Source: http://marysfamilymedicine.org/f/fhop.ucsf.edu1.html
Timestamp: 2019-04-18 18:43:23+00:00

Document:
problems such as coughing, wheezing, chest tightness, or shortness of breath.
medication therapy. An individual's severity classification can change over time.
Individuals at any severity level can experience mild, moderate, or severe asthma attacks.
hives, faintness, loss of consciousness, severe difficulty breathing, and throat closing.
anaphylaxis and establish an emergency plan for rapid treatment and medical attention.
exercise-induced symptoms and allow a child to participate ful y in exercise activities.
recommended for children with asthma.
as inhaled corticosteroids in improving asthma outcomes.
medications. The nebulizer is plugged into an electrical outlet or may be battery powered.
regular nebulizer treatments may need to keep the nebulizer at school.
occur. Children over five years old are generally able to use these devices.
exposure to asthma triggers or an asthma episode.
Code (CEC) Section 49423.5 and California Code of Regulations (CCR) Section 3051.12.
the condition adversely affects their educational performance.
mold, furry animals, odors, respiratory infections, changes in weather, and exercise.
known to increase the student's asthma symptoms.
assistance from trained school staff (for students with severe and frequent asthma episodes).
with a history of mild intermittent asthma may experience a life-threatening asthma episode.
• Activity limitations should not be necessary.
best peak flow value and have minimal or no asthma symptoms.
zone. No change in asthma medications wil be needed at this level.
guardian and health care provider.
wil decrease to between 50 to 80 percent of the expected personal best.
zone, the child's asthma should gradual y become stabilized again in the green zone.
The child's activity level should be adjusted to accommodate compromised lung function.
have difficulty completing sentences and appear breathless, weak, or pale.
an almost certain asthma crisis.
child's parent or guardian should be notified of the child's condition.
The child must not be left unsupervised.
are available in liquid form for nebulization (Albuterol, Xoponex®, Pulmicort®).
quieting to a verbal command or loud voice.
The student only responds to a painful stimulus. The student should withdraw from the stimulus.
Moaning or crying may also be elicited.
The student shows no spontaneous responses and no responses to verbal or painful stimuli.
*Weight is approximate median of boys and girls combined, except for age 17 **Systolic blood pressure for the 90th – 95th height percentiles Adapted from National Institutes of Health Clinical Center Website (www.cc.nih.gov/) and Pediatrics, v98, p654, 1996.
NEVER LEAVE A STUDENT WITH BREATHING PROBLEMS ALONE.
DO NOT SEND A STUDENT WITH BREATHING PROBLEMS ANYWHERE.
GET HELP AND HAVE MEDICATION BROUGHT TO THE STUDENT.
• Current health status of student.
• Specific triggers that exacerbate the student's asthma.
My signature below provides authorization for the above written orders. I understand that all procedures will be implemented in accordance with state laws and regulations. I understand that specialized physical health care services may be performed by unlicensed designated school personnel under the training and supervision provided by the school nurse. This authorization is for a maximum of one year. If changes are indicated, I will provide new written authorization. I have instructed the above named student in the proper way to use his/her medications. It is my professional opinion that they should be allowed to carry and use that medication by him/herself. I request that the school nurse provide me with a copy of the completed Individualized School Health Care Plan.
I (we) the undersigned, the parent(s)/guardian(s) of the above named student, request that the above authorization for specialized physical health care service for management of asthma in school be administered to my (our) child in accordance with state laws and regulations. I (we) will: 1. Provide the necessary supplies and equipment. 2. Notify the school's nurse if there is a change in student health status or attending authorized health care provider. 3. Notify the school nurse immediately and provide new consent for any changes in authorized health care provider's I (we) give consent for the school nurse to communicate with the authorized health care provider when necessary.
I (we) understand that I (we) will be provided a copy of my (our) child's completed Individual School Health Care Plan.
My signature below provides authorization for the above written orders. I understand that all procedures will be implemented in accordance with state laws and regulations. I understand that specialized physical health care services may be performed by unlicensed designated school personnel under the training and supervision provided by the school nurse. This authorization is for a maximum of one year. If changes are indicated, I will provide new written authorization. I request that the school nurse provide me with a copy of the completed Individualized School Health Care Plan.
I (we) the undersigned, the parent(s)/guardian(s) of the above named student, request that the above authorization for specialized physical health care services for management of asthma in school be administered to my (our) child in accordance with state laws and regulations. I (we) will: 1. Provide the necessary supplies and equipment. 2. Notify the schools nurse if there is a change in student health status or attending authorized health care provider. 3. Notify the school nurse immediately and provide new consent for any changes in authorized health care provider's I (we) give consent for the school nurse to communicate with the authorized health care provider when necessary.
coughing, shortness of breath, chest tightness, or breathing difficulty.
2. All equipment and supplies necessary for administering medication.
1. Determine if the student is displaying symptoms such as wheezing, coughing, shortness of breath, chest tightness, or difficulty breathing.
As the airway becomes inflamed, swollen, or narrowed, breathing becomes difficult.
3. Encourage student to take slow, deep breaths. Seat student comfortably. Do not allow student to lie down or go to sleep.
Expansion of the lung and movement of the diaphragm are greatest in this position.
4. Give asthma quick-relief medication (e.g., Albuterol inhaler or Albuterol nebulizer treatment) as authorized in student's ISHP.
Asthma quick-relief medication should relax and open airway to improve breathing.
Quick-relief asthma medication will general y provide improvement.
6. Follow ISHP directions for when to al ow student to return to class or resume school activities.
Response time from medication may vary.
7. If no improvement in five minutes after medication administration, and student has: • Very fast or hard breathing • Skin sucking in over child's stomach or ribs with breathing • Breathing so hard they cannot walk or speak • Lips or fingernail beds turn blue Cal for help. Call 9-1-1. Repeat quick-relief medication every 20 minutes or as authorized in student's ISHP. Stay with the student and be prepared to do CPR.
Student may have a respiratory infection or more severe exacerbation.
1. To improve the ability to document the onset of and to assess the severity of asthma 2. To detect the small changes in airflow that occur at the start of an asthma attack.
3. To identify exercise-induced asthma.
4. To monitor the need for, or the response to, prescribed medication.
5. Measures peak expiratory flow (PEF).
1. Determine the need for the student to use the peak flow meter at school by reviewing ISHP.
Some students with asthma may not wheeze even though they are in acute distress.
They may not be moving enough air through the airways to cause audible wheezing.
Make sure that the pointer is on zero.
Be sure there is no candy or gum in the student's mouth.
5. Have the student hold the meter without obstructing the outflow vent. Fingers must not obstruct the vent.
the meter cylinder paral el to the floor.
Poor inspiration may produce a false low PEF reading.
7. Have the student place the mouthpiece on the tongue with lips around the outside of the mouthpiece.
Be sure that lips form a tight seal.
the measurement that registers on the meter.
9. Replace the marker at zero. Repeat the procedure two more times for a total of three exhalations.
10. Record the best PEF measurement. Compare this reading with the personal best PEF documented in the student's ISHP.
breathing easier, able to cough and clear secretions, and resume usual activity.
12. If measurement is in the yel ow zone, administer asthma quick-relief medication and control medication according to student's ISHP.
school nurse with PEF reading. Notify parent.
13. If measurement is in the red zone, administer asthma quick-relief medication and control medication according to student's ISHP.
student in sitting position and keep student calm. Be prepared to do CPR.
Notify school nurse and parent of unusual findings and actions.
15. Refer to the manufacturer's guide for cleaning and maintenance of the peak flow meter.
Wear gloves for cleaning. Remove gloves and wash hands.
authorized by their authorizing health care provider.
Review authorized health care provider's order and student's ISHP.
3. Shake the metered dose inhaler wel ten times. Dry power/disk inhalers do not require shaking.
The right amount of medication may not spray out if the inhaler is not shaken wel .
open or closed mouth technique. Please see education references, pages 57-58.
directions for the correct position.
If sprayed at the end of a breath, the medication wil not work as wel .
than being delivered to the lungs.
Do not let the student take more puffs than directed by physician.
9. Determine if medication has improved signs and symptoms and observe for five minutes.
authorized in student's ISHP. Stay with student and be prepared to do CPR.
Have help notify site administrator, school nurse, and parent.
depth, effort, noise, color, restlessness, and level of consciousness.
comparison after medication is given.
3. Monitor heart rate during and after treatment by taking pulse when bronchodilators are administered.
has any of these signs and symptoms.
Use students own medication cup, mouthpiece, or mask.
7. Place the appropriate amount of medication and saline solution or water in the nebulizers.
Do not exceed the ordered amount.
allowing for maximum treatment of the basilar areas of the lungs.
Demonstrate the procedure if needed.
10. Attach the nebulizer hose to the air compressor and turn it on. A fine mist should be visible.
trouble shooting. If nebulizer does not mist, cal the school nurse.
Use the mask if the student cannot use the mouthpiece.
breathing until time for the next deep breaths.
14. Observe the expansion of the student's chest. 15. Remove the mouthpiece or mask if a cough occurs during the treatment and al ow the student to clear the secretions completely and then continue the treatment.
Turn off the machine when it is not being used.
Treatment may take 8 to 20 minutes depending on equipment used.
student, and have help cal school nurse.
19. Upon completion of the treatment have the student take several deep breaths, cough, and spit out the secretions.
Instruct and demonstrate the technique as needed.
20. Obtain and record student's pulse and respirations and observe student for ten minutes.
are within a normal range, then the student may return to their classroom.
Pursuant to Section 49423 and subdivision (b) of Section 49423.6 of the Education Code, any pupil who is required to take, during the regular school day, prescribed medication may be assisted by a school nurse or other designated school personnel if both of the fol owing conditions are met: (a) The pupil's authorized health care provider executes a written statement specifying, at a minimum, the medication the pupil is to take, the dosage, and the period of time during which the medication is to be taken, as wel as otherwise detailing (as may be necessary) the method, amount, and time schedule by which the medication is to be taken. (b) The pupil's parent or legal guardian provides a written statement initiating a request to have the medication administered to the pupil or to have the pupil otherwise assisted in the administration of the medication, in accordance with the authorized health care provider's written statement. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49423 and 49423.6, Education Code. New article 4.1 (sections 600-611) and section filed 11-20-2003; operative 11-20-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 47). §601. Definitions.
As used in Section 49423 and subdivision (b) of Section 49423.6 of the Education Code and in this article: (a) "Authorized health care provider" means an individual who is licensed by the State of California to prescribe medication. (b) "Medication" may include not only a substance dispensed in the United States by prescription, but also a substance that does not require a prescription, such as over-the-counter remedies, nutritional supplements, and herbal remedies. (c) "Medication log" may consist of a form developed by the local education agency for the documentation of the administration of the medication to the pupil or otherwise assisting the pupil in the administration of the medication. The medication log may include the fol owing: (1) Pupil's name; (2) Name of medication the pupil is required to take; (3) Dose of medication; (4) Method by which the pupil is required to take the medication; (5) Time the medication is to be taken during the regular school day; (6) Date(s) on which the pupil is required to take the medication; (7) Authorized health care provider's name and contact information; and (8) A space for daily recording of medication administration to the pupil or otherwise assisting the pupil in administration of the medication, such as date, time, amount, and signature of the individual administering the medication or otherwise assisting in administration of the medication. (d) "Medication record" may include: (1) The authorized health care provider's written statement; (2) The written statement of the parent or legal guardian; (3) The medication log; and (4) Any other written documentation related to the administration of the medication to the pupil or otherwise assisting the pupil in the administration of the medication. (e) "Other designated school personnel" may include any individual employed by the local education agency who: (1) Has consented to administer the medication to the pupil or otherwise assist the pupil in the administration of medication; and (2) May legal y administer the medication to the pupil or otherwise assist the pupil in the administration of the medication. (f) "Parent or legal guardian" means the individual recognized by the local education agency as having authority to make medical decisions for the pupil. (g) "Regular school day" may include not only the time the pupil receives instruction, but also the time during which the pupil otherwise participates in activities under the auspices of the local education agency, such as field trips, extracurricular and cocurricular activities, before- or after-school programs, and camps or other activities that typical y involve at least one overnight stay away from home. (h) "School nurse" means an individual employed by the local education agency who is a currently licensed registered nurse and is credentialed pursuant to Education Code section 44877. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 44877, 49423 and 49423.6, Education Code. 1. New section filed 11-20-2003; operative 11-20-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 47). § 602. Written Statement of Authorized Health Care Provider.
§ 603. Written Statement of the Parent or Legal Guardian.
(a) A school nurse may administer medication to a pupil or otherwise assist a pupil in the administration of medication as al owed by law and in keeping with applicable standards of professional practice. (b) Other designated school personnel may administer medication to pupils or otherwise assist pupils in the administration of medication as al owed by law and, if they are licensed health care professionals, in keeping with applicable standards of professional practice for their license. (c) The pupil's parent or legal guardian may administer medication to the pupil or otherwise assist the pupil in the administration of medication as al owed by law. (d) An individual designated to do so by the parent or legal guardian may administer medication to the pupil or otherwise assist the pupil in the administration of medication as allowed by law. A local education agency may establish rules governing the designation of an individual by a parent or legal guardian in order to ensure that: (1) The individual is clearly identified; (2) The individual is wil ing to accept the designation; (3) The individual being designated is permitted to be present on the school site; (4) Any limitations on the individual's authority in his or her capacity as designee are clearly established; and (5) The individual's service as a designee would not be inconsistent or in conflict with his or her employment responsibilities, if the individual being designated is employed by the local education agency. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49423 and 49423.6, Education Code. §605. Self-Administration of Medication.
With the approval of the pupil's authorized health care provider and the approval of the pupil's parent or legal guardian, a local education agency may allow a pupil to carry medication and to self-administer the medication. A local education agency may establish rules governing self-administration in order to protect the health and safety both of the pupil and of the whole student body and staff at the schoolsite. Through such rules, a local education agency may describe circumstances under which self-administration may be prohibited. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49423 and 49423.6, Education Code. § 606. Delivery and Storage of Medication.
§ 608. Deviation from Authorized Health Care Provider's Written Statement.
A local education agency may establish policies regarding any material or significant deviation from the authorized health care provider's written statement in order to ensure that, as quickly as possible upon discovery, appropriate notification of the deviation is made: (a) In accordance with applicable standards of professional practice, if the discovery is made by a licensed health care professional; or (b) To the schoolsite administrator, the pupil's parent or legal guardian, an employee of the local education agency who is a licensed health care professional (if any), and the pupil's authorized health care provider, if the discovery is made by an individual who is not a licensed health care professional. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49423 and 49423.6, Education Code. § 609. Unused, Discontinued and Outdated Medication.
A local education agency may establish policies regarding unused, discontinued, and outdated medication in order to ensure that: (a) Such medication is returned to the pupil's parent or legal guardian where possible; (b) Such medication that cannot be returned to the pupil's parent or legal guardian is disposed of by the end of the school year in accordance with applicable law. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49423 and 49423.6, Education Code. § 610. Applicability of this Article.
Nothing in this article may be interpreted as creating a state-mandated local program or as affecting in any way: (a) The statutes, regulations, or standards of practice governing any health care professional licensed by the State of California in the carrying out of activities authorized by the license; (b) The statutes or regulations governing the administration of medication to pupils or otherwise assisting pupils in the administration of medication by individuals who are not licensed health care professionals, other than Section 49423 and subdivision (b) of Section 49423.6 of the Education Code; (c) The use of emergency epinephrine auto-injectors pursuant to Section 49414 of the Education Code; (d) The content or implementation of a pupil's individualized education program prepared in accordance with applicable provisions of federal and state law, or a pupil's Section 504 Accommodation Plan prepared in accordance with applicable provisions of the federal Rehabilitation Act of 1973. Authority cited: Sections 33031 and 49423.6, Education Code. Reference: Sections 49414, 49423 and 49423.6, and Part 30 (commencing with Section 56000) of Division 4 of Title 2, Education Code. § 611. Issuance and Periodic Updating of Advisory.
1. Very fast or hard breathing.
2. Skin sucking in over child's stomach or ribs with breathing.
3. Breathing so hard they cannot walk or speak.
4. Lips or fingernail beds turn blue.
1. Stay with student, call for help, and have someone call 9-1-1.
2. Keep student sitting upright.
assist in immediate administration (inhaler or nebulizer).
in student's asthma action plan.
6. Have someone notify the school nurse.
A spacer device is a chamber which attaches to any MDI ordered by your doctor. There are several types of spacer devices available. The most common brands are the Ventahaler® and the Aerochamber®. Spacer devices can be purchased at most local pharmacies.
breathe normal y for three to four breaths through the mouthpiece.
TIP: If you hear a whistle sound from the Aerochamber, you are breathing too fast.
Slow down your breathing. This wil allow more medication to reach your lungs.
Health Care Utilization, and Mortality, Pediatrics, Aug 2002; 110: 315 - 322.
American Academy of Al ergy, Asthma and Immunology, Inc., Academic Services Consortium. Pediatric Asthma: Promoting the Best Practice, Milwaukee, 1999. American Academy of Al ergy, Asthma & Immunology, Inc., The Allergy Report, Volumes I-III, Milwaukee: Wisconsin, 2000. www.theallergyreport.org/reportindex.html American Association of School Administrators, Asthma Wel ness Keeping Children with Asthma in School and Learning, School Governance and Leadership, Vol. 5, No. 1, Spring, 2003. http://www.aasa.org/publications/sgl/Spring_2003.pdf California Department of Health Services, Strategic Plan for Asthma in California, 2002. www.dhs.ca.gov/ps/cdic/cdcb/Medicine/Asthma/Documents/SP/Final%20Strategic%20Plan.pdf Department of Health and Human Services, Centers for Disease Control and Prevention, Strategies for Addressing Asthma Within a Coordinated School Health Program, 2002. http://www.cdc.gov/HealthyYouth/asthma/pdf/asthma.pdf Farber, Harold, M.D. and Michael Boyette. Control Your Child's Asthma: A Break Through Program for the Treatment and Management of Childhood Asthma, New York: Henry Holt & Co., 2001. Gregory, Elizabeth, Empowering Students on Medication for Asthma to be Active Participants in Their Care: An Exploratory Study." The Journal of School Nursing, Vol. 16, No. 1 (February 2000). Illinois Department of Human Services, Division of Community Health and Prevention, Office of Family Health, Asthma Management: A Resource Manual for Schools, January 2001. Mannino DM, Homa DM, Akinbami LJ, et al. Surveil ance for Asthma-United States, 1980–1999. MMWR Morb Mortal Wkly Rep2002; 51(SS-1): 1 –13. www.cdc.gov/mmwr/preview/mmwrhtml/ss5101a1.htm Michigan Asthma Strategic Planning Initiative Task Force, Asthma in Michigan – A Blueprint for Action, May 2001. National Asthma Education and Prevention Program. Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma, Update on Selected Topics, 2002. Bethesda, MD: National Heart, Lung, and Blood Institute; June, 2003. www.nhlbi.nih.gov/guidelines/asthma/index.htm Newacheck PW and N Halfon. Prevalence, impact, and trends in childhood disability due to asthma. Arch Pediatr Adolesc Med.2000; 154: 287 –293. Schering-Plough Corporation, Respiratory Guidelines and Programs, Teaching Tool kit, 2000.
International Journal of Applied Psychoanalytic StudiesInt. J. Appl. Psychoanal. Studies (2015)Published online in Wiley Online Library(wileyonlinelibrary.com) DOI: 10.1002/aps.1430 The Skinless Work Group: Facingthe Uncertainty of "Restingon a Void" MATÍAS SANFUENTES This paper examines the conﬂicts and resistances that contemporary organizationsface in the effort of generating new and challenging work opportunities. Assumingthe metaphoric and real character of the ‘body of the organization', differentdilemmas that work groups tackle in the generation of collaborative and productivespaces are described. Based on a socioanalytic consultancy carried out with agroup of Reichian body psychotherapists, the study illustrates the complexities todelineate a common strategy and to overcome the threatening porosity and incon-sistencies of the ‘institutional skin'. The lack of a body support is particularlyparadoxical for a group of psychotherapists that base their therapeutic method onbody techniques, and which crystallizes as an institution the place of rejectionand exclusion that Reich and the concern for the body have historically occupied.Copyright © 2015 John Wiley & Sons, Ltd.

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