# 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.**

### 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

**About the Editors**

**Stephanie M. Porter, M.S.N., RN**, is Program/Project Coordinator within the Medicine Patient Services Department at Boston Children’s Hospital.

**Patricia A. Branowicki, M.S., RN, NEA-BC, FAAN**, is Associate Chief Nurse for Medicine Patient Services at Boston Children’s Hospital.

**Judith S. Palfrey, M.D.**, is the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School.

## 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. The manual is divided into two distinct sections:

- Section I: **Children and Youth Assisted by Medical Technology in Educational Settings**
- Section II: **Guidelines for Care**

## Disclaimer
The recommendations contained in this volume reflect the best and most current medical, nursing, and educational advice. However, readers should not assume endorsement by the federal government. Each school system must make its own determinations as to which recommendations to follow and which to reject.

## Tube Feeding

### Gastrointestinal System Structure and Function
The gastrointestinal system breaks down food into basic nutrients that can feed the cells of the body.

#### Gastrostomy Tube
A gastrostomy is a surgical opening into the stomach through the surface of the abdomen. The G-tube may be used to administer medications, nutrition, and fluids directly into the stomach in the following instances:

- Obstruction or abnormality of the esophagus.
- Impaired swallowing, creating a risk for choking/aspiration.
- Difficulty taking enough food by mouth to maintain adequate nutrition.

### Suggested Settings
There are no restrictions as to when a student may be fed. 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. The administration of G-tube feeding may be delegated by the school nurse to individuals with proven competency-based training.

### 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.

### Procedure for gastrostomy tube feeding: gravity bolus method
1. Wash hands.
2. Assemble equipment:
   - Formula at room temperature
   - 60-mL/cc catheter-tipped syringe
   - Tape
   - Gloves
3. Explain the procedure to the student.
4. Position student.
5. Unclamp the tubing and check residuals (if ordered).
6. Clamp tubing, disconnect the syringe, and remove the plunger.
7. Insert the catheter tip of the syringe into the tubing.
8. Unclamp tube, and allow bubbles to escape.
9. Pour feeding/fluid into the syringe and allow to flow in by gravity.
10. Document feeding and/or medication, residual volumes, and feeding tolerance in logs.