phb-porter-all.indb
Supporting Students with Special Health Care Needs
Guidelines and Procedures for Schools
Third Edition
edited by Stephanie M. Porter, M.S.N., RN and 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
- Caring for Children with Special Health Care Needs in Schools and the Community ... 3
Authors: Ann Marie Foustoukos, Elizabeth Tannebring, Elena Daha-Slavkova, Maureen McAndrew, Emily Jean Davidson, and Lynn A. Hook - Legal Issues in the Education of Students with Special Health Care Needs ... 37
Authors: Matthew Engel, Patricia Mariko Favini, and Tim Sindelar - The Child with Special Health Care Needs: Planning for Care in the Educational Setting ... 65
Authors: Christine M. Obusek, Dorothy R. Page, Karen Baldassari, Judith S. Palfrey, and Stephanie M. Porter
II Guidelines for Care
- Tube Feeding ... 211 Authors: Julia M. Perkins and Fiona Paul
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. The mouth, throat, esophagus, stomach, and small intestine are components of this part of the digestive tract.
Procedure for gastrostomy tube feeding: gravity bolus method
| Procedure |
|---|
| 1. Wash hands. |
| 2. Assemble equipment: |
| • Formula at room temperature |
| • 60-mL/cc catheter-tipped syringe or other container for feeding |
| • Clamp or cap for end of tube (if needed) |
| • Water (if prescribed) |
| • Gloves |
| 3. Explain the procedure to the student at their level of understanding. |
| 4. Position student. |
| 5. Wash hands. Put on gloves. |
| 6. Unclamp tubing and check residuals (if ordered) by inserting a catheter tipped syringe. |
| 7. Clamp tubing, disconnect the syringe, and remove plunger from syringe. |
| 8. Reinsert catheter tip of syringe into tubing. |
| 9. Unclamp tube, and allow bubbles to escape. |
| 10. Pour feeding/fluid into syringe and allow to flow in by gravity. |
Suggested Settings
There are no restrictions as to when a student may be fed. The student may be fed with other students or, if they prefer, in a more private setting (e.g., the health room). The frequency of feedings will depend on the student’s individual needs.
Individualized Health Care Plan: Issues for Special Consideration
Each student’s individualized health care plan (IHCP) must be tailored to their specific needs. The following items should receive particular attention:
- Student’s underlying condition and possible complications
- Obtain doctor’s orders for procedures and treatments
- Size and type of feeding device
- Requirements for repositioning after feeding
- Frequency of measuring gastric residuals
- Standard care precautions
- Manufacturer’s specific instructions
Possible problems that require immediate attention
| Observations | Reason/action |
|---|---|
| Facial color changes/breathing difficulty | Stop feeding, assess the situation, and notify staff. |
Possible problems that are not emergencies
| Observations | Reason/action |
|---|---|
| Nausea and/or cramping | Check rate of feeding and temperature of formula. If necessary, adjust as per student guidelines. |
NOTE: This content is an excerpt from Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools, and is intended to provide general information and guidance for care.