Rev. 2/07 Health Technician skills checklist TEMPERATURE 1. Explain to student what you are going to do. 2. Wait for Welch-Allyn thermometer to beep, then apply probe cover. Make sure probe cover is secure. Use a new cover for each temp, even for repeat temps on the same child. DO NOT save & reuse covers. 3. ORAL: Place probe under tongue in right or left posterior sublingual pocket, not in front under tongue. Have student keep mouth closed without biting probe. 4. AXILLARY: Place end of probe in the center of armpit, in direct contact with skin. Fold the students arm across the chest and hold the thermometer in place. 5. TYMPANIC (AURAL): Place end of probe in ear: Infants: pull pinna down & back; Children: Pull pinna up and back. Push button on top or back of thermometer for 3 seconds and release. DO NOT use in an ear that is actively draining. 6. Temporal (forehead sweep). May be used without probe cover as method is not invasive. 7. Always hold on to the thermometer, no matter which method is being used. 8. Always dispose of probe cover into the waste container without touching it. 9. Read and record temperature. (Indicate method used if not oral). 10. Take appropriate action based on the temperature. 11. Normal: Oral: 97-99F Axilla: 96-98F Aural: 98-99.6F Temporal: 97-99F
pg. 2 of 10 PULSE 1. Access a watch or clock with a 2 nd hand. 2. Explain to the student what you are going to do. 3. Position student s hand and arm so that it is comfortable. 4. Place the middle three fingers of your hand on the thumb side of the student s wrist. (DO NOT use your thumb). 5. Press gently until you feel the pulse. 6. Count the pulse for one minute. Remember rhythm should be regular, so report any abnormalities to your nurse. 7. Record the pulse and report to your nurse if findings are outside the normal or expected range. 8. Normal ranges: Infant: 70-170 per minute Child: 80-110 per minute Adult: 60-100 per minute
RESPIRATIONS 1. Access a watch or clock with a second hand. 2. Position the student or yourself so that you can see the chest without being obvious. 3. Watch the chest go up and down for one minute. (Inspiration + Expiration = 1 Respiration). 4. Record and report to your nurse if findings are outside normal or expected range. 5. Consider: prior activity. Watch for noisy breathing, blue skin color, regularity of respirations, very rapid or slow respirations. Share all of this information with your nurse. 6. Normal respirations: Infant: 25-30 per minute Child: 20-25 per minute Adult: 12-20 per minute 7. Try to do this vital sign right after doing the pulse, while still holding on to the person s wrist.
BLOOD PRESSURE 1. Consult with your nurse about the need to check a blood pressure. 2. Assemble your equipment: stethoscope, blood pressure cuff, alcohol wipes. 3. Choose the appropriate size BP cuff (pediatric, adult, thigh). 4. Clean stethoscope ear pieces with alcohol wipe. 5. Position student comfortably and rest their arm so that it is supported with wrist up. 6. Wrap the cuff around the arm 1-11/2 inches above the elbow. 7. Locate the brachial artery on the inside of the elbow. The center of the cuff should be above the brachial artery. 8. Close the valve on the bulb. 9. Place the stethoscope diaphragm over the brachial artery and the ear pieces in your ears. You will not hear the heartbeat at this time. 10. Inflate the cuff to about 30mm above the person s normal BP (ask if it an adult, or about 30 above the normal range). 11. Slowly open the valve and allow the cuff to deflate as you listen through the stethoscope. 12. Note the measurement when you hear the first sound and the last sound through the stethoscope. 13. Once you hear the last sound, open the valve completely, allow the cuff to completely deflate and remove it from the arm. 14. If you missed the readings and need to retake, allow one minute before re-inflating the cuff. 15. Clean the earpieces & diaphragm of the stethoscope with alcohol wipes. 16. Document the BP (xxx/xx), including which arm, time of day, size of cuff and other pertinent information. 17. Have the student/staff remain in the health office until you have spoken with your nurse. 18. Normal ranges: Child: 65-115/40-65
GLUCOMETER times per school year. When complete, please send form to the Health Services coordinator. 1. Explain to student what you are going to do. 2. Set up the glucometer. Insert strip with bar code into machine. Check to see the strip number corresponds to the number on the memory on the glucometer. 3. Have the student wash their hands, making sure to dry them thoroughly. (Wet hands may result in a diluted specimen). Health technician/nurse apply gloves. 4. Puncture the finger with a new, sterile lancet. Do not use a lancet-holding device unless it is dedicated to use by the individual student. Avoid the center of the finger pad. Set up rotating schedule for finger to be poked, e.g. odd days for left hand, even for right and pointer finger for Monday, etc. 5. Touch strip to drop of blood and fill strip section appropriately. 6. Always dispose of glucometer strip without touching the blood, or have student do it. 7. Read and document glucose level. 8. Report result to school nurse as directed. Take appropriate action based on the parent/physician orders. 9. Normal: Individual for each child, refer to orders or parent information.
GLUCAGON ADMINISTRATION 1. Assess the diabetic student for severe hypoglycemia, change in level of consciousness, seizure activity or unconscious. 2. Call for help. Assign someone to call 911. Call the nurse. Call the parents. 3. Cut or remove clothing over thigh area. 4. Remove the cap from the vial with the powder or tablet. 5. Take the cap off the needle, insert into the top of the vial and inject fluid into the vial. 6. Remove the needle from the vial, recap needle. 7. Roll and mix the contents in the vial until no lumps appear and solution is clear. 8. Reinsert the needle into the vial and withdraw the contents into the syringe. Always invert the vial and keep the end of the needle below the fluid level while drawing out solution. 9. Locate site, midway between knee and fold of hip. Insert needle into muscle. Inject the full 1.0 ml. for any child older than five years old. For a child less than five years, see Individual Action Plan. 10. Position child on side. Maintain open airway. Anticipate vomiting. 11. Supervise closely until EMS responders (or parent) assume care of the individual. 12. Document findings, actions, and response in Student Record.
pg. 7 of 10 NEBULIZER THERAPY 1. Wash hands. 2. Explain to student what you are going to do. 3. Have the student sitting in an upright, comfortable position if awake and alert. 4. Confirm medication order, checking for parental consent, and following medication administration rights. Do Peak Flows as ordered. 5. Consult nurse as needed prior to giving treatment. 6. Connect nebulizer machine to small bore tubing. 7. Assemble medication compartment and mouthpiece as appropriate. Connect to tubing. 8. Place medication in medication cup. 9. Turn on machine. 10. A fine mist should be present if equipment is properly set-up. 11. Student should hold the mouthpiece (or if it is a young or special needs child, technician may do it for them) and breathe normally throughout the procedure. Mask may be used as an alternative to mouthpiece if individual is unable to hold mouthpiece. 12. Procedure takes 10-15 minutes, until all the medication is used. 13. Clean mouth piece, and nebulizer according to protocol. 14. Document appropriately.
EPI PEN ADMINISTRATION 1. Call for help. Have someone call 911. Call nurse. Call parents. 2. Place patient flat, elevate legs, loosen clothing. 3. Select appropriate Epi-Pen auto injector. Children < 60 lbs.: Epi-Pen Junior Auto-injector Delivers 0.15 mg in 0.3 ml epinephrine 1:2000 solution Adults > 60 lbs.: Epi-Pen Adult Auto-injector Delivers 0.3mg in 0.3 ml epinephrine 1:1000 solution 4. Grasp Epi-Pen with black tip pointing downward. Never put thumb, fingers, or hand over black tip. 5. Pull off the gray activation cap. 6. Hold black tip near outer thigh. Jab firmly into the outer thigh so that the auto-injector is perpendicular (at a 90 degree angle) to the thigh. You will hear a click as it is injected. 7. Hold firmly in the thigh for 10 seconds 8. Remove unit, massage injection area for several seconds. 9. Check Epi-Pen. If needle is exposed, the dose was given. If needle is not exposed repeat steps #4-8. Dispose of used Epi-Pen in sharps container. 10. Continue to monitor student s vital signs and level of consciousness. Remain calm and stay with student until student leaves the building. 11. Be sure medical personnel and family understand that Epi-pen has been given. If epi-pen is administered, 911 must be activated. 12. Monitor individual closely until EMS personnel or parent/guardian assume care. 13. Document findings, actions, response in Student Record.
pg. 9 of 10 INHALER USE 1. Verify that it is an appropriate time for the medication, and that there is a parental consent signed, along with a physician s order. 2. If any of the above are not available or the time is not appropriate, consult your nurse. 3. Explain to the student what you are going to do. 4. Have student shake the inhaler. 5. Take off the cap. 6. Attach to spacer/holding chamber if appropriate and/or available. 7. Have student exhale completely. 8. Hold inhaler appropriately (1-2 inches in front of mouth, directly in mouth or spacer in mouth with lips forming a seal). 9. As student starts breathing in slowly, depress the inhaler one time. 10. Student should hold breath and count slowly to ten (for some children the nurse or tech may need to count). 11. Have student wait one minute between puffs-have student watch clock. 12. Repeat steps 7-10. 13. Replace medication, and document appropriately. 14. Be certain to observe student when they come in for the medication and after using the inhaler, i.e. breathing pattern, audible wheezing, facial coloring, etc. Document.
pg. 10 of 10 PEAK FLOW METER 1. Explain to the student what you are going to do. 2. Use the student s own peak flow meter. If using an LPS meter, use a disposable mouth piece for each student. 3. Move the marker to the bottom of the scale. 4. Have student stand up or sit down. 5. Have student take a deep breath, filling lungs all the way. 6. Have student hold their breath while placing the mouthpiece in their mouth, between their teeth. The student should close their lips around the mouthpiece. 7. Have student blow out as hard and fast as they can. 8. Repeat the procedure two more times. The highest of the numbers is the peak flow. This is the number that is recorded. 9. Check the student s asthma action card to determine what, if any, steps need to be taken at this time. 10. Review when to use the flow meter: routinely vs. emergency.