CAIR Please review form; add email and school Promise of CONFIDENTIALITYPassword and User NameDistrict Nurses to follow upCAIR web information