Guidelines for Specialized Health Care Procedures (Revision 2004)
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1 Guidelines for Specialized Health Care Procedures (Revision 2004) Vickie H. Southall, MSN, RN Family, Community, and Mental Health Systems Department School of Nursing University of Virginia for the Virginia Department of Health
2 Foreword ii
3 Acknowledgements The Guidelines for Specialized Health Procedures was developed with funding provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. Special thanks are extended to Vickie Southall, RN, MSN, the primary author of the revised Guidelines, a review panel of school nurses and medical providers, and Gwen Smith, RN, MSN, with the Virginia Department of Education. The editor was Carol Pollock, RN, MSN, FNP, with the Virginia Department of Health s Division of Child and Adolescent Health. Specialized Health Care Procedures Review Panel Suzanne Burns, RN, MSN, RRT, CCRN, ACNP-CS, FAAN William L. Clarke, MD Cyndi Fisher, RN, MSN, PNP Sue Ann Fitzpatrick, RN, MSN Joyce Hillstrom, RN, BSN Donnese Kern, RN-C, MSN, NCSN, NP John Kirchgessner, RN, MSN, PNP Kiki Larkin, RN, BSN Kathryn Moyer, RN, MSN Teresa Polk, RN, MSN Barbara Robinson, RN, MSN Kathy Robinson, RN, BSN, MBA Andrea Snyder, RN, MSN, PNP Julie Strunk, RN, MSN Suzie Trotter, RN, BSN iii
4 Table of Contents Foreword ii Acknowledgements iii Table of Contents iv Introduction viii Care of the Circulatory System 1 Circulatory System Overview 2 Central Venous Catheter 4 Management of PICC Lines 9 Heparin/Saline Lock Intermittent Intravenous Device 10 Use of Needleless Systems and Safer Medical Devices 14 Procedure for One-Handed Needle Recapping 17 Care of the Endocrine System 18 Diabetes Overview 19 Diabetes Medical Management Plan 28 Procedure for Blood Glucose Testing 34 Procedure for Mild or Moderate Low Blood Glucose 35 Emergency Procedure for Severe Low Blood Glucose 37 Glucagon 38 Procedure for Giving Glucagon for Severe Hypoglycemia 39 Procedure for High Blood Glucose 41 Procedure for Testing Urine Ketones 43 Insulin 44 Procedure for Insulin Administration by Syringe 46 Procedure for Insulin Administration by Syringe Two Types of 48 Insulin Together Procedure for Insulin Pen Delivery System 50 Insulin Pump Therapy 52 Procedure for Hypoglycemia with Pump Therapy 54 Procedure for Hyperglycemia with Pump Therapy 55 Procedure for Pump Alarms 56 Resources for Teachers, Child Care Providers, Parents, and Health 57 Professionals Care of the Gastrointestinal System 58 Gastrointestinal System Overview 59 Gastrostomy Tube 62 Procedure for Gastrostomy Tube Feeding Bolus Method 65 Procedure for Gastrostomy Tube Feeding Continuous Feeding by 68 Pump or Slow Drip Method Skin-Level or Low Profile Gastrostomy Devices (G-Button) 74 Procedure for Skin-Level Gastrostomy Device Feeding Bolus 77 Method Procedure for Skin-Level Gastrostomy Device Feeding Slow Drip or 80 Continuous Feeding by Pump iv
5 Nasogastric Tube Procedure for Inserting Nasogastric Tube Procedure for Checking Placement of the Nasogastric Tube Procedure for Nasogastric Tube Feeding Bolus Method Procedure for Nasogastric Tube Feeding Slow Drip or Continuous Feeding by Pump Jejunostomy Tube Procedure for Jejunostomy Feeding Continuous Feeding by Pump Nasojejunal Tube Procedure for Checking Placement of Nasojejunal Tube Colostomy Procedure for Emptying a Colostomy Procedure for Changing a Colostomy Pouch Ileostomy Procedure for emptying an Ileostomy Procedure for Changing an Ileostomy Pouch Care of the Musculoskeletal System and Mobility Care 133 Musculoskeletal System and Mobility Care Overview 134 Physical Mobility Assistance 135 Procedure for Positioning a Student 136 Procedure for Assisting Student with a Cane 138 Procedure for Assisting Student with Crutches 140 Procedure for Assisting Student with a Walker 142 Procedure for Assisting Student with a Wheelchair 143 Procedure for Assisting Student with a Prosthesis 145 Procedure for Assisting Student with an Orthosis 147 Procedure for Cast Care 149 Principles of Good Body Mechanics 153 Care of the Neurological System 156 Seizure Management Overview 157 Procedure for Managing a Seizure 163 Rectal Diazepam for Seizures 166 Procedure for Administering Rectal Diazepam 168 Vagal Nerve Stimulation for Seizures 169 Procedure for Activating Vagal Nerve Stimulation 171 Ventricular Shunt 172 Procedure for Monitoring a Ventricular Shunt 174 Care of the Respiratory System 177 Respiratory System Overview Asthma Peak Expiratory Flow Rate Monitoring Procedure for Peak Flow Rate Monitoring Procedure for Using a Metered Dose Inhaler (MDI) Procedure for Using Spacers with Metered Dose Inhalers Procedure for Using Dry-Powder Inhalers Nebulizer Treatments v
6 Procedure for Nebulizer Aerosol Treatment 201 Oxygen Use 205 Procedure for Using a Nasal Cannula 209 Procedure for Using an Oxygen Mask 211 Pulse Oximetry 215 Procedure for Measuring Pulse Oximetry 217 Tracheostomy 221 Tracheal Suctioning 229 Procedure for Tracheal Suctioning 232 Procedure for Tracheal Suctioning Using a Sleeved Catheter 236 Tracheostomy Tube Changes 241 Procedure for Changing a Tracheostomy Tube 243 Procedure for Using Oxygen with a Tracheostomy Collar 247 Manual Resuscitation Bag 249 Procedure for Using a Manual Resuscitator with a Tracheostomy 250 Nose and Mouth Suctioning 251 Procedure for Nose and Mouth Suctioning Using a Suction Machine 253 Procedure for Nose and Mouth Suctioning Using a Bulb Syringe 256 Chest Physiotherapy Postural Drainage and Percussion 259 Procedure for Chest Physiotherapy 261 Use of Mechanical Ventilators 265 Ventilator Equipment 268 Ventilator Parameters 270 Ventilator Modes 271 Ventilator Alarms 272 Special Care Issues 277 Attention Deficit Hyperactivity Disorder (ADHD) Overview 278 Management of ADHD 281 Managing Food Allergies in Schools 290 Managing Anaphylaxis 294 Managing Latex Allergies 300 Measuring Body Temperature 304 Care of the Urinary System 308 Urinary System Overview Clean Intermittent Catheterization Procedure for Clean Intermittent Catheterization--Male Procedure for Clean Intermittent Catheterization--Female Indwelling Urinary Catheter Procedure for Monitoring an Indwelling Urinary Catheter Crede s Method External Urinary Catheter Procedure for Application and Removal of External Catheter Ostomies for Urinary Elimination Procedure for Changing a Urostomy Pouch Procedure for Catheterizing a Continent Urostomy/Vesicostomy/ Appendicovesicostomy/Umbilical Stoma vi
7 Peritoneal Dialysis Hemodialysis Appendix A Individualized Health Care Plans and Forms 356 Appendix B Skills Checklists for Procedures 362 vii
8 Introduction The Guidelines for Specialized Health Care Procedures is intended to enhance the educational process of students with special health care needs by providing guidance to school nurses, teachers, and other staff regarding the medical care of the students within the school setting. The Guidelines are based on current nursing and medical protocols for the care of children with special health care needs. Parents or guardians have the primary responsibility for providing appropriate health care for their children. Whenever possible, parents are encouraged to work with their health care provider to administer medications and specialized health care procedures before or after school. When procedures and medications need to be administered during school hours, the parents or guardians, health care provider, student (if appropriate), and school nurse should develop an individualized health care plan (IHCP) to outline what needs to be done during the school day. Parents or guardians also need to provide the school with comprehensive medical information, medications, medical equipment, and medical supplies to help school staff care for their child. The Guidelines are intended to provide a broad framework for planning appropriate health care services for students with special health care needs. Because each student is different and has a unique array of needs, these guidelines should not be the sole source or a substitute for development of an IHCP that addresses the student s health care needs. The Guidelines for Specialized Health Care Procedures also should be used as a tool to help school staff care for students with special health care needs. It does not attempt to provide medical advice and should not be used as a substitute for professional medical consultation. The Guidelines are divided into eight sections reflecting systems of the body. Each section is further divided into an overview of the system, selected chronic conditions within the system, and an alphabetical listing of procedures affecting that system. Appendix A includes sample individualized health care plans. Appendix B includes checklists that may be used to train staff on procedures. viii
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