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VITAL SIGNS, MEDICAL CONDITIONS, ILLNESS & INJURY

In this Chapter . . .

 

VITAL SIGNS

 

Vital signs are the traditional signs of life.  Vital signs include temperature, pulse, respiration, and blood pressure.  It is important to accurately take vital signs and record the results.

 

Temperature

 

Temperature is the measure of body heat.  The body produces heat during such processes as the oxidation of food.  Respiration, perspiration and excretion release body heat.  Direct measurement of the temperature indicates if the balance between heat produced and heat lost is being maintained.

 

An elevated oral temperature above 100° F or an axillary (under the arm) temperature of 99° F may be one of the first signs of an infectious disease.  Call the parent/guardian to come and take the student home - fever notice.

 

General Information

 

4     RECTAL TEMPERATURES SHOULD NEVER BE TAKEN IN THE SCHOOLS.

4     GLASS THERMOMETERS ARE NOT TO BE USED IN THE SCHOOLS.

 

If an electronic, digital, a tympanic membrane sensor (ear) instrument or temporal scanner is used, follow the instructions accompanying the thermometer.

 

Always use disposable plastic sheaths with digital thermometers and disposable probe covers with electronic and tympanic thermometer.

 

Refer to the Digital Oral or Tympanic Temperature Measurement Skills Checklist for temperature measurement procedure.

 

Measurement of Pulse

 

The pulse rate indicates the number of times the heart beats in one minute and is a measure of how well the circulatory system is functioning.  When you feel a pulse, you are feeling the pressure of the blood against the artery wall as the heart contracts and then relaxes.  The radial pulse is one of the easiest to find.  The radial artery is located on the thumb side of the wrist.  Use the tip of your first two fingers to take a radial pulse.  At around age 2, the rate ranges from 70 to110 beats/minute.  With adolescence, the rate varies between 55 and 90 beats/minute and remains so throughout adulthood.  See Radial Pulse and Respiration Count Skills Checklist for procedure for measuring pulse.

 

Measurement of Respiration

 

Respiration is the process of oxygen and carbon dioxide exchange in the lungs.  Breathing in once (inspiration) and breathing out once (expiration) makes up one respiration cycle.  It is important to be aware that respiratory patterns can change for a variety of reasons.  Some reasons are more critical and require immediate attention, such as an asthma attack or the presence of foreign body airway obstruction.  A young child may have a respiratory rate of 8 to 26 breaths/minute; an adult may have normal respiration of 12 to 20 breaths/minute.  See Radial Pulse and Respiration Count Skills Checklist for the procedure for taking a pulse reading.

 

Measuring Blood Pressure

 

Blood pressure (BP) refers to the force of blood against the arterial walls when the heart contracts (systole) and when the heart is at rest (diastole).  The standard unit for measuring BP is millimeters of mercury (mm Hg).  The measurement indicates the height to which the BP will raise a column of mercury.  The systolic pressure is the first reading.  Normal systolic pressure readings are from 90 to 140 mm, but will vary with age. The diastolic pressure is the second reading.  Normal diastolic pressure readings are from 60 to 90 and vary with age.  The blood pressure reading is written in a fraction with the systolic reading on the top of the line and the diastolic reading on the bottom under the line.  A student’s normal blood pressure range is to be determined by the child’s licensed health care provider.

 

If a student’s blood pressure is to be taken during the school day, a Medication/Treatment Authorization Form signed by the physician and parent/guardian will be required.  The form will list the day(s) of the week, time, parameters, and action to be taken when the blood pressure is outside the parameters.  A Blood Pressure Skills Checklist will need to be completed unless the procedure is performed by a licensed medical professional as designated in their job description.  Alert the school RN if a student needs blood pressure monitoring in the school. 

 

Record the blood pressure measurement on the Blood Pressure Log below.

 


 

Blood Pressure Log                                              

 

Display/Print Log

 

Student's Name _________________________________________ DOB____School_____________________

Parent/Guardian's Name___________________________________________ Phone ____________________

Physician's Name________________________________________________ Phone _____________________

Physician's Order________________________________________________________Date________________

DATE

TIME

READING

COMMENTS

INITIALS

 

 

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Signature_______________________________________________     Initials_____  Date ________

Signature_______________________________________________     Initials_____  Date ________

Signature_______________________________________________     Initials_____  Date ________

 


 

 TEMPERATURE MEASUREMENT (TYPE:_______________)

SKILLS CHECKLIST

Display/Print Checklist

*Contact your school RN for your performance check and form completion

 

*Name: ____________________________________ School: _____________________

SKILL

Performs skill in

accordance to written

guidelines

Requires further

instruction & supervision

 

Date

Date

 

1.       If student has recently had something to drink, wait for 10-15 minutes before measuring oral temperature.

 

 

 

2.       Wash your hands.

 

 

 

3.       Explain the procedure to the student.

 

 

 

4.       Cover digital thermometer with protective sheath (use probe cover for tympanic thermometer).

 

 

 

5.       Insert covered probe of electronic thermometer into student's mouth for oral temperature (for tympanic thermometer gently insert probe into ear canal; apply a gentle but firm pressure).  Move scanner across forehead, if using temporal scanner.

 

 

 

6.       Keep thermometer in contact with student until temperature registers.  Follow manufacturer’s instructions.

 

 

 

7.       Remove protective sheath or probe cover and place in proper receptacle.  Clean scanner with alcohol wipe.

 

 

 

8.       Return thermometer to storage unit.

 

 

 

9.       Wash hands.

 

 

 

10.   Record temperature in AS400 Clinic Program.  If no access to AS400, record on the student's Health Room Visit Card.

 

 

 

Preceptor’s Signature __________________________________________ Initials _______ Date _____________

Preceptee's signature __________________________________________ Initials _______ Date______________

*Initial and date in space beside each skill indicates procedure has been demonstrated in a competent manner.

 

Distribution: original to preceptee, one copy kept in Health Room file, one copy to Sherri Reynolds/PSS Landings


 

 

RADIAL PULSE & RESPIRATION COUNT

SKILLS CHECKLIST

 

Display/Print Checklist 

*Contact your school RN for your performance check and form completion.

 

Name: ____________________________________ School: _________________________

SKILL

Performs skill in

accordance to written

guidelines

Requires further

instruction & supervision

 

Date

Date

 

1.      Wash your hands.

 

 

 

2.      Place fingertips of first three fingers over student’s radial pulse site.  DO NOT use your thumb because it contains a pulse which may be confused with the student’s pulse.

 

 

 

3.      Palpate (feel) the pulse.

 

 

 

4.      Count pulse for 15 or 30 seconds and convert rate to minute rate.  (If 15 second count, multiply by 4 for number per minute.  If 30 second count, multiply by 2 for the number per minute).  Remember the number.  If pulse is not regular, count for 1 full minute.

 

 

 

5.      With fingertips still on student’s pulse, begin counting respiratory rate.

 

 

 

6.      Count respiration cycles for 30 seconds; convert rate to minute rate.  If rate is not regular, count for 1 full minute.

 

 

 

7.      Record rate correctly, noting any irregularity. 

 

 

 

Preceptor’s Signature __________________________________________ Initials _______ Date _____________

Preceptee's signature __________________________________________ Initials _______ Date______________

*Initial and date in space beside each skill indicates procedure has been demonstrated in a competent manner.

 

Distribution: original to preceptee, one copy kept in Health Room, one copy to Sherri Reynolds/PSS Landings

 


 

MEDICAL CONDITIONS, ILLNESS & INJURIES

 

Guidelines

 

The guidelines on the following pages provide direction for the care of students with physical complaints or injury.  óWhen the school RN is on campus, contact him/her in case of emergency or if there is a question about the condition of a student.

 

Use these guidelines when caring for students:

  •     Follow District emergency policy regarding moving any student with bleeding or serious injury.

  •         If the health room aide has to leave her station, coverage needs to be provided in the health room by designated personnel.

  •       Review the student’s Health Emergency Information Card (see "Forms" chapter).

  •     Discreetly question the student about his/ her injury or physical complaint.

  •         Observe for visible signs of injury or illness.

  •     Follow the procedure recommended for the particular injury or physical complaint.

  •     DO NOT DIAGNOSE health problems.

  •     Practice Standard (Universal) Precautions/infection control.

  •     Allow the student to rest 15 minutes before taking temperature post exertion; if the temperature is not elevated the student may return to class.

  •     If the oral, tympanic or temporal temperature is 100° F or higher, or axillary is 99° F or higher, the student may not remain at school.  Call the parent to come and take the student home.  (If tympanic thermometer is used, it must be set on oral mode).  Sick students are to remain at home until at least 24 hours after there is no longer a fever (without the use of a fever-reducing medicine) - fever notice.

  •     Rectal temperatures should never be taken in school.

  •       Always contact the parent whenever there is an injury to the head, eyes, bones, or there is bleeding which will not stop.    

  •       To ensure that further observation and care will be provided at home, notify the parent/guardian when first aid is given at school.  If the parent cannot be reached by phone, complete the Student Incident Report and send home with the student.

  •      Notify the parent/guardian if the student does not feel well enough to return to class or returns to the health room after being sent back to class.

  •       If there is a question, consult with the parent/guardian and principal to decide whether or not the student should stay in school.

  •       Document all student visits to the health room, the intervention/care given, and the outcome/disposition.

  •    For suspected abuse or neglect follow link http://www.dcf.state.fl.us/abuse/report/

 

Releasing a student

 

Follow your school’s policy for releasing a student to the parent/guardian.  No student is permitted to leave the school before the parent/guardian or an adult delegated by the parent/guardian arrives to sign the student out of school.  School health aides should not transport a student off the school campus.  When a major emergency necessitates immediate transfer to the hospital, call 911, contact the parent/guardian immediately, and notify the principal.

 

Referrals

 

Those students who exhibit frequent or patterned health room visits should be referred to the school RN for further nursing assessment. 

 

Abrasions

 

Description:

 

Partial loss of skin surface caused by scrape, scratch or rub; affected area appears reddened; may bleed or ooze clear fluid.

 

Intervention:  

 

  •     Wear gloves.

  •     Using clean gauze pads, wash the abrasion gently with soap and water to remove as much dirt and debris as possible and then rinse.

  •     Blot dry with gauze pad.

  •     Apply sterile, non-stick bandage loosely, so air may enter.  All wounds must be covered.

  •     Send student back to class.

 

NOTE:  If abrasions are over a large area of the body, or very painful, or you are unable

to clean dirt and debris from the wound - CALL THE PARENT/GUARDIAN!  Notify the parent/guardian of the date of the student’s last tetanus booster to take to the licensed health care provider.

 

 

ABUSE

 

Abuse can be physical, sexual and/or emotional in nature and may include abandonment or neglect.  Health room aides are mandated reporters.  This means that all health room aides are required by law to report any known or suspected child abuse, neglect, and/or abandonment.  Follow link http://www.dcf.state.fl.us/programs/abuse/howtoreport.shtml for abuse/neglect reporting policy.

 

ADD/ADHD

(Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder)

 Definitions

ADD/ADHD consists of developmental deficiencies in the regulation and maintenance of behavior by rules and consequences.  These deficiencies give rise to problems with inhibiting, initiating or sustaining responses to tasks or stimuli, and adhering to rules or instructions, particularly in situations where consequences for such behavior are delayed, weak, or nonexistent.

 

Three main characteristics of ADD/ADHD illustrate how such a child might behave:

 

Impulsivity  (Many experts consider impulsivity to be the hallmark of ADD/ADHD)

  •       Often blurts out answers to questions before the questions have been completed.

  •       Often has difficulty waiting in lines or awaiting turn in games or group situations.

  •       Interrupts or intrudes on others (e.g. interrupts conversations or games).

  •       Careless errors made in a rush to finish chores or homework.

  •      May lead to unnecessary risk-taking behavior, resulting in injury and damage to property

Inattention

  •       Often fails to give close attention to details or makes careless mistakes in schoolwork or other activities.

  •    Often has difficulty in sustaining attention in tasks or play activities, especially with monotonous tasks and when there is no immediate reward, yet if highly motivated or attracted by something stimulating, may show a long attention span (like when watching TV or playing a video game).

  •    Often does not seem to listen to what is being said to him or her.

  •    Often does not follow through on instructions and fails to finish school work, or chores, without supervision (not due to oppositional behavior or failure to understand instructions).

  •    Has difficulty organizing tasks and activities.

  •    Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.

  •    Loses things necessary for tasks or activities.

  •    Is distracted by extraneous stimuli, such as sound outside the classroom.

  •    Is forgetful.

Hyperactivity

  •       Often fidgets with hands or feet or squirms in seat.

  •    Leaves seat in classroom or in other situations in which it is inappropriate (a restless feeling).

  •    Has difficulty playing or engaging in leisure activities quietly.

  •    Is “on the go” or acts as if “driven by a motor”.

  •    Talks excessively.

Without the hyperactivity characteristics

  •    Student is less disruptive.

  •    Students often described as “spacey” or “daydreamers”.

If a physician or mental health professional has diagnosed a student as ADD/ADHD, the student may be taking medication in school.  The medication or dosage may occasionally change to insure optimum effectiveness.

 

 

 ANAPHYLAXIS

For complete information about Life-Threatening Allergies see the Life Threatening Allergies Chapter.

Description:

 

A medical emergency requiring immediate treatment that occurs when a person is exposed to any allergy-causing substance.  Common Causes: Insect stings or bites, foods, or medications.  Anaphylaxis may also be caused by an unknown substance.

Symptoms:

 

 

  •     Sudden sense of uneasiness/anxiety.

  •     Flushed skin.

  •     Widespread hives.

  •     Itching around the eyes.

  •     Dry, hacking cough.

  •     Constricted feeling in throat/chest.

  •     Wheezing.

  •     Dizziness.

  •    Facial edema or swelling (i.e. lips, tongue, and eyes).

  •    Abdominal pain.

  •    Nausea or vomiting.

  •    Difficulty breathing.

  •    Difficulty swallowing.

  •    Hoarseness or thickened speech.

  •    Confusion

  •    Feeling of impending doom.

 

 

Intervention:

 

 

  •        Call 911   

If emergency injection kit (Epi-Pen®) is available:

 

If no emergency injection kit is available:

  •   Give emergency medication as ordered by licensed health care provider.

  •   Check Airway, Breathing, and Circulation, and initiate steps of CPR as needed.

  •   Check Airway, Breathing, and Circulation, and initiate steps of CPR as needed.

  •   Observe for shock and treat accordingly (see "Shock" section).

  •   Observe for shock and treat accordingly (see "Shock" section).

  •    Keep patient warm.

  •   Keep patient warm.

  •    Call parent/guardian and notify principal.

  •   Call parent/guardian and notify principal.

 

 

NOTE: Strongly recommend that the student see a licensed health care provider for further evaluation.

 

 

Asthma

 

Description:

 

A chronic condition that narrows air passages and may cause recurrent episodes of breathing difficulties, often called “attacks”.  These "attacks" can be very frightening for the student and school staff.  During an "attack" the student may have episodes of shortness of breath, wheezing, coughing and chest tightness.  Symptoms can range from mild to life threatening.  Many different "triggers" can cause the "attacks", such as: physical activity, respiratory illness, weather changes, environmental factors, emotional upset or allergic reactions.  Sometimes a physician will order Peak Flow readings to be done at school to determine the respiratory status of the student and action to be taken.  A peak flow meter measures how quickly air can be forcefully exhaled. 

 

NOTE:  Refer to student’s Individual Health Plan (IHP) and/or Health Emergency Information Card.  The IHP, written by the school RN, should outline student-specific signs and symptoms of asthma episodes and guidelines for carrying out the medical treatment plan in the school setting.  When a student with asthma has been identified on their Health History or Health Emergency Information Card, request parent/guardian to complete the Asthma History.  Place student on High Risk List.  If a physician orders peak flow readings notify the school RN immediately.  Record readings on the Peak Flow Meter Reading Log.

 

Symptoms:

  •     Coughing.

  •     Wheezing.

  •     Difficulty breathing.

  •     Breathing in quickly with inability to speak.

  •     Chest discomfort or tightness.

  •     Anxiety or restlessness.

  •     Forward leaning posture.

  •     Flaring nostrils.

 

Intervention:

  •     Place student in a sitting position within your view.

  •     Check peak flow reading if ordered and follow asthma action plan.

  •     Give quick relief (inhaler/nebulizer) medication as ordered by physician.

  •     Continue to monitor student and offer reassurance.

  •     Check student for rapid breathing.

 

If the student improves after rest and medication:

  1.  Send student back to class. 

  2.  Notify parent.

Call 911 If the student does not improve within 15 minutes after medication and rest and exhibits any of the following symptoms:

 

 

  •    Struggling for air (breath)/talking in broken sentences due to shortness of      breath.

  •       Pale or blue in color around lips or fingernails.

  •    Not mentally alert as evidenced by difficulty concentrating or appearing confused.

  •    Using neck, rib, or stomach muscles to breathe.

  •       Having obvious difficulty breathing.

  •    Quick relief medicine is not helping

  •    Peak flow reading is in the red zone.

Remember:  when airways get very tight, wheezing often goes away because the child cannot breathe with enough force to cause a wheeze.

Ø      Call parent/guardian and alert the principal that 911 has been called.

                

REMEMBER----Asthma can be fatal!!!  When in doubt, call 911.

 

 

 

 

BITE - Animal

 

 

Description

Injury in which skin surface is damaged or torn by an animal resulting in an abrasion, puncture, or lacerated wound.

 

Intervention:

  •     Wear gloves.

  •     Wash with soap and water, irrigating with running water for 2-3 minutes unless bleeding heavily.

  •     Use direct pressure as needed to control bleeding.

  •     Cover with sterile, non-stick bandage.

  •         Follow Standard (Universal) Precautions for clean up and disinfection.

  •     Call parent/guardian and notify principal.

NOTE:  Advise the parent/guardian to contact their licensed health care provider about all bites that break the skin and give the parent/guardian the date of the student's last Td.

All animal bites must be reported to the Sarasota County Sheriff’s Animal Services Unit (941-861-9500) and the Environmental Health Division of the Sarasota County Health Department (941-861-6092) for investigation of potential rabies.  Remind the parent/guardian to watch for the possible signs of infection (redness, pain, draining, or swelling at wound site).

 

 

BITE - HUMAN

 

 

 

Maintain confidentiality at all times. 

Parents do not have access to the name of the student who did the bitingOnly those directly involved in the incident (teacher or aide and administrator) should know the details.

 

Description:

 

Injury in which skin surface is damaged or torn by a student resulting in an abrasion, puncture or lacerated wound.

 

Intervention:

  •      Wear gloves.

  •     Thoroughly wash area/site immediately with soap and water, irrigating with running water 2-3 minutes unless bleeding heavily.

  •     Cover with sterile, non-stick bandage.

  •     Follow Standard (Universal) Precautions for clean up and disinfections.

  •     Notify principal and call parent/guardian. Advise the parent/guardian to contact their licensed  health care provider about all bites that break the skin and give the parent/guardian the date of student’s last tetanus shot (DTaP/Td/Dt/TDAP).

  •    Student Incident Report and the Student Accident Report (contact SCSB Risk Management Office for this form) forms are to be completed if applicable.

  •    Notify school RN.

 

 NOTE:  If a staff member is bitten by a student, follow the procedures outlined in the Sarasota County School Board Occupational Safety & Health Act Standard for Occupational Exposure to Bloodborne Pathogens.

 

 

BITE - SNAKE

Description:

 

A puncture wound that may bleed and will usually swell even if from a non-poisonous snake.

Note: If present, get away from the snake, but if possible note any identifying characteristics of snake such as: large triangular head, rattle and/or coloration. 

 

Remember, “dead snakes can bite” due to a reflex action.

 

Signs and Symptoms of Snake Bites Include:

 

  •      Swelling and discoloration.

  •      Weakness.

  •      Sweating.

  •      Fainting.

  •      Nausea

  •      Vomiting

  •      Shortness of breath

  •      Rapid pulse

 

Intervention

 

1.      Call 911.  Then call poison control at 1-800-222-1222 for information. 

2.      Keep student quiet.  Limit movement.

3.      Remove jewelry near the bite site.

4.      Keep bitten part of body at or below heart level.

5.      DO NOT APPLY ICE TO BITTEN AREA.  Cold therapy (cryotherapy) on top of skin with snake venom worsens skin damage.

6.      DO NOT apply a tourniquet.  Snake venom causes swelling.  Tight bands worsen the swelling and cause deformities due to poor circulation.

7.      DO NOT cut and suck the bite site.  This causes damage, increases the chance of   infection, and removes very little venom.

8.      Call parent/guardian and notify principal. 

9.      Provide parent with date of students last Td.

10.    Inform school RN.

 

Florida Poisonous Snakes

 

 

There are two types of poisonous or venomous snakes native to Florida.  They are very different in the way their body is shaped and in bite treatment by physicians.

1.      Pit Vipers include:

Rattlesnakes, Copperheads, & Water Moccasins (Cottonmouths). 

These snakes have a head larger than their neck.  They may have a colored stripe that appears to go through their eyes like a mask.  Only the rattlesnakes have rattles.  Treatment includes testing and observation to see if antivenin is needed.

 

                           

          Rattlesnake                   Copperhead                       Cottonmouth

2.      Coral Snakes

These snakes have slender heads no bigger than their necks.  They have red, yellow, and black bands that circle their bodies like many necklaces.  The first color they start with is black - they always have black noses.  Also, if "red touches yellow, kill a fellow.  Red touches black, friend of Jack".  A bite from a Coral Snake always requires antivenin and intensive care.

Coral Snake

 

 

 

BLEEDING (Cuts or Wounds)

 

Description:

 

Because of an injury, a blood vessel (artery, vein, or capillary) is broken; depth of injury and type of vessel broken will determine the severity of the bleeding and how difficult it will be to control.

 

Intervention:

 

  •    Use gloves.

  •    Apply a sterile dressing or clean cloth over the wound and apply direct pressure with your palm until bleeding stops.

  •    Elevate bleeding area above the heart unless evidence of fracture or elevation causes pain.

  •    Continue to apply direct pressure or apply pressure bandage.

  •    Keep child warm and quiet.

  •   Observe for shock and treat accordingly (see “Shock” section).

 

If bleeding does not stop within 15 minutes call 911 and notify the parent/guardian and principal.

 

Ø      DO NOT remove blood-soaked dressing.  Add more dressing and continue direct pressure.

Ø      Locate pressure point and apply pressure, but do not release pressure over the wound.

Ø      DO NOT apply tourniquet.

 

NOTE: If there is a broken bone, or embedded object protruding from the wound site:

  •     DO NOT use direct pressure.  Apply pressure to the pressure point* above the wound to slow or stop the flow of blood to the wound.

  •     DO NOT disturb a broken bone or attempt to remove a deeply embedded object.

 

* A pressure point is a spot on the body where you can squeeze the nearby artery against the bone underneath; arm – brachial artery; leg – femoral artery.

 

 

blood or body fluid contact, Student-to-Student

 

MAINTAIN CONFIDENTIALITY AT ALL TIMES

 

Parents do not have access to the name of the student who exposed the other child to blood or body fluids.  Only those directly involved in the incident (teacher or aide and administrator) should know the details.

 

Type of Incident:

 

SKIN EXPOSURE

Exposure of skin to blood or body fluids, especially when the exposed skin is chapped, abraded, or afflicted with dermatitis (inflammation of the skin).

 

Intervention:

 

  •    Wear gloves.

  •    Thoroughly wash area/site immediately with soap and water; or flush with copious amount of water if eyese or mucous membranes are involved.

  •    Follow Standard (Universal) Precautions for clean up and disinfections.

  •    Notify the parent/guardian of the exposed child and advise to contact their licensed health care provider.

  •    Notify principal.

  •    Student Incident Report and the Student Accident Report forms are to be completed if applicable.

  •    Notify school RN.

 

BLISTERS

 

 

 

Description:

 

“Bubble” of fluid under the outer layer of skin, caused by friction; usually heals in  3-7 days.

 

Intervention:

 

  •       Use gloves.

  •       Wash gently with soap and water.

  •       DO NOT open the blister.

  •       Cover loosely with sterile, non-stick bandage.

  •       Send the student back to class.

 

NOTE:   Blisters resulting from burns or frostbite or poisonous plants are treated as burns, NOT as blisters.

 

 

BODY INJURY

 

Following a hard blow to the body caused by a fist, auto, or sports injury, there may be injury and bleeding of an internal organ (e.g. spleen, liver).  The internal bleeding could be slow but continuous loss of blood could cause shock (see "Shock" section).

 

Intervention:

 

  •     Have the student rest quietly in a comfortable position and notify the parent/guardian and principal.

  •     Observe for signs of shock:

    • Rapid, shallow or painful breathing.

    • Bluish lips.

    • Pale, cool, and damp skin.

    • Change in mental status.

    • General weakness.

    • Coughing up blood.

 

If the student has any of the following CALL 911, parent/guardian and notify principal.

 

 

  •     Chest discomfort

  •     Difficulty breathing.

  •     Change in alertness.

  •     Coughing up blood or vomiting.   

  •     Pain and/or tenderness.

  •     Signs of shock (see "Shock" section).

       Observe for the following:

  •     Restlessness or irritability

  •     Rapid pulse and breathing

  •     Pale, cool and damp skin.

  •     General weakness.

  •     Decreased alertness.

 

Student may return to class with instructions for teacher to notify health room aide of any further complaints by student if:

  •     No pain or tenderness, no feeling of pressure in the area of injury.

  •     No signs or symptoms of shock.

  •     No problem breathing.

  •     No chest pain.

 

 NOTE:   Strongly recommend that the student see a licensed Health Care Provider for further evaluation.  Send Incident Report form home when applicable.

 

BONE / MUSCLE / JOINT INJURIES

 

                                       

 

 

Description

 

Injuries of the bones, muscles, and joints may be fractures, dislocations, or sprains/strains.  Only a licensed health care provider can determine the type of injury.  Typical signs and symptoms of these types of injuries can be: pain, swelling, redness, bruising, and/or inability to move the extremity. 

 

Note: If spinal cord injury (head, neck, or back) is suspected DO NOT MOVE STUDENT

(See Spinal Injuries - Back or Neck).

 

RICE is an acronym for basic first aid treatment to treat musculoskeletal injuries.  The R-I-C-E principle includes:

 

Rest Rest of the injured area.
Ice Ice is placed on the injured area for 20 minutes at a time, several times a day.  An ice pack should never be applied directly to the skin, but should first be wrapped in a paper towel.
Compression Involves wrapping the affected joint or muscle in an elastic bandage (ACE bandage).  If the student complains of throbbing or that the ACE bandage is too tight, remove the bandage and re-wrap the area.  (See below for instructions to wrap an ACE bandage).
Elevation Elevation is most effective when the injured area is raised above the level of the heart.

 

Applying a Compression Wrap (ACE Bandage)

 

A compression wrap is used to prevent swelling. It does not support the ankle or prevent it from moving, so it does not protect it except by reminding you to be careful of your ankle.

Instructions

  1. Roll up the elastic bandage if it isn't already rolled up. Hold your ankle at about a 90-degree angle. Start where your toes meet the body of your foot. Hold the loose end of the bandage at the side of your foot. Wrap the bandage around the ball of your foot once, keeping it somewhat taut with a light pull.
  2. After this, slowly start circling your way around the arch of the foot. Pull the bandage diagonally from the bottom of the toes across the foot's top and circle it around the ankle. Now bring the bandage diagonally across the top of the foot and under the arch in a figure-eight pattern.
  3. When you get to the anklebone, wrap the bandage around the felt piece so it stays in place at the outside anklebone. Continue around the ankle and foot in a figure eight, moving toward the heel on the bottom and toward the calf at the top of the eight.
  4. The wrap should cover the entire foot (but not the heel) and end several inches above the ankle. Most compression wraps are self-fastening or come with clip fasteners. If not, use tape to secure the end. The wrap should be snug but should not cut off circulation to the foot.
 
 
By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
Last Revised December 31, 2009
WebMD Medical Reference from Healthwise
 
Last Updated: December 31, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

 

SPINAL INJURIES – BACK OR NECK

 

 If spinal cord injury is suspected, DO NOT MOVE student!

 

Description:  

 

Damage to the spinal cord that protects the nerves of the spine.  Most often caused from motor vehicle or bicycle accidents, sports injuries or falls involving bending, twisting or jolting of the body.  The pain is usually made worse by pressure or movement and may radiate to arm or leg; may have weakness, numbness or inability to move arm or leg.

 

Intervention:

  •     Call 911.

  •     Do not move the student.

  •     Do not bend, twist or rotate the neck or body of the student.

 

If the Student is Unconscious:

  •     Check Airway, Breathing and Circulation and initiate the steps in CPR as needed (use jaw thrust, not head tilt/chin lift, to open airway) - ALWAYS CALL 911 immediately.

  •     Unless CPR is necessary or the student must be moved from fire or other life-threatening situation DO NOT MOVE THE STUDENT.

 

NOTE:

  •      If you must move the student, be sure to support the head, neck, and body as one unit

  •     Minimize movement of the head, neck, and spine in the position found.  Place rolled up  clothing, blankets, towels, etc. around the head and sides.  If necessary to place student on his/her back for CPR, roll the head, neck and spine as one unit.

  •     Call parent/guardian and notify principal.

  •     Document date, time, nature of injury, and intervention in the AS400 Clinic System or on  the student’s Cumulative School Health Record (see "Forms" chapter).

  •    Notify the school RN.

If the Student Regains Consciousness:

  •     Instruct the student not to move until help arrives.

  •     Minimize movement.  DO NOT MOVE THE HEAD OR NECK.

  •     Ask the student what happened and where it hurts.

  •     Call 911 for assessment

  •     Call parent/guardian and notify principal

 

 

Burns

 

Description:

 

Destruction of a layer or layers of skin caused by heat, electricity, chemicals, or radiation.  The deeper the burn the more severe. 

 

Note: If student comes to school with unexplained burns (i.e. iron or cigarette) or repeated health room visits for burns, consider the possibility of child abuse. 

                       

Degrees of severity:

1.      First degree (superficial) – pain and redness with no blisters.

2.      Second degree (partial-thickness) – pain, redness, and blisters.

3.      Third degree (full thickness) – red, raw, ash white, black, leathery, or charred skin with little or no pain.

 

 
Critical Burns

 

           Any of the following   Call 911 and notify 

           Parent/guardian and principal.                         

  •    Breathing difficulty.

  •    Burns covering more than one body part.

  •    Burns to the head, neck, hands, feet, or genitals.

  •    Burn resulting from chemicals, explosion, or electricity.

 

Intervention:

 

1.      Stop the burn:

  •      Extinguish flames.

  •    Remove student from source of the burn.

    •     Note:  If electrical injury, NEVER go near the student until you are sure the power is turned off.

2.      Cool the burn:

  •    Use large amounts of cool water on burned area.

  •    DO NOT USE ICE!  (Can cause bruising or freezing).

  •    DO NOT break blisters.

  •    DO NOT use butter, Vaseline, or other greasy ointments.

3.      Cover the burn:

  •    Loosely cover with dry, sterile dressing.

  •    Call parent/guardian and notify principal.

  •    Strongly advise parent/guardian to seek medical treatment immediately.

  •    Provide the parent/guardian with the date of the student's last tetanus booster to take to the licensed health care provider.

  •    Accident and incident reports to be completed as applicable.

 Note:  If electrical injury, NEVER go near the student until you are sure the power is turned off.

 

 

Cerebral Palsy

 

Cerebral Palsy is a condition caused by damage to the brain.  “Cerebral” refers to the brain and “palsy” refers to the disorder of movement or posture.  It’s not progressive or communicable, because it’s not a disease.  Congenital causes account for the great majority of cerebral palsy.  This may be caused by illness during pregnancy or insufficient oxygen during or shortly after birth.  Acquired causes due to accident, poisoning, illness, child abuse, or other factors, usually occur early in life.

 

Cerebral Palsy is characterized by an inability to fully control motor function.  Depending on what part of the brain has been affected and to what degree, different areas of the body will be affected with differing degrees of severity.  Impairment of sight, hearing and speech may be affected.  Mental retardation may result as well.

 

 

There are three main types of cerebral palsy:

  •     Spastic, stiff and difficult movements.

  •     Involuntary and uncontrolled movement.

  •    Ataxia with a disturbed sense of balance and depth perception.

 

Activities for students with cerebral palsy may include:

  •     Speech and language therapy.

  •     Occupational therapy.

  •     Physical therapy.

  •     Medical intervention.

  •     Family support services.

  •     Special education.

CHAFED/CHAPPED SKIN OR LIPS

 

 

Intervention:

 

  •   Apply a thin layer of petroleum jelly (Vaseline) over affected area using individual packets. 

NOTE:  Severe redness, inflamed areas, or cracks in skin which bleed are symptoms of a more serious skin condition.  Do not apply petroleum jelly (Vaseline).  Advise student to see his/her health care provider.

 

 

CUT/LACERATION

 

Description:

 

A wound that breaks the skin with either smooth or irregular edges; may bleed freely.

 

Intervention:

 

  •     Wear gloves.

  •     Control bleeding by applying direct pressure (see "Bleeding" section if bleeding continues).

  •     Clean minor cuts with soap and water.

  •     Cover the wound with a sterile dressing.

  •     Recommend that parent/guardian contact licensed health care provider for further instruction.

  •     Give the parent/guardian the date of the student’s last tetanus booster to take to the licensed health care provider.

 

 

Cystic Fibrosis

 

Cystic Fibrosis is an inherited digestive and pulmonary disorder and is the most common fatal genetic disease in the United States today.

 

Cystic fibrosis affects the secreting glands of the body.  Mucus produced by the glands of the lungs is normally thin and clear.  In cystic fibrosis the mucous is thick and sticky. It clogs breathing passages and can lead to recurrent lung infections and lung damage.  Treatment to help bring up the abnormal mucus includes postural drainage and inhalation of aerosol medications and antibiotics.

 

The thick mucous also affects the pancreas, preventing enzymes from reaching the intestinal system, as they should.  Treatment for the digestive disorders of cystic fibrosis includes supplementary enzymes and a diet low in fat and high in protein.

 

The severity of cystic fibrosis varies from individual to individual even within the same family.  Students may cough frequently and should not be discouraged from doing so.  People with cystic fibrosis are particularly susceptible to contagious respiratory diseases and should not be exposed to other children with cold symptoms.

 

 

 

DENTAL INJURIES

Knocked out Tooth

 

Intervention:

 

Save tooth and place in a cup of water or milk.

 

  •     Call the parent/guardian and notify principal.  Emphasize to the parent/guardian the need to get to the dentist on an emergency basis to maximize the chances for successful re-implantation of the tooth.

  •     DO NOT touch root portion of the tooth.

  •     DO NOT attempt to clean tooth; this may interfere with the re-implantation process.

  •     Have the student rinse mouth with warm salt water, if desired.

Chipped/Broken Tooth

 

Intervention:

 

Save large fragments and see dentist immediately because break could extend down to the root of the tooth.

 

  •     Rinse mouth with warm water.

  •     Cover sharp edge of tooth with gauze to prevent laceration of tongue or cheek.

  •     Apply cold pack to face next to injured tooth to minimize swelling.

  •     Call parent/guardian and notify principal.

  •     Suggest that the parent/guardian get the student to the dentist as soon as possible.

  •     Accident and incident reports are to be completed as applicable.


 

Diarrhea

 

Description

 

Diarrhea is a condition associated with frequent watery stools and may be accompanied with vomiting and fever.  It may be a symptom of infection, which can be caused by many different organisms.  Antibiotics may also induce diarrhea due to changes in the normal bacterial flora of the intestinal tract.

 

Transmission:

 

The organisms are transmitted via the fecal oral route.  Transmission of the infection to others can be prevented by thorough handwashing, especially before eating, after using the toilet and changing diapers. 

 

Intervention:

  •     Take the student’s temperature.

  •     Call parent.  The student should be excluded from school until the diarrhea has stopped.

  •     Disinfect all contaminated surfaces and instruct student to wash hands.

  •     Recommend parent/guardian contact licensed health care providers for further instruction.

 

 EAR COMPLAINTS

 

 

 

Earache

Intervention:

 

  •     Take oral, axillary, or temporal temperature.  Do not take tympanic temperature in affected ear.

  •        Make student comfortable. 

  •        Call parent/guardian.

  •    Recommend parent/guardian to seek medical attention.

 

Foreign Body in Ear:

 

Description:  Student complains of “something in my ear”, usually no pain.

 

Intervention:

 

  •    DO NOT try to flush out object with water or oil (including earwax).

  •     DO NOT try to remove a foreign body unless it can be easily seen and grasped with finger.  When in doubt, do not attempt to remove.

  •    Call parent/guardian and notify principal.

  •    Recommend the parent/guardian to seek immediate medical care.

 

ELECTROCUTION

 

  •       Cut off electrical power.

  •    Call 911. Notify principal and parent/guardian.

  •    Separate person from contact using a dry, long, non-metal stick.

  •    Initiate CPR if indicated.

  •    Treat for shock (see "Shock" section) and burns.

 

 

EYE INJURIES

 

Impact to the Eye

 

If there is no cut or foreign body:

  •     Place a cold pack on the bone around the eye for 10-15 minutes.

  •     Call parent/guardian and notify principal.

  •     Recommend the parent/guardian seek medical care for the child.

 

If the eye or eyelid is cut (lacerated):

  •      DO NOT wash the eye.

  •       DO NOT press on or rub eye.

  •     Cover both eyes loosely with gauze pads.

  •     Keep the student propped up (not flat, not fully upright).

  •     Call parent/guardian and notify principal.

  •     Advise the parent/guardian to seek immediate medical care.

  •     Call 911 for transport if the parent /guardian is unable to transport immediately.

 

If there is penetration by a Foreign Body:

  •     DO NOT ATTEMPT to remove the object.

  •     Call 911.

  •     Secure a paper cup over the injured eye if object is small enough to fit underneath.

  •     Bandage other eye.*

  •     Keep the student’s head slightly elevated.  Movement should be minimal.  Do not allow the student to walk around.

  •     Call parent/guardian and notify principal.

 

* Because both eyes move in unison, covering the uninjured eye will help prevent the injured eye from further movement and damage.


 

Chemical Burn to the Eye

 

Intervention:

  •     Hold the injured eye open.

  •     Flush eye with warm water for 15 minutes from the inside corner to outside corner.

  •     Have someone call the poison control center (1-800-222-1222) for further instructions.

  •     Call 911 for transportation if the parent/guardian is unable to transport immediately.

  •         Call parent/guardian and notify principal.

  •         Loosely cover both eyes.

  •    Advise the parent/guardian to seek immediate medical attention.

 

Foreign Body in the Eye (non-penetrating)

 

Description:

 

Bits of sand, dirt, insects, and/or eyelashes caught in the eye may cause discomfort and tearing of the eye.

 

Intervention:

  •     Instruct student to remove contact lenses if present.

  •     Gently flush eye with warm water.

  •     Avoid rubbing.

  •     If object cannot easily be removed, call parent/guardian.

  •     Send student back to class if object is successfully removed.

 

NOTE:  Foreign bodies in the eye always create the risk of scratching the surface of the eye.  It is always advisable to seek medical attention for any situation except for those specks that are easily removed.

 

 

Eye Infections/Irritations

 

Description:

 

There could be redness of the whites of the eyes, discharge of pus or pus-like substance, redness, and/or swelling of eyelids, itching and rubbing of eyes, or crusted lids associated with a cold or allergic reaction, bacterial infection or viral infection.

 

Intervention:

  •        Observe for redness, discharge, swelling and crusts.

  •        Call parent/guardian.

  •    Advise parent/guardian to seek medical diagnosis of condition.

  •    Complete the Unidentified Medical Condition form and give to parent.

  •    Student should be excluded from school until (a) diagnosis in writing by a licensed health care provider indicates a non-contagious eye ailment or (b) signs and symptoms have resolved.

 

Note:  Bacterial infections will usually require 24 hours of treatment before return to school is permitted.


 

STY

 

 

 

Description:

 

Sty: A tiny abscess on the edge of the eyelid that may have a slight redness.

 

Intervention:

  •     Call parent/guardian and inquire if aware of the problem and if any treatment has been initiated.

  •          Instruct student not to rub or touch the eyes.

  •         Instruct student in proper hand washing techniques.

  •     Apply warm compress for 10 minutes for comfort, if desired (wet paper towel under the faucet with warm water).

  •     Send student back to class.

  •        Call parent/guardian if discomfort persists.

 

 

FAINTING

 

 

 

Description

 

This is a mild form of shock with a brief, partial or complete loss of consciousness due to a brief lack of blood and oxygen to the brain, caused by a nervous system reaction to fear, hunger, pain, or strong emotions.  It may occur after prolonged standing in heat or because of low blood pressure when suddenly rising to standing position. 

 

Signs and Symptoms:

  •     Weakness or fatigue

  •     Lightheaded or dizziness

  •     Sleepiness

  •     Sweating

  •     Pallor

  •     Nausea

  •     Collapse to the ground

Intervention:

 

If student is on the verge of fainting:

  •     Have student lie down on back.

  •     Loosen clothing around neck and waist.

  •     Elevate legs 8-12 inches.

  •     Apply cool cloth to face and neck.

  •     Ask student about circumstances of episode.

  •     Call parent/guardian.

 

If student has fainted:

  •     Lay student on back.

  •     Elevate legs 8-12 inches.

  •     Check Airway, Breathing and Circulation, and initiate steps of CPR as needed.

  •     Turn head to side if vomiting occurs.

  •     Check for injuries that may have occurred from falling when fainting.

  •     Loosen tight clothing.

  •     Apply cool cloth to face and neck.

  •     DO NOT use ammonia or smelling salts.

  •     Call 911 if student remains unconscious after performing the procedures above.

  •     Call parent/guardian and notify principal.

 

If student is recovering from fainting:

  •     Have student remain on back.

  •         Elevate legs 8-12 inches.

  •     Apply cool cloth to face and neck.

  •     Ask student about circumstances of episode.

  •     Have student rest until episode has resolved.

  •     Notify parent/guardian and principal.

  •     Advise parent/guardian to seek medical assessment.

 

NOTE:   Allow the student time to awaken by him/herself.  Do not use ammonia or smelling salts because they irritate the mucus membranes of the eyes, nose and breathing passages.

 

 

 

HEADACHE

 

 

 

Description:

 

Muscular- steady dull pain of gradual onset usually precipitated by stress or over-exertion.

Sinus – deep, full ache associated with nasal congestion and face pain. 

Migraine - throbbing pain of gradual onset lasting hours or days which may be precipitated by certain foods, beverages, or bright lights.

 

NOTE: If headache is sudden and severe and there is no known medical history of migraine, or if there are any symptoms such as slurred speech, blurred vision, sensitivity to light, vomiting or weakness on one side, condition may not be a simple headache.  CALL 911. Call parent/guardian and notify principal.

 

Intervention:

 

  •     Give appropriate medication ordered by the student’s physician.

  •     Have student lie down and relax in a quiet, darkened room.

  •     Take temperature to rule out fever.

 

If the condition does not improve in 30 minutes:

  •       Call the parent/guardian.

 

If there is no temperature and the condition improves in 30 minutes:

  •    Send back to class.

 

 

HEAD INJURIES

(Bump, Scalp, or Internal Head Injury)

 

 

 

Description:

 

This trauma to the scalp may be an abrasion, laceration, and/or bruise with swelling (goose egg).  A head injury may be superficial or serious and life threatening, with or without loss of consciousness.

 

Signs and Symptoms of Internal Head Injury:

 

  •  Unconsciousness.

  •    Pupils of unequal size.

  •  Seizure.

  •    Clear fluid or blood from nose or ear.

  •  Unusual sleepiness.

  •    Confusion or dizziness.

  •  Difficulty with speech or vision.

  •    Difficulty with walking.

  •  Vomiting more than once.

  •    Pale, sweaty appearance.

  •  Severe headache.

  •  Neck pain.

  •    Loss of muscle coordination.

  •   Nausea.

 

Intervention:

  •     Call 911 if signs and symptoms of internal head injury (loss of consciousness, seizure, or any of the above)If unconscious, do not move.  Initiate steps of CPR as needed.

  •     Verbally notify parent/guardian of injury.  Notify principal.

  •     Have student rest.  Keep them warm and quiet.

  •          If student vomits, turn head to side

  •     DO NOT leave student alone.

  •     DO NOT give anything by mouth.

  •     Student Incident Report to be completed and given to parent/guardian.

  •     Student Accident Report form to be completed if applicable.

  •     Document the date, time, nature of injury, and intervention in the AS400 system.

  •     Inform the school RN of the 911 call.

 

If abrasion or laceration:

  •      Follow Abrasion or Laceration procedure.

  •     Call 911, if signs and symptoms of internal head injury (see above).

  •     Verbally notify parent/guardian of injury.

  •     Notify principal of injury.

  •     Student Incident Report to be completed and given to parent/guardian

  •     Student Accident Report form to be completed if applicable. 

 

If bruise with swelling (goose-egg):

  •     Apply cold pack.

  •     DO NOT apply pressure to area of swelling.

  •       Call 911, if signs and symptoms of internal head injury (see above).

  •     Have student rest. 

  •     Verbally notify parent/guardian of injury.  Notify principal.

  •     Send student back to class when discomfort has subsided.

  •     Direct the teacher and student to notify you of any further complaint or change in behavior.

  •     Student Incident Report form to be completed and given to parent/guardian.

  •     Student Accident Report form to be completed if applicable.  

IT IS VERY IMPORTANT THAT THE PARENT/GUARDIAN OBSERVE THE STUDENT FOR DELAYED SYMPTOMS OF INTERNAL HEAD INJURY FOR 48-72 HOURS FOLLOWING INJURY - NO MATTER HOW MINOR IT MAY APPEAR.

 

 

HEART CONDITIONS

 

Description:

 

Heart conditions in children can include problems with heart rate and conduction (transmission of electrical impulses), high blood pressure and chest pain.  These children may have decreased activity tolerance and endurance. 

 

Signs and Symptoms:

 

Shortness of breath, chest pain, pale blue lips, tingling in hands, irritability or lethargy

 

Intervention:

 

  •     Notify parent or guardian

  •         Let student rest

  •     Reassure student.

NOTE:  Refer to the student’s Individual Health Plan.

 

 

HEAT RELATED EMERGENCIES

 

 

          

Description:

 

These emergencies are related to overexposure to high temperatures resulting in the body either losing too much water and salt through sweating (Heat Exhaustion) or the body becoming unable to regulate its temperature (Heatstroke).

 

Prevention:

Listed below are some suggestions for preventing heat disorders. Keep them in mind when planning outdoor activities.

Listed below are some suggestions for preventing heat disorders. Keep them in mind when planning outdoor activities.

1)  Water is the best source for hydration. Free access to water is essential with the temperature of the water being 59-72 F degrees. Encourage students to drink 10-20 ounces of water two hours prior to the activity. Hydration prior to the activity is just as important as hydration during the activity.  Encourage students to have a filled water bottle available for use during the events.

2)  Avoid beverages that promote dehydration (such as drinks with large          amounts of sugar and caffeinated sodas).

3).  Limit outside activity to morning and evening hours. Be cautious and stay out of the sun when exercising between 10:00 a.m. and 4 p.m.

4).  Rest in shady areas when outside, or remain inside in an air-conditioned space.

5).  Protect your eyes and skin by wearing sunglasses and sunscreen (SPF 15 or higher that protect against both UVA and UVB rays).

6).  Dress for summer by wearing lightweight, light-colored and loose fitting clothing to reflect heat and sunlight.  Wear wide-brimmed hats to shade your face and neck from the sun.

See Heat Disorders Letter.

 

Signs of Heat Exhaustion:

  •      Cramps.  (Cramps are one of the first signs that the body is having trouble with heat.)

  •    Skin is moist, pale, and cool.

  •    Headache.

  •    Dizziness.

  •    Nausea.

  •    Weakness.

    •   Move student to cool place out of the sun.

    •   Have student lie on back with feet elevated 8-12 inches.

    •   Give sips of cool water.

    •   Apply cool cloths to face and neck.

    •   Call parent/guardian and notify principal.

    •   Call 911, if condition does not improve or worsens.

Signs of Heatstroke:

  •    Skin is hot, dry, and flushed.

  •    Elevated temperature.

  •    Rapid, weak pulse.

  •    Rapid, shallow breathing.

  •    Weakness.

 

NOTE:  Heatstroke is a severe emergency.  Call 911 without delay!

 

Can progress to life threatening condition with:

  •     Confusion.

  •     Vomiting.

  •     Agitation.

  •     Refusal to take liquids.

  •     Change in consciousness.

  •     Seizure.

    •  Check Airway, Breathing and Circulation, and initiate steps of CPR as needed.

    •  Call 911.

    •  Move student to cool place.

    •  Apply cool wet towels to head, trunk and limbs.

    •  Apply ice packs to neck, armpits and groin.

    •  Monitor for seizure activity (see Seizure procedure).

    •  Call parent/guardian and notify principal.



 

Hyperventilation

 

Description:

 

Abnormally prolonged and rapid breathing often associated with acute anxiety or emotional tension.

 

The student may complain of one or more of the following:

  •     Pounding heart

  •     Dizziness.

  •     Tingling sensation in lips and extremities.

  •     Stomach discomfort.

  •     Sensation of smothering.

     

    •  Health room personnel may notice an unsteadiness, decreased alertness, and/or fainting.

 

Intervention:

  •     Allow the student to sit in a quiet place.

  •      Reassure student.  Make direct eye contact and speak clearly and slowly.  Stay with the student.

  •      Focus the student on slowing his/her breathing.  Have student do the following exercise:

    • Take slow deep breaths through the nose counting to four while inhaling.

    • Exhale slowly through closed lips (like blowing through a straw) to a count of four.

  •      If the breathing exercise does not help, breathing into cupped hands over face may be helpful.

  •      If symptoms continue for more than several minutes or student passes out, call 911.

  •      Notify the parent/guardian and the principal.

  •      Record action taken on the AS/400.

  •      Report the incident to the school RN.

 

MENSTRUAL DISCOMFORT / CRAMPS 

 

Intervention:

  •          Give medication if ordered by health care provider for this condition.

  •         Have student rest in a quiet area.

  •     To lessen pain, place a heating pad with manufacturer's cover over the student's clothes on the area   of discomfort.  (Do not allow student to lie on top of heating pad.  Heat is increased with pressure which could cause burns).

  •        Call parent/guardian if experiencing severe discomfort.

  •        Notify the school RN if there is a pattern of frequent visits for this particular problem.

 

 

MOUTH INJURIES

 

 

 

Bitten Tongue or Lip:

Intervention:

  •       Wear gloves.

  •       Have student rinse mouth with warm water.

  •       Control bleeding by direct pressure with a piece of gauze or clean cloth.

 

If bleeding stops and no laceration to skin around lip:

 

If deep cut extends from lip to skin surrounding lip or gaping cut on tongue with persistent bleeding:

  •   Check for broken teeth.

  •   May apply ice pack if no broken teeth.

  •   Send student back to class.

  •   Notify parent/guardian.

 

  •   Call parent/guardian to pick up student and notify principal.

  •   Recommend parent/guardian contact licensed medical professional for further instruction.

NOTE: See "Dental Injuries" also.

 

 

NAUSEA

 

 

 

Intervention:

 

  •     Have student rest.

  •     DO NOT give liquids or food.

  •    T ake temperature to rule out fever.

If nausea continues or temperature is elevated:

 

If nausea subsides and no temperature:

 

  •   Call parent/guardian.

  •   Send student home.

  •   Send back to class.

NOTE:  See "Vomiting" procedure if vomiting occurs.

 

 

NOSEBLEED

 

Intervention:

  •      Wear gloves.

  •      Pinch nostrils together at top of soft part of nose for a minimum of five (5) minutes by the clock, ten (10) minutes if bleeding has not stopped at the end of 5 minutes.

  •      Lean student forward so blood will not run down the throat.

  •      Inform parent/guardian of frequent unprovoked bleeding, even if quickly stopped and encourage them to discuss with their licensed health care provider.

 

If bleeding stops:

  •     DO NOT apply ice to the face or head.

  •     Encourage mouth breathing.

  •     Instruct the student not to blow or pick nose for several hours.

  •     Send student back to class.

  •     Report all nosebleeds to the parent/guardian.  If needed, call student's parent/guardian to supply a change of clothing (parent/guardian can then take contaminated clothing home).

  •     Dispose of gloves and other soiled items in a red plastic bag (see OSHA manual).

 

If bleeding persists:

  •     Call the parent/guardian and notify principal.

  •     Advise the parent/guardian to seek medical attention as soon as possible.

 

NOTE:  If bleeding occurs after a direct, forceful blow to the nose, suspect fracture.  Encourage parent/guardian to contact licensed health care provider for further instructions.

 

 

OVERDOSE - DRUG/ALCOHOL

 

Suspect a possible drug/alcohol overdose if you observe the following signs/symptoms:

 

  •      Decreased alertness/inability to stay awake.

  •      Hallucinations.

  •      Vomiting.

  •      Slurred speech.

  •      Smell of alcohol or chemicals on breath.

  •      Bright, cherry red lips.

 

NOTE: With any suspicion of drug/alcohol overdose call administration immediately.

 

Intervention:  Try to find out what drug has been taken, how much, and when.

 

  •      Call 911.

  •      Check Airway, Breathing and Circulation, and initiate steps of CPR as needed.

  •      Call the poison control center (1-800-222-1222) for directions on what to do until EMS arrives.

  •      Stay with student.

  •      Notify the school RN.

 

If the student is unconscious but is breathing:

  •      Position on his/her side to prevent aspiration of vomit, and monitor.

  •      Observe for shock and treat accordingly (see "Shock" section).

  •      Call parent/guardian and notify principal.

 

If the student is conscious:

  •      Observe for signs of shock and treat accordingly (see "Shock" section).

  •      Call parent/guardian and notify principal.

  •      Monitor for seizure activity (see Seizure/Epilepsy" section).

  •      Reassure the student; be supportive and non-judgmental.

  •      Keep him/her quiet and calm.

  •      Protect from injury.

  •      Ensure privacy.

 

 

POISON - SWALLOWED

 

Intervention:  Identify the poison, how much was taken, and when.

 

Call 911 and Poison Control 1-800-222-1222.

 

If student is unconscious:

  •      Check Airway, Breathing, and Circulation, and initiate steps of CPR as needed.

  •      Position student on his/her side to prevent aspiration.

  •      Call parent/guardian and notify principal.

 

If student is conscious and the poison is known and is non-corrosive:

  •      Keep student calm.

  •      Call the Poison Control Center for directions.

  •      Call parent/guardian and notify principal.

  •      Monitor student’s behavior.

If student is conscious and poison is unknown or is corrosive:

  •      Keep student calm.

  •      Call 911 and Poison Control 1-800-222-1222.

  •      DO NOT induce vomiting.

  •      Call parent/guardian and notify principal.

 


 

 

POISON OAK/ IVY/ SUMAC

 

 

 

Description:

 

A contact dermatitis which is caused by an allergic reaction to the oil of these plants, as a result of touching the leaves, stems, or roots directly; or indirectly, by touching tools, clothes, pets, or other articles that touched the plant.  Dermatitis may include redness, itching, blisters, and generalized swelling of the area.

 

Intervention:   Wear gloves.

  •     Wash exposed area with soap and water immediately if exposure is suspected.  (Do not use pretreated towelettes; using pretreated towelettes will just spread the oil.)

  •     Apply Calamine lotion on dry lesions if desired.

  •     Cold packs may relieve discomfort.

  •     Discourage scratching.

  •     If drainage noted from lesion, areas must be covered. Notify parent/guardian.

  •     Send student back to class.

Note:  If severe itching and dermatitis is widespread, student may need to go home.

 

RASHES

                                                                                               

Intervention:  Exclusion from school for all unidentified rashes/skin conditions:

 

  •     Consider the rash to be contagious until diagnosis or status of contagion is confirmed with a note from a licensed health care provider.  Give the "Unidentified Medical Condition" form to the parent or guardian.  If the rash is identified by the parent/guardian as chickenpox, no note is required and the student may return to school when all lesions are dry to the crust stage.

  •      If a previous unidentified condition is no longer present, the student may return to school.

  •      Whenever there is more than one student in a classroom with an unidentified or a diagnosed skin condition, the school RN must be informed.

NOTE:  If scabies, ringworm, or impetigo is diagnosed, treatment must be started before the student is allowed to return to school.  See additional information about chickenpox, impetigo, fifth disease, ringworm, rubella, scabies, and scarlet fever in the chapter on "Communicable Diseases".

 

 

Ring Removal

 

 

 

 

A ring or object may become tight on a finger or toe causing swelling.  This can occur after an injury to the body part or incident such as a bee sting.   There can be very serious consequences such as loss of finger if the constricting object is not removed.

 

Intervention:

  •      Apply ice and elevate the extremity to limit swelling.

  •      Lubricate with soap and cool water.

  •      Pull down the skin below the ring.  Usually this is enough to help you twist the ring off the finger or toe.

   

If the ring or object is still too tight or there is too much pain for the above technique:

  •     Call local 911 for assistance with a ring cutter.

  •      Inform the parent that ring or object could not be removed by lubrication with soap and water and that 911 was called for assistance.

  •      Notify principal.

Note:  If there is an injury to arm or hand, remove ring or object immediately to prevent swelling and constriction.

 

 

 

SEIZURES/EPILEPSY

 

Description:

 

A seizure is a disturbance of the electrical impulses of the brain, causing a variety of body responses ranging from a few seconds of staring to longer pauses and loss of attention, to collapse on the floor with loss of consciousness and strong shaking of large voluntary muscles.

 

Intervention:

 

Seizure - Convulsive First Aid Pictorial

 

Plan of Action for Convulsive Seizure Disorders:

 

  •   Help the student to the floor if falling and position on her/his side.

  •   Loosen restrictive clothing and remove glasses.

  •   Clear the area around the student to protect from injury.

  •   Cushion student's head with clothing.

  •  TIME THE SEIZURE.

  •  DO NOT RESTRAIN other than to prevent injury

  •  DO NOT PUT ANYTHING IN THE MOUTH

If any seizure lasts more than 5 minutes, if more than one seizure occurs, if there is no previous history of seizures, or if there is absence in breathing after muscle jerks subside:

  •    Call 911

  •   Check Airway, Breathing, and Circulation and initiate steps of CPR as needed.

 

  •   Offer reassurance when consciousness returns.  Let the student rest.

  •   Notify School RN.  Call parent/guardian, and notify principal.

  •   Document seizure on the Seizure Observation Form.

 

Seizure - Non-Convulsive First Aid Pictorial

 

Plan of Action for Non-convulsive Seizure Disorders:

 

  •   Do not leave the student suspected of being in a state of confusion or non-responsiveness alone.

  •   Do not restrain other than to prevent injury.

  •   Never assume that the student heard or understood the instructions you gave.

  •   There is no recall of events that occur during these episodes.

  •   Notify School RN.  Call parent/guardian.

  •   Document seizure on the Seizure Observation Form.

 

 

If seizure activity is part of a chronic condition and is to be expected:

  •  Refer to the student's Individualized Health Care Plan to determine the agreed upon procedure developed between the School RN, student, and family.

  •  Notify the parent/guardian of any seizure activity.

  •  Document on Seizure Observation Form.

 

NOTE:  Refer to the student’s Individual Nursing Care Plan.

 

 

SHOCK

 

Shock is a life threatening condition where the body responds to serious injury or illness such as blood loss, head or body trauma, fainting, or severe allergic reaction.  This response is a natural attempt to keep oxygen rich blood flowing to the vital organs such as the brain and heart.  Loss of oxygen to other parts of the body causes the following symptoms to develop:

  •     Restlessness or irritability.

  •     Rapid pulse and breathing.

  •     Pale, cool, and damp skin.

  •     General weakness.

  •     Change in mental status/loss of consciousness.

Note:  may have one or more of these symptoms.

 

Intervention:

  •     If you suspect shock, call 911.

  •     Notify the principal and call the parent/guardian.

  •     Care for severe or life-threatening injuries and control bleeding (initiate CPR as needed).

  •         Have the student lie down in the most comfortable position.

  •     Help to calm the student especially if in pain since severe pain can accelerate shock.

  •         Elevate the legs 8 to 12 inches unless you suspect head, neck, or back injuries.

  •     If you suspect broken bones involving the leg or the hip, keep the student lying flat.

  •     Keep student warm.

  •        If no spinal injuries and breathing is difficult, raise to a propped up position.

  •        If no spinal injury and is vomiting, have student lay on his/her side.

  •    Do not give liquids.

  

SORE THROAT

 

 

Intervention:

  •      Take temperature to rule out fever.

  •      Gargling with warm salt water (1/4 tsp. in 8 oz. of water) may relieve discomfort.

 

If temperature is elevated:

  •      Call parent/guardian.

If temperature is not elevated:

  •      Send student back to class.

  

SPLINTERS/PENCIL LEADS

 

Management:

 

If the splinter/pencil lead is protruding above the surface of the skin:

  •      Remove by grasping with tweezers and pulling out.

  •      Wash with soap and water.

  •      Cover with sterile bandage.

  •      Send back to class.

 

If the splinter/pencil lead is imbedded:

  •      DO NOT try to remove.

  •      Cover with bandage.

  •      Call parent/guardian.

  •      If unable to contact parent/guardian, send incident report home with student.

 

NOTE:   Pencil “lead” is made of graphite.  Although graphite is not toxic, a permanent mark may be left where the injury occurred.

 

  

STING (Insect)

 

 

 

Prevention:

  •  Avoid areas where stinging/biting insects are present.

  •  Avoid perfume scented soaps and brightly colored clothing.

 

For complete “Life Threatening Allergy Guidelines” see Life Threatening Allergy chapter.

 

When a bite or sting from an insect injects venom under the skin, a local or systemic reaction may be produced.  Local reactions indicate that the body’s immune system is effectively defending against the insect venom without a whole body response.  A systemic reaction, however, may involve the whole body. It may progress to anaphylaxis   (See Anaphylaxis).

 

SIGNS AND SYMPTOMS OF INSECT STINGS (these symptoms may occur in any combination):

Local

Systemic

  •   Immediate stinging pain.

  •   Redness around the site.

  •   Skin warm to the touch.

  •   Swelling for a few hours at sting site.

  •   Skin flushed.

  •   Generalized hives.

  •   Swelling, sometimes severe at the site and elsewhere, especially face, lips or tongue.

  •   “Tickle” in the throat.

Intervention:

  •     Examine site for stinger.

  •     If stinger is visible and protruding above the surface of the skin, remove by scraping with a card.  Do not squeeze venom sack as this may cause additional venom to be injected.

 

If local reaction:

  •     Observe for signs of systemic allergic reaction.

  •     Wash with soap and water.

  •     If sting area is painful, a paste made of baking soda and water (1 Tablespoon of baking soda to 1 teaspoon   of water) may be rubbed on the sting and left on for 5 minutes.

  •     If sting area itches, apply Calamine lotion.

  •     Use cool pack (ice pack) on sting site for 15-20 minutes.

  •     Send student back to class if there are no other symptoms.

  •         Direct student and/or teacher to notify health aide of any complaints and/or change in behavior.

 

If systemic reaction:

 

  •     Give medications according to physician’s orders.

  •     Continue to apply cold packs.  Position student with sting site lower than heart.

  •     Keep student quiet.

  •     Call parent/guardian and notify principal.

      

           

If student progresses to anaphylactic allergic reaction and has an Epi-Pen® with Physician’s order: (See Anaphylaxis, in the Life Threatening Allergies Chapter.)

  •      Have someone call 911.

  •      Give emergency injection as ordered.

  •      Check Airway, Breathing and Circulation, and initiate steps of CPR as needed.

  •      Continue to apply cool packs (Ice).

  •      Position student with sting site lower than heart.

  •      Keep student quiet.

  •      Call parent/guardian and notify principal.

 

If student progresses to anaphylactic allergic reaction and does not have an Epi-Pen®:

 

  •     Have someone call 911.

  •     Check Airway, Breathing, and Circulation, and initiate steps of CPR as needed.

  •     Continue to apply cool packs (Ice).

  •     Position student with sting site lower than heart.

  •     Keep student quiet.

  •     Call parent/guardian and notify principal.

 

 

STOMACHACHE

 

 

Stomach aches can be from a variety of causes.  Notify the school RN if there is a pattern of frequent visits for this particular problem.

 

Intervention:

  •     Ask the student to describe the pain and its specific location.

  •     Ask whether or not he/she has eaten recently or needs to use the restroom.

  •     Take temperature.

  •     Observe for facial signs of distress, worry or pain.

 

If temperature is within normal limits:

  •     Allow the student to rest for 15 minutes.

  •     Send the student back to class if pain subsides.

  •     Call the parent/guardian if the pain increases or persists.  Encourage the parent/guardian to discuss with their healthcare provider.

 

If temperature is elevated:

  •     Call parent/guardian.

  •     Send student home if temperature is 100° F orally or 99° F axillary or greater.

If vomiting or diarrhea is present:

  •     Call parent/guardian.

  •     Send student home.

 

Information on APPENDICITIS

 

The vermiform appendix is a part of the bowel that is a worm shaped tube, connected to the first portion of the large intestine.  Sometimes it can become inflamed causing appendicitis.

 

Symptoms of appendicitis:

  •         Fever - may be low early in the course of appendicitis (99-101° F).

  •     Pain - is usually present over the right lower part of the abdomen, but may be present throughout the abdomen.

  •     Young children may not be able to give an exact location of where the pain is located.  The pain may get worse; progression is usually more rapid in the younger student.

  •     Facial expression usually shows discomfort.

  •     The student will usually rather lie down than sit up and is often more comfortable positioned on the left side with the right leg drawn up.

  •     Paleness and vomiting may be present.

 

If you suspect that the student may have appendicitis:

  •     Do not give the student anything to eat or drink.

  •     CALL THE PARENT/GUARDIAN.

  •     SEND STUDENT HOME with parent/guardian. 

  •     STRONGLY RECOMMEND TO PARENT/GUARDIAN THAT THE STUDENT SEE A LICENSED HEALTH CARE PROVIDER FOR ASSESSMENT IMMEDIATELY.

 

 

TICKS

 

 

Intervention:

 

Call the parent/guardian for tick removal.  Recommend that parent/guardian contact licensed health care provider for further instruction.

 

 

TOOTHACHE

 

 

 

Intervention:

  •      If there is swelling of gums, jaw, or face, apply cold pack to the cheek.

  •      Call the parent/guardian and strongly recommend that the student promptly see a dental care provider.

 

NOTE:  If the family requests assistance, refer to the school RN assigned to your school. ]

 

 

VOMITING

 

 

Intervention:

  •     Take student’s temperature.

  •     Have the student rest.

  •     Have the student close to the toilet or emesis basin for vomiting.

  •     Sponge face and neck with cool water.

  •     Give no food or liquid.

  •     Call parent/guardian to take the child home.

 

WOUND (open)

 

   

Description

 

A wound is an injury that causes either an internal or external break in body tissue. An open wound is a break in the skin or mucous membrane. The most common accidents resulting in open wounds are falls, mishandling of sharp objects, accidents with tools or machinery, and car accidents.

 

After an injury that causes a break in the skin or after an operation, various wound infections may occur. The most common cause for wound infections are Staphylcoccus aureus. One type of Staphylococcus aureus is MRSA (Methicillin Resistant Staphylococcus aureus). Although rare, these infections may lead to more serious complications.

 

Intervention

 

These types of infections can be transmitted by close contact with infected persons and/or sharing of items such as towels, razors, fingernail clippers, sports pads, sports equipment, etc. that are not cleaned between uses. The most important ways to prevent the spread of skin infections are to:

 

Wash hands frequently with soap & water or alcohol-based hand sanitizer.

Clean & cover new skin injuries immediately.

Cover all draining/open wounds/scrapes/abrasions with a dry bandage that can contain the affected area & will remain in place during the activity.  Clean/disinfect shared equipment regularly.

 

If a student develops symptoms of a skin infection, the parent should take them to their health care provider. Most infections can be easily treated.

 


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Last updated: 07/25/12