Southern Seven Head Start/Early Head Start Plan of Action Forms

Transcription

1 Southern Seven Head Start/Early Head Start Plan of Action Forms Grantee and delegate agencies operating center-based programs must establish and implement policies and procedures to respond to medical and dental health emergencies with which all staff are familiar and trained. Compiled By the Health & Nutrition Specialist Last Updated: July, 2015

2 Table of Contents Plan of Action: Asthma/Breathing Difficulties... 3 Plan of Action: Allergy... 8 Plan of Action: Diabetes Hyperglycemia: Hypoglycemia: Plan of Action: Seizures Other Health Conditions: Works Cited

3 Plan of Action: Asthma/Breathing Difficulties Asthma is a chronic inflammatory disease of the respiratory system that causes the airways of the lungs to swell, tighten and constrict. During an asthma episode three things can happen: Swelling of the airways (inflammation) Squeezing: the air passages are squeezed together by the muscles that surround the outside of each airway (constriction) Clogging: the mucus blocks the airways and thus allows less air to pass through the airways This combination of swelling, squeezing, and clogging dramatically reduces the size of the airways. Quick Facts Asthma is one of the most common chronic diseases nationwide, impacting the lives and families of over 7 million children. Asthma is the third-ranking cause of hospitalization among children under 15. An average of one out of every 10 school-aged children has asthma million school days are missed each year due to asthma. Checklist Have parent/guardian fill out and sign Southern Seven Head Start/Early Head Start Asthma Plan of Action Form Have parent/guardian fill out NHLBI Asthma Action Plan If medication may be needed have parent fill out Parent/Guardian s Request for Medication Administration Form If asthma attack occurs follow procedure outlined in your site s Emergency/Medical Management Plan Afterwards, complete Symptom Record Form, send a copy to the Health & Nutrition Specialist, and file the original at your center 3

4 Southern Seven Head Start/Early Head Start ASTHMA PLAN OF ACTION FORM Child s Name: Site: 1) What things/triggers may bring on this child s asthma? 2) Asthma SYMPTOMS may include: Coughing; Shortness of Breath; & Wheezing. Pollens Dust Animals Animals Exercise Foods Illness Other: Please list any other symptoms specific for this child: 3) Will there be Asthma Medications kept AT SCHOOL? Yes No Order will be for current school year unless otherwise indicated. Medicine: Albuterol (Ventolin, Proventil, ProAir); Xopenex; Maxair (circle one) Directions: Plan of Action: 2 puffs every 4-6 hours as needed. Nebulizer every 4-6 hours as needed. puffs every hours as needed. Other Medication: Instructions: 2 puffs minutes prior to exercise. Parent/Guardian Signature: Date: 4

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7 Asthma/Breathing Difficulties Management Plan STAY CALM: Don t Panic. Getting upset only makes things worse. Remove child from area of trigger and have child sit upright. Encourage use of deep breathing and relaxation exercises to avoid panic. Designate 2 individuals to care for child in a private area. Never leave the child alone. Check Peak Flow Rate: Take a peak flow reading and compare the rate to the asthma zones on the Asthma Action Plan. Use the Asthma Action Plan. Take medicines as directed: Take quick-relief medicine if breathing is labored or if a peak flow monitor is not used. No medication is to be given unless the child has a PRN inhaler or nebulizer. Child should respond to treatment within minutes. Recheck with peak flow meter if possible. If NO change is observed or breathing becomes significantly worse, call for emergency help and contact parent immediately. Make sure someone reassures the children that were present when the attack began and incorporate the experience into a health lesson. Seek Immediate Emergency Care If:! Coughs constantly! Is unable to speak in complete sentences without taking a breath! Has lips, nails, mucous membranes that are gray or blue! Demonstrates severe retractions and/or nasal flaring! Is vomiting persistently! Has pulse of greater than 120 per minute! Has respirations of greater than 30 per minute! Is severely restless! Shows no improvements after 15 minutes 7

8 Plan of Action: Allergy The job of the body s immune system is to identify and destroy germs (such as bacteria or viruses) that make you sick. A food allergy results when the immune system mistakenly targets a harmless food protein an allergen as a threat and attacks it. Although nearly any food is capable of causing an allergic reaction, only eight foods account for 90 percent of all food-allergic reactions in the United States. These foods are: Peanut Milk Wheat Fish Tree nuts Egg Soy Shellfish Symptoms typically appear within minutes to several hours after eating the food to which you are allergic. Keep in mind that children may communicate their symptoms in a different manner than adults. Mild symptoms may include one or more of the following: Hives (reddish, swollen, itchy areas on the skin) Eczema (a persistent dry, itchy rash) Redness of the skin or around the eyes Itchy mouth or ear canal Nausea or vomiting Diarrhea Stomach pain Nasal congestion or a runny nose Sneezing Slight, dry cough Odd taste in mouth Uterine contractions Severe symptoms may include one or more of the following: Obstructive swelling of the lips, tongue, and/or throat Drop in blood pressure (feeling faint, confused, weak, passing Trouble swallowing out) Shortness of breath or wheezing Loss of consciousness Turning blue Chest pain A weak or thread pulse Sense of impending doom 8

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10 Anaphylaxis Anaphylaxis is an extreme and severe allergic reaction. The whole body is affected, often within minutes of exposure to the substance which causes the allergic reaction (allergen) but sometimes after hours. During anaphylaxis, allergic symptoms can affect several areas of the body and may threaten breathing and blood circulation. Food allergy is the most common cause of anaphylaxis, although several other allergens insect stings, medications, or latex are other potential triggers. Epinephrine (adrenaline) is a medication that can reverse the severe symptoms of anaphylaxis. It is given as a shot and is available as a self-injector, also known as an epinephrine auto-injector, that can be carried and used if needed. Epinephrine is a highly effective medication, but it must be administered promptly during anaphylaxis to be most effective. Delays can result in death in as little as 30 minutes. Even if epinephrine is administered promptly and symptoms seem to subside completely, the individual who was treated with epinephrine should always be taken to the emergency room for further evaluation and treatment. Quick Facts Food allergy is a serious medical condition affecting up to 15 million people in the United States, including 1 in 13 children. In the U.S., food allergy symptoms send someone to the emergency room every three minutes. People who have both asthma and a food allergy are at greater risk for anaphylaxis. Checklist Have parent/guardian fill out and sign Southern Seven Head Start/Early Head Start Allergy Plan of Action Form If anaphylaxis is a possibility, have parent/guardian fill out FARE Food Allergy & Anaphylaxis Emergency Care Plan If medication may be needed have parent fill out Parent/Guardian s Request for Medication Administration Form If an allergic reaction occurs follow procedure outlined in your site s Emergency/Medical Management Plan Afterwards, complete Symptom Record Form, send a copy to the Health & Nutrition Specialist, and file the original at your center 10

11 Southern Seven Head Start/Early Head Start ALLERGY PLAN OF ACTION FORM Child s Name: Site: 4) What things cause this child s allergic reaction? 5) Does the child have a Food Allergy? *Yes No *If Yes, food substitution form will need to be filled out & signed by a Doctor. 6) Symptoms of the allergic reaction for this child: Medications: Stinging Insects: Other: Please list any food allergies: Any food not to be served to the child? Please list alternative foods for the child: Is the child Lactose Intolerant? Yes No Itching/Burning of Lips, Mouth, Tongue or Throat Shortness of Breath Swelling of airway or localized swelling Other: Hives/Rash Wheezing 7) Is anaphylaxis a possibility? Yes No Unconsciousness 8) Medications AT SCHOOL? Yes No If yes, what medications? Epinephrine Antihistamine Other: 9) Does the child have asthma? Yes No Plan of Action: Nausea/ Vomiting/Stomach Cramps Coughing Dizziness Parent/Guardian Signature: Date: 11

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14 Allergic Reaction/Anaphylaxis Management Plan STAY CALM: Don t Panic. Getting upset only makes things worse. Follow Allergy Action Plan. Mild Symptoms: o Antihistamines may be given if ordered by a healthcare provider. No medication is to be given unless the child has a PRN on file. o Stay with child and alert emergency contacts. o Watch child closely for changes. If symptoms worsen, administer epinephrine immediately and call 911. Severe Symptoms: o Inject Epinephrine Immediately. o Call 911 Tell them the child is having anaphylaxis and may need more epinephrine when they arrive. o Consider giving additional medications following epinephrine if child has PRN for antihistamine or inhaler. o Lay child flat, raise legs and keep warm. If breathing is labored or they are vomiting, let them sit up or lie on their side. o IF SYMPTOMS DO NOT IMPROVE OR SYMPTOMS RETURN MORE DOSES OF EPINEPHRINE CAN BE GIVEN ABOUT 5 MINUTES OR MORE AFTER THE LAST DOSE. o Alert Emergency Contacts. o Transport to ER even is symptoms resolve. Make sure someone reassures the children that were present when the attack began and incorporate the experience into a health lesson. Severe Symptoms! Short of breath, wheezing, or repetitive cough! Pale, blue, faint, weak pulse, or dizzy! Throat is tight, horse, or has trouble breathing/swallowing! Mouth has significant swelling of the tongue and/or lips! Skin has many hives over body or widespread redness! Repetitive vomiting or severe diarrhea! Feeling something bad is about to happen, anxiety, and confusion! Or a combination of symptoms from different areas 14

15 Plan of Action: Diabetes Diabetes is a problem with the body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type I Diabetes: Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. Only 5% of people with diabetes have this form of the disease. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. At its core, proper type 1 diabetes management is composed of a handful of elements: blood glucose control and insulin management, exercise, nutrition and support. Medication: Type I Diabetes requires multiple daily injections with insulin pens or syringes or an insulin pump. Exercise: With type 1, it s very important to balance insulin doses with the food eaten and the activity performed. Sometimes people experience a drop in blood glucose during or after exercise, so it is very important to monitor blood glucose, take proper precautions, and be prepared to treat hypoglycemia (low blood glucose). Nutrition: How much and what type of carbohydrate foods are important for managing diabetes. The balance between how much insulin is in the body and the carbohydrate eaten makes a difference in blood glucose levels. Most diabetics have individual meal plans that need to be followed. Type II Diabetes: Type 2 diabetes is the most common form of diabetes. In Type 2 diabetes the body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time it isn t able to keep up and can t make enough insulin to keep blood glucose at normal levels. Management of Type 2 Diabetes includes healthy eating, regular exercise, blood glucose monitoring, and sometime medication. Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. 15

16 Quick Facts Type 1 diabetes can also be called insulin-dependent diabetes because people with type 1 must take insulin in order to live. With tight blood glucose control, a person with diabetes can avoid many of the shortand long-term complications associated with diabetes. Hyperglycemia: Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can't use insulin properly. The signs and symptoms include the following: High blood glucose Tired High levels of sugar in the urine Hunger Frequent Urination Headache Increased Thirst Ketones in Urine Dry Mouth *If symptoms persist they can lead to nausea, vomiting, stomach pain, and fruit smelling breath Hypoglycemia: Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. However, it is important talk with a child s parent/guardian about individual blood glucose targets, and what level is too low that specific child. Signs and Symptoms of Hypoglycemia (happen quickly): Shakiness Nervousness or anxiety Tingling or numbness in the lips Sweating, chills and clamminess or tongue Irritability or impatience Headaches Confusion, including delirium Weakness or fatigue Rapid/fast heartbeat Anger, stubbornness, or sadness Lightheadedness or dizziness Lack of coordination Hunger and nausea Nightmares or crying out during Sleepiness sleep Blurred/impaired vision Seizures Unconsciousness 16

17 Checklist Have parent/guardian fill out and sign Southern Seven Head Start/Early Head Start Diabetes Plan of Action Form, Hyperglycemia Plan of Action Form, and Hypoglycemia Plan of Action Form. Contact the Health & Nutrition Specialist to schedule a diabetes training for site staff If medication may be needed have parent fill out Parent/Guardian s Request for Medication Administration Form If hypoglycemia or hyperglycemia occurs follow procedure in plans Afterwards, complete Symptom Record Form, send a copy to the Health & Nutrition Specialist, and file the original at your center 17

18 Southern Seven Head Start/Early Head Start DIABETES PLAN OF ACTION FORM Child s Name: Site: 10) Diagnosis: 11) When should blood sugar monitoring be done? 12) Diet Requirements: Plan of Action: Type I Diabetes Type II Diabetes Pre-Diabetes Other Condition Requiring Glucose Monitoring: As needed for signs/symptoms of low or high blood sugar Before Feeding As needed for Other: signs/symptoms of illness No Concentrated Sweet Diet Carbohydrate Count: carbs/meal Other: Does the child require a SCHEDULED snack at any time during the school day? Yes No If yes, do they need insulin with the snack? Yes No How many units of insulin? Parent/Guardian Signature: Date: 18

19 Southern Seven Head Start/Early Head Start HYPERGYLCEMIA (HIGH BLOOD SUGAR) PLAN OF ACTION FORM Child s Name: Site: Signs & Symptoms: dry mouth; increased urination; tired; thirsty; sores or infections that will not heal; hungry; sleepy; dry, itchy skin; headache *If symptoms persist, they can lead to nausea, vomiting, stomach pain, fruity smelling breath High Blood Sugar for this Child Requiring the Following Interventions is Greater Than: (Fill in the number) Encourage extra liquids without sugar such as water. No extra juice or milk. Allow frequent trips to the restroom. Interventions: Ketone monitoring: (If child is positive for ketones, MUST notify parent/guardian) Other: Plan of Action: Parent/Guardian Signature: Date: 19

20 Southern Seven Head Start/Early Head Start HYPOGYLCEMIA (LOW BLOOD SUGAR) PLAN OF ACTION FORM Child s Name: Site: Signs & Symptoms: dizzy; crying; headache; clammy sweat; nervous; unable to think clearly; shaky; blurry vision; restless; weak; combative; unusually sleepy; pale; pounding heart; confused or disoriented; stumbling around; change in personality (mean/hateful) Low Blood Sugar for this Child Requiring the Following Interventions is Lower Than: (Fill in the number) Follow 15/15 rule: Give equivalent of 15 grams of carbohydrates. If no improvement within 15 minutes, then repeat simple sugar. Follow immediately with a 15 gram snack of complex carbohydrate OR lunch. Interventions: Staff should check blood sugar 30 minutes after initial treatment. Call parent if the blood sugar does not rise above mg/dl. Allow minutes for complete recovery before resuming normal school activities. It may not be necessary to send the student home. Other: Plan of Action: Parent/Guardian Signature: Date: 20

21 Hyperglycemia Management Plan STAY CALM: Don t Panic. Getting upset only makes things worse. Follow Hyperglycemia Treatment steps listed in child s action plan If child uses a pump, check to see if pump is connected properly and functioning. Give child plenty of water to drink. Allow extra trips to the restroom. Re-check glucose every 2 hours to determine if glucose is reaching normal level. Restrict physical activity. Notify parent/guardian immediately if ketones are present. Moderate Hypoglycemia Management Plan STAY CALM: Don t Panic. Getting upset only makes things worse. Provide simple sugar equal to grams of carbohydrates in child s action plan. Wait 15 minutes. Recheck blood glucose level. Repeat if blood glucose level is still low. Follow immediately with a 15 gram complex carbohydrate snack or next meal. Contact the student s parents/guardian. Severe Hypoglycemia Management Plan STAY CALM: Don t Panic. Getting upset only makes things worse. Position the student on his or her side. Do not attempt to give anything by mouth. Follow child s action plan. While treating, have another person call 911 (Emergency Medical Services). Contact the student s parents/guardian. Stay with the student until Emergency Medical Services arrive. Hypoglycemia Severe Symptoms! Inability to eat or drink! Unconscious! Unresponsive! Seizure activity or Convulsions 21

22 Plan of Action: Seizures Seizures are caused by abnormal electrical activity in the brain. Someone having a seizure might collapse, shake uncontrollably, or have another brief disturbance in brain function, often with a loss of or change in consciousness. Seizures can be frightening, but most last only a few minutes, stop on their own, and are not life threatening. Seizures that happen more than once or over and over might indicate the ongoing condition epilepsy. Some children under 5 years old have febrile seizures, which can develop during a medium or high fever usually above F (38 C). While terrifying to parents, these seizures are usually brief and rarely cause any serious or long-term problems. Quick Facts You can t swallow your tongue during a seizure. It's physically impossible. You should NEVER force something into the mouth of someone having a seizure. Epilepsy is NOT rare. There are more than twice as many people with epilepsy in the US as the number of people with cerebral palsy (500,000), muscular dystrophy (250,000), multiple sclerosis (350,000), and cystic fibrosis (30,000) combined. Checklist Have parent/guardian fill out and sign Southern Seven Head Start/Early Head Start Seizure Plan of Action Form If medication may be needed have parent fill out Parent/Guardian s Request for Medication Administration Form If seizure occurs follow procedure outlined in your site s Emergency/Medical Management Plan Afterwards, complete Symptom Record Form, send a copy to the Health & Nutrition Specialist, and file the original at your center 22

23 Southern Seven Head Start/Early Head Start SEIZURES PLAN OF ACTION FORM Child s Name: Site: 13) Type of seizure: 14) What does the seizure usually look like? 15) How long does it usually last? 16) Possible triggers that should be avoided: Grand Mal or Generalized Absence Myoclonic Tonic-Clonic Clonic Tonic Atonic Other: 17) Does the child need any special activity adaptation/protective equipment? Yes No If yes, explain: 18) Are medications needed to control the seizures? Yes No If yes, what medications? Dose? How often and for what signs? Plan of Action: Parent/Guardian Signature: Date: 23

24 Seizure Management Plan If Generalized Seizure Occurs: If falling, assist student to floor, turn to side. Loosen clothing at neck and waist; protect head from injury. Clear away furniture and other objects from area. Have another classroom adult direct students away from area. Time the seizure. Allow seizure to run its course; DO NOT restrain or insert anything into student s Do not try to stop purposeless behavior. During a general or grand mal seizure expect to see pale or bluish discoloration of the skin or lips. Expect to hear noisy breathing. If Smaller Seizure Occurs: (lip smacking, behavior outburst, staring, twitching of mouth/hands) Assist student to comfortable, sitting position. Time the seizure. Stay with student, speak gently, and help student get back on task following seizure. Seizure Is Considered An Emergency When:! A convulsive (tonic-clonic) seizure lasts longer than 5 minutes! There are repeated seizures without regaining consciousness! It s a first-time seizure! The child is injured or has diabetes! The child has breathing difficulties! The seizure is in water 24

25 Other Health Conditions: Checklist Have parent/guardian fill out and sign Southern Seven Head Start/Early Head Start Other Health Conditions Plan of Action Form If medication may be needed have parent fill out Parent/Guardian s Request for Medication Administration Form If an incidence occurs related to the specific condition(s) follow the Plan of Action. Afterwards, complete Symptom Record Form, send a copy to the Health & Nutrition Specialist, and file the original at your center 25

26 Southern Seven Head Start/Early Head Start OTHER HEALTH CONDITIONS PLAN OF ACTION FORM Child s Name: Site: Diagnosis: Latex Allergy? Precautions at School: Sickle Cell Anemia Seizures Cystic Fibrosis Long QT Syndrome Hemophilia Hypertension Ostomy Type: Spina Bifida Fainting Spells VP Shunt Other: Yes No Restrictions/Exclusion at School: Other Comments: Plan of Action: Parent/Guardian Signature: Date: 26

27 Southern Seven Head Start/Early Head Start PARENT/GUARDIAN S REQUEST FOR MEDICATION ADMINISTRATION All Medication Must Be In The Original Container! Child s Name: Center: Child s Home Address: Child s Phone Number: Emergency Phone #: Parent Information: Father s Name: Work Place: Work Phone #: Mother s Name: Work Place: Work Phone #: Physician Information: Physician s Name: Office Address: Physician s Phone #: Prescription Information: Pharmacy: Date: Prescription #: Diagnosis: Drug: Dosage: Frequency of Administration: Directions for Administration: Benefit of Medication: Possible Side Effects: I hereby request Head Start to administer the above medication to my child. I will hold and save the Head Start Program from and against any and all actions or cause of action, claims, demands, and liabilities, loss, damage, or expense of whatsoever kind and nature which the Head Start Program shall or may at any time sustain or incur by reason or in consequence of the administrating of the medication to my child. Parent/Legal Guardian s Signature: Date: Witness: Date: 27

28 Southern Seven Head Start/Early Head Start SYMPTOM RECORD Child s Name: MAIN SYMPTOM: When did it began? How much? Date: How long has it lasted? How often? Is it staying constant, getting better or worse? OTHER SYMPTOMS/COMPLAINTS: General appearance (ie. comfort, mood, behavior, activity level, appetite): CHECK () THE SYMPTOMS Breathing: coughing wheezing breathing fast difficulty breathing other: Skin: pale flushed rash sores swelling bruises itchiness other: Vomiting (number of times): Diarrhea (number of times): Urine: Eyes: pink/red watery discharge crusty swollen other: Nose: congested runny other: Ears: pulling at ears discharge other: Mouth: sores drooling difficulty swallowing other: Odors (ie. Breath, stool): Temperature: axillary oral rectal other: Comfort: WHAT HAS BEEN DONE Rest: Liquids Name: Amount: Time: Food Name: Amount: Time: Medications (see medication administration procedure) Name: Amount: Time: Emergency measures: Who was called and when (ie. parent/guardian, emergency contact person, health consultant, child s health provider, emergency medical services)? Signature: Date: 28

29 Works Cited American Diabetes Association. (2015). ADA. Retrieved from American Diabetes Assocation: American Lung Associate. (2015). Learning More About Asthma. Retrieved from American Lung Association: Fighting for Air: Food Allergy & Research Education. (2015). FARE. Retrieved from Food Allergy & Anaphylaxis Emergency Care Plan: Kid's Health. (2015). Seizure Basics. Retrieved from Kid's Health: National Heart, Lung, & Blood Institute. (2007). NIH. Retrieved from Asthma Action Plan: PPMD. (n.d.). Seizure Action Plan for Schools. Retrieved from Parent's Place of Maryland: 29