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Treatment of Students with Adrenal Crisis PowerPoint Presentation

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Description : Check out this medical presentation on adrenal gland, which is titled "Treatment of Students with Adrenal Crisis", to know about the adrenal insufficiency in students that places them at risk for adrenal crisis.

Tags : adrenal gland, Treatment, Students, Adrenal Crisis, adrenal insufficiency

Published on : May 06, 2021 | Views : 1622 | Downloads : 3

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1 Treatment of Students with Adrenal Crisis This training was created for teachers and staff associated with students diagnosed with adrenal insufficiency and suffering from an adrenal crisis. EMS & Trauma Program Created 3/2016
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Credits Thank you to the following people and organizations for contributing to the creation of this training protocol: Oregon Department of Education School Nurse Advisory Group Adrenal Insufficiency United 2
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Objectives Review changes to Oregon Revised Statute and Oregon Administrative Rule Identify training requirements Explain the requirements for a School Health Management Plan Provide general information about adrenal insufficiency and the dangers associated with adrenal insufficiency. Be able to recognize the symptoms of a person who is experiencing adrenal crisis and common factors that lead to adrenal crisis. Provide examples of the types of medications that are available for treating adrenal crisis. Instruct on proper administration of several common medications that treats adrenal crisis. Explain the importance of follow-up treatment. 3
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State Law In 2015 the Oregon legislature amended ORS 433.800 – 433.830 (laws pertaining to the training of lifesaving treatments) to authorize persons to be trained to administer medication to students diagnosed with adrenal insufficiency who are suffering from an adrenal crisis when a licensed health care provider is not immediately available and whose parent or guardian has provided the necessary medication and equipment for administration. The Oregon Administrative Rules supporting this law (OAR 333-055-0000 to 333-055-0035) were amended and adopted by the Oregon Health Authority (OHA), Public Health Division in February 2016 to support this training on the treatment of students with adrenal insufficiency. 4
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Conducting Training This training program must be conducted by one of the following individuals: A physician licensed to practice in Oregon; or A nurse practitioner licensed to practice in Oregon; or A registered nurse licensed in Oregon. 5
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Training Recipients The training should be provided on behalf of students with a known diagnosis of adrenal insufficiency that places them at risk for adrenal crisis. The person to be trained must be 18 years of age or older and must have, or reasonably expect to have, responsibility for or contact with a student diagnosed with adrenal insufficiency described above. Individuals who are likely to fall under the definition of the law include public or private school employees and school volunteers. The Oregon Administrative Rule states that school personnel must be retrained every three years on adrenal crisis, but the OHA recommends retraining every year to maintain competency. 6
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School Health Management Plan For children in school, parents or guardians of children with adrenal insufficiency must notify school personnel of their child’s medical needs to initiate a health management plan (may be included in a 504 Plan or Individualized Education Plan (IEP)). This plan should document agreements among the parents or guardian, school personnel, and the student's medical provider about providing a safe and supportive learning environment for the child with adrenal insufficiency. A school nurse, if available, is usually the lead staff for implementation of a health management plan. 7
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School Health Management Plan A School Health Management Plan must include: specific actions for school personnel to perform; a plan for communicating with parents and the child’s medical providers; school policies and procedures for administering medications, including parental authorization; procedures for handling bodily fluids as encountered with vomiting, injections; and an action plan for each child who has adrenal insufficiency, which includes information about medications, dosage, method of administration and frequency, procedures to follow during field trips or outings, and how to handle emergency situations including specific signs and symptoms specific to the student. The child’s medical provider writes and signs medical orders to support the child’s health management plan at the school. 8
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Adrenal Insufficiency Adrenal insufficiency is a chronic medical condition in which the adrenal glands do not produce enough of the necessary hormones (cortisol and aldosterone) to respond to stressors such as illness and injury. These hormones help to maintain and regulate key functions in the body such as blood pressure; metabolism (how the body uses food for energy); the immune system; and how the body responds to stress. 9
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Adrenal Insufficiency Adrenal insufficiency is caused by congenital conditions, cancers, tumors and many other conditions that affect the pituitary gland, adrenal gland or other endocrine organs. Addison's disease, the common term for primary adrenal insufficiency, occurs when the adrenal glands are damaged and cannot produce enough cortisol. Much like a diabetic student who needs insulin, a student with adrenal insufficiency is missing a hormone vital to life and must take replacement medications on a daily basis. 10
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Adrenal Glands The adrenal glands are located on the top of the kidneys The adrenal glands are made up of two parts, the cortex and the medulla 11
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Daily Medications There are many medications that a student can be prescribed to treat adrenal insufficiency. Solu-Cortef or Hydrocortisone are steroids that naturally occur in the body and allow the body to metabolize glucose and control vascular activity to maintain blood pressure. It also controls water and salt balance within the body. In order to keep their condition under control, a student is often required to take a daily, oral dose of hydrocortisone, dexamethasone or prednisone. The medication prescribed must be taken in the amount and at the times identified in the student's health management plan. 12
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Adrenal Insufficiency vs. Adrenal Crisis Adrenal Insufficiency: Chronic condition Adrenal glands fail to produce specific stress hormones The student will take daily medications 13 Adrenal Crisis: Acute This is an exacerbation of a students adrenal insufficiency which can be caused by: Illness Injury Stress Missing daily medications
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Adrenal Crisis Triggers Illnesses such as a cold or the flu An injury, such as a twisted ankle or a broken bone Exposure to stressful situations; i.e. a fire-drill Missing or stopping daily steroid medications Staff should refer to the School Health Management Plan for each student that suffers from adrenal insufficiency and become familiar with what triggers their adrenal crisis and how it presents. 14
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Adrenal Crisis Adrenal crisis is a sudden, severe worsening of symptoms which may include: Severe pain in the lower back, abdomen or legs Muscle weakness or cramping Trouble focusing Lethargy Stomach ache Nausea and/or vomiting Diarrhea Dehydration Low blood pressure Headache Red cheeks (not attributed with recess or PE class) Dizziness Loss of appetite Dark rings under the eyes Changes in emotional behaviors- student may seem upset, angry or more tearful than normal Fainting or passing out Fever (over 100°F) 15
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Stress Dose When a person who does NOT suffer from adrenal insufficiency suffers significant physical or emotional stress, they produce up to 10X the normal amount of hormones needed in response to the event. Patients with Adrenal Insufficiency cannot produce these hormones and must be given an extra dose of medication (on top of their daily prescribed dose) when their body experiences physical or emotional stress. This is called a “STRESS DOSE.” Depending on the severity of the event, a stress dose may be given orally or via injection. 16
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Stress Dose Your student’s School Health Management Plan will have: instructions for oral stress dosing for minor illness or injury instructions for emergency injection for serious illness or injury. 17
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Adrenal Crisis Each student is different and will deteriorate differently. This is related to their age, physical condition and the specific stress event. One third of adrenal crises occur outside of the home. Vomiting and diarrhea account for most adrenal crisis events because it interferes with the absorption of their daily, prescribed medication. 18
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Adrenal Crisis If your student is unconscious, very lethargic or hard to keep awake, he/she is at risk of adrenal crisis. If your student has suffered a traumatic injury such as a broken bone, he/she is at risk for adrenal crisis. Be sure you have reviewed your student’s School Health Management Plan for the instructions on when to give the student an injection. 19
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Crisis Medications When there is suspected adrenal crisis, additional doses of oral medication may be necessary, or an injectable medication, such as Solu-Cortef or Solu-Medrol may be required. Injectable medications are given intra-muscularly, which means that it is injected into a large muscle, such as the thigh or buttock. Remember to consult the student’s School Health Management Plan for the appropriate medication and administration. 20
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Treatment WHEN IN DOUBT, INJECT! The lack of Cortisol (stress hormone) during adrenal crisis puts your student at risk of disability and death. Even if the student is not in crisis, administering the medication will not have any adverse effects. 21
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Medication Access and Storage Plans should be in place to assure that medication is readily available and in close proximity of the student. Consideration of transportation activities such as field trips or other off facility functions must be taken into account when planning emergency measures for possible treatment of adrenal crisis. Depending on the age of the child and school policies, it may be advisable for students to carry their own medication during these special activities and trained personnel must accompany the child. 22
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Medication Access and Storage Oral medication – hydrocortisone tablets should be stored at room temperature (68°-77°F), fludrocortisone acetate (Florinef) should be stored at room temperature (between 59 and 86 degrees) and away from excess heat and moisture. Injectable medications – Act-o-Vials of Solu-Cortef or Solu-Medrol should be stored at room temperature (68°-77°F), in a dry place protected from light. The solution should only be used if it is clear. 23
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Treatment If you determine that your student is suffering from an adrenal crisis: Instruct someone to call 911 and the student’s parents. If the student is still conscious, keep talking to them and reassure them that you are there to help. Keep them calm. Get the injection ready Administer the injection and wait with the student until help arrives. The injection will start to take effect in 15 minutes. Give the empty vial to the Emergency Medical Responders when they arrive. 24
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Equipment Needed Non-sterile gloves Medication Syringe and injection needle Alcohol swab Cotton ball or tissue Sharps container 25
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Preparing for Administration 1. Assemble medication and check the expiration date. 2. Consider location where medication is to be injected. If the injection needs to be in the buttock or upper thigh, it will be necessary for the student to pull down pants or raise a skirt. This should occur in a private location and steps should be taken to make the student as comfortable as possible. Consider having a blanket or curtain. It is recommended that two personnel be present if possible. 3. Wash hands 4. Put on gloves 26
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Preparing Medication “Act-o-Vial” Make sure that the medication is clear and not expired. Press down on the plastic activator (cap) and force the diluent (liquid) into the lower chamber of powdered medication. The rubber stopper separating the two will fall into the lower chamber. Gently mix the solution by turning the vial upside down several times. DO NOT SHAKE. *The solution will initially appear cloudy, then clear. If the solution does not clear, do not administer the medication to the student and wait for rescue personnel to arrive. Remove the plastic tab covering the center of the stopper (small circular disc on the plastic cap). 27
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Preparing Medication – Reconstitution Use a 4x4 gauze to snap off the top of the glass ampule. Use a filter needle to draw up all of the fluid from the glass ampule. Remove the filter needle from the syringe and replace it with a regular straight needle. Remove the cap from the vial of powder medication. Insert the syringe and inject the fluid. Gently mix the solution by turning the vial upside down several times. DO NOT SHAKE. *The solution will initially appear cloudy, then clear. If the solution does not clear, do not administer the medication to the student and wait for rescue personnel to arrive. 28
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Drawing Up the Medication Wipe the top of the Act-o-Vial or Reconstitution Vial with an alcohol swab. Take the cap off of the syringe and insert the needle squarely through the center of the top rubber stopper, just until the tip of the needle is visible in the vial. Invert the vial and withdraw the required dose. Always be cautious when handling needles. 29
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Administering Medications 5. Uncover the area to be injected (upper thigh or buttock). 6. Use an alcohol swab to cleanse the injection site on the skin. 7. Hold the syringe like a dart. 30
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Administering Medications 8. Using the thumb and first two fingers, spread the skin while pushing down lightly. 31
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Administering Medications 9. Dart the needle into the injection site, going straight into the tissue at a 90-degree angle. 10. Depress the syringe plunger, administering the drug into the student. 32
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Administering Medications 11. With draw the syringe quickly and discard into a sharps container. 12. Use a cotton ball or tissue and massage the injection site gently. 13. Clean up and dispose of waste safely. 14. Remove gloves. 33
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After Administration of an Injection Do not leave the child unattended. Advise the 911 dispatcher of the type of medication given. Turn the student on his or her side and monitor their breathing. If the student’s condition worsens, advise the 911 dispatchers of the change in status. 34
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Scenario #1 A student with diagnosed adrenal insufficiency suffers a broken wrist after falling from a jungle gym on a sunny day. She is crying in pain and states her stomach hurts. What would you do? 35
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Scenario #1 Answer Call 911 and call the student’s parents. Reassure the student that you are there to help and keep them calm. Retrieve the student’s stress dose of medication and administer the injection. Stay with the student and place them on their side while waiting for EMS to arrive. Monitor the student’s breathing and level of consciousness. If the student’s condition changes, alert 911 dispatchers. 36
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Scenario #2 A student with know adrenal insufficiency suffers a skinned knee while running from a bee. The child complains of pain to the knee, but is happy that the bee “went away.” The child is alert and has no other complaints. What would you do? 37
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Scenario #2 Answer The child is not suffering from an adrenal crisis at this time. Treat the student for their skinned knee and monitor them. If no other symptoms arise, the student is not at risk for adrenal crisis. Notify the student’s parents of what happened so that they can continue to monitor their child later. Attempt to keep the child relaxed throughout the rest of the day, by not adding any additional stress and by avoiding emotional triggers. 38
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Summary Students who are diagnosed with adrenal insufficiency are unable to produce the hormones needed when responding to specific emotional or physical stressors such as: A broken limb A fire drill The flu Students will need a “STRESS DOSE” of medication when they are suffering from an adrenal crisis. 39
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Summary Adrenal crisis is a sudden, severe worsening of symptoms which may include: 40 Severe pain in the lower back, abdomen or legs Muscle weakness or cramping Trouble focusing Lethargy Stomach ache Nausea and/or vomiting Diarrhea Dehydration Low blood pressure Headache Red cheeks (not attributed with recess or PE class) Loss of appetite Dark rings under the eyes Changes in emotional behaviors- student may seem upset, angry or more tearful than normal Fainting or passing out Fever (over 100°F) Dizziness
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Summary Review and be familiar with your student’s School Health Management Plan for: the student’s baseline activity level, attitude and behavior. the specific emotional or physical stressors that might trigger an adrenal crisis. the student’s past history with adrenal crisis. the medication and administration route that is prescribed to the student from their physician to use during an adrenal crisis. 41
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Summary When in doubt, INJECT the student with their STRESS DOSE! The lack of Cortisol (stress hormone) during adrenal crisis puts your student at risk of disability and death. Even if the student is not in crisis, administering the medication will not have any adverse effects. 42