DIABETES Although diabetes is a disease, it is not infectious; a child With greater understanding of Diabetes, teachers can help diabetic students lead …

2008/2009 School Year
Elementary School
CONFIDENTIAL HEALTH LIST

This is a list of students with significant health problems
Information on this list was obtained from the Health History Forms, parent
conferences, enrollment records and other sources It was generated from
the information that was entered into SASI If you have health information
about students not on this list, or suspect that a student has a health
problem, please inform the school nursing or office staff

Many students are sensitive about their health problems and strict
confidentiality is advised When appropriate, reassure your students that
you understand about their health condition, and allow them to go to the
office as needed for rest or medications Please check the lists and read
the information that relates to your students

If you need more information than what has been provided about a
specific health problem or student, please contact the school nurse

Information about medical issues follows the student list

ALLERGIES

Allergies vary in
type and severity Some parents may not be aware that
their child has allergies Please notify the office or school nurse if you
notice a student with continuing symptoms, not related to colds or flu

Common reactions include:
1 Continuous sneezing, sniffling
2 Swollen and watery eyes
3 headache
4 skin rash
5 vomiting
6 itching
7 anxiety

Some common allergens are:
1 Insects stings, usually bees, wasps or fire ants
2 Medications, including aspirin
3 Immunizations, usually by injection
4 Food such as nuts, beans, eggs, shellfish or dairy products
5 Pollen, dust mites, mold, pet dander
6 Industrial or office chemicals or their vapors
7 Latex rubber

An extreme reaction is called an Anaphylactic reaction Onset is rapid and
requires instant action to prevent fatality Notify the office if you
observe the following symptoms:
1 Swollen face
2 Sweating, weakness
3 Change of color
4 Asthma type symptoms see Asthma, this document
5 Skin rash with itching
6 Swollen throat, which may cause breathing difficulty
7 Swollen lips, tongue, eyelids or nose
8 Breathing difficulty, shallow respiration
9 Chest or Abdominal pain
10 Low
blood pressure with weak, rapid pulse
11 Change in voice
12 Tingling sensation around mouth or face, nasal congestion, itching,
wheezing
13 Hives spreading over the body
14 Child has sense of impending doom
15 Vomiting
16 Loss of consciousness, shock, convulsions or coma

Treatment:
Some children may have an EpiPen epinephrine in the office This should
go with him/her on field trips, sporting events or emergency evacuations

In the case of an anaphylactic reaction:

1 Give EpiPen or EpiPen Jr immediately Hold against the outer thigh,
through clothing if necessary Push HARD until you hear a click
Hold in place for 10 seconds Remove
2 Call 911 immediately Paramedics should always be called if EpiPen is
administered EpiPen only lasts 20-30 minutes
3 Contact parents or emergency contact person If parents are
unavailable, school personnel should accompany the child to the
hospital

EpiPen Administration Procedure

NOTE: If the reaction is a result of bee, wasp, or other sting, remove
stinger ASAP, after administering EpiPen Remove stinger quickly with
fingernail Do NOT push, pinch, or
squeeze, or further embed the stinger
into the skin This may cause more venom to be injected into the child
Apply covered ice pack to sting area

a Cover student with blanket, to maintain body temperature
b If at any time breathing stops, INITIATE CPR IMMEDIATELY
c If trained, take vital signs Call physician listed on Health
History Form
d When paramedics arrive on the scene, state factually the
incident and time the EpiPen was administered
e If parents are unavailable, school personnel should accompany
the child to the hospital

ASTHMA

Asthma is the most common chronic disease in children and the most common
medical cause of chronic absenteeism Asthma may present in a number of
distinct fashions:
1 Episodes of wheezing or shortness of breath related to exposure to an
allergen, such as cats, dust, outdoor pollens or mold
2 Prolonged and often refractory cough and wheeze with shortness of
breath related to acute respiratory viral illness
3 Shortness of breath, cough or wheeze triggered by exercise, stress or
cold-air that takes more than just a
minute or two from which to
recover

Some asthmatic children will have an inhaler in the office Some students
will carry their inhaler in their pocket or backpack Always send a
companion with the student when they need to use their inhaler The
inhaler should go with him on field trips, sporting events or during
emergency evacuations Usually the student knows his /her limitations and
if his/her condition is worsening Asthmatic students should be encouraged
to carry their inhaler with them at all times, as an attack could occur at
any time

Asthma can be a serious condition, but is treatable with medication
Students with asthma usually can participate in short term exercise When
assisting a student with an asthma attack:
1 Be calm and supportive
2 Encourage the student to relax and whistle breathe or purse lips to
encourage diaphragmatic breathing
3 If the student has a Peak Flow Meter, use it to determine the need for
medication
4 Then proceed according to the reading
5 Give prescribed medications inhaler
6 Have students drink water
7 Reassure
8 Child may return to class when symptoms stop
9 If symptoms remain unrelieved after 15
minutes, call parents and 911

10 If rate of breathing is more than 1/3 of pulse rate, handle as a
medical emergency

An acute asthma attack is a medical emergency that should be treated
promptly and effectively Children having a severe asthma attack will
often evidence observable signs:
1 Sitting upright, leaning forward, using neck muscles to assist
breathing; nasal flaring may be present
2 Prolonged exhales, sometimes with pursed lips
3 High pitched cough; irregular high pitched wheeze
4 Poor air movement; rapid shallow breathing
5 Fast pulse 120 beats per minute
6 Speaking in very short sentences
7 gasping for air
8 Student complaining of chest tightness

ADHD/ADD

ATTENTION DEFICIT HYPERACTIVE DISORDER
ATTENTION DEFICIT DISORDER

ADHD AND ADD are similar disorders which are diagnosed by a medical
doctor, and often students will be taking medications to help them focus
ADHD/ADD is a persistent pattern of inattention and/or hyperactivity-
impulsivity that is more frequent and severe than is typically observed
in individuals at a comparable
level of development

Students diagnosed with ADHD/ADD have had six or more of the following
symptoms, for a period of 6 months or more Some symptoms must have been
present before the age of 7 years, and the symptoms must be present in at
least 2 settings, such as home and school
1 poor attention
2 cant sustain attention
3 doesnt listen
4 makes careless mistakes, doesnt pay attention to details
5 does not follow through with instructions
6 has difficulty organizing tasks
7 reluctant to engage in tasks that require sustained mental effort
8 looses things necessary for tasks
9 easily distracted
10 fidgets or squirms
11 wont remain in seat
12 runs about and climbs excessively
13 has difficulty playing or relaxing
14 acts as if driven by a motor
15 talks excessively
16 blurts out answers
17 cant wait his turn
18 often interrupts

The school nurse and/parents should be notified if the following side
effects from the medication are noticed:
1 decreased appetite
2 weight loss
3 headaches
4 stomachaches
5 tics or involuntary motor movements eg eye blinks
6 dizziness

7 rashes
8 irritability
9 feeling anxious, jittery
10 tenseness
11 heart racing
12 socially withdrawn
13 sadness

DIABETES

Diabetics should always have a source of quick sugar with them candy,
raisins, honey, juice, sugar cubes Sugar is available in the office
or kitchen At times diabetics have sugar control problems There are
two types of diabetic reactions: Hypoglycemia and hyperglycemia If a
student is having a diabetic reaction, the following symptoms may be
observed Also see appendix A, page 24

HYPOglycemia Symptoms
Low blood sugar

1 comes on suddenly, can worsen within minutes
2 administration of sugar resolves symptoms
3 cool, clammy skin
4 pale face and skin
5 dazed look, glassy eyed
6 shaky, nervous, unable to concentrate
7 personality changes
8 crankiness
9 restlessness
10 dizziness
11 changes in vision
12 slurred speech
13 tingling sensation
14 headache
15 stomachache
16 hunger
17 irritability
18 combativeness
19 poor coordination

20 shallow or fast respiration
21 Feels funny
22 convulsions

HYPERglycemic Symptoms
High blood sugar

1 comes on slowly over days or weeks
2 administration of sugar will increase thirst and need to urinate
3 dry, warm flushed skin
4 lethargic, slow
5 unable to concentrate
6 thirsty
7 increased need to urinate
8 hunger
9 fruity breath odor
10 weight loss
11 nausea
12 changes in vision
13 vomiting

Although diabetes is a disease, it is not infectious; a child with diabetes
is not sick and should not be treated as if he is ill

Insulin is a potent drug and too much insulin is just as serious as too
little If there is too much insulin or too little in the blood stream,
it can cause an insulin reaction

If you are not sure whether the symptoms are caused by low or high blood
sugar, always treat them as though low blood sugar were the cause

Usually both the teacher and the child can learn to recognize an insulin
reaction Although the child may resist, she/he must eat or drink one
fruit exchange of simple carbohydrates:

? Cup
soda pop not dietetic
? Cup apple juice
Cup orange juice
Cup grape juice
10 grams vanilla frosting in a tube
3 teaspoons sugar
3 large 1-inch sugar cubes
5 small sugar cubes sugar which is dissolved in water will be absorbed
quicker
10 grams instant glucose
2 teaspoons honey

10 - 15 minutes or so after the administration of the carbohydrates, the
childs symptoms usually improve If not, repeat every 10 - 15 minutes
until symptoms subside

When the symptoms have subsided, the child should be given a sandwich or
food high in protein to prevent a reaction happening again an hour later
After eating, the child can resume his normal day

If the child does not improve, call 911 Always notify parents and when
appropriate, also the physician If the child begins to lose
consciousness, insert glucose gel in the cheek, or a sugar cube under the
tongue and then call the paramedics immediately Do not give fluids or
solid food

If high blood sugar appears to be the cause of the reaction, the student
should be given lots of water and encouraged to walk around, accompanied
by an adult

PERTINENT INFORMATION FOR ANYONE

SUPERVISING A DIABETIC STUDENT

1 Know the name of your students doctor and the daytime phone numbers
of the childs parents

2 Although diabetes is a disease, it is not infectious; a child with
diabetes is not sick and should not be treated as if he is ill

3 Insulin is a potent drug and too much insulin is just as serious as
too little If there is too much insulin or too little in the blood
stream, it can cause an insulin reaction

If you are not sure whether the symptoms are caused by low or high blood
sugar, always treat them as though low blood sugar were the cause
Usually both the teacher and the child can learn to recognize an insulin
reaction Although the child may resist, she/he must eat or drink one
fruit exchange of simple carbohydrates:
? Cup soda pop not dietetic
? Cup apple juice
Cup orange juice
Cup grape juice
10 grams vanilla frosting in a tube
3 teaspoons sugar
3 large 1-inch sugar cubes
5 small sugar cubes sugar which is dissolved in water will be absorbed
quicker
10 grams instant glucose
2 teaspoons honey

10 - 15
minutes or so after the administration of the carbohydrates, the
childs symptoms usually improve If not, repeat every 10 - 15 minutes
until symptoms subside

When the symptoms have subsided, the child should be given a sandwich or
food high in protein to prevent a reaction happening again an hour later
After eating, the child can resume his normal day

If the child does not improve, call 911 Always notify parents and, when
appropriate also the physician If the child begins to lose
consciousness, insert glucose gel in the cheek, or a sugar cube under the
tongue and then call the paramedics immediately Do not give fluids or
solid food

If high blood sugar appears to be the cause of the reaction, the student
should be given lots of water and encouraged to walk around, accompanied
by an adult

4 Diabetic children often can recognize and treat symptoms of low blood
sugar themselves, and should be permitted to carry candy at all times
The teacher or school nurse should have quick-acting sugar or a soft
drink available Children having a reaction should always be
accompanied when sent to the office

5
Symptoms of more severe reaction are drowsiness, unconsciousness, and
convulsions

In the event of a more severe reaction, notify the school nurse
immediately Do not force an unconscious child to swallow Notify the
parents and doctor immediately

6 If the child is having repeated insulin reactions, notify the school
nurse, who may then get in touch with the parents or doctor

7 A diabetic child who doesnt feel well should never be sent to the
office or home alone

Exercise is important for all children, but for the diabetic child, think
of it as an extra dose of insulin Therefore, the diabetic child should
eat something before doing any strenuous exercise such as running,
basketball, football, etc Physical Education should be scheduled after
lunch period Physical education activities should be discussed with the
childs physician or dietician

An adequate diet is an important method of controlling diabetes and often
young diabetics are instructed to eat snack foods at certain times of the
day Frequently they carry candy or something sweet with them in case
they start to feel an insulin reaction Do not forbid
this

Because urine testing is an important part in the control of diabetes,
the diabetic student may need to use the bathroom more often than other
students do This may be for testing or for more frequent urination
He/she should be allowed more restroom breaks if needed

Because young diabetics are still growing, and because, like all growing
students, they may have numerous short-term illnesses, their insulin
management may vary, and they may experience symptoms quite the opposite
of an insulin reaction These symptoms from acidosis are extreme
thirsty, extreme hunger, frequent urination, and tiredness

The child should still receive his insulin, eat some food, and check his
urine during these times It would be helpful to point these symptoms
out to the school nurse and/or parent Other more advanced symptoms
could be deep breathing, flushed, dry skin, and vomiting, fruity breath
odor Any of these symptoms should be reported to the parents or doctor
immediately

With greater understanding of Diabetes, teachers can help diabetic
students lead happy, well-adjusted classroom lives

HEARING

Hearing losses may be classified as conductive due to fluid wax,
sensorineural nerve loss, or mixed-loss combination of the above
They may affect one or both ears and can be mild, moderate or severe
They may also fluctuate if related to allergies or illness ie: colds,
sore throats or ear infections

Physical adjustments for the student include seating toward the front of
the room with the better ear toward the speaker Please see the nurse
if you have questions about a students degree of hearing loss or care of
hearing aids, if they are worn

The following students have appreciable hearing loss for which
preferential seating is recommended:

EAR PROBLEMS

Some students may have fluctuating hearing loss due to chronic ear
infections, tubes in ears, ear surgery or allergy related hearing loss
These students may also need to sit up front, with the good ear toward
the teacher They may also need to be excused from class to take
medications as needed

VISION

Sometimes students fail to wear their glasses or contact lenses as
needed If you
notice that a student is having difficulty in the
classroom or is complaining of blurry, watery eyes, squinting, or having
frequent headaches, please let the nurse know This may indicate a need
for a professional vision examination

If students other than those listed below are wearing glasses, notify the
nurse

If a contact lens wearer were to pass out or have a seizure, it is
important that the EMT be aware that the student is wearing contacts, so
that the EMT or doctor treating the student can remove the contacts

COLOR VISION DEFECT COLOR BLINDNESS

Children with color vision defect do see colors, but do not notice all
the different shades of color Many shades of red, green and blue look
the same to them They often have trouble identifying colors They may
confuse reds with greens This defect is more common in males than
females There is no treatment or cure for color vision defect In some
cases using tinted filters or tinted contact lenses will help a student
to identify colors

HEART CONDITION

A student with a heart condition may demonstrates any of these
symptoms:

1 shortness of breath
2 fatigue
3 pain in chest
4 dusky color
5 headache
6 nose bleed

When these symptoms occur, the student should stop all activity and rest
Notify the parent and obtain medical intervention

ORTHOPEDIC:

OSGOOD-SCHLATTER, SCOLIOSIS, and LEGG PERTHES

Orthopedic problems may involve muscles, tendons, ligaments or bones
The student may be limited in activity by crutches, braces, casts on
arms, legs or body For the duration of the injury or disease, some of
the students may have some difficulty getting to class on time If you
know of a child with an orthopedic problem and he/she is not on this
list, please notify the nurse Some orthopedic conditions are:

Osgood-Schlatter Disease: this disease causes swelling below the kneecap
and is painful and tender These students may have a limited ability to
participate in PE activities

Scoliosis: students with Scoliosis have a curvature of the spine Rarely,
a student may need surgery, or wear a brace, in which case PE should be
limited

Legg Perthes: this disease
causes the head of the femur thigh bone to
flatten due to poor blood supply and is seen mostly in boys Symptoms
include persistent limp, pain in the hip joint, usually of gradual onset
and slow progression, which may become severe The child may wear a cast,
brace or crutches

SEIZURES

Seizures are sudden, temporary disturbances of brain function Some
students are aware of impending seizures and may lie down; others fall
down There are three classifications of seizures:

1 Generalized:

Petit Mal: the student will have a brief loss of consciousness
He/she appears to be daydreaming There are no convulsions

Grand Mal: the student will lose consciousness; his/her body muscles
will relax and contract over a period of 2 to 5 minutes There may be
jerky involuntary movements, twitching of the body or eyes, froth
around the mouth, involuntary urination, defecation or vomit The
student will be very sleepy after the seizure

2 Complex Partial: these are tremors that start in the hand, foot or
around the mouth, and spread to other parts of the body, with eventual
loss of consciousness
and possibly convulsions

3 Simple Partial: the student may stare or stagger, or perform
purposeless movements and sound confused

First Aid for Seizures: Also see Seizure Report Flow Chart, Appendix B,
page 26

1 Help the students to lie down on his/her left side Do not restrain
If possible without restricting airway, place something soft under
his/her head
2 Clear area of sharp or dangerous objects Remove glasses Loosen
clothing around chest and neck
3 Do not put anything into mouth
4 Note type of movement and time seizure began and ended
5 Stay with student until he/she is alert
6 After a seizure, turn head to side to allow saliva to drain from mouth
Keep warm Do not leave student unsupervised until fully alert Allow
student to rest Do not give the student anything to eat or drink, until
fully recovered
7 Call office immediately Notify parents if any seizure occurs
8 Call 911 if:

Seizure lasts more than five 5 minutes

This is the first known seizure

Student shows signs of respiratory distress

Directed by Students Health Care Plan

If the student is slow to recover

Has a second seizure

Has
difficulty breathing afterward

9 In the case of a diabetic seizure, see the sections on treating a
diabetic reaction see pages 12-13, 24-25
10 Record the students behavior during the seizure on Seizure Report Flow
Chart, page 26
11 Often after rest, the student may return to class

Seizure Report Flow Chart

Childs name_____________________________ Grade____________________

Teacher__________________________________ DOB_____________________

Enter the date and time of seizure and your name or initials
Put x in appropriate boxes in the column

TICS AND TOURETTE SYNDROME GTS:

A tic is a rapid, involuntary recurrent nonrhythmic, stereotyped motor
movement or vocalization Any part of the body may be involved, face,
neck, hands or legs

Tourette Syndrome Gilles de la Tourette Syndrome, abbreviated GTS is an
inherited, neurological disorder characterized by involuntary body
movements and vocal sounds It may be accompanied by obsessions, attention
problems, and impulsivity Features of GTS are:
1 Multiple motor tics and one or more vocal tics These may appear
simultaneously or at different periods
2 Tics occur many times a day, nearly every day
3 Vocal tics may include clicks, grunts, yelps, barks, sniffs, snorts
and cough In 10 of cases complex sounds such as obscenities occur
4 The disorder may cause impairment in social functioning
Management:
1 Rewards and punishments are not helpful
2 Educate staff and peers to understand the disorder
3 Medications may be used when tics are interfering
with functioning

———————–

A Pull off the GRAY Safety Cap

B Place BLACK TIP on OUTER THIGH can be over the clothing

C Push HARD until you hear a click

D Hold in place for 10 seconds, then remove

Call 911

Student may feel heart pounding This is normal

Source:martin.amedd.army.mil