Request training from the health care professional or school PHN on seizure disorder and what to do in the event of a seizure.
|Types of Seizures and Signs/Symptoms||Actions|
1. Generalized Seizures: involves whole brain
1. Because of altered state of awareness
2. Partial Seizures: involves part of brain and symptoms relate to the part of brain effected
2.a. There is no change in consciousness
2b. Complex Partial
2.b. Because of altered awareness
Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the brain. Hydrocephalus is sometimes called “water on the brain.” (The word “Hydrocephalus” in Greek literally means “watery head.”) This condition can arise before birth or at any age.
Hydrocephalus can be due to many causes including a birth defect, hemorrhage into the brain, infection, meningitis, tumor, or head injury. Most forms of hydrocephalus are the result of an obstructed flow of CSF into the ventricles or normal cavities in the center of the brain. Increased CSF in the brain can compress and damage the brain.
The key sign of hydrocephalus in infants is an abnormally large head. This occurs because of the constant outward pressure on the brain and skull from the CSF during the development and growth of the head. In older children, symptoms of hydrocephalus include headaches, nausea, vomiting, and blurred vision.
Contact the PHN assigned to your school for:
Some children may come to school with assistive medical devices/appliances that may require attention during the school hours. Many receive the skilled nursing services provided by a licensed nurse. Contact the PHN assigned to your school if you have questions or concerns.
Anyone can have a stoma (Greek word for opening). Stomas are created surgically by a procedure known as an ostomy. A stoma is not a disease, but is required because of a congenital or chronic health condition/disability, infection, or trauma. Individuals with a stoma are no different from anyone else, but have an alternative way of breathing, eating, or eliminating waste.
An incision is made through the neck into the windpipe (trachea) to allow breathing when the normal pathways are impaired. A tracheostomy tube is then inserted into the stoma (opening), which keeps the hole open. The tracheostomy bypasses a person’s nose and mouth and becomes his or her airway. People with a tracheostomy may not be able to communicate effectively with staff or family and may rely on the ability of others to read their lips or use other communication strategies such as writing or a letter board.
A tracheostomy becomes a person’s airway.
Periodic suctioning may be necessary to remove secretions that accumulate and to maintain the airway. Suctioning requires inserting a small catheter into the tracheostomy tube. To properly care for a child with a tracheostomy tube, a portable suction machine may be needed. The frequency and extent of care needed varies with each student. The physician, in collaboration with the school nurse and parents, should develop a procedural care plan and standing orders.
A nebulizer is a device used to humidify air or deliver medication in a mist form. When breathing through a tracheostomy, the air no longer passes through the nose where it normally would be warmed, filtered, and humidified. Because of this, most patients require a nebulizer that humidifies the air delivered to the trachea and lungs. A large volume nebulizer provides this humidification and is commonly used.
In some situations, a child with a tracheostomy is ventilator dependent.
When a child is physiologically stable and able to attend school, the IEP team needs to consider placement where nursing care is available on a regular basis.
(See page F-11 for Request for Individualized Procedures in School - Tracheostomy.)
When a child cannot be fed by mouth, an opening is made in the abdominal wall and a tube inserted directly into the stomach (gastrostomy). A qualified individual can give liquid or semiliquid foods directly through the gastrostomy. The amount of food, as prescribed by the physician, varies greatly and is based on age, weight, and physical condition. The doctor may also prescribe blenderized table food for the child. The child’s feeding, as at any mealtime, should be a social event where the child can join others during their regular meals.
Some students are fed with a tube inserted through the nose, which goes down the back of the throat, and into the stomach (a nasogastric tube). A tube that starts in the mouth is an orogastric tube. Nose and mouth tubes are changed by parents and healthcare professionals as prescribed by the physician to prevent irritating the lining of the nose and throat.
Some students may use a combination of oral and tube/gastrostomy feedings. Certain health professionals (i.e., occupational therapists, nutritionists, nurses, and speech pathologists) are trained to work with feeding problems and can be consulted (see dysphagia, pages 25-27).
Follow any specific directions you receive for positioning the student prior to and after feeding — usually the student’s head is at least at a 45-degree angle.
(See page F-9 for Request for Individualized Procedures in School - Gastrostomy and F-10 for Emergency Action Plan.)
For some children with inflammatory bowel diseases (i.e., ulcerative colitis, Crohn’s), cancer, congenital abnormalities, or trauma, an opening in the abdomen is required for the removal of waste products from the body. The three main types of abdominal ostomies are colostomy, ileostomy, and urostomy.
The bladder, which is the storage vessel for urine, is removed or bypassed. There are two kinds of urostomies:
Because an ostomy may be a permanent condition, the basic goal is to promote personal habits and techniques that keep the skin and stoma healthy.
As defined by the Maternal and Child Health Bureau (MCHB) of the U.S. Health Resources and Services Administration (HRSA): “Children with special health care needs are those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.”
One end of the spectrum of children with special health care needs: those with the most severe medical problems and most complex medical service needs.
Working definition used by Kapiolani Medical Center: “The child with (a) severe (potentially life-threatening) disability(ies) who has reached his or her state of well-being which is maintained only with continuing complex interventions that are medical/nursing and/or technologic in nature.”
Definition used by the Department of Human Services under Medicaid, for Early Periodic Screening, Diagnosis, Treatment (EPSDT) Medically Fragile Case Management Services:
Child, with complex medical problems AND WITHOUT technological devices, for whom care coordination service is essential to prevent re-hospitalization. Examples: child with
**A Task Force was formed in 2001 to establish a common definition of medically fragile. SCR No. 15, H.D. 1: Requesting the Creation of A Coordinating Committee to Oversee The Care of Medically Fragile Children. A Specialized or Individualized Physical Health Care Plan includes those physician prescribed services that must be provided by a nurse or qualified, trained person during the school day to assist the student to benefit from education or to attend school, i.e., gavage feeding, suctioning, catheterization.
A “qualified person” can be school personnel trained and delegated to provide the nursing services by the nurse or physician in the administration of the specialized physical health care procedure(s).
A plan of action which is developed by the nurse in collaboration with the parent, physician, and school staff for children who have a known life threatening condition. Training on intervention(s) by the responsible parties is provided, as appropriate, by the nurse or physician.
A disorder of language learning; the loss of the ability to express or understand language symbols (the spoken or written word) as a result of some central nervous system dysfunction. It can be expressive (or motor) in which the person can understand but cannot give back appropriate responses, receptive (or sensory) in which the person cannot understand language he/she hears or sees, or both.
A brain disorder characterized by loss of ability to manipulate and use common objects and execute planned movements.
The inability to coordinate the muscles in voluntary movement. Ataxic is often used to describe a staggering gait.
A condition in which slow, irregular, twisting, involuntary movements occur.
An “umbrella” term for a group of disorders resulting from central nervous system damage before, during, and after birth. Although non-progressive, these disorders may become more obvious as the infant grows older. Symptoms include paralysis, weakness, uncoordinated movement, and/or ataxia.
An interference with sound transmission in the outer part of the middle ear. Causes include wax accumulation and chronic ear infection.
Any mental or physical trait or condition that exists at birth because of something that happened to the fetus during the time it was in the womb; it may nor may not be hereditary.
An abnormality of the hip joint present from birth. It is the most common disorder that affects hip joints of children under the age of three. Congenital hip dislocation can cause abnormal joint development and permanent disability.
An inherited disease of infants, children, and young adults. It causes abnormal gland secretions that are carried throughout the body in the blood. The hallmark of this condition is severe, chronic lung disease in children which is characterized by increased mucus production and thickness. It is also associated with malnutrition and diseases of the liver.
A progressive disorder with muscle deterioration, usually beginning in childhood. The disease, mostly in males, is transmitted as a sex-linked recessive trait.
Paralysis of one side of the body. It is caused by a brain lesion involving the upper motor neurons which results in paralysis of the opposite side of the body.
Excessive muscle tone.
Less than normal muscle tone.
A protrusion of the membranes around the brain or spinal cord.
Any problem in the body that interferes with how food is built up or broken down in the body. Disorders are usually caused by an abnormality in enzyme production.
A chronic, progressive disease of the central nervous system characterized by a patchy loss of myelin (fatty sheath) in the brain and spinal cord. The cause is unknown but an immunologic abnormality is suspected.
Paralysis of the lower portion of the body and both legs due to a lesion or injury involving the spinal cord.
Indicates an ongoing disease process during which the symptoms get worse. Examples of such diseases include multiple sclerosis, myasthenia gravis, brain tumor, and other rare degenerative diseases affecting the central nervous system. In certain conditions, the earliest symptoms observed are subtle changes in the higher cognitive functions. If the motor area of the brain is involved, a change in writing or physical ability may be noticed.
Paralysis of all four extremities and, usually, the trunk. The cause is an injury to the spinal cord in the cervical spine. The higher the injury, the less intact function and sensation is in the arms. An injury above the third cervical vertebra requires a mechanical respiratory device to maintain life as innervation to the diaphragm is lost.
A loss of function in the inner ear or on the path from the ear to the brain. Causes include birth defects, certain medications, and prolonged exposure to noise.
Increased tension/contractions of muscles causing stiff and awkward movements.
A group or set of symptoms that together make up a certain disease or condition.