Managing Existing Health Services
School nurses will need to consider how they're going to manage existing health services including:
- Medication administration
- Performing aerosol generating procedures
- Helping students manage chronic conditions
- Immunization clinics
- Working with students, families, and the communities to promote adequate access to essentials
Although the special focus for this school year is on COVID-19, all the typical healthcare services must still be offered. Organization is going to be crucial, including the updating of all health records for all students. Nurses should make sure they have all current emergency contacts available, and transportation is lined up for any student who can’t reach their emergency contact when needed. Allow for additional time spent at home for students experiencing illness, and find ways to supplement their education with remote learning, if possible. Here are some guidelines for managing specific chronic conditions:
Some of the symptoms of asthma are similar to symptoms of COVID-19, so it will be important to be able to distinguish the difference between an asthma attack and an infection. It is common for asthma sufferers to experience wheezing, shortness of breath, chest pain or tightness, or rapid breathing. These symptoms can sometimes be present in a COVID-19 patient, but the onset will typically be quicker if it’s asthma. The easiest way to tell the difference between the two is looking for symptoms that are not related to asthma, such as a fever, nausea, vomiting, body aches, diarrhea, loss of smell or taste, or headaches.
Asthma treatments using inhalers with spacers are preferred right now over nebulizer treatments whenever possible. It is uncertain at this time, whether aerosols generated by nebulizer treatments are potentially infectious, and they should be reserved for children who cannot use or do not have access to an inhaler.
Based on limited available data, the forceful exhalation required during the use of peak flow meters is not considered to increase the risk of transmitting the virus that causes COVID-19, but it may trigger coughing, which can transmit the virus.
Type 1 Diabetes
Having Type 1 diabetes does not put one at higher risk of contracting COVID-19, but there is a risk of developing more serious complications if diabetes is not well managed. Those who are at the greatest risk are people with consistently elevated blood sugar levels or those with a second comorbidity, including obesity, or heart, kidney, or lung disease. The following steps can be taken to help keep those with Type 1 diabetes safe:
- Monitor a student’s blood glucose and ketone levels more often than normal
- Call a student’s emergency contact if they experience moderate or large ketones or vomiting
- Maintain a strict medication schedule
- Stock the nurse’s station with snacks that will maintain carbohydrate intake, such as crackers, vegetables, noodle soups, and fruit juices
- Remind students that continuous hydration is important
- Keep vital diabetes medical supplies on hand
There is no evidence that epilepsy increases the risk of contracting COVID-19 or the severity of it, and those with epilepsy do not typically have a weakened immune system. However, some people with epilepsy can have other health conditions or be taking medications that put them at higher risk from COVID-19. They may also have other neurological or developmental issues that affect their immunity, and could put them at higher risk of infection. Nurses should note on student files all medical issues an epileptic student has to better understand their situation. For example, a person treating their epilepsy with immunotherapy such as steroids or immunoglobulin may develop a more serious case of COVID-19. In the case of a seizure, make sure that anyone treating the student wears a facemask and gloves.
It’s more important than ever to prevent students with food allergies from coming into contact with a food that will cause a reaction. This will require clear communication with the cafeteria staff to ensure that students with allergies do not accidentally receive another student’s lunch. If a student with food allergies falls into respiratory distress, epinephrine is still a good solution, but remember to wear PPE when helping administer medication, including a facemask or shield and disposable gloves.