29 School Health – Flashcards

c. Lack of another source of regular health care Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.

c. She demonstrated that school nurses decreased absenteeism by 50%. In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.

c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco.

c. The National School Lunch Program The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs.

b. At school, especially on playgrounds Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at schoo

d. Tobacco use Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States.

a. Alcohol All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%).

b. Marijuana The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused.

b. Dental caries One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches.

b. Contagious diseases Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school-aged and adolescent children.

d. Lead toxicity screenings The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing.

Asthma In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps.

e. Attention-deficit hyperactivity disorder (ADHD) medications Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.

a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education.

c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings.

d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers.

Elementary school grades 4, 5, and 6 It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children.

b. Obesity and related problems (diabetes) Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.

c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students.

b. Continue to listen while assessing for possible underlying problems The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.

a. Elementary school grades 4, 5, and 6 Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.

d. That the school should develop an emergency management plan. Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school.

c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.

d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty.

b. Express concern that the student was under a lot of stress and offer to help if possible Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.

b. Meet with the student and ask directly about sexual or physical abuse Adolescents being physically or sexually abused may have symptoms that include changes in behavior; difficulty in walking, sitting, or other movements; and refusing to change into gym attire or participate in physical activities. It would not be appropriate to minimize the situation, call the student out in front of the class, or have a conversation about the importance of physical education. Rather, the nurse should address the potential signs and symptoms that have been displayed by this student.

c. Obesity and nutrition Gordon and Barry surveyed 263 school nurses in 2006 to identify what the nurses believed to be the top research priorities for the specialty. The first most crucial response was obesity/nutrition—nutrition and weight-loss counseling programs, eating disorders, obesity in children and teens, and importance of exercise.

a. Community resources c. School leadership preferences d. State legislative requirements e. Students' needs School health services goals and objectives vary from state to state, community to community, and school to school. These differences reflect wide variations in state regulation, student needs, community resources, funding sources, and school leadership preferences. The national statistics on health problems and teacher preferences do not create differences among schools in regards to health services that are available.

a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 Healthy People 2020 sets goals that schools provide health education courses in priority areas. The six behavioral categories or topics identified include the following negative behaviors that often start in childhood or adolescence and persist into adulthood: (1) alcohol and drug use; (2) injury and violence; (3) tobacco use; (4) poor nutrition; (5) lack of physical activity; and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies. These problems and behaviors are preventable and lead to additional problems. In a comprehensive health education program, students should be given the opportunity to practice decision-making and communication skills. Funding may not fit local needs. All school nurses should be competent in teaching related to healthy behaviors or know experts who could assist. The priorities should be based on Healthy People 2020, not on the parent and student interests or on the basis of available funding sources.

a. Blood pressure d. Height and weight e. Scoliosis f. Visual and hearing acuity Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.

a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered The guidelines from the National Association of School Nurses indicate that medications should be in containers that are properly labeled with all appropriate student and medication information, accompanied by a written request from the health care provider and parent or guardian, and administered without violating standing orders or nursing protocols. The nurse would not typically find an approval from the student's teacher for the student to see the nurse each day for a medication or a student's assent for the medication to be administered. The parents and health care provider are responsible for the written request for the medication to be administered.