Asthma

1. Calcasieu Parish School BoardNursing Department2423 6th StreetLake Charles, LA 70601337-217-4260Asthma,Seizures,Diabetes,and Other Conditionsin the School Setting

2. Asthma

3. ASTHMA • If you suspect a student is having an asthma attack, send the child to the office with a buddy and notify the office that the student is coming. • Give student medication prescribed by the physician for school use ASAP. • Document the time medication was given. • Note the first signs of asthma may be mild. • Notify parent and school nurse if student needs asthma medication several times a week. • If medication does not relieve asthma symptoms and distress is noted, call 911 and parent. If 911 is called and the student is not transported, they do not charge for the visit. Remember, they have equipment that school personnel does not.

4. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 ASTHMA PROTOCOL Signs or Symptoms of Asthma • Onset may be sudden or gradual. • Respiratory difficulty, shortness of breath, cough, wheeze • Prolonged expiration • High-pitched whistling wheezes • Usually no fever present • Student breathes more easily sitting up • Symptoms may be aggravated by exercise Prevention • Avoidance of dust, molds, animals, pollen, or other allergens • Preventive treatment such as inhalers and other medication prescribed by physician Management (Acute Attack) • With shortness of breath, cough, tightness in chest, or any of the other signs and symptoms listed above, follow the student's treatment plan. • Remain with the student and reassure him. Allow him to choose the position which makes his breathing easiest. • If students does not respond promptly to his health care plan, call parent/ legal guardian. • If student's condition worsens in spite of treatment, and parent has not yet arrived, call 911. (For example, increased difficulty breathing, blueness of the lips or nailbeds, difficulty talking)

5. CALCASIEU PARISH SCHOOL BOARD NURSING DEPARTMENT 2423 6TH STREET LAKE CHARLES, LA 70601 PHONE: (337) 217-4260 FAX: (337) 217-4261 CHILD SPECIFIC EMERGENCY PLAN ASTHMA STUDENT: __________________________________SCHOOL: __________________________ IF AN EMERGENCY OCCURS: STAY WITH CHILD IMPLEMENT EMERGENCY PLAN ABOVE CALL 911, IF INDICATED NOTIFY PARENT(S)/LEGAL GUARDIAN(S) ______________________________________ ____________________________ Nurse’s Signature Date ______________________________________ Phone #

9. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 PROTOCOL FOR THE USE OF THE NEBULIZER IN THE SCHOOL SETTING • Determine the need: • visible problems with breathing, • wheezing, and • complaints of shortness of breath • Assemble the equipment and prescribed medication(s) near the student. • Wash your hands and have the student wash his hands. • Place the appropriate amount of medication(s) in the medicine cup of the nebulizer. • Have the student sit comfortable. The upright position promotes the greatest expansion of the lungs and diaphragm. • Attach the nebulizer hose to the air compressor and turn the machine on. A fine mist should be visible. (If possible, have the student turn the machine on. This will promote his independence.) • Let the student put the mask or mouthpiece in place if possible. • Remove the mask or mouthpiece if a cough occurs. Allow the student to clear his secretions completely. Give the student time to rest if needed and then continue the treatment. Turn the machine off when it is not being used. • Continue the procedure until all of the liquid has been nebulized. Note the amount of time needed for this procedure. • Have the student take several deep breaths, cough, and spit out the secretions after the treatment. (Dispose of tissues properly.) • Wash your hands and have the student wash his hands. • Document appropriately on the log. Record the following information: • Date and time • Signs and symptoms present before the treatment • Name and amounts of medications or solutions administered • Duration of the treatment • Description of secretions expectorated • Description of student's condition following the treatment CLEANING AND CARE OF THE NEBULIZER A thorough cleaning should be done at home. After each treatment: • Rinse the nebulizer medicine cup and the mouthpiece, or mask under hot running water. Shake off the excess water. • Place these parts on a clean cloth or towel to dry. Cover the nebulizer parts with cloth or towel. • When the parts are dry, store them in a clean plastic bag and close the bag.

10. Seizures

11. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 PROTOCOL FOR MANAGEMENT OF SEIZURES IN THE SCHOOL SETTING Absence or Petit Mal Seizures • For this type of seizure you need only to protect and observe the student. • Notify parent/legal guardian if there is a change in the seizure pattern. Generalized Tonic-Clonic Seizures (Grand Mal) • Remain calm. Begin timing the seizure. Remove furniture and other potentially harmful objects from the student's immediate environment. • Lay the student down and turn his head to one side to allow saliva or vomitus to drain from the mouth. Do not offer anything by mouth, such as fluids or medication. • You cannot stop the seizure; let it run its course. Do not try to restrain the student and do not stimulate by rubbing the chest, face or arms or by loosening clothing. • Do not force anything between the child's teeth, such as a tongue blade or finger. • If the motor activity lasts less than 5 minutes and there is no post-convulsive drowsiness, protect the student, observe him, and notify the parent/legal guardian. Student may stay at school. • If the motor activity lasts less than 5 minutes and post-convulsive drowsiness continues, protect the student, notify the parent/legal guardian to come and pick up the student. • If the motor activity lasts longer than 5 minutes, or if the student has multiple seizures that follow each other in rapid succession and the sequence lasts longer than a total of 10 minutes, call 911. • Log seizure on the proper form. (Send log with student if he is transported.) Complex Partial Seizures (Psychomotor or Temporal Lobe) • Do not attempt to stop the seizures or to restrain the student. • Remove furniture and other potentially harmful objects from the student's immediate environment and guide him away from potential hazards. • Use a calm, soft voice when talking to the student. • Re-orient the child to his surroundings following the episode and give him emotional support. • Notify the parent/legal guardian if there is a change in the seizure pattern.

12. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 CHILD SPECIFIC EMERGENCY PLAN SEIZURE DISORDER • IF ANY EMERGENCY OCCURS: STAY WITH CHILD. IMPLEMENT EMERGENCY PLAN ABOVE CALL 911, IF INDICATED NOTIFY PARENT(S)/LEGAL GUARDIAN(S) __________________________________ ________________________ Nurse’s Signature Date

19. Diabetes

20. DIABETES • If you know you have a student with diabetes, make yourself aware of the signs and symptoms of low and high blood sugar. Post them in an easily accessible and visible area. • If the student is exhibiting any signs and symptoms of low or high blood sugar, send them to the office with a buddy. • Document the time, what the symptoms were (exactly what the student told you), and how the student looked. • Every student will have different physician’s orders regarding their diabetic care. • Notify parent and school nurse of repeated signs and symptoms of low or high blood sugar.

21. DIABETIC EMERGENCY PLAN STUDENT: ___________________DOB: ___________ MEDICATION:__________UNITS plus SLIDING SCALE: IF READING IS - ______--- ADD 1 UNIT ______--- ADD 2UNITS ______--- ADD 3 UNITS _________ low range for hypoglycemia is less than _________. _________ high range for hyperglycemia is greater than ____. TIME: __________________________ Select ONE of the following to treat hypoglycemia: • 3 glucose tablets • ½ cup of fruit juice • ½ cup of regular soft drink • 1 carton of milk • 3 – 4 peppermints EMERGENCY PLAN: If ____________ becomes unconscious: • Rub the instaglucose gel on the gums inside the mouth. • CALL 911 • CALL PARENT/GUARDIAN

28. OTHER CONDITIONS

29. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 ANAPHYLACTIC REACTION PROTOCOL Definition Anaphylactic reaction is a rare, extremely serious form of allergy. Onset is rapid, may be sudden, and requires immediate action to prevent death. Students are known to be highly allergic to insect venom or other allergens should receive medication as soon as sting or exposure to allergen is reported. Causes Extreme sensitivity to one or more of the following: 1. Insect sting, usually a bee or wasp 2. Medication or immunization, usually by injection 3. Food or pollen 4. Industrial or office chemicals or their vapors Signs of Anaphylactic Reaction Coughing Swelling (especially face) Diarrhea Wheezing Flushing Faint feeling Shortness of breath Apprehension Faint pulse Hives, itching Rash (face or upper chest) Pallor, bluish color Management 1. Inject the EpiPen 2. Call 911 3. Call parent/legal guardian 4. Stay with child 5. Keep airway open 6. Elevate legs How to Use the EpiPen 1. Pull off the gray safety cap. 2. Place black tip on outer thigh at 90 degree angle. 3. Push EpiPen against thigh until unit activates; hold in place 10 seconds. (May be injected through clothing if necessary) 4. Discard unit properly. The EpiPen and emergency information will be kept in school's front office. The EpiPen requires a doctor's prescription, which must be renewed annually.

31. Calcasieu Parish School Board • Nursing Department • 2423 6th Street • Lake Charles, LA 70601 • Phone (337) 217-4260 Fax (337) 217-4261 • SIGNS AND SYMPTOMS OF CARDIAC INVOLVEMENT • 1. Change in activity tolerance • 2. Increased problems breathing • 3. Cyanosis (blue discoloration of lips, extremities, nailbeds) • 4. Chest pain or discomfort • 5. Irritability • 6. Malaise/lethargy • 7. Unusual tiring • Dizziness or fainting • With the presence of any of the above possible signs and/or symptoms of cardiac involvement, have the student lie down and stop all activity. Call the parent at once. Should the condition of the child worsen and the parent has not yet arrived, call 911.

32. Calcasieu Parish School Board Nursing Department 2423 6th St Lake Charles, La. 70601 Phone: (337) 217-4260 Fax: (337) 217-4261 SHUNT PRECAUTIONS IN THE SCHOOL SETTING THERE ARE STUDENTS IN THE SCHOOL SETTING WHO MAY HAVE A SHUNT IN PLACE FOR TREATMENT OF HYDROCEPHALUS. HYDROCEPHALUS IS A CONDITION WHICH OCCURS IF THERE IS AN OBSTRUCTION IN THE FLOW OF CEREBROSPINAL FLUID (CSF) OF THE BRAIN, OR IF THERE IS AN IMBALANCE IN THE PRODUCTION AND ABSORPTION OF THE CSF. CAUSES: TUMORS, INFECTIONS, (EXAMPLE – MENINGITIS), BRAIN HEMORRHAGE, AND TRAUMA TREATMENT: THERE ARE SEVERAL POSSIBLE TREATMENTS, WITH MOST CHILDREN REQUIRING PLACEMENT OF A SHUNT THAT PROVIDES DRAINAGE FROM THE VENTRICLES TO THE PERITONEUM OR THE ATRIUM. MAJOR COMPLICATIONS: INFECTION OR SHUNT MALFUNCTION ACTIVITY RESTRICTIONS: THESE NEED TO BE ESTABLISHED. CONTACT PARENT AND PHYSICIAN FOR NECESSARY RESTRICTIONS. GENERALLY ALL ACTIVITIES ARE ALLOWED WITH THE EXCEPTION OF CONTACT SPORTS. SIGNS OF INFECTION COULD INCLUDE: 1. REDNESS, PUFFINESS, OR TENDERNESS ALONG THE SHUNT TRACT 2. ELEVATED TEMPERATURE PLEASE OBSERVE FOR SIGNS OF INCREASED INTRACRANIAL PRESSURE. THESE CAN BE SIGNS OF A MALFUNCTIONING SHUNT AND WILL NEED IMMEDIATE ATTENTION! SIGNS OF INCREASED INTRACRANIAL PRESSURE COULD INCLUDE: • VOMITING, LETHARGY, IRRITABLITY • HEADACHES • SEIZURES • REDNESS OR SWELLING ALONG THE SHUNT TRACT • DECREASED SCHOOL PERFORMANCE • LACK OF COORDINATION

38. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA. 70601 (337) 217-4260 CHOKING PRECAUTIONS Definition of Choking: Inability to breathe due to choking on a solid object, inhaling toxic fumes, drowning or strangulation Physical Findings: • Student is conscious and making attempts to breathe. • Complete or near-complete inability to speak. • Grasping of neck, usually with both hands, palms toward neck. • Rapid onset of cyanosis (blueness of lips and finger tips), cessation of breathing efforts, and loss of consciousness. Management: If a student is unable to cough, speak, or breathe or has much difficulty breathing: • Have another person call 911 and notify parent/guardian. • If a solid object in the throat is suspected, administer choking rescue. (Give a combination of 5 back blows and 5 abdominal thrusts.) Remember: Never give back blows and abdominal thrusts to a person who is not choking! • Continue until- • the object is forced out. • the person can breathe, speak, or cough forcefully. • the person becomes unconscious. • If no pulse, begin modified CPR: mouth-to-mouth resuscitation and chest compression. If student is able to cough or breathe: • No immediate intervention is necessary, continue to observe only. • If student’s own efforts cease, proceed to above steps. Follow Up: (depends on cause and severity) • Notify parent/guardian of choking episode. • Frequent observation throughout that day. • If child continues to cough the next day, suspect retained bronchial foreign body, bronchitis or pneumonia, and notify Parent. • Education: Common causes of choking in children include- • trying to swallow large pieces of poorly chewed food (make sure food is cut up appropriately) • eating while talking excitedly or laughing, or eating too fast • round, smooth objects (such as balloons, pebbles, coins, beads, and toy parts) and foods (such as grapes, wieners, popcorn, and nuts) are common causes of choking in children. • walking, playing, or running with food or objects in the mouth • proper supervision is necessary to maintain safety during snack and mealtimes *Adapted from National Safety Council, Clinical Guidelines for School Nurses, and American Red Cross

39. Please Read: Preventing young children from choking on food Foods identified as choking hazards… • Seeds (for example, sunflower or watermelon) • Nuts • Popcorn • Hot dogs • Chunks of peanut butter • Raw vegetables • Raisins • Whole grapes • Chunks of meat or cheese • Hard or sticky candy • Chewing gum • Fruit chunks, such as apple chunks Prepare food for young children in ways that reduce their risk of choking. Some examples include: • Fruit with skins or pits, such as apples or apricots. Remove pits and peel fruits before giving them to your child. Fruits can also be diced or cooked and mashed. • Fish or chicken with bones. Carefully cut the meat off the bone and then into small pieces. Check meat thoroughly for any signs of bones. • Peanut butter. A spoonful of peanut butter can block the windpipe. Peanut butter can also stick to the lining of the throat and windpipe, making a child unable to breathe. Only allow peanut butter that is spread thinly on a slice of bread or a cracker. • Hot dogs, sausage, and small sausages (such as Vienna sausages). Slice and dice these meats. You may want to remove the skin before cutting them. • Grapes. Peel and mash grapes before serving. • Beans (green, string, lima, kidney, and others the size of a marble or larger). Mash before serving. • Peas. Although peas are small individually, a child who eats more than one pea at a time may choke. • Whole carrots. A child may break off too big of a bite and choke. Cook carrots and cut them into smaller pieces or cut raw carrots into thin slices.

40. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 PANIC ATTACK PROTOCOL Signs or Symptoms of a Panic Attack • Intense fear • Racing or pounding heartbeat • Shortness of breath or a feeling of being smothered • Nausea • Sweating or chills • Sense of numbness or tingling in the hands • Fear of dying, losing control, or losing your mind • A panic attack may last minutes to hours Prevention • Panic attacks are unexpected and unpredictable, and frequently develop without warning. • There is some tendency for panic attacks to start during periods of high stress of shortly following a major life transition. • Preventive medication prescribed by the student’s physician. Management (Acute Attack) • Stay calm. If the student sees you panic, it could potentially cause the situation to escalate. • If the student is experiencing shortness of breath or hyperventilating, remind them to take slow, even breaths by inhaling through their nose and exhaling by blowing out of their mouth. • If the student is experiencing sweating, help them to a place where they can be cooler. Place a cold, wet towel on the back to the student’s neck. Have the student remove any jackets, if necessary. • It is probably safest for you not to try to restrain the student or stop them from leaving the classroom. Have an agreed upon place (the school nurse’s office) where the student can go if he/she is having a panic attack. • As a safety precaution, send the student with a “buddy” to the school nurse’s office. • If the student continues to experience symptoms and is unable to regain composure, call parent/ legal guardian.

41. If the student’s condition worsens in spite of treatment, and a parent has not yet arrived, call 911. (For example: increased difficulty breathing, loss of consciousness, irrational or hysterical behavior.) • Accommodations • The most important thing you, as the teacher, can do is create an emotionally safe and supportive environment for the student. • Reassure the student that you understand their condition and that you will work with them to give them accommodations and to make class as non-anxious for them as possible. • When the student is not having a panic attack, speak with the student and decide where the student feels safest sitting and how they can quietly leave the classroom if they are feeling panicky or highly anxious. • Consider giving the student a “permanent pass” so that they can just quickly leave the classroom without having to interrupt your lesson or ask for permission. • If the student needs to leave class due to a panic attack, provide hard copies of any missed notes or assignments. • Consider breaks during tests or testing in a quieter location. • Impact of a Panic Attack • In school, anxiety of having a panic attack may significantly affect the student’s ability to concentrate in class. While you are trying to talk about your lesson or teach new skills, the student is feeling their heart racing and pounding, and may be afraid that they are about to die or have a heart attack and won’t be able to get help. • Panic attacks and anxiety about having a panic attack can also interfere with concentration during tests, and both may contribute to fatigue and poor stamina. • Other students may not fully understand the involuntary nature of a panic attack because it’s so irrational and they may respond critically to a student who may be in a state of near-hysteria.

43. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 PROTOCOL FOR MANAGEMENT OF CYSTIC FIBROSIS IN THE SCHOOL SETTING Definition Cystic Fibrosis is an inherited autosomal recessive disorder that affects endocrine glands of the body. The mucous-producing glands fail to produce normal free-flowing fluid. Instead, they produce thick, sticky mucous that interferes with proper functioning of body organs. Organs affected 1. Lungs – mucous obstructs airways and impairs normal respiration and cleansing and clearing of dust and pathogens, thus causing repeated respiratory infections and chronic lung disease. 2. Pancreas – Mucous blocks passageways carrying enzymes into intestines. Proteins and fats cannot be properly digested and mal-absorption can result in poor weight gain and growth. This mal-absorption may also cause frequent large, foul-smelling fatty stools, abdominal pain and discomfort, and excessive gas. • Sweat glands – More than normal amount of salt is lost in the perspiration. This may cause heat exhaustion and dehydration, especially during strenuous exercise, hot weather, or fevers. Management 1. Seek assistance for symptoms of airway blockage (Call parent/legal guardian.) • Frequent or lingering cough • Excessive sputum production • Wheezing • Difficulty breathing • Difficulty exercising • Repeated lung infections 2. Seek assistance for flare-ups or worsening of lung problems. (Call parent/legal guardian.) • Increase in cough or wheeze • Increase in sputum production • Decrease in exercise tolerance • Increase in fatigue • Fever • Poor appetite or weight loss 3. Seek assistance for symptoms of salt depletion (fatigue, weakness, fever, muscle cramps, abdominal pain, vomiting, and dehydration). (Call the parent/legal guardian.) 4. Student may need various modifications during the school day. • He/she needs to be allowed to cough as needed. He/she may need to go into hall to cough. • He/she may need tissues with proper disposal in a double-bagged waste can. • He/she will need pancreatic enzymes for meals and snacks. • Snacks may be eaten in classroom or in hallways between classes. • Student will need to be allowed to go to the water fountain anytime. • He/she may need juice or soft drinks with lunch because of milk intolerance. • Student will need to be allowed bathroom privileges as needed. He/she will need an easy access bathroom with privacy. • Student must avoid unnecessary exposure to persons with communicable diseases, especially influenza or other respiratory problems.

44. Calcasieu Parish School Board Nursing Department 2423 6th Street Lake Charles, LA 70601 Phone (337) 217-4260 Fax (337) 217-4261 PROTOCOL FOR THE MANAGEMENT OF HEMOPHILIA IN THE SCHOOL SETTING Management • Minor injuries, small cuts, abrasions, and nosebleeds are usually not serious, but must be observed to determine if the bleeding has stopped. • Internal bleeding into joints, muscles, abdomen, head, neck, eye, lower back, and groin require immediate medical attention. Some signs of internal bleeding may include, but are not limited to, the following: • Muscles and joints—tingling sensation, pain, warm and tender to touch, swelling, stiffness or limitation of motion, numbness or loss of sensation in limb • Intracranial (within the head)—headache, dizziness, visual disturbances • Subcutaneous (below the skin)—large, purplish areas firmer than the surrounding skin What to Do • Treat all bleeding episodes as promptly and adequately as possible. • Use Universal Precautions and give proper first aid for bleeding. First Aid for External Bleeding • For skin lacerations or abrasions, apply firm, direct pressure with your gloved finger or hand. A pressure dressing may also be used. Do not remove the dressing once it is applied but reinforce it as necessary. • Apply ice pack. This relieves pain and limits the amount of bleeding. • Notify parent or emergency contact. • Notify physician if parent or emergency contact is not available. • Notify the principal and document appropriately. First Aid for Possible Internal Bleeding • Direct someone to call parent or emergency contact. Call 911. • Have the student lie down quietly. Elevate the lower extremities about 12 inches. Keep him warm and remain with him until help arrives. • Notify the principal and document appropriately.

45. Calcasieu Parish School Board • Nursing Department • 2423 6th Street • Lake Charles, LA 70601 • Phone (337) 217-4260 Fax (337) 217-4261 • VON WILLEBRAND’S PROTOCOL • VON WILLEBRAND’S IS A MILD HEREDITARY BLEEDING DISORDER THAT IS NOT CONTAGIOUS. • PHYSICAL CHARACTERISTICS • 1. MINOR CUTS, BRUISES, ABRASIONS ARE NOT SERIOUS PROBLEMS. THEY • BLEED LONGER, NOT FASTER. • 2. INTERNAL BLEEDING MAY OCCUR ANYWHERE IN THE BODY AND CAN • BE A SERIOUS PROBLEM. • MUSCLES AND JOINTS; TINGLING SENSATION, PAIN, WARMTH, • TENDERNESS, LIMITED MOVEMENT. • ABDOMINAL: PAIN, TENDERNESS, NAUSEA. • INTRACRANIAL (WITHIN THE HEAD); HEADACHE, DIZZINESS, VISUAL DISTURBANCES, SIGNS OF A STROKE, (MOUTH DROOPS, CAN’T MOVE LIMBS, ETC.) • SKIN: BRUISING OR BLOOD BLISTERS. • 3. PROLONGED BLEEDING IS LIKELY TO OCCUR AFTER DENTAL • EXTRACTION. • 4. IN SEVERE CASES, FREQUENT JOINT BLEEDING MAY LEAD TO • CRIPPLING. • MANAGEMENT • 1. STUDENT MAY BE RECEIVING SPECIAL BLOOD PRODUCTS. • 2. FIRM PRESSURE FOR TEN MINUTES OVER SKIN LACERATIONS OR ABRASIONS. • ICE PACK MAY HELP. • 3. NO ASPIRIN. (PROLONGS BLEEDING TIME) • 4. CAREFULLY OBSERVE STUDENT FOR POSSIBLE INTERNAL BLEEDING • FOLLOWING MINOR TRAUMA. • FOLLOW DOCTOR’S ORDERS FOR ANY SPORTS PARTICIPATION. • FOLLOW-UP • 1. MAY NEED TO ALLOW FOR FREQUENT ABSENCES FOR DOCTOR • APPOINTMENTS. • 2. OBSERVE FOR SIGNS OF EARLY BLEEDING. MANY CHILDREN DO NOT • REPORT EARLY BLEEDING.

46. EMERGENCY PLAN WITH ANY BLEEDING, GIVE PROPER 1ST AID FOR BLEEDING USING UNIVERSAL PRECAUTIONS. • EXTERNAL BLEEDING – APPLY DIRECT PRESSURE WITH YOUR GLOVED HAND OR A PRESSURE DRESSING. DO NOT REMOVE THE DRESSING ONCE IT IS APPLIED. FOR A NOSE BLEED, HAVE THE CHILD SIT QUIETLY WITH THE HEAD TILTED FORWARD, PINCH THE NOSTRILS TIGHTLY FOR 10 MINUTES THEN GENTLY CHECK TO SEE WHETHER THE BLEEDING HAS STOPPED. APPLY ICE IN A CLOTH OVER THE NOSE IF NEEDED. 2. SUSPECTED INTERNAL BLEEDING – CALL PARENT/LEGAL GUARDIAN, AND THEN 911. HAVE THE CHILD LIE DOWN AND REMAIN QUIET. ELEVATE THE LOWER EXTREMITIES ABOUT 12 INCHES, KEEP THE CHILD WARM, AND REMAIN WITH HIM UNTIL HELP ARRIVES. IMPORTANT CALL PARENT/LEGAL GUARDIAN WITH ANY BLEEDING YOU ARE CONCERNED ABOUT. IF YOU CANNOT GET PARENT/LEGAL GUARDIAN OR THE EMERGENCY CONTACT, CALL 911.

48. Most Common Ways You Can be Exposed to Pathogens in School Settings • Contact – Skin to Skin • Diseases like staph, and scabies • Airborne – Particles in the Air • Diseases like chicken pox, and measles • Droplets – Sneezing, Coughing, Etc • Disease like influenza, and common cold

49. How to prevent the spread of diseases to myself and others • Wear protective barriers • Use Gloves • Dispose of contaminated material immediately • Use approved sharps containers for needles, etc. • Double bag bloody clothes, napkins, etc • Disinfect surface areas • Use approved disinfectants to clean surface areas daily and when needed • Wash your hands • # 1 way to prevent the spread of disease and illness

50. Proper Steps of Hand Washing for You and Your Students • Wet your hands with clean, running water (warm or cold) and apply soap. • Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails. • Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice. • Rinse your hands well under running water. • Dry your hands using a clean towel or air dry them • Turn off the faucet using your paper towel