CommunityCommunityAcquired MRSAAcquired MRSA

► Julie Clark, RN and Mary Perez, RN Montgomery County Julie Clark, RN and Mary Perez, RN Montgomery County Health DepartmentHealth Department

► April Aleman RN MUHSDApril Aleman RN MUHSD

►Physiology of MRSAPhysiology of MRSA

►Risk factorsRisk factors

►Preventing the Spread of MRSAPreventing the Spread of MRSA

MRSA MRSA Methacillin Resistant Staph AureusMethacillin Resistant Staph Aureus

► Staphylococcus aureus-a type of bacteria that Staphylococcus aureus-a type of bacteria that causes most skin and soft tissuecauses most skin and soft tissue infectionsinfections

► Unable to be killed by common antibiotics Unable to be killed by common antibiotics including all penicillin (Methicillin) and including all penicillin (Methicillin) and cephalosporinscephalosporins

► MRSA has been reported in increasing numbers MRSA has been reported in increasing numbers among healthy persons of all ages. This is among healthy persons of all ages. This is referred to as referred to as Community Acquired MRSACommunity Acquired MRSA

► Grows rapidly and is difficult to killGrows rapidly and is difficult to kill

Results of infectionsResults of infectionsPatients infected with CA-MRSA most often Patients infected with CA-MRSA most often present with: present with:

Skin or soft tissue infections- Skin or soft tissue infections- abscesses, boils, cellulitis, and impetigo

Necrotizing fasciitis leading to disabilityNecrotizing fasciitis leading to disability

Bacteremia leading rapidly fatal Bacteremia leading rapidly fatal septicemia septicemia

EndocarditisEndocarditis

OsteomyelitisOsteomyelitis

Toxic shock syndromeToxic shock syndrome

Risk factorsRisk factors — Although many patients with CA- — Although many patients with CA-MRSA infection have no risk factorsMRSA infection have no risk factors,

THERE ARE SOME SPECIFIC RISK FACTORS:

►Skin trauma (eg, "turf burns", Skin trauma (eg, "turf burns", lacerations or lacerations or

abrasions) abrasions) ►A higher body mass index A higher body mass index ►Cosmetic body shaving Cosmetic body shaving ►Physical contact with a person who has Physical contact with a person who has

a draining lesion or is a carrier of MRSA a draining lesion or is a carrier of MRSA ►Sharing equipment that is not cleaned Sharing equipment that is not cleaned

or laundered between users or laundered between users

Other studies have identified the Other studies have identified the following significant risk factors: following significant risk factors:

►Prison residence Prison residence ►Military personnel Military personnel ►Comorbidities: Comorbidities: Diabetes,Diabetes, Immunosuppressant Immunosuppressant

illness illness

►Prior skin infection Prior skin infection ► Illicit drug use Illicit drug use ►Tattoo recipients Tattoo recipients ►Previous antibiotic usePrevious antibiotic use►Owning a dog Owning a dog

WHAT SPORTS/ATHLETES ARE AT RISK?WHAT SPORTS/ATHLETES ARE AT RISK?

ALL ATHLETES ARE AT RISK ALL ATHLETES ARE AT RISK

Anyone participating in organized or Anyone participating in organized or recreational sports is at riskrecreational sports is at risk

Even though little physical contact occurs in Even though little physical contact occurs in some sports skin contact or activities that some sports skin contact or activities that may lead to spread of MRSA skin infections may lead to spread of MRSA skin infections may take place may take place before or after participation before or after participation such as in the lockersuch as in the locker room. room.

ATHLETES WITH EXTRA RISKATHLETES WITH EXTRA RISK

►Lineman or linebacker position in Lineman or linebacker position in footballfootball

►Wrestling Wrestling ►Rugby Rugby ►FootballFootball►Swimmers who shaveSwimmers who shave►BasketballBasketball

Signs and SymptomsSigns and Symptoms

► Local swelling, redness, heat► Painful lesion or pimple with or without drainage► Boil-tender red lump with a white “head”► Fever► These skin infections commonly occur either at

sites of breaks in the skin such as cuts and abrasions, and areas of the body covered by hair (for example, the back of the neck, groin, buttock, armpit, or beard area of men).

MRSA infections start out as small red bumps that can quickly turn into deep, painful abscesses.

BOILBOIL

BOIL 2BOIL 2

CELLULITISCELLULITIS

CELLULITISCELLULITIS

TRANSMISSIONTRANSMISSION

►Touching skin, wounds of an Touching skin, wounds of an infected personinfected person

►Touching a dog Touching a dog ►Sharing towels Sharing towels ►Touching dirty athletic Touching dirty athletic

equipment equipment ►Touching used bandagesTouching used bandages

MRSA TransmissionMRSA Transmission

► S. aureus is most often spread to others by S. aureus is most often spread to others by contaminated handscontaminated hands

Colonization vs: Colonization vs: InfectionInfection

Colonization – state of a microorganism Colonization – state of a microorganism living in or on a body without causing living in or on a body without causing disease- even after your infection is cleared disease- even after your infection is cleared up, and you don’t experience any up, and you don’t experience any symptoms, you may still carry MRSA. symptoms, you may still carry MRSA.

ASSUME THAT ASSUME THAT ALL ALL

SURFACES SURFACES COULD HAVE COULD HAVE

MRSA BACTERIA MRSA BACTERIA AND AND

PRACTICE PRACTICE PREVENTION!PREVENTION!

PREVENTION Protect YourselfPREVENTION Protect Yourself► Practice good personal hygiene Practice good personal hygiene

Keep your hands clean by washing Keep your hands clean by washing frequently with frequently with soap and watersoap and water or using or using an an alcohol-based hand rub. alcohol-based hand rub.

►Liquid soap is preferred over bar soap Liquid soap is preferred over bar soap in these settings to limit sharing.in these settings to limit sharing.

►Wash your hands after using shared Wash your hands after using shared weight-training equipmentweight-training equipment

PREVENTION CONTINUEDPREVENTION CONTINUED

►Shower immediately after exercise especially Shower immediately after exercise especially after there has been substantial skin to skin after there has been substantial skin to skin contact.contact.►Shower before using whirlpools Shower before using whirlpools ►Report possible infections to coach, athletic Report possible infections to coach, athletic trainer, school nurse, other healthcare trainer, school nurse, other healthcare providers, or parents. providers, or parents. ►Do not share bar soap and towels, razors , Do not share bar soap and towels, razors , clothingclothing► Wear protective clothing or gear designed to prevent Wear protective clothing or gear designed to prevent skin abrasions or cuts skin abrasions or cuts ►Do not share ointments that are applied by placing Do not share ointments that are applied by placing your hands into an open-container. your hands into an open-container.

PREVENTION PREVENTION CONTINUEDCONTINUED

► Use a barrier between skin and shared equipment Use a barrier between skin and shared equipment e.g. exercise machines and massage tables e.g. exercise machines and massage tables

► Avoid contact with other people’s cuts and sores Avoid contact with other people’s cuts and sores ► Wash cuts, scrapes, lesions, insect bites and sores Wash cuts, scrapes, lesions, insect bites and sores

with soap and waterwith soap and water► Do not try to treat the infection yourself by picking Do not try to treat the infection yourself by picking

or popping the sore.or popping the sore. ► Keep lesions clean and dry and cover them with Keep lesions clean and dry and cover them with

bandages until they are healedbandages until they are healed► Change dressings when soiled or damp, place Change dressings when soiled or damp, place

dressings in a paper bag, then placedressings in a paper bag, then place in the regular in the regular garbagegarbage

How should sports equipment be How should sports equipment be cleaned?cleaned?

► Shared equipment should be cleaned after each use and allowed to Shared equipment should be cleaned after each use and allowed to dry, including mats etc. dry, including mats etc. Wipe surfaces of equipment to Wipe surfaces of equipment to disinfect disinfect before and after use, especially if the before and after use, especially if the

surface has become wet with sweat with an surface has become wet with sweat with an EPA registered agentEPA registered agent

► Equipment, such as helmets and protective gear, should be cleaned Equipment, such as helmets and protective gear, should be cleaned according to the equipment manufacturers’ instructions to make sure according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.the cleaner will not harm the item.

► Wash uniforms and clothing after each use. Follow the clothing label’s Wash uniforms and clothing after each use. Follow the clothing label’s instructions for washing and drying. Drying clothes completely in a instructions for washing and drying. Drying clothes completely in a dryer is preferred. dryer is preferred.

► Shower immediately after exercise. Do not share bar soap and towels. Shower immediately after exercise. Do not share bar soap and towels. ► TakeTake

How should athletic facilities be How should athletic facilities be managed?managed?

Athletic facilities such as locker rooms should Athletic facilities such as locker rooms should always be kept clean whether or not MRSA always be kept clean whether or not MRSA infections have occurred among the athletes. infections have occurred among the athletes.

► Review cleaning procedures and schedules Review cleaning procedures and schedules with the janitorial/environmental service staff.with the janitorial/environmental service staff. Cleaning procedures should focus on Cleaning procedures should focus on

commonly touched surfaces and surfaces commonly touched surfaces and surfaces that come into direct contact with people’s that come into direct contact with people’s bare skin each day. bare skin each day.

Cleaning with Cleaning with detergent-based cleaners or detergent-based cleaners or Environmental Protection Agency (EPA) -Environmental Protection Agency (EPA) -registered detergents/disinfectantsregistered detergents/disinfectants will will remove MRSA from surfaces. remove MRSA from surfaces.

Athletic facilities Athletic facilities continuedcontinued

►Non approved cleaners and disinfectants, Non approved cleaners and disinfectants, including household chlorine bleach, can be including household chlorine bleach, can be irritating and exposure to these chemicals irritating and exposure to these chemicals has been associated with health problems has been associated with health problems such as asthma and skin and eye irritation. such as asthma and skin and eye irritation.

►Take appropriate precautions described on Take appropriate precautions described on the product’s label instructions to reduce the product’s label instructions to reduce exposure. Wearing personal protective exposure. Wearing personal protective equipment such as gloves and eye equipment such as gloves and eye protection may be indicated. protection may be indicated.

Athletic facilities Athletic facilities continuedcontinued

►Environmental cleaners and disinfectants should not Environmental cleaners and disinfectants should not be put onto to skin or wounds and should never be be put onto to skin or wounds and should never be used to treat infections. used to treat infections.

►The EPA provides a list of registered products that The EPA provides a list of registered products that work against MRSA (List H): work against MRSA (List H): http://epa.gov/oppad001/chemregindex.htm http://epa.gov/oppad001/chemregindex.htm

►There is a lack of evidence that large-scale use (e.g., There is a lack of evidence that large-scale use (e.g., spraying or fogging rooms or surfaces) of spraying or fogging rooms or surfaces) of disinfectants will prevent MRSA infections. disinfectants will prevent MRSA infections.

►Repair or dispose of equipment and furniture with Repair or dispose of equipment and furniture with damaged surfaces that do not allow surfaces to be damaged surfaces that do not allow surfaces to be adequately cleaned. adequately cleaned.

Should athletes with MRSA skin Should athletes with MRSA skin infections be excluded from infections be excluded from

participation?participation?

► If sport-specific rules do not exist, in general, If sport-specific rules do not exist, in general, athletes should be excluded if wounds cannot athletes should be excluded if wounds cannot be covered by a be covered by a securely attached bandage securely attached bandage that will contain all drainage and will remain that will contain all drainage and will remain intact throughout the activity.intact throughout the activity.

► The athlete needs to told to practice good The athlete needs to told to practice good hygiene measureshygiene measures

► . . ► Top Top

Athletes with MRSA Athletes with MRSA continuedcontinued

► A healthcare provider might exclude an A healthcare provider might exclude an athlete if the activity poses a risk to the health athlete if the activity poses a risk to the health of the infected athlete (such as injury to the of the infected athlete (such as injury to the infected area), even though the infection can infected area), even though the infection can be properly covered. be properly covered.

► Athletes with active infections or open wounds Athletes with active infections or open wounds should not use whirlpools or therapy pools not should not use whirlpools or therapy pools not cleaned between athletes and other common-cleaned between athletes and other common-use water facilities like swimming pools until use water facilities like swimming pools until infections and wounds are healedinfections and wounds are healed

►Question: Do we want to send home Question: Do we want to send home the MRSA flyers to parents?the MRSA flyers to parents?

Preventing the SpreadPreventing the Spread

► Carry alcohol-based hand cleaner with you Carry alcohol-based hand cleaner with you so you can clean your hands if water and so you can clean your hands if water and soap are not availablesoap are not available

AcknowledgementAcknowledgement► Epidemiology and clinical manifestations of methicillin-resistant

Staphylococcus aureus infection in adults John M Boyce, MDUpToDate (16.1)

► PHARMACIST’S LETTER / PRESCRIBER’S LETTERPHARMACIST’S LETTER / PRESCRIBER’S LETTER

October 2006 ~ Volume 22 ~ Number 221008October 2006 ~ Volume 22 ~ Number 221008

Community-Acquired Community-Acquired Methicillin-Resistant Staphylococcus aureus Methicillin-Resistant Staphylococcus aureus (CA-MRSA): An Update(CA-MRSA): An Update

► CA-MRSA Information for the Public, Centers for Disease Control and CA-MRSA Information for the Public, Centers for Disease Control and Prevention, Prevention, www.cdc.gov/ncidodwww.cdc.gov/ncidod

By April Roberts Aleman RN MS School NurseBy April Roberts Aleman RN MS School Nurse

MUHSD Health Services SupervisorMUHSD Health Services Supervisor

Based on the program developed by Based on the program developed by

School Nurse Mary Zombeck RN MS CPNPSchool Nurse Mary Zombeck RN MS CPNP

Diabetes Basics: Diabetes Basics:

A Training A Training Program for Program for

School School PersonnelPersonnel

WHY IS IT IMPORTANT TO LEARN WHY IS IT IMPORTANT TO LEARN ABOUT THIS ILLNESS?ABOUT THIS ILLNESS?

..► People with this illness cannot utilize the People with this illness cannot utilize the

food they eat because they are not food they eat because they are not producing insulin.producing insulin.

► The illness can have deadly complications, The illness can have deadly complications, both short term and long term.both short term and long term.

► The illness requires constant monitoring The illness requires constant monitoring every day of their life, it becomes every day of their life, it becomes oppressive.oppressive.

Different Types of DiabetesDifferent Types of Diabetes

►Type IType I diabetes, also known as diabetes, also known as Juvenile Onset Diabetes, begins in Juvenile Onset Diabetes, begins in childhood up until about age 20. childhood up until about age 20.

► It is believed to be an autoimmune It is believed to be an autoimmune illness, but not genetic.illness, but not genetic.

►Patient is completely dependent on Patient is completely dependent on injected insulin for survival.injected insulin for survival.

Diabetes Type 2Diabetes Type 2

► In type 2 diabetes, either the body In type 2 diabetes, either the body does not produce enough insulin or the does not produce enough insulin or the cells ignore the insulin. cells ignore the insulin.

►Very geneticVery genetic

►High incidence in certain ethnic groupsHigh incidence in certain ethnic groups

Prevention: Diet and Prevention: Diet and ExerciseExercise

AAcanthosis Nigricans canthosis Nigricans 

•TREATMENT•Diet and exercise

•The next step, if necessary, is treatment with oral anti-diabetic drugs. Anti-diabetic drugs include:

Sulfonylureas metformin phenforminrosiglitazone , pioglitazone, troglitazone. acarbose miglitol. nateglinide, repaglinide exenatide liraglutide (not FDA approved) sitagliptin pramlintide

•If necessary some type 2 diabetics need to use insulin.

•The long term effects are the same for diabetes type one: Heart disease

•Heart attacks

•High Blood Pressure

Blindness (retinopathy),

Nerve damage (neuropathy)

Kidney damage

Gestational DiabetesGestational Diabetes► Gestational diabetes affects about 4% of all Gestational diabetes affects about 4% of all

pregnant women.pregnant women.

► We don't know what causes gestational diabetes, We don't know what causes gestational diabetes, but we have some clues. but we have some clues.

The placenta supports the baby as it grows. Hormones The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. from the placenta help the baby develop.

But these hormones also block the action of the mother's But these hormones also block the action of the mother's insulin in her body. This problem is called insulin insulin in her body. This problem is called insulin resistance. resistance.

Insulin resistance makes it hard for the mother's body to Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much use insulin. She may need up to three times as much insulin. insulin.

DiagnosisDiagnosisThe Classic Symptoms The Classic Symptoms

They are all due to high blood sugar which because They are all due to high blood sugar which because the illness is not diagnosed goes untreated until a the illness is not diagnosed goes untreated until a

crisis.crisis.

PPolyphagia (frequently hungry)olyphagia (frequently hungry) Blurred visionBlurred vision Polyuria (frequently urinating)Polyuria (frequently urinating) FatigueFatigue Polydipsia (frequently thirsty)Polydipsia (frequently thirsty) Weight loss Weight loss Poor wound healing (cuts, scrapes, etc.) Poor wound healing (cuts, scrapes, etc.) Dry mouth Dry mouth Dry or itchy skin Dry or itchy skin Recurrent infections such as vaginal yeast infections, Recurrent infections such as vaginal yeast infections,

groin rash, or external ear infections (swimmers ear)groin rash, or external ear infections (swimmers ear)

Why is it important to takeWhy is it important to take care of diabetes??? care of diabetes???

The long term effects for diabetes type The long term effects for diabetes type I: I:

► Heart disease Heart disease ►Heart attacksHeart attacks►High Blood PressureHigh Blood Pressure

► Blindness (retinopathy), Blindness (retinopathy), ► Nerve damage (neuropathy)Nerve damage (neuropathy)► Kidney damage Kidney damage

BALANCING ACT ALL THE TIME

INSULININSULIN

► Insulin is a naturally occurring hormone Insulin is a naturally occurring hormone that moves the glucose that moves the glucose from the blood stream to the cells, so from the blood stream to the cells, so

the body can use the glucose to work.the body can use the glucose to work.

►The pancreas makes insulin as the body The pancreas makes insulin as the body needs it, depending what a person eats needs it, depending what a person eats and how much they exercise.and how much they exercise.

TOO MUCH INSULINTakes too much sugar out of the bloodNot enough sugar in the blood for the brain to work.Brain will die, life will cease.

► TOO LITTLE INSULINTOO LITTLE INSULIN► Results in too much sugar in the bloodResults in too much sugar in the blood► Thirst as body tires to dilute bloodThirst as body tires to dilute blood► Increased urinationIncreased urination► SleepinessSleepiness

Up until Sept 2007 the standard policy in schools was as stated here.

Lawsuit against C.D.E.Lawsuit against C.D.E.► Good settlement results regarding Good settlement results regarding

discrimination and lack of care for diabetic discrimination and lack of care for diabetic students. students.

► EXCEPT The settlement allows an unlicensed EXCEPT The settlement allows an unlicensed school employee to be trained and to administer school employee to be trained and to administer insulin.insulin.

► It is believed that this practice is against the It is believed that this practice is against the Nurse Practice Act and dangerous: school nurses Nurse Practice Act and dangerous: school nurses are refusing to teach UAPs to give insulin.are refusing to teach UAPs to give insulin.

► The issue still needs to be settled.The issue still needs to be settled.► The diabetes association of America is upset The diabetes association of America is upset

because there are not enough school nurses to because there are not enough school nurses to help childrenhelp children. .

FOOD FOOD

►Food provides the body with Food provides the body with glucose.glucose.

►The brain can only use a sugar called The brain can only use a sugar called glucose to work. Without glucose the glucose to work. Without glucose the brain will DIE in a matter of minutes!brain will DIE in a matter of minutes!

Too much or too little FOODToo much or too little FOOD

TOO MUCH FOODToo much food causes the diabetic to gain weightThe diabetic will need more insulin the more he eatsIf he does not take enough insulin, the blood sugar will be high If the blood sugar gets too high this causes hyperglycemia and this causes long term effects

TOO LITTLE FOODTOO LITTLE FOOD► Too little food causes low blood sugarToo little food causes low blood sugar► The blood sugar will be even lower if insulin is taken.The blood sugar will be even lower if insulin is taken.

►Starch 15 CARBS Starch 15 CARBS Breads, Pastas, Beans, Chips, PotatoesBreads, Pastas, Beans, Chips, Potatoes

►Vegetable 5 Vegetable 5 ►Fruit 15Fruit 15►Fat 0Fat 0►Meat 0Meat 0►Milk 12Milk 12

Is good for every student body!!!

Decreasing ExerciseDecreasing Exercise Does not use glucose/sugarDoes not use glucose/sugar

If the diabetic does not eatIf the diabetic does not eat less the sugar will get too less the sugar will get too high in the blood.high in the blood.

If the sugar is high in the blood If the sugar is high in the blood and the diabetic uses insulin to and the diabetic uses insulin to lower it they will gain weight.lower it they will gain weight.

Encourage the diabetic to Encourage the diabetic to exercise and maintain correct exercise and maintain correct blood sugars.blood sugars.

Increasing Exercise:

Uses glucose (sugar)

Causes the level of sugar in the blood to go down (low blood sugar)

Is good for diabetics, but they must plan ahead and have snacks handy in case their blood sugar gets too low.

May have to schedule PE at a time convenient for the diabetic in terms of blood sugar stability.

There are

3 variables

that influence

blood sugar

beyond the tri-angle.

BALANCING ACT ALL THE TIME

► Stress causes the blood sugar to go up. Tests, Stress causes the blood sugar to go up. Tests, boyfriend issues, drama, girlfriend problems, boyfriend issues, drama, girlfriend problems, home dysfunctions, bad grades, up-coming tests, home dysfunctions, bad grades, up-coming tests, no money, yelling teachers, out of control no money, yelling teachers, out of control diabetes; it all can cause the diabetic student to diabetes; it all can cause the diabetic student to have a high level of glucose in their blood.have a high level of glucose in their blood.

► In general illness and injuries cause blood sugar In general illness and injuries cause blood sugar to go up, unless the diabetic stops eating (or is to go up, unless the diabetic stops eating (or is vomiting).vomiting).

Signs of low blood sugarSigns of low blood sugarMOST IMPORTANT PART OF THIS TRAININGMOST IMPORTANT PART OF THIS TRAINING

Mild hypoglycemiaMild hypoglycemia ► Symptoms of mild low blood sugar usually Symptoms of mild low blood sugar usually

develop when blood sugar falls below 60 to develop when blood sugar falls below 60 to 65 mg/dL 65 mg/dL

► Nausea. Nausea. ► Extreme hunger. Extreme hunger. ► Feeling nervous or jittery. Feeling nervous or jittery. ► Cold, clammy, wet skin; excessive Cold, clammy, wet skin; excessive

sweating not caused by exercise. sweating not caused by exercise. ► A rapid heartbeat (tachycardia). A rapid heartbeat (tachycardia). ► Numbness or tingling of the fingertips or Numbness or tingling of the fingertips or

lips. lips. ► Trembling. Trembling.

Moderate hypoglycemiaModerate hypoglycemia ► MOST IMPORTANT PART OF THIS TRAININGMOST IMPORTANT PART OF THIS TRAINING

► If blood sugar continues to fall, the nervous If blood sugar continues to fall, the nervous system will be affected. system will be affected.

► Mood changes, such as irritability, anxiety, Mood changes, such as irritability, anxiety, restlessness, or anger. restlessness, or anger.

► Confusion, difficulty in thinking, or inability Confusion, difficulty in thinking, or inability to concentrate. to concentrate.

► Blurred vision, dizziness, or headache. Blurred vision, dizziness, or headache. ► Weakness, lack of energy. Weakness, lack of energy. ► Poor coordination. Poor coordination. ► Difficulty walking or talking, such as Difficulty walking or talking, such as

staggering or slurred speech. staggering or slurred speech. ► Fatigue, lethargy, or drowsiness. Fatigue, lethargy, or drowsiness.

Severe hypoglycemiaSevere hypoglycemia ► The symptoms of severe low blood sugar The symptoms of severe low blood sugar

develop when blood sugar falls below 30 develop when blood sugar falls below 30 mg/dL and may include:mg/dL and may include:

► Seizures or convulsions. Seizures or convulsions. ► Loss of consciousness, coma. Loss of consciousness, coma. ► Low body temperature (hypothermia). Low body temperature (hypothermia). ► Prolonged severe hypoglycemia can cause Prolonged severe hypoglycemia can cause

irreversible brain damage and heart irreversible brain damage and heart problems, problems,

► If emergency medical treatment is not If emergency medical treatment is not provided, severe hypoglycemia can be fatal.provided, severe hypoglycemia can be fatal.

Denial and Hypoglycemic Denial and Hypoglycemic UnawarenessUnawareness

► Tighter diabetic control is achieved Tighter diabetic control is achieved through intensive insulin therapy; through intensive insulin therapy; however, an unwanted consequence of however, an unwanted consequence of this therapy is a threefold increase in this therapy is a threefold increase in severe episodes of severe episodes of hypoglycemiahypoglycemia

► Developmentally, children may also lack Developmentally, children may also lack the cognitive and emotional sophistication the cognitive and emotional sophistication to develop adaptive coping strategies in to develop adaptive coping strategies in the face of threatening experiences the face of threatening experiences related to related to hypoglycemiahypoglycemia. .

Treatment for hypoglycemiaTreatment for hypoglycemia

►Food-Carbohydrates, simple Food-Carbohydrates, simple then complexthen complex

►JuiceJuice►ChipsChips►FruitFruit►Bagels, etcBagels, etc

►Glucose TabsGlucose Tabs►Gucose GelGucose Gel►GlucagonGlucagon

Glucagon ProcedureGlucagon Procedure

Essential StepsEssential Steps

► Verify signs of severe low blood glucose:Verify signs of severe low blood glucose: Unable to swallow; Uncooperative; Combative; Unconscious.Unable to swallow; Uncooperative; Combative; Unconscious.► Place student on side – or – in upright position if Place student on side – or – in upright position if

restless/uncooperativerestless/uncooperative► Have someone call paramedics, parent, and school nurseHave someone call paramedics, parent, and school nurse► Place one of the following in cheek pouch closest to ground and Place one of the following in cheek pouch closest to ground and

massage:massage: 15 gm. of Glucose Gel15 gm. of Glucose Gel► If student becomes unconscious or starts to seize, give Glucagon If student becomes unconscious or starts to seize, give Glucagon ► Perform first aid for seizurePerform first aid for seizure► When student is able to swallow give sips of regular soda pop (not When student is able to swallow give sips of regular soda pop (not

diet) as tolerated until paramedics arrive.diet) as tolerated until paramedics arrive.► When paramedics arrive, student will be transported for medical When paramedics arrive, student will be transported for medical

care.care.► Document in aeriesDocument in aeries

HYPERGLYCEMIAHYPERGLYCEMIAHigh Blood SugarHigh Blood Sugar

► Excessive thirstExcessive thirst

► Fatigue, weaknessFatigue, weakness

► Increase in number of trips to the Increase in number of trips to the bathroombathroom

► Blurry vision Blurry vision

► Diabetic ketoacidosisDiabetic ketoacidosis

►Water, LOTSWater, LOTS

►ExerciseExercise

► InsulinInsulin

►Re test after 20 to 30 minutes, if Re test after 20 to 30 minutes, if stable return to classstable return to class

HYPERGLYCEMIAHYPERGLYCEMIATreatmentTreatment

MUHSD MUHSD Standard Standard AccommodationsAccommodations

►Students can check their blood sugar Students can check their blood sugar anywhere on campus including in classanywhere on campus including in class

►Students can eat and drink in classStudents can eat and drink in class►Students can go to the restroom as Students can go to the restroom as

neededneeded►Students can use the health office as Students can use the health office as

needed.needed.

CONCLUSIONCONCLUSION

Together we can help the diabetic Together we can help the diabetic student take good care of themselves, student take good care of themselves,

attend school, attend school,

participate in student activities, participate in student activities,

and enjoy life.and enjoy life.