• Advanced Procedures

    In this Chapter 

    • Assisted Cough Procedures
    • Assisted Cough Checklist
    • Blood Glucose Monitoring
    • Blood Glucose Monitoring Procedure
    • Blood Glucose Monitoring Skills Checklist
    • Blood Pressure Log
    • Blood Pressure Measurement Procedure
    • Blood Pressure Measurement Skills Checklist
    • Clean Intermittent Catheterization
    • Clean Intermittent Catheterization Log
    • Clean Intermittent Catheterization Skills Checklist - Female
    • Clean Intermittent Catheterization Skills Checklist - Male
    • Credé Maneuver Procedure
    • Credé Maneuver Skills Checklist
    • Daytrana Patch Treatment Log
    • Daytrana Procedure
    • Daytrana Skills Checklist
    • Gastrostomy Tube Feeding
    • G-Tube Feeding Treatment Authorization
    • G-Tube Feeding Log
    • Gastrostomy Tube Feeding Procedure
    • Gastrostomy Tube Feeding Skills Checklist
    • Ketone Monitoring
    • Ketone Testing Procedure/Checklist
    • Ostomy Flow Sheet
    • Trixie Lift™ Procedure
    • Trixie Lift™ Procedure Checklist
    • VNS Checklist
    • VNS Procedure

    ASSISTED COUGH PROCEDURE 

    Purpose: 

    Manual assistance with coughing so that a cough will be more forceful and productive in bringing up secretions.  It is used when a person’s cough is ineffective or weak or when excessive secretions exist due to inadequate muscle strength. 

    ACTION TO BE PERFORMED BY: 

    A person who has been trained by a licensed health care professional and successfully completed a Skills Checklist.

    Procedure: 

    Standing in front of the person, place your open hands around the chest just below the rib cage with the thumbs touching.  Have the student take a breath and cough, as you firmly push inward and upward on the diaphragm.  Repeat as necessary with short rest periods between assisted manual coughs.  

    ASSISTED COUGH CHECKLIST

    See Assisted Cough Checklist in Forms Section

    BLOOD GLUCOSE MONITORING

    Purpose:

    Blood glucose monitoring (BGM) is a reliable method of measuring blood glucose levels in a student diagnosed with diabetes mellitus.  In Type 1 Diabetes the body cannot produce insulin.  In Type 2 Diabetes the pancreas makes some insulin, but either it cannot make enough or the insulin it does make does not work very well.  Monitoring blood glucose levels provide feedback on how nutritional intake, physical activity, and medications are impacting the student's blood glucose.  Students who can control their diabetes by maintaining normal or close to normal blood sugar levels lower their risk of complications and enjoy a better quality of life.  

    ACTION TO BE PERFORMED BY: 

    A person trained by a licensed health care professional and completion of child-specific Skills Checklist.   

    Procedure:

    The blood glucose will be checked according to the student's medical orders found in the Diabetes Medical Management Plan (DMMP).  Instructions that come with the monitoring device must be followed.  Blood glucose monitoring will be done in the health room in accordance with the Sarasota County School  Board Exposure Control Plan unless a Student Blood Glucose Monitoring and Diabetes Self-Management in The Educational Setting-Physician's Report has been completed.  The medical orders found in the Diabetes Medical Management Plan (DMMP) must be renewed each school year.   (See Blood Glucose Monitoring Procedure).      

    Considerations and Accommodations:

    • Most children are encouraged to self-monitor blood glucose as part of their diabetes management.
    • The Health Room Aide or other school staff member must have a child-specific Blood Glucose Monitoring Skills Checklist completed before observing, performing or supervising a student's blood glucose monitoring.
    • Watch for signs of hypoglycemia/hyperglycemia.  The Individualized Healthcare Plan (IHP), written by the school nurse, outlines student-specific signs and symptoms of hypoglycemia and hyperglycemia (low and high blood glucose levels) and guidelines for carrying out the student's medical treatment plan in the school setting.
    • Instruct the student on the policies and procedures for proper biohazard waste disposal and monitor their compliance.      

    BLOOD GLUCOSE MONITORING PROCEDURE

    See Blood Glucose Monitoring Procedure in Forms Section

     

    BLOOD GLUCOSE MONITORING SKILLS CHECKLIST

    See Blood Glucose Monitoring Skills Checklist in Forms Section

     

    BLOOD PRESSURE LOG

    See Blood Pressure Log in Forms Section.

     

    BLOOD PRESSURE MEASUREMENT PROCEDURE

    See Blood Pressure Measurement (Digital) Procedure in Forms Section

     

    BLOOD PRESSURE MEASUREMENT SKILLS CHECKLIST

    See Blood Pressure Measurement (Digital) Skills Checklist in Forms Section

     

    CLEAN INTERMITTENT CATHETERIZATION (CIC)

    Clean intermittent catheterization (CIC) is a method of catheterization for individuals with chronic urination problems that use a clean but non-sterile technique to release urine and empty the bladder.  Students with some chronic health conditions or physical disabilities will find it difficult or physically impossible to empty their bladders.  These students may need catheterization during the school day.  Clean intermittent catheterization helps avoid bladder infections because it prevents stretching of the bladder and urine is not allowed to stay in the bladder.  Bacteria can grow in residual urine in the bladder.  

    This technique frees the individual from the embarrassment and inconvenience of urinary incontinence or having a catheter that remains in place (indwelling catheter).  Many students can catheterize themselves.

    This procedure may be performed by a person who has been trained by a licensed health care professional and who has successfully completed a skills check.  See the procedure and checklist forms in the Forms Section.

    Follow manufacturer's guidelines for cleaning plastic or rubber catheters.

    Parent/guardian may request that catheters be re-used.  A plastic catheter may be re-used if it is washed and dried after each use and stored in a plastic bag marked "used catheter" and with the student's name.  These catheters should be sent home to be cleaned by the parent/guardian.

    CLEAN INTERMITTENT CATHETERIZATION LOG

    See Clean Intermittent Catheterization Log in Forms Section 

     

    CLEAN INTERMITTENT CATHETERIZATION PROCEDURE - FEMALE AND MALE

    See Clean Intermittent Catheterization Procedure - Female and Male in Forms Section   

     

    CLEAN INTERMITTENT CATHETERIZATION SKILLS CHECKLIST - FEMALE

    See Clean Intermittent Catheterization Skills Checklist - Female in Forms Section

     

    CLEAN INTERMITTENT CATHETERIZATION SKILLS CHECKLIST - MALE

    See Clean Intermittent Catheterization Skills Checklist - Male in Forms Section 

     

    CREDÉ MANEUVER PROCEDURE

    See Credé Maneuver Procedure in Forms Section

     

    CREDÉ MANEUVER SKILLS CHECKLIST

    See Credé Maneuver Skills Checklist in Forms Section

     

    DAYTRANA PATCH TREATMENT LOG

    Request Daytrana Patch Treatment Log from the school nurse.

     

    DAYTRANA PROCEDURE

    Request Daytrana Procedure from the school nurse.

    DAYTRANA SKILLS CHECKLIST

    Request Daytrana Skills Checklist from the school nurse.

     

    GASTROSTOMY TUBE FEEDING


    Purpose:
    The purpose of this procedure is to provide feedings for the student who is unable to eat enough to meet nutritional requirements to maintain health, is unable to swallow safely and is at risk for choking/aspiration, or it may be necessary if the esophagus is blocked.

    Students with some chronic health conditions or disabilities may need alternative methods of eating.  One of these methods involves a surgical procedure called a gastrostomy or an endoscopic procedure called a percutaneous endoscopic gastrostomy (PEG).  With either gastrostomy procedure, an opening (called a "stoma”) is made through the skin of the abdomen that goes directly into the stomach.  A tube called a gastrostomy tube, G tube or PEG tube is inserted into the stoma.  One end of the tube opens into the stomach and the other end can be attached to a feeding device like a syringe.  A balloon or widened area on the end of the tube that is in the stomach helps to keep the tube from falling out.  The tube remains in at all times and is clamped or plugged between feedings to prevent leakage of stomach contents.  The gastrostomy tubes cause no discomfort and are usually covered by clothing.  Sometimes a button gastrostomy is used, with a short tube inserted into an established opening in the stomach.  The button fits closely to the skin on the abdomen and has a small plug that is opened to attach an adapter and tubing for the feedings.  The gastrostomy tube may be used to administer a feeding or medication directly into the stomach.  The student may receive a gastrostomy tube feeding by bolus or continuous slow-drip method.  A bolus is a specific amount given at one time over 20-30 minutes.  A slow drip is a feeding that is given over a number of hours and runs continuously. 
    Always review the physician’s treatment order first. The physician’s order (G-Tube Authorization Form) must be obtained and is to include:

    • Type of tube
    • Type and amount of feeding
    • Time and frequency of feeding
    • Amount of flush
    • Whether residual is to be measured before feeding
    • If checking of residual is ordered, will the amount measure alter the volume of the feeding?
    • Delivery apparatus    

    The Gastrostomy Procedure involves:

    • Proper positioning of the student,
    • checking the placement of the tube, 
    • administering the feeding, and
    • instilling water after the feeding to flush the tube. 

    See Gastrostomy Tube Feeding Procedure and Checklist.

    G-TUBE FEEDING TREATMENT AUTHORIZATION FORM

    See G-Tube Feeding Treatment Authorization in Forms Section 

     

    G-TUBE FEEDING LOG

    See G-Tube Feeding Log in Forms Section

     

    GASTROSTOMY TUBE FEEDING PROCEDURE

    See Gastrostomy Tube Feeding Procedure in Forms Section

     

    GASTROSTOMY TUBE FEEDING SKILLS CHECKLIST

    See Gastrostomy Tube Feeding Skills Checklist in Forms Section

     

    KETONE MONITORING

    Ketone monitoring is a critical tool for the school nurse in caring for a student with hyperglycemia, illness (nausea or vomiting) or both.  Hyperglycemia (very high blood sugar) is generally considered a blood glucose reading greater than 240mg/dL or 300mg/dL and can occur gradually or rapidly.  Due to a lack of adequate insulin, the body is unable to process the glucose.  The body starts burning stored fat for energy leading to the formation of ketones that results in acidosis.

    Ketone levels in the urine will be checked according to the student's medical orders found in the Diabetes Medical Management Plan (DMMP).  Instructions that come with the strips must be followed.  Ketone testing will only be done in the school health room in accordance with the Sarasota County School Board Exposure Control Plan unless a Student Blood Glucose Monitoring and Diabetes Self-Management in the Educational Setting - Physician's Report has been completed.  The medical orders found in the Diabetes Medical Management Plan (DMMP) must be renewed each school year.

    • The student or health room aide may do ketone testing after successful demonstration per skills checklist.
    • Notify the school RN to implement ketone testing procedures.
    • The student’s Diabetes Medical Management Plan and, if self-managing, the Physician’s Report, as well as emergency parent notification numbers, should be readily available for reference.
    • Watch for individual signs of hyperglycemia (very high blood sugar)/ketoacidosis.  The Individualized Healthcare Plan (IHP) written by the school nurse, outlines student-specific signs and symptoms of hyperglycemia (very high blood sugar)/ketoacidosis and guidelines for carrying out the student's medical treatment plan.  Signs of ketoacidosis include extreme thirst, abdominal pain, labored breathing, fruity-sweet breath, vomiting, weakness, dizziness and fatigue/drowsiness.
    • Contact the parent/guardian immediately for any of these symptoms. Follow up with a health care provider is essential. If left untreated the student can lapse into a coma. (School RN must also be notified.)
    • Encourage children with insulin-dependent diabetes to test ketones as part of their diabetes management.

    KETONE MONITORING PROCEDURE

    See Ketone Monitoring Procedure in Forms Section

     

    KETONE TESTING PROCEDURE AND CHECKLIST

    See Ketone Testing Procedure/Checklist in Forms Section

     

    OSTOMY FLOW SHEET

    See Ostomy Flow Sheet in Forms Section


    TRIXIE LIFT™ PROCEDURE

    See Trixie Lift™ Procedure in Forms Section

     

    TRIXIE LIFT™ PROCEDURE CHECKLIST

    See Trixie Lift™ Procedure Checklist in Forms Section

     

    VAGUS NERVE STIMULATOR (VNS) CHECKLIST

    Request the Vagus Nerve Stimulator (VNS) Checklist from the school nurse.

     

    VAGUS NERVE STIMULATOR (VNS) PROCEDURE

    Request Vagus Nerve Stimulator (VNS) Procedure from school nurse.