7/17/2020 - showmeecho.org · 7/17/2020 6 aerosolized proteins –not odors cause allergic...
TRANSCRIPT
7/17/2020
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FOOD ALLERGIES FOR THE NEW SCHOOL NURSE“WHAT DO I DO NOW?!?”
Sally Schoessler, MSEd, BSN, RN, AE-C
Director of Education, Allergy & Asthma Network
MY NURSING JOURNEY
School Nurse
School Nurse Teacher
State School Nurse
Consultant –New York
State
Director of Nursing
Education –National
Association of School Nurses
Director of Education –Allergy & Asthma
Network –
Asthma Educator
Sally Schoessler
A FEW FACTS
TO GET US
GOING -
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FOOD ALLERGY 101ALLERGENS, ALLERGIES & INTOLERANCES
WHAT HAPPENS IN A FOOD ALLERGY REACTION?
An abnormal
immunologic response
to a food protein
NO reaction at first
exposure
Subsequent exposures –
degranulation of mast
cell – release of
histamine
Allergic reaction occurs
TOP 8
ALLERGENS
Sesame is commonly
considered the 9th top
allergen
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IS IT A FOOD ALLERGY OR
FOOD INTOLERANCE?
Example: Milk
Allergy or Lactose
Intolerance?
Food
Intolerance
Food Allergy
Where reaction takes
place
Digestive System Immune system
Intensity of reaction Mild to moderate
discomfort
Can be life-threatening
Symptoms Gastrointestinal Multiple body systems:
skin, respiratory, heart
and/or gastrointestinal
Reaction time May be delayed Usually immediate
(within 30 – 60
minutes)
Action to take See healthcare provider Call 911 if anaphylaxis
occurs
WHAT SHOULD THE SCHOOL NURSE DO?
First Year Nurse
Identifies students at risk for a life-threatening
allergic reaction
Obtains documentation from Healthcare
Provider (Allergy identification, Emergency
Care Plan, medication orders)
Meets with parents and student to assess
history and understanding of allergy
Future Considerations
Coordinates care between home, school and medical home
Provides education tailored to student developmental abilities, understanding of allergy and ability to self-monitor allergy management
Collects data on prevalence of food allergy at individual school
Advocates for least restrictive educational environment
SCHOOL PARTNERSHIPS
Inform staff with a "need to know" in a confidential manner
Inform teachers & staff with supervisory role with student of allergy – No health lists – provide an Emergency Care Plan (ECP)
Red folder system – ECPs in red folder in each teacher’s upper right hand desk drawer – substitutes should know to find them there
Can post sign with symptoms over phones in each classroom
BUILD BRIDGES – Whenever possible, get to your principal with an issue before a parent or teacher does
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AMERICAN ACADEMY
OF PEDIATRICS
Allergy & Anaphylaxis
Emergency Plan
PREVENTION AT SCHOOLTHE GOAL IS TO NEVER HAVE AN EXPOSURE OR EMERGENCY
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PREVENTION
Different Risks with different routes of exposure
• Oral
• Skin
• Inhalation
Relevant concepts, practical challenges and practical interventions for each
ORAL EXPOSURE
Allergens, hidden ingredients, cross-contact – most allergic reactions start in classroom
Younger students: passing saliva, supervision during meals and snacks
Older students: risk-taking, peer pressure, bullying, kissing
Labels must be read, should offer meals without allergens, assist students with choices
No sharing of food, drink or utensils, no unlabeled food –nonfood celebrations
Strategies to avoid cross-contact, food free classrooms only when necessary
Periodic check-ins with students and staff
SKIN EXPOSURE
Isolated contact on intact skin = no severe or systemic response –skin reactions
Both children & adults touch eyes, nose & mouth regularly
Soap & water best – commercial hand wipes good – Hand sanitizer is not
Nonedible items contain some food allergens – finger paint, play dough, shaving cream
For young children – skin exposure can quickly become mucosal or oral exposure
HAND WASHING! Have a cleaning protocol, curricular activities should be food free
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Aerosolized proteins – not odors cause allergic reactions, can be fatal
Science experiments involving burning/heating of allergens create risk
Use caution when cooking with food, flours, powders & other small particles of food that can go up in the air
Avoid food in curricular classroom activities
Field trips – a mine field of issues for students with allergies –food, activities & more
Some require prior assessment from the school nurse for special accommodations
Law: All students go on the field trip or no students go on the field trip
INHALATION
WHAT SHOULD THE SCHOOL NURSE DO?
First Year Nurse
Assess school & classroom environment to reduce possible exposures – without singling out a student
Help staff to understand how exposures can happen and how to mitigate the risk
Provide basic education for staff
Create an “allergy-aware” school environment
Future Considerations
Provide leadership at the school building and/or district level to promote and enhance allergy prevention strategies
Help student with decision-making skills to help them prevent exposure to allergen
Explore evidence-based allergy information
Resources
Journal articles
SCHOOL PARTNERSHIPS
Develop school-wide allergen avoidance practices –create a safe school environment
Assess classroom for allergens – foods, classroom supplies, instructional materials
Teach staff to read food labels – always consult with parent if unsure
Teach staff about the importance of allergen avoidance – reinforce messages regularly through newsletters, flyers, etc.
Assess cafeteria and special areas for allergens
Always provide for respectful confidentiality for student
Teach staff about student rights to confidentiality – become familiar with FERPA and discourage hallway conversations about health issues
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ANAPHYLAXIS - EMERGENCY CAREEPINEPHRINE FIRST – EPINEPHRINE FAST
TREATMENT OF ANAPHYLAXIS
EPINEPHRINE
Epinephrine First, Epinephrine FAST
Determine the correct dose
Prescriber’s order
If stock, don’t take the time to weigh the child – if you don’t know weight, use Broselow tape (prepare ahead)
When to upsize?
Antihistamine
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TREATMENT OF ANAPHYLAXIS
Stay with and observe student until EMS arrives
Maintain airway, monitor circulation, start CPR if necessary
Do not have the student arise to an upright position
Consider lying on the back with legs elevated, on side if vomiting
Observe for changes until EMS arrives
IF NO IMPROVEMENT OR IF SYMPTOMS WORSEN IN ABOUT 5 MINUTES OR MORE, ADMINISTER A 2ND DOSE OF EPINEPHRINE
Transport to Emergency Department vis EMS even if symptoms get better
WHAT SHOULD THE SCHOOL NURSE DO?
First Year Nurse
Create a medication system that keeps epinephrine accessible but secure (don’t lock it)
Know how to give epinephrine, teach designated staff members to administer an auto-injector
Keep ECPs updated
Know policies about stock epinephrine
Future Considerations
Expand medication system to include
medication accessibility during lockdowns and
building evacuations
Determine best practice for stock epinephrine
storage in your setting
Create medical emergency response team with
well defined staff goals
Lead Table Top Drills with staff
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SCHOOL PARTNERSHIPS
Know who can and will administer epinephrine if nurse is not available
Have school district protocol to back up emergency procedures
Have administration backing about emergency procedures
Give staff a chance to practice with epinephrine trainers
Be sure staff is willing and able to administer ECP.
Develop procedure to manage allergies on field trips, after school activities
QUALITY RESOURCESYOU WANT TO GET SOME OF THESE!
SCHOOL FOOD
ALLERGY
MANAGEMENT AND
PREVENTION PLAN
Page 44 – CDC Voluntary Guidelines
Overall School District Plan
Benchmark to see how your school is
doing with food allergy management
A place to begin!
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FAMEST. LOUIS CHILDREN’S HOSPITAL
Different sections for unique stakeholders
• Families
• Schools
• Healthcare Professionals
ALLERGY & ASTHMA NETWORK RESOURCES
ALLERGY & ASTHMA NETWORK RESOURCES
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FIRST YEAR DO’S AND DON’TS
DO
DO implement 1 – 2 things now
DO add 1 – 2 more strategies for
the next school year
DO develop a vision for where you
want to go
DO ask for help when you need it
DON’T
DON’T feel like you need to do EVERYTHING all at once
DON’T write care plans too long for you to do
DON’T Panic
DON’T judge yourself too harshly
SCHOOL NURSING
School Nursing is the best job you’ll ever have –
It’s hard. There are days when you wonder how you could ever have decided it’s a good idea to be responsible for the health & well-being of hundreds of people every day.
It’s fulfilling. You get to have long-term relationships with your students & you get to show them that they are worth caring about and caring for.
When you fall asleep at night, you never once have to wonder if you made a difference that day.
FOOD ALLERGIES FOR THE
NEW SCHOOL NURSE
THANK YOU FOR LISTENING – HAVE A GREAT FIRST YEAR!
SALLY SCHOESSLER – [email protected]
WWW.ALLERGYASTHMANETWORK.ORG