School Nurses: Partnering to Avoid & Respond to Anaphylaxis
School nurses can play a vital role in helping to avoid and manage an anaphylactic reaction
Episode 1 talks about the role of school nurses as the healthcare professional and team leader when it comes to preventing anaphylaxis in the learning place and encourages parents to reach out and partner with their child’s school nurse.
- Moderator: Tia Campbell, MSN, RN, NCSN, Vice President, NASN
- Speaker: Suzie Trotter, MA, BSN, RN, Public Health Nurse Supervisor
Chesterfield County Health Department, School Health Services
Anaphylaxis Information & Resource Section
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This section provides information, answers to some frequently asked questions and links to serveral resources that you may find useful.
Anaphylaxis is a severe, life-threatening, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance such as bee sting venom, a person's immune system becomes sensitized to it. On a later exposure to that allergen, an allergic reac-tion may occur. This reaction happens quickly after the exposure, is severe, and involves one or more body systems. MedLine Plus, 2012
Like other allergic reactions, an anaphylactic reaction does not usually occur after the first exposure to an allergen but may occur after a subsequent exposure. However, many people do not recall a first exposure. Any allergen that causes an anaphylactic reaction in a person is likely to cause that reaction with subsequent exposures, unless measures are taken to prevent it.
Anaphylaxis can occur in response to any allergen. Common causes include, but are not limited to:
- Food allergies such as nuts and shell fish
- Drug allergies for example penicillin or sulfa
- Insect bites/stings
- Latex allergies
Pollens and other inhaled allergens rarely cause anaphylaxis. However some people have an anaphylactic reaction with no known cause. Anaphylaxis is life threatening and can occur at any time.
MedLine Plus – US National Library of Medicine, Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/000005.htm
Symptoms develop rapidly, often within minutes and may include the following:
- Respiratory System: coughing, wheezing, shortness of breath, chest pain/tightness, swelling or tightness of the throat, hoarse voice, nasal congestion, trouble swallowing (70% of reactions)
- Cardiovascular System: weak pulse, dizzy or lightheaded, loss of consciousness or collapse, shock, pale/blue color, palpations (10-45% of reactions)
- Skin: Hives/itching, warmth, redness, rash (80-90% of reactions)
- Gastrointestinal System: nausea/vomiting, pain, cramps, diarrhea (30-45% of reactions)
- Central Nervous System: uneasiness, throbbing headache, dizziness, confusion, tunnel vision (10-15% of reactions)
Other symptoms: swelling of the tongue, anxiety, headache, metallic taste, and some report a sense of impending doom.FAAN, 2012
In some reactions, the symptoms go away, only to return one to three hours later. This is called a “biphasic reaction.” Often these second-phase symptoms occur in the respiratory tract and may be more severe than the first-phase symptoms. Studies suggest that biphasic reactions occur in about 20% of anaphylactic reactions.
Allergens are present at school, as they are in any environment, and as children spend much of their day in the school setting, it is necessary to identify a student’s specific allergen and work to avoid an exposure to that allergen. Possible causes of allergic reactions include, but are not limited to:
- Certain drugs such as penicillin
- Foods such as peanuts or shellfish
- Substances such as latex
- Insect bites
Approximately 20-25% of epinephrine administrations in schools involve individuals whose allergy was unknown at the time of the reaction. Food allergy is the leading cause of anaphylaxis outside the hospital setting. More than 15% of school aged children with food allergies have had a reaction in school.
Special precautions include identifying ingredients in art materials and paint products as some contain egg. Be sure school supplies such as pencils, band aids, and gloves do not contain latex. Work with your custodial staff and grounds keepers to address wasp or hornet nests and to monitor bee activity near playgrounds and ball fields.
Anaphylaxis is an emergency condition that needs professional medical attention right away.
When anaphylaxis occurs, it is a dire emergency. Anaphylactic reactions begin within 1 to 15 minutes of exposure to the allergen.
The school nurse has nursing assessment skills to effectively identify anaphylaxis and it is vital that epinephrine, the drug of choice, be administered without delay. Emergency medical services, or 911, should be accessed and the student should be transported to the hospital as soon as possible. The nurse provides training and education to school staff for emergency response in the event that the nurse is not available to initiate the emergency care. There are many more aspects to anaphylaxis care and these are covered in online learning modules available from NASN.
Robinson & Ficca, 2011
Elements of a strong anaphylaxis action plan include not only the health history and medical orders from the student’s medical provider, but also the critical communication and training for school staff to be ready to respond and to be aware of anaphylaxis signs and symptoms.
It takes a team to implement a health emergency action plan. The team is typically composed of school staff, administration, teachers, cafeteria manager, transportation, counselor, athletic trainer, parent, student and nurse. As there is no cure for life-threatening allergies, it is important to prevent exposure and through awareness education to the entire school staff.
Once a plan is brought to the school by a parent, student specific precautions and emergency response plans are communicated by the school nurse to those staff who will be directly involved with the students emergency response if the need should arise. Attention to the individual students developmental needs is important to address as well as confidentiality and emotional support for any student with a health concern.
Epinephrine auto-injectors were developed for use by laypersons, or non-medical personnel, for quick and immediate access to emergency medication. The first minutes before the arrival of emergency medical services personnel are critical when responding to life-threatening medical emergencies. Epinephrine auto-injectors are packaged in two different doses based on the child’s weight. The school nurse has the expertise and knowledge to train school staff on the proper selection, use, administration skills, and disposal methods as well as the process for storing, transporting and maintaining safe medication administration in schools.
The school nurse is the school leader and health professional for health related concerns. The parent should arrange to meet with the school nurse before the school year begins when possible, to discuss their child’s specific needs and their concerns, and any time the health status of their child changes. As a part of the parent – nurse collaboration the parent needs to supply the nurse with a written diagnosis and medication permission and the parent needs to provide the medication to the school. The school nurse can, with parent permission, collaborate with teaching staff, food service staff and other school team members to create a safe environment for the student. Supporting the success of a student with a life threatening allergy requires a team approach with a coordinated plan case managed by the school nurse health professional.
Parental collaboration is critical to creating a safe environment
Watch Episode 2 >>
About the NASN program
School Nurses: Partnering to Prevent & Respond to Anaphylaxis
This 3-Part Video Series is designed to help create a safer learning environment for students with severe allergies. The three programs are designed to empower parents to partner with their child’s school nurse and create an action plan that promotes allergen avoidance and has a clear course of action when it comes to emergency response.