1. Integrating Health Care and Educational Programs Chapter 9

2. Introduction Students with severe and multiple disabilities often have medical conditions and special health care needs. Medical conditions – Asthma – Pressure sores – Skin irritation – Dehydration – Anemia – Respiratory infections Health care needs – Feeding tubes – Catheters – Colostomy care – Tracheotomy suctioning

3. Introduction It is important for teachers to understand these needs in order to:  understand how the illnesses can affect performance  know what to do if an emergency occurs  monitor and intervene early.  adapt appropriately

4. Maintain a Safe, Healthy Environment for all Students Injury Prevention A. Keeping aisles clear (fall/trip hazard) B. Avoid animals in classroom (asthma) C. Avoid flashing lights (seizure disorders)

5. Follow universal precautions to prevent the spread of infection A. Hand Washing Teach students how and when to wash hands B. Use personal protective equipment (PPE) Masks and gloves C. Follow proper decontamination procedures D. Use personal hygiene precautions E. Dispose of bodily fluids properly

6. Evacuation Plans A. From Classroom B. Other areas C. Practice, practice, practice Basic first aid, CPR

7. Common Medical Conditions Nutritional deficits and anemia  Causes : anything that will affect receipt or absorption of nutrients  Treatment and Prevention : early detection, balanced meals, foods prepared for ease of chewing and swallowing.

8. Dehydration  Causes : insufficient fluid intake; diarrhea, vomiting  Treatment and Prevention : Do the skin check Regular fluid intake

9. Skin Irritation  Causes : prolonged contact with sweat, urine, feces  Treatment and Prevention : Thorough skin cleaning

10. Pressure Sores  Causes : continuous pressure on bony areas from lack of movement Concerns: what we see is small compared to the amount of damage below the surface!

11. Pressure Sores  Treatment and Prevention : Shift weight every 10-15 minutes Do not allow students to sit in wheelchair > 2 hours Good skin care Regular inspections

12. Ear Infections  Signs – rubbing ears, hearing loss, ear ache, banging head Contractures  Shortening of muscle fibers resulting from limited movement.  Causes a decrease in range of motion  Prevention : PT/OT; range of motion exercises, bracing equipment, activity!

13. Respiratory Infections  Causes – build up of mucus in lungs due to weak coughs, poor drainage  Treatment and Prevention :  Aerosol therapy  Postural draining  Percussion  Suctioning  Regular exercise  Infection control: cover cough; send sick students home

14. Common Medications Reference Table 9.1 in text – page 391.  Provides common drugs, uses and side effects.  Be familiar with what your students take!

15. Guidelines:  Have permission  Original bottles  Check expiration dates  Store correctly and safely

16. Administering Medications: Have a policy in place for:  WHO can administer  HOW training will occur  Preventing medication errors 1. Right Drug 2. Right Student 3. Right Dose 4. Right Route 5. Right Time Know possible side effects and what to do!

17.  Teach students the how, when and why about their medication.

18. Common Health Care Procedures Schools are mandated to provide services. WHO provides the service in the school is directed by the individual state’s  Nurse Practice Act, Regulations, school policies, team decisions.

19. Training  If unlicensed (non-RN) are to perform the procedures, appropriate training must occur with periodic monitoring/ supervision.  More than one individual trained!

20. Common Procedures:  Tube Feeding (button or NG tube)  Clean Intermittent Catheterization

21. Individualized Health Care Plan:  Provides detailed information on the student’s medical condition, and specific way in which it will be addressed.  ONE plan per procedure.  When appropriate, include objectives for the student to become responsible for their own self care.  Include both an instructional plan and task analysis.

22. Impact of Disabilities on Health and School Performance  Motor and sensory limitations  Restricted communication  Fatigue and endurance limitations  General health issues  Experiential deficits  Neurocognitive impairments  Psychosocial and environmental factors

23. WORKING AS A TEAM  To manage effectively, school, home an medical personnel must work closely together.  COMMUNICATION!