1. Introduction to Health Care and Health Services

2. Health Services, Who are we?

3. The Health Services Team
There are six program nurses, with two nurses assigned to each program, Secondary School Program, Lower School Program and the Deaf Blind Program and one nurse assigned to the Early Learning Center.
Medical staff consists of pediatricians from Children’s Hospital and a pediatric nurse practitioner along with a consulting psychiatrist and neurologist.
Additional health services staff include the director, nutritionist and administrative assistant.

4. Perkins School for the Blind Health Services
Sue Buckley, Admin. Assist.
Adria Hodas, Director of Health Services
Jessica Roth, Pediatrician
Kelly Chiu, Pediatrician
Sarah Kochis
Pediatric Nurse Practitioner
John Julian, Psychiatrist
Anne Rollins Nutritionist
Program Nurses
Secondary School
Lower School
Deaf Blind Program
Muriel Comick Brooks, KS, May, Independent Living Apts
Fisher, Oliver
Marissa Jenkins Glover and Early Learning Center
Kelly Becker
Potter
Darlene Stanton Eliot, Moulton
Kami Guthrie Bridgman,Tompkins
12/16/13

5. When are we available?

6. Hours of Operation
Health Services in open for student care from 8:00am-4:30pm Monday thru Friday when school is in session.
There is a nurse on campus at 7:00am- 6:30pm Mon-Thurs and 7:00-4:30pm on Fri
Outside of these hours there is on-call access to a nurse, pediatrician, and psychiatrist.

7. What do we do?

8. Health Services staff are available to check and follow-up on student illness and injuries
Health Services does not replace the student’s primary care or specialty care physicians, except in some cases psychiatry and neurology

9. How do you contact us?

10. Health Emergencies Getting Help for Students
During Health Services Hours of Operation:
8-4:30 Mon-Fri call the emergency line: Ext 7800,
During off hours call 911 if it is an immediate life threatening situation, otherwise call the on-call nurse immediately: (339) , speed dial 6-005,
Always call your Coordinator of Residential Living (CRL or ACRL) or Classroom Teacher

11. Getting Emergency Help for Staff Occupational Health
CALL 911 FIRST
Then…
Weekdays
Call Mary Salvucci, Occupational Health Nurse at x7256
If unavailable call Human Resources at x and ask them to call Mary on her cell phone
Evenings and Weekends: Call AEC
For all other medical concerns, staff should call their own MD

12. Non-Emergency Situations
Each program nurse has an office telephone and a cell phone for on campus hours
Each nurse has
Each program nurse has an office in their program and in Health Services
Program nurses are on the move, they can be found in either office, in a cottage, in a classroom, in a team meeting, with a student or with a staff member

13. Before calling the program or on-call nurse please be prepared with information that is detailed, complete and uses clear objective descriptions.
Information to give the nurse:
Student’s name
Age
Weight
Reason for the call
Description of the problem

14. Students can visit Health Services both by appointment for evaluation of health problems, daily injections and lab work, and as necessary during hours of operation.
Health Services staff will provide examination and treatment of minor medical conditions, monitoring of chronic conditions, and initial emergency care.
Health Services will refer the student either to Children’s Hospital or a local emergency room for more serious medical care and emergencies.

15. Medical Appointments May be on-campus or off-campus
Appointment schedules are distributed to cottages each Friday

16. Off-Campus Medical Appointments
Please be on time, being late may result in missing an appointment that may be difficult to reschedule
The time noted on the schedule is the time to arrive at Health Services
At Health Services, pick up cab slips and paperwork
Review appointment information, such as location, name of physician
Bring activities, snack, personal care items, etc, as appropriate and necessary

17. On-Campus Appointments
Program nurses will schedule routine and episodic appointments.
Many appointments are scheduled in advance, such as ear checks, lab work, exams, weights, desensitization, injections.
New problems will be evaluated by Health Services; CRL’s & teachers consult their program nurse to arrange the appointments as necessary.

18. Medication Administration
Only staff who have successfully completed the medication administration clearance training program are permitted to administer medication (including medicated skin creams).
All PRN meds (give only when needed) must be cleared by a nurse before they are given, (including medicated skin creams).
Only med cleared staff may handle medications.

19. Common Problems for Which We Give Medications
Student Medications
Common Problems for Which We Give Medications
Seizure Disorders
Behavioral Disorders
Respiratory or Ear Infections
Skin Rashes and Infections
Constipation
Endocrine Disorders
Eye Problems

20. Staff Responsibilities Staff are the eyes and ears of the health care providers
Contact Health Services If You see:
Changes in behavior: they may be an important indication of an illness or an adverse reaction to a medication
New signs and symptoms of new illnesses or worsening of chronic illnesses
Immediately reporting your observations to the program nurse is the first step in evaluating and treating the problem

21. Medication Effects
Mostly medications control the symptoms of an illness (rarely actually cure an illness)
Medications can often also cause adverse or side-effects
Sometimes a medication has too many or severe adverse reactions or just don’t work well in controlling the symptoms of the illness
Sometimes when someone takes multiple medications the combination can cause adverse reactions
Sometimes there are bad reactions between medications and certain foods

22. Medication Adverse Reactions Watch For and Report
New rash
Changes in behavior
Changes in sleeping patterns
Drowsiness or difficulty with attention
Changes in eating patterns, nausea or vomiting
New or worsening constipation or diarrhea
Changes in voiding (urinating) patterns
Unsteady walking or balance, dizziness
New headaches
Anything new or different about the student

23. Personal Hygiene
Personal hygiene needs to be done with dignity, respect, and privacy
Tell the student what you are about to do before and during the task
Students should be encouraged, taught, and assisted to do as much as possible for themselves
Look at each part of the body as you are washing it for rashes, bruises, open areas, etc… and report anything different or unusual to your CRL. It is the nurse role to do a thorough exam of the finding
Consult with the CRL for assistance if the student is having difficulty with a personal hygiene task
Some tasks such as nail or hair cutting, shaving, facial hair removal or tampon use require consent from the parents; check with the CRL or teacher regarding the need to do any of these tasks
The student’s team, including the OT, behaviorist, residential, educational and nursing staff work together to determine the best approach to assisting each student with personal hygiene

24. Reporting and Documenting
Documentation is extremely important.
Write clearly, in detail, using only the facts.
Observations done by all staff are essential to the ability of medical providers to manage student health.
Complete all documentation soon as possible.

25. Forms and Charts Bowel charts
Body charts for describing all marks, cuts, bruises, scratches, etc…
Menstrual records
Weight chart (notebook in Health Services)
Seizure logs

26. These logs are essential to managing student health and knowing what care to provide
It is your responsibility know which daily logs need to be kept for the students with whom you work
It is extremely important to complete the logs each and every shift

27. First Aid Addition Information

28. Why Perkins Specific First Aid Course?
Many students at Perkins have complex medical needs
Direct care staff are often the first staff to recognize that a student is sick or injured
In many situations immediate recognition, reporting of observations and care can be very important
This training supplements the First Aid Training required every 2 years

29. First Aid Topics Special Medical Safety Concerns:
Infection Control
Getting Help
First Aid Kits and Personal Protection Equipment Kits
Allergies: prevention and management
Seizure Disorders: recognition and first aid
Concussions
Special Medical Safety Concerns:
Shunts: what are they, recognizing dysfunction
Spinal fusion and Harrington rods
Eye Protection

30. Infection Control
Essential to prevent spread of infection from person to person
Frequent and thorough hand washing with soap and water seconds (sing “happy birthday song” twice)
Alcohol based hand sanitizer when soap and water not available
Wear gloves when you might come in contact with body fluids.
Clean toys, teaching materials, and surfaces frequently using disinfectant wipes
Assist, teach and remind students to wash their hands

31. You are the first line of care
Please Observe and Report
A Delay in Reporting Means a Delay in Care

32. Observing and Reporting Signs & Symptoms of Illness & Injury
What are examples of signs of illness or injury you might see?

33. First Aid Kits and PPE Kits
Located in all buildings
Your responsibility: to locate the kits closest to your work area, and familiarize yourself with the contents. check with your supervisor
Red First Aid Kits Contain: bandaids, bandages, ice pack, scissors, tape, CPR masks and triangular bandages
PPE (Personal Protective Equipment) Kits Contain: gloves, goggles, face masks, gowns, spills kits, red bags for contaminated waste

34. ALLERGIES and ANAPHYLAXIS

35. Allergies
Allergies can be to food, medication, latex, chemicals, bee/wasp stings
Common food allergies include: nuts, peanuts, eggs, seafood/fish, dairy products, and soy
Things that you are allergic to are called allergens

36. Allergies to Food
Allergic reactions to foods vary among students and can range from mild to severe life-threatening anaphylactic reactions.
Some students, who are very sensitive, may react to just touching or inhaling the allergen.
For other students, consumption of as little as one 5000th of a teaspoon of an allergen, so be careful to avoid cross contamination

37. Prevention of Allergic Reactions
Know which students have allergies and what they are allergic to
Avoid exposing students to known allergens
For students with food allergies: read all food labels, avoid food sharing, monitor or prevent food sent in from home being shared with other students, never give a student food if you don’t know all the ingredients or their allergies
Wash your hands, any items and surfaces that may have come in contact with the food
Think about allergens with craft materials

38. Further Allergic Reaction Prevention
Keep Epi-pens available at all times, when both on or off-campus
Contact the Health Services emergency number or nurse on-call immediately if you suspect the student is showing any signs of an allergic response

39. What is an Allergic Reaction
During an allergic reaction there are potential inflammatory reactions in many systems of the body:
skin: itching, hives, rash, pale or flushed, swelling
respiratory system: cough, itchy lips or mouth difficulty breathing, wheezing throat tightness or closing
gastrointestinal tract: nausea, vomiting, diarrhea, abdominal pain
cardiovascular system: decreased blood pressure, irregular heartbeat, shock
other signs and symptoms: feelings of doom, dizziness, changes in mental status

40. ANAPHYLAXIS
When the symptoms involve 2 or more systems of the body the reaction is termed “anaphylaxis,”
THIS IS POTENTIALLY LIFE-THREATENING because the airway may swell and close
Immediate administration of an Epi-pen (epinephrine) and calling 911 is critical
You will learn to adminster Epi-pen in First Aid and then receive student specific training from your program nurse; this will be reviewed every opening week

41. SEIZURE DISORDERS

42. Tonic – Clonic (Grand Mal) Seizures
Involves motor activity of the whole body
There is stiffening or rigidity (tonic action) & jerking (clonic action) of the muscles of the body, particularly of the arms & legs, caused by a sudden bursts of abnormal generalized electrical discharges involving the whole brain without warning
A contraction of the diaphragm & chest muscles may cause the characteristic "epileptic cry“ and brief period of not breathing
Other common features are falls, incontinence, high risk for injury
May last up to several minutes
Usually are followed by a period of drowsiness & disorientation (post‑ictal phase) which may last from minutes to several hours.
This type of seizure disorder is usually well controlled in only about 50 % of people

43. Absence (Petit Mal) Seizures
May consist of a brief loss of consciousness
May present as small amounts of tremors or twitching, staring, blinking, eye movements or movements of the mouth such as lip smacking
Usually last only a few seconds, may be frequent and may be hard to recognize
There is immediate and full recovery afterwards

44. Simple Partial Seizures
Usually does not involve loss of consciousness, the person is aware
Affects only a part of the body or extremity, but it can spread to the rest of the body, in which case it then becomes a generalized seizure
May consist of a sensory experience such as a sound, smell, visual disturbance or strange feeling, abdominal pain or discomfort
Partial seizures may be difficult to recognize if they appear as a blank expression or sensory experience, unless the person is a good reporter

45. Complex Partial Seizures (Temporal Lobe, Psychomotor)
Consciousness is impaired, the person is unaware of the seizure & will has no have memory of it
Often preceded by an aura which can be a sensory experience or feeling a strange sensation such as a strange feeling in the stomach, an unpleasant odor, flashing lights, ringing sound, dreamy sense of unreality, or a sense of deja vu.
Sometimes people can become irritable or have behavior changes for hours or even days before the actual seizure activity
During the seizure the person may engage in random behaviors that look purposeful
Usually there is a similar pattern of behaviors or actions with each seizure. Examples of behavioral patterns are: lip smacking, lint picking, hand rubbing, chewing motions, violent rages, fear, walking about, or inappropriate laughter.
The person will be unaware of his/her surroundings, unresponsive to others
The seizure may be followed by a period of confusion.

46. First Aid for Seizure Disorders
There are many types of seizures and seizures can present in many different ways
Each student is different; speak with your program nurse regarding student specific seizure protocols, care and reporting
Learn the typical seizure patterns and protocols for the students with whom you work
Students can have several different types of seizures
Look for changes in level of consciousness, responsiveness to stimuli, involuntary movement, falls, unusual behaviors
Anything the brain and body do normally can be done abnormally as part of a seizure

47. What to do if you see a seizure
Stay calm
Call for help if it is needed
Do not leave the person alone
Remove all hazards in the area
Help the person to the floor, but do not try to restrain the person
Turn the person's head or body to the side to keep the airway open and to allow saliva and other fluids to flow out and prevent fluids from going into the lungs
Loosen tight clothing, especially around the neck
Protect the head from injury, place something soft under it
Allow time and a comfortable place for the person to rest with supervision afterwards if the person is sleepy or unsteady (post-ictal period)
Do not expect the person to respond to verbal instructions during the seizure

48. Reporting Seizure Activity
Report seizure activity to the program nurse and supervisor
Report immediately in the following situations:
the student's first seizure
the student was injured during the seizure
the seizure was different from the usual pattern for the student
Diastat or Ativan protocol has been met. If no nurse on campus or on a community outing call 911
Be sure to document all seizure activity on the seizure record and send a copy to your program nurse.

49. Seizures Requiring Emergency Attention General guidelines for calling 911:
to the student’s individualized protocol
When the seizure lasts over 5 minutes or per specific student protocol
If there are multiple seizures in a short period of time, especially if there has not been complete recovery between the seizures
This is a first time seizure
If significant injury, especially of the head, occurs as a result of a seizure
If the student has difficulty breathing or if the face turns blue for over 1 minute
If a seizure has occurred while swimming or bathing and there is a question of water being swallowed and entering the lungs
Anytime Diastat was administered while the student was off campus or there is no nurse on campus
The person has diabetes

50. What Not To Do During a Seizure
Do not put anything into the person's mouth (except Ativan or Klonopin prescribed to be put inside the cheek to stop seizure activity)
Do not attempt to force the mouth open during a seizure
Do not try to restrain the person during a seizure
Do not give the person anything to eat or drink until the person is fully awake and alert

51. Status Epilepticus
Prolonged seizure activity or rapid succession of seizures without regaining consciousness between seizures.
This requires emergency care.

52. Concussions

53. Concussions – Head Injury
A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt and can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
This can occur during sports, accidents or as a result of self-injurious behaviors that involve the head
A concussion alters the way your brain functions. Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination. May not include loss of consciousness.
Treatment may include rest and modifying activities until symptoms resolve

54. Signs and symptoms of concussion
Headache
Nausea/Vomiting
Fatigue/Drowsiness
Visual problems
Balance problems/Dizziness
Sensitivity to light or noise
Problems with concentration/memory
Mental fogginess
Irritability/Nervousness/Feeling Emotional
Trouble sleeping

55. Concussion Red Flags Needing Emergency Medical Evaluation
Headaches that worsen
Seizures (other than those typical for a student)
Neck Pain
Looks very drowsy, can’t be awakened
Repeated vomiting
Slurred speech
Can’t recognize people or places
Increasing confusion or irritability
Weakness or numbness in arms or leg
Unusual behavior changes
Loss of consciousness

56. Additional Student Safety Considerations

57. Shunts
A shunt is placed to relieve intracranial (inside the skull) pressure caused by hydrocephalus (blockage of flow of fluid in the brain). The fluid is drained from the brain usually into the abdomen because too much pressure can be harmful to the brain
Generally shunts do not require special precautions, but be aware of who has them
Shunt Blockage or Failure Requires immediate evaluation
Persistent headache
Vomiting
Lethargy, drowsiness, lethargy

58. Spinal Fusion – Harrington Rods
Used to straighten and fuse the spine in people with Scoliosis (curvature of the spine)
Protect the spine from injury, report back pain, obtain clearance before participating in contact sports

59. Eye protection
Many of our students are at risk for injuries to their eyes such as retinal detachment
Learn about your students to see who needs special eye protection
Watch for and immediately report any changes in vision after any injury to the head or face

60. Questions?
Because each student is unique it is important that you now speak with your supervisor and program nurse to learn more about your students.
Thank you