The symptoms of hypoglycemia vary from one individual to another. Also, they may vary for one individual, from one episode to another. The symptoms of mild hypoglycemia are the first alert that the body is in a state of sugar deficiency. Symptoms may include the following: Headache Shakiness Tremors Dizziness Extreme hunger Increased heart rate/palpitations Pallor Clammy skin Sweating Anxiety Changed personality Diluted pupils Lethargic Mild hypoglycemia can usually be treated easily and effectively. Most episodes of hypoglycemia that will occur in school setting are of the “mild” type. However, if not treated promptly a mild hypoglycemic reaction can quickly progress to a severe state or condition which may be characterized by: Yawning Irritability/frustration Behavior/personality changes Extreme tiredness/fatigue Sudden crying Confusion Restlessness Dazed Appearance Inability to swallow Unconsciousness/coma Seizures, convulsions, jerking movements Remember, onset and progression can happen very quickly. Each student will have his/her own set of symptoms that characterize hypoglycemia. These should be listed in the DMMP. The important thing to remember is that early recognition and intervention is the best strategy to prevent progression to more severe symptoms.
Asthma, epilepsy, diabetes and life threatening allergic reactions
Annual Employee Training:Asthma, Epilepsy, Diabetes andLife-Threatening AllergicReactions Requiring EmergencyAuto-injector Epinephrine Greenwich Township School District Cathy A. Tortella, RN, BA, CSN Jean Morrison, RN, BSN, CSN 1 09/05/12
Special Health Needs StudentsAt the beginning of this school year, your schoolnurse will be available to conference with you re:your students who have medical concerns.Many times those concerns are brought to lightonly upon review of the Annual Health UpdateForm completed by the parent/guardian that is senthome each September.Upon parent/guardian permission, those healthconcerns will be shared with the appropriate schoolstaff. 2 09/05/12
Purpose To comply with D.O.E. health services policy and procedural requirement 6A:16-2.1 To assist staff in the recognizing of medical emergencies as it relates to asthma, diabetes seizure disorder, and anaphylaxis. To obtain rapid medical response to the student who has a medical emergency. To remind staff of the location of: AED (Automated External Defibrillator)- lobby Epinephrine (Adult Dose) location: see indiv. students’ EHP (emergency health plan) 3 09/05/12
Agenda “Dealing With Asthma, Diabetes, and Epilepsy in Schools” “Anaphylaxis When Seconds Count…”Demonstration of the emergency epinephrine auto injector will be reviewed and are available for practice at the nurse’s office for all delegates. 4 09/05/12
ASTHMA Asthma is a disease that affects the lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma accounts for a high degree of absenteeism from school. Asthma can be triggered by allergens and irritants. Controlling exposure to these triggers can reduce asthma episodes. Respiratory allergens and irritants include animals with fur or feathers, mold, dust mites (for example, in carpets and upholstery), cockroaches, and strong odors or fumes from such products as pesticides, paint, perfumes, and cleaning chemicals. 5 09/05/12
ASTHMA continued… Students may carry and self-medicate with their personally prescribed emergency inhaler (aka “puffer”). These medications are usually Albuterol, Ventolin, and Proventil. A list of students with asthma will be available to you at the beginning and throughout this school year . Two puffs from an inhaler in four hours is a normal dose…if you see a student using their inhaler more frequently, please report it to the school nurse. If you see a student using 1-2 puffs from their inhalers prior to exercise it is not necessary for them to report to the school nurse. This is part of their individualized treatment plan to prevent an asthma episode. Most students report to the Health Office prior to physical activity to use their inhaler.COACHES: IF THE ATHLETE DOES NOT HAVE HIS/HER OWN INHALER THEY ARE NOT PERMITTED TO PRACTICE OR PLAY!!!! 6 09/05/12
Epilepsy (Seizure Disorder) Epilepsy is a neurological condition that from time to time produces brief disturbances in the normal electrical functions of the brain. Seizures are a symptom of epilepsy. Seizures are not painful and the person does not remember having one. There are many different types of seizures. People may experience just one type or more than one. Experts divide seizures into generalized seizures (absence, atonic, tonic- clonic, myoclonic), partial (simple and complex) seizures, nonepileptic seizures and status epilepticus. Students with seizure disorders are never allowed to work at heights, climb ladders, work with hazardous machinery and have special precautions regarding waterway activities (as there is a risk of drowning). 7 09/05/12
First Aid for Seizures Observe the type and time of the seizure. Position the student on his/her side to prevent blockage of the airway from tongue, saliva or vomit. Protect the student from getting hurt; remove harmful objects from the student’ pathway or gently coax away from them. Use a soft, calm voice when talking to the student. NEVER place anything in their mouth!! Protect the student from embarrassment. If the seizure lasts for 5 minutes or more, have the Administrative Office call 911. If the seizure is less than 5 minutes but the student appears to be having one right after another, call 911. If the student is a diabetic and having a seizure, call 911. 8 09/05/12
Diabetes Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Type 2 diabetes is the most common form of diabetes and either the body does not produce enough insulin or the cells ignore the insulin. The student who does not produce insulin needs to give themselves an insulin injection: either by drawing up a dose in a syringe, giving a prefilled insulin pen dose, or entering a dose given through an insulin pump (looks like a pager…so don’t take it away! They are not text messaging!) 9 09/05/12
Hypoglycemia:Possible Signs & Symptoms MILD SYMPTOMS Hunger Sleepiness Shakiness Changed behavior Weakness Sweating Paleness Anxiety Blurry vision Dilated pupils Increased heart rate/palpitations M ODE RAT T SE RE SYM T S E O VE P OM Yawning Confusion Irritability/frustration Restlessness Extreme tiredness/fatigue Dazed appearance Inability to swallow Unconsciousness/coma Sudden crying Seizures 10 09/05/12
What to do if your student shows symptoms ofhypoglycemia (low blood sugar): If symptoms of low blood sugar and conscious and able to swallow give: Glucose tablets: 3 to 4 OR Glucose gel 31mgm tube amount: 1/2 - 2/3 of tube : Must follow specific Doctor order for child! If not available give: cake icing (1 tsp = 4 grams) 4 - 5 tsp. OR Honey or maple syrup: 3 - 4 tsp. OR Orange or apple juice: 3/4 - 1 cup OR Table sugar 4- 5 tsp. OR Regular Soda 5-6 oz OR milk 8 - 10 oz OR Life savers: 5 - 7. OR Raisins 3 tablespoons Usually follow with a snack of ½ sandwich Student is to repeat finger stick blood sugar after 15 minutes of ingestion. 11 09/05/12
Ifstudent is unconscious or having a seizure 911 needs to be called immediately. The school nurse will administer glucagon intramuscularly, if ordered. Trainedstaff volunteer delegates can administer glucagon for severe life-threatening HYPO glycemia. Notify School Nurse. If nurse is not available notify Administrative Office. Consider calling 911. The student should show improvement within 15-20 minutes after treatment with glucose/sugar source. 12 09/05/12
Life-Threatening Allergic Reactions A person can have a severe allergic reaction resulting in death! Common allergens include, but are not limited to, bees/wasps, foods like peanuts, soy, tree nuts, milk, and items contains latex. – The student is to avoid the allergen! During celebrations know what your student is allergic to! Avoid latex balloons!SIGNS OF AN ALLERGIC REACTION INCLUDE: SYSTEMS: SYMPTOMS: MOUTH/FACE Itching, swelling of lips, tongue, or mouth. Swelling of face, area around eyes. THROAT Itching and/or a sense of tightness in the throat, hoarseness, hacking cough SKIN Hives, itchy rash, and/or swelling about the face or extremities, cold/clammy skin. GUT Nausea, abdominal cramps, vomiting, and/or diarrhea LUNG Shortness of breath, repetitive coughing, and/or wheezing HEART Thread like or weak pulse, passing outThe severity of symptoms can quickly change! 13 09/05/12
Treatment for life threatening allergy… ANAPHYLAXIS! DO NOT HESITATE TO HAVE THE STUDENT ADMINISTER THEIR OWN EPINEPHRINE AND NOTIFY SCHOOL NURSE OR ADMINISTRATIVE OFFICE TO CALL 911! Trained staff volunteer delegates can administer epinephrine via an auto-injector. See nurse for training specific to each student. We need volunteers especially for after-school programs, field trips, etc. Know where that student’s Epi-Pen is located. Pull off the gray safety cap, place black tip on outer thigh, push EPI-PEN against thigh until unit activates (you will hear/feel a click). Hold in place several seconds (count to 10). Massage injection area for 10 seconds. Discard unit in safe container until it can be placed in a sharps container. WAS 911 CALLED? ALWAYS CALL EVEN IF THE STUDENT IS BETTER! SEE Health Guidelines for students WITH SEVERE ALLERGIES AND FIRST AID GUIDELINES. COACHES: Ask the athlete to include spare Epinephrine in the First Aid kit: it 14 must go with the athlete to all practices and games. 09/05/12
Where to Get More InformationEpilepsy Foundationhttp://www.epilepsyfoundation.org/about/faq/index.cfmSchoolAsthmaAllergy.com http://www.schoolasthmaallergy.com/PADRE Foundation (teens with diabetes) http://www.padrefoundation.org/resources.htmlThe Food Allergy and Anaphylaxis Network http://www.foodallergy.org/downloads.htmlThe Pediatric/Adult Asthma Coalition of New Jersey http://www.pacnj.org 15 09/05/12
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