# Supporting Students with Special Health Care Needs ## Guidelines and Procedures for Schools ### Third Edition edited by **Stephanie M. Porter, M.S.N., RN** **Patricia A. Branowicki, M.S., RN, NEA-BC, FAAN** and **Judith S. Palfrey, M.D.** Boston Children’s Hospital Boston, Massachusetts *Illustrations by Marcia Williams* *Photographs by Douglas Quagliaroli* --- ## Contents - About the Downloadable Materials ... xi - About the Editors ... xiii - Contributors ... xiv - Foreword Betsy Anderson ... xvii - Preface ... xix - Acknowledgments ... xxi - How to Use This Book ... xxiii - Disclaimer ... xxv ### I Children and Youth Assisted by Medical Technology in Educational Settings 1. Caring for Children with Special Health Care Needs in Schools and the Community ... 3 2. Creating a Positive School Experience: Perspectives from the Team ... 17 3. Legal Issues in the Education of Students with Special Health Care Needs ... 37 4. The Child with Special Health Care Needs: Planning for Care in the Educational Setting ... 65 5. Preparing Students for Health Care Transition: Strategies for Youth, Families, and School Nurses ... 109 6. Safe Transportation of Children with Special Health Care Needs ... 141 7. Infection Prevention and Control in the School Setting ... 151 8. Allergies to Food and Latex in the School Setting ... 163 9. Disaster Planning for Children with Special Health Care Needs and Disabilities ... 175 10. Working with Families and Students of Diverse Cultures and Languages ... 191 ### II Guidelines for Care 11. Tube Feeding ... 211 12. Intravenous Lines ... 249 13. Dialysis ... 267 14. Clean Intermittent Catheterization ... 279 15. Ostomy Care ... 291 16. Respiratory Care ... 313 17. Diabetes ... 387 18. Neurological Issues ... 451 --- # How to Use This Book This manual and its guidelines are intended for use by professionals and parents who care for children and youth who are assisted by medical technology. Parts of this manual are written for people with little or no medical background. Other parts detail the specific technical procedures that are needed by children with specific conditions daily. Many of the materials are intended for distribution and daily use. Forms to use when developing individualized health care plans (IHCPs), emergency plans, and checklists about each procedure/technology are included. # Tube Feeding ## Gastrointestinal System Structure and Function The gastrointestinal system breaks down food into basic nutrients that can feed the cells of the body. Functionally, the gastrointestinal tract is divided into two parts: upper and lower. The upper gastrointestinal tract is where digestion and absorption of most of the nutrients occur. ### Gastrostomy Tube A gastrostomy is a surgical opening into the stomach through the surface of the abdomen. There are different types of gastrostomy tube (G-tube) devices. The G-tube may be used to administer medications, nutrition, and fluids directly into the stomach. ### Suggested Settings There are no restrictions as to when a student may be fed. The setting should be clean and appropriate to the student’s need for privacy. Students who require more frequent feedings should be allowed to receive them in the classroom. ### Suggested Personnel and Training A health assessment needs to be completed by the school nurse. State nurse practice regulations should be reviewed to ensure that the management of G-tube feedings can be considered a delegable task by the school nurse. ### The Individualized Health Care Plan: Issues for Special Consideration Each student’s individualized health care plan (IHCP) must be tailored to the individual’s needs. The following items should receive particular attention: - Student’s underlying condition and possible problems associated with the treatment. - Obtain doctor’s orders for procedures and treatments. - Size and type of feeding device. - Type of feeding the student is receiving (e.g., bolus/continuous). ### Procedure for gastrostomy tube feeding | Procedure | | --- | | 1. Wash hands. | | 2. Assemble equipment: e.g., formula, 60-mL/cc catheter-tipped syringe. | 3. Explain the procedure to the student. | | 4. Position student. | | 5. Wash hands and put on gloves. | | 6. Unclamp the tubing and check residuals if ordered. | | 7. Pour feeding/fluid into the syringe and allow it to flow in by gravity. | | 8. Flush tubing after feeding. | | 9. Document feeding/medications on log sheet. | ### Possible Problems | Observations | Reason/action | | --- | --- | | Facial color changes/breathing difficulty | Stop feeding immediately, call nurse, assess situation. | | Nausea and/or cramping | Check rate of feeding; it may need to be decreased. Notify school nurse if problem continues. | | Blocked G-tube | Try to clear with warm water via catheter-tipped syringe. Contact nurse/family if blockage remains. | --- For comprehensive guidance and additional procedures, refer to the full manual.