1. By: Dr. Sabrina Chimienti

2. Standard(Universal) Precautions: The need to take precautions/guidelines appropriate for preventing the spread of all infectious disease. The routine use of appropriate precautions by caregivers regardless of knowledge of germs present in the individual student’s blood, saliva, nasal discharges, vomitus, urine, or feces prevents the spread of disease and protects the caregiver. Handwashing: Is the single most affect tool that you can protect yourself, your co-workers, and your students. Purpose: To reduce the # of microorganisms found on the hands. Equipment: Liquid soup in dispenser, paper towels, hand lotion, cover waste receptacle with disposable plastic liner. Gloves: Are to be worn by staff members who administer first aid involving blood, open wounds, or handling of body fluids. Disposable gloves should be standard components of first aid supplies. Cleaning up spills: Call the school custodian to clean up any body fluid spills..

3. EMERGENCIES Front Office/Dispatch notified Front Office/Dispatch notifies Health Office If nurse or health assistant not available, trained personnel should proceed with emergency kit and AED to student Upon arrival assess situation and determine if the situation is serious or minor

4. EMERGENCIES If serious call 911,notify the front office/administrator and stabilize the student REMAIN CALM Do not move student depending on injury Remain with student until medics arrive

5. When do you call 911 911 must be called when a life-threatening situation occurs. Such emergenicies may include: 1. Absent or weak pulse: Apply AED Pads and follow AED voice prompt directions. 2. Absent or difficult breathing ( for example, prolonged asthma) 3. Profuse bleeding 4. Prolonged seizures of more then 5 minutes, or no history of known seizures 5. Severe injuries or illness. 6. When you believe 911 should be called. ( Quiz ? What do I mean by this statement?)

6. Steps to take in a 911 call: 1. After 911 is called, notify parent/guardian or designated emergency contact as stated on the emergency card. 2. School nurses and/or health assistant must be with the injured student at all times until the medical emergency team arrives. 3. Inform the school administrator and school nurse (if she is not there). 4. Be prepared to give a copy of the student’s emergency card to the emergency medical team (assign one of the staff on location to do this).

7. 5. The school administrator will assign or direct the emergency medical team to the location of the injured student. 6. If the injured student is transported to the hospital and the parent/guardian or designated school personnel is not available, the school administrator must accompany student.

8. Post Emergency Procedures 1. Documentation : Write an Incident report( form # D- 15 REV. 4/04 a. Sent a copy to Risk Management, keep a copy in the health office. All accident reports should be kept for 3 years. b. Do Not give a copy of the accident report to the Parent/Guardian 2. Replenish emergency kit 3. Debrief

9. Diabetes A chronic, lifelong health “condition” (which is what they prefer it be called rather than a disease) which impairs the body’s ability to use food properly to provide energy for cells. Insulin is necessary to transport sugar to the cells to be converted into energy.

10. “The Two Types of Diabetes commonly seen in schools” TYPE 1 -Usually lean child seen most often in 5-7 year olds and adolescence -Little or no family history -Usually very ill at diagnosis TYPE 2 -Usually seen in overweight child with highest incidence between 13-15 years -Strong family history -Often discovered while checking for something else.

11. SCHOOLS MUST: Must always have doctor’s orders! Always document blood sugars taken at school on school form! CALL YOUR NURSE WITH ANY QUESTIONS!

12. “Basic Nutrition Guidelines” Three Meals and 0-3 snacks daily depending on insulin regimen Include a protein with carbohydrate containing meals and snacks Fresh foods can be eaten anytime Avoid high sugar sweets

13. “Carbohydrates” Provides energy and helps raise blood sugar Bread/starch group Bread, cereal, starchy vegetables, rice Fruit Group Recommend whole fruits Use fruit juice only for low blood sugar Milk Group - Milk and Yogurt

14. Fast Acting Sugars Fruit juice Honey Glucose tablets

15. “Protein” Helps Stabilize Blood Sugar 1 oz Meat or Cheese 1 Egg 1 Tbsp. Peanut Butter ¼ cup Cottage Cheese or Tuna Tofu 1 oz Meat Alternative Cheese and crackers Peanut Butter and crackers What else has protein? Quiz question time?

16. Glucagon or GlucaGen Kit Storage Place: As designated in DMMP accessible to school personnel Store at room temperature Expiration date: Monitor After mixing, dispose of any unused portion within one hour

17. Emergency Kit Contains 1 mg of freeze-dried glucagon (Vial) 1 ml of water for reconstitution (Syringe) Combine immediately before use

18. What Is Glucagon? Naturally occurring hormone made in the pancreas A life-saving, injectable hormone, Glucagon/GlucaGen that raises blood glucose level by stimulating the liver to release stored glucose Treatment for severe hypoglycemia Life-saving, cannot harm a student – cannot overdose

19. PREPARATION 1. Flip cap off glass vial containing dry powder 2. Remove cap from syringe 3. Put on gloves if available

20. MIXING SOLUTION 4.Inject entire fluid in syringe into the bottle containing powder 5.Without taking the syringe with a needle out of the vial, gently shake the vial in your hand until the powder has completely dissolved, and the solution is clear.

21. DOSING AND DRAWING OUT 6.Inspect. Solution should be clear and colorless. 7.Draw prescribed amount of glucagon back into syringe.

22. INJECTING 8.Clean site if possible. 9.Inject at 90° into the tissue under cleansed area (may administer through clothing as necessary –buttocks –thigh –arm

23. Definition & Causes of Anaphylaxis

25. EpiPen ® 2-Pak Quiz ? Why in a two pack?

26. Directions for Use Pull off Gray Cap!

27. Step two

28. Immediately After Use Put in a sharps container. If you’re not near a sharps container, carefully put unit (needle first) back into the carrying tube (without the gray activation cap) and recap the carrying tube Note: most of the liquid (about 90%) stays in the auto-injector and cannot be reused. Call 911 (if not already done) Inform Parent Notify District Nurse You may need to use second Epi-pen if student is not responding to first injection. Keep person comfortable until first responders arrive on scene.

29. Epi-pen Questions? Practice Time!

30. Medication Administration Medication can be given 30 minutes before or after the time ordered.

31. Out of State Doctors Can you give a medication that is prescribed by an out of state doctor? NO

32. RN or LVN ONLY Medications What medications can ONLY be given by an RN or LVN? 1. Insulin 2. Diastat - Bill did not pass the Senate- unlicensed personnel can NOT give Diastat (rectal Valium)

33. When do you NOT give a medication? 1. Never accept out of state Drs. Orders 2. Never give Controlled Substances 3. Never give Expired Medications 4. Never give a pill if it comes out of a bottle where there are two colors of pills. 5. Never give medication if the Doctors orders don’t match the Bottle 6. Never give a medication if the medication form is not signed by both the parent and the MD.

34. Questions ?