Food Allergy Health Care Plan Name: Parent: Home Phone: Emergency/Cell: DOB: Allergies: Medications:
Effective Date: School: Bus: yes no School Nurse: Doctor: Preferred Hospital:
Office # Office #
(Add personal data: i.e. onset, brief history, etc and change to regular font.) Anaphylaxis is a rare, life-threatening allergy to certain substances such as foods, bee stings, chemicals and medications. It occurs rapidly and can effect the entire body. It can close off the breathing passages; it can affect the skin (rash), it affects the heart and/or it can give stomach upset. If immediate treatment does not occur, it can be fatal. Exposure to this substance should be avoided, including skin contact, at all times! (____) wears a Medic Alert neck chain. (For the Nurse: Posting the picture, in the main office and in the lunchroom office (in a discreet place), of students with a history of anaphylaxis can be helpful. Nuts are a common cause for anaphylaxis Consider establishing a nut free zone at school. A nut free table at lunch is an easy accommodation. The table is reserved for any student that is eating a nut free lunch. The table must be washed with clean soapy water, separate from the other tables.) Problem: Breathing difficulty Goal: Maintain airway. Action: 1. (____) has a severe allergy to ________, which can be life threatening. 2. Symptoms of anaphylaxis include: Tingling sensation in the mouth Feelings of apprehension Swelling of the tongue and throat Difficulty breathing Hives Itching Vomiting and/or abdominal cramps Chest pain Diarrhea Drop in blood pressure Weakness or dizziness Wheezing Shallow respirations Loss of Consciousness. 3. If the above symptoms are noted: Do not hesitate to administer medication and call 911. a. If (____) presents with one of the above symptoms (i.e. hives or rash from skin contact) immediately give Benadryl as ordered by his/her health care provider. Wash the affected area with soap and water and call parents. Continue to monitor for progression of symptoms b. If two or more of the above symptoms are present immediately give Epi-Pen Jr. (Inject into lateral thigh and Benadryl as ordered by his/her health care provider. c. Call 911, and then call his/her parents. Problem: Epinephrine injection Goal: To understand what is given in the EpiPen or Twinjet Action: 1. Epinephrine is a hormone produced by all of us in the adrenal glands and is released in response to stress. An injection of epinephrine is a way to give a higher dose of something our bodies are already making. It is important to note that there is little downside to giving epinephrine if it is not needed. Delaying treatment can result in tragedy.
2. Epinephrine has three major actions that are important in the treatment of anaphylaxis. It constricts blood vessels and helps reduce the swelling caused by the allergic reactions. It helps to open the breathing passages and it helps prevent blood pressure from falling. 3. Epinephrine is very safe, but can cause minor side effects, including rapid heart beat, shakiness, headache, and restlessness. 4. Prepared to initiate CPR if breathing stops. Problem: School staff must be trained in how to give EpiPen or Twinjet injection. Goal: To understand how to give in the injection. Action: 1. The kit must be readily accessible and available at school or on field trips at all times. (____)’s medication will be kept at school in _____________. 2. Check expiration date every month to insure safety. 3. A minimum of three people must be trained in kit use. At school, _________, _______________, and ______________ are trained to give emergency injections. 4. Administration of EpiPen: 1. Take out of the plastic cover 2. Do not remove gray safety cap until ready to use. 3. Place black tip on the upper, outer thigh at right angle to leg. 4. Press hard into thigh until you hear the click. 5. Hold for 10 seconds against thigh. 6. Massage injection area for 10 seconds. 7. Discard injector properly. 8. Call 911 immediately. One person stays with (____) at all times. Notify parents 9. Prepare for a second injection as ordered. Repeat steps 1-7.
(OR) 5. Administration of Twinjet:
1. Pull off the green end cap labeled #1. You will now see a Gray cap. Never put your thumb, finger, or hand over the gray cap. 2. Pull off the red cap labeled #2. 3. Put the gray cap against the middle of the outer, upper thigh 4. Press down firmly and hold for 10 seconds against thigh. 5. Remove the twinjet- check the gray cap to make sure the needle is exposed. If you do not see the needle, repeat steps 3 and 4. 6. Call 911. Notify parents 7. Get ready for the second dose: unscrew and remove the gray cap (beware of the exposed needle). Then, holding the blue hub at the needle base. Pull the syringe from the barrel. Then slip the yellow orange or orange call or off the plunger. 8. If symptoms are the same or worse and Emergency medical personnel have not arrived, prepare a second dose. Inject the needle into the upper outer thigh and push the plunger in and remove the needle. 9. Discard injectors properly.
School Nurse Signature:
Date:______________
Trained Campus Staff Signature:___________________________________ _ Date:______________
Trained Campus Staff Signature:___________________________________ _ Date:______________
Trained Campus Staff Signature:___________________________________ _ Date:______________
For more information: http://www.foodallergy.org/anaphylaxis/index.html http://www.foodallergy.org/anaphylaxis/index.html http://www.anaphylaxis.com/pro/6_6_2.cfm?continue=1 http://www.twinject.com/
6/2012
Anaphylactic Reaction Emergency Steps Observe for symptoms: • • • • • • • •
Apprehension and flushing Sneezing, Coughing, wheezing, or shortness of breath, hoarseness Itching, burning, or rash Swelling of the lips, tongue or mouth, tightness in the throat Pallor or bluish color Passing out Abdominal pain
When in doubt, treat for the reaction.
Directions for use of the EpiPen: 1. PULL OFF THE GRAY SAFETY CAP. 2. PLACE BLACK TIP ON OUTER THIGH. 3. PUSH EPIPEN AUTO-‐INJECTOR AGAINST THIGH UNTIL UNIT 4. 5. 6. 7. 8. 9.
ACTIVATES. HOLD IN PLACE TEN SECONDS. REMOVE NEEDLE MASSAGE INJECTION SITE. DISCARD UNIT BY GIVING IT TO THE EMERGEGY MEDICAL TEAM CALL 911 NOTIFY PARENT
MANAGING ANAPHYLAXIS IN THE SCHOOL SETTING.
Anaphylaxis is a life threatening immunologic
syndrome of acute onset, which has more systemic manifestations and often has an identifiable cause. Diagnosis: 1. 2.
History and physical exam Skin testing
Signs and Symptoms: 1. 2. 3. 4. 5. 6. 7.
Anxiety, flushing Rash and itching (skin and/or eyes) Nausea, vomiting, dizziness, sweating, headache Trouble breathing, sneezing, coughing, wheezing, runny nose Heart beat is irregular, chest pain Drop in blood pressure Abdominal pain
Management: 1. 2. 3. 4.
Clear and secure airway Rapidly assess level of consciousness Give Epi-Pen and/or Benedryl as ordered Position on back with legs elevated
5.
Call 911 and alert parent
Prevention: 1. Avoidance
2. Epinephrine- when in doubt… treat!
TREE NUTS Read Labels Carefully! Common Names of Tree Nuts
Always Contains It
Cashews Nut Meat, Nut Pieces and Nut Oil Pecans Nut Paste (such as almond paste) Macadamia nuts Ganduja (a nut mixture in some chocolate) Almonds Pesto Pistachios Mandelonas Brazil nuts Marzipan/Almond Paste Pine nuts Nan-‐Gai Nuts Hazelnuts Nougat Walnuts Pralines Hickory Nuts Nut Butters Natural Nut Extract Pinion Artificial Nuts Common Sources/Foods Containing Tree Nuts: Artificial Nut Meal nuts (peanuts altered to look and taste like almonds, Caponata pecans and walnuts) Other Names for Tree Nuts Baked goods (cakes, cereal bars, cookies, doughnuts, Anacardium nuts energy/granola bars, muffins, pastries) Mandelonas (e.g. peanuts that have been altered to Baking mixes, cereals, crackers, muesli look and taste like tree nuts) Coffee grinders Marzipan (almond paste) Dressings/gravies Nu-‐Nuts ™ (e.g. peanuts that have been altered to Chinese food look and taste like tree nuts) Gianduja (chocolate and chopped nuts mixture found in premium or imported chocolate and ice cream) The Following Are Nuts, But Not Considered “Tree Ice cream/frozen desserts/frozen yogurts/sundae Nuts”: toppings Coconut Lychee Nuts Natural flavorings and extracts Nutmeg Shea Nuts Nut butter Water Chestnuts Nut-‐flavored coffee/liqueurs Non-‐Food Sources of Tree Nuts Sauces (barbeque, pesto, Worcestershire) Hacky sacks Salads (Waldorf salad, curried chicken) Bird seed Spreads (almond paste, cheese, chocolate nut, nougat, Cosmetics, hair care products, lotions Nutella) Pet food Trail mixes