Classroom Health Care Plan School: Effective Date: Student Name: DOB: Parent/Guardian: Parent/Guardian: Health Care Provider: School Nurse: BUS: # Allergies: Seizure Disorders, also known as Epilepsy, is a disorder of the central nervous system characterized by a tendency for recurrent seizures. The term “seizure” refers to sudden, uncontrolled episode of abnormal behavior related to abnormal electrical discharges in the brain. A seizure is a symptom of the disorder just as fever is a symptom of infections. Seizure disorders are not contagious or a sign of mental illness. Only in rare cases do seizures require emergency intervention. Most seizures are over in a few minutes and do not require medical follow up. (____) has an absence seizure, which are brief and last only a few seconds. This is the most common type of seizure disorder in children and can occur frequently throughout the day. If frequent, it can severely affect a student's learning. Seizure activity often mistaken for daydreaming may include staring spells, eye blinking, and mild facial twitching. (Add child specific activities.) (____) has a history of febrile seizures. Febrile seizures are seizures that are associated with an illness where the child has a fever. They rarely develop into a disorder where they have seizures on going, as in epilepsy, and usually go away without any treatment. They are the most common seizures in children under five years of age and have an excellent prognosis. Febrile seizures are age dependent and are rare prior to nine months and after five years of age. (Add child specific information.) (____) has generalized tonic-clonic seizures, which are also known as grand mal seizures. This disorder is characterized by loss of consciousness followed by stiffening for few seconds (tonic phase) then followed by period of jerking (clonic phase). As a rule, these seizures last from less than a minute to three minutes. After the seizure, a period of deep sleep occurs (postictal stage) lasting from minutes to hours. (____) a has complicated, difficult to control seizure disorder, called Lennox Gastaut Syndrome. Unlike other seizure types, this condition can lead to increasing permanent brain damage resulting in various degrees of intellectual impairment. Although some skills may be regained, it is felt that the child will have lost some intellectual prowess. He/She can have different types of seizures. He/She has generalized tonic-clonic and absence seizures. (____) is heavily medicated with many different medications. (Name medications.) Developmental arrest or regression can occur after the onset of these seizures. (____) has a simple partial seizure in which only one part of the brain is involved. In this type of seizure, the student is aware of the seizure because consciousness is not impaired. Some symptoms include hand or mouth movement, head or eyes turned to the side, a pins and needles sensation, feeling of numbness, or hearing noises. (Add child specific symptoms.) (____) has a complex partial seizure in which only one part of the brain is involved. The student may be somewhat aware or have a distortion of consciousness. Symptoms are unique from individual to individual. (Add child specific symptoms.) (____) has atonic seizures, which are also known as "drop attacks." These seizures consist of sudden loss of postural tone and consciousness. They may be very brief, in which case a sudden drop of the head or sudden fall may be the only manifestation. More prolonged attacks may begin with a fall but the student then remains limp and unresponsive for seconds or minutes. The more prolonged atonic seizures are usually followed by postictal drowsiness, which helps to distinguish them from these other conditions. (____) has Rolandic seizures. These are light sensitive/self-stimulating seizures. They occur outside in bright lights. He/She has been encouraged to wear sunglasses outdoors. School staff need not take any action when these are observed at school. They should, however report the seizure activity to the parents. (____) has stimulus-induced seizures. In his/her type of seizure, he/she induces the brief electrical discharge himself by ______. It is possible he/she is momentarily unconscious or in a state of altered consciousness at that time. (____) has myoclonic epilepsy. Myoclonic seizures are brief, shock-like jerks of a muscle or a group of muscles. “Myo” means muscle and “clonus” means rapidly alternating contraction and relaxation – jerking or twitching- of a muscle. Usually they don’t last more than a second or two. There can be just one, but sometimes many will occur within a short time. Assessment _____ Student has a reported history of Seizures per parent/guardian on the Nurse Health History Report. _____ Student has a reported history of Seizures per health care provider and a medical statement/documentation has been provided (Seizure Action Plan). Problem (#1) Potential for seizures at school. Plan: Student will be monitored for events that precipitate a seizure. • Student will be monitored for seizure activity. • School staff will report immediately to nurse any warning signs of an impending seizure: ______• If seizure activity is noted, all staff will follow Seizure Action Care Plan (EAP) outlining emergency as applicable. • Student’s privacy and dignity will be maintained during a seizure at school. Goal: Student will maintain optimum health, safety and well-being during the school day. Problem (#2) Potential for injury related to generalized tonic-clonic seizure activity Plan: Student will be monitored for seizure activity. *****ACTIONS FOR STAFF TO TAKE: WHILE STUDENT IS AT SCHOOL: 1. If you witness seizure activity, attempt to prevent injury by easing the student to the floor. 2. Keep hard, sharp or hot objects out the way. 3. Follow Emergency Protocol (School nurse, parent/guardian, and administrator will be contacted by office personnel). 4. On call nurse to be contacted if school nurse or nurse sub is not on campus. 5. Office staff/school nurse/administration will contact emergency services (911) as applicable; seizure lasting longer than ______minutes, or if the student is not breathing. 6. Front office staff will contact the parent/guardian. 7. Front office staff will notify administrator. 8. Turn student to their side to allow saliva to drain and to prevent choking. 9. Do not restrain. You may place a thin, soft towel or item under the child’s head if the floor is hard. 10. Do not force anything between teeth or place any object in mouth. 11. Do not give fluids or food during or immediately after seizure. 12. Loosen restrictive clothing. 13. Observe: Time seizure starts and stops. 14. Document all seizure activity in the seizure log. *****WHILE ON A FIELD TRIP: 1. If you witness seizure activity, attempt to prevent injury by easing the student to the floor/ground. 2. Time the seizure (Start and stop) 3. Keep hard, sharp or hot objects out the way. 4. Turn student to their side to allow saliva to drain and to prevent choking. 5. Do not restrain. You may place a thin, soft towel or item under the child’s head if the floor is hard. 6. Do not force anything between teeth or place any object in mouth. 7. Do not give fluids or food during or immediately after seizure. 8. Loosen restrictive clothing. 9. Call 911 as indicated. 10. Simultaneously beginning CPR as indication, as trained and/or certified. 11. Contact the school to notify nurse/administration of situation. 12. Nurse/Administration will contact the parent and notify them of the situation. 13. Document all seizure activity in the seizure log. *****WHILE ON THE BUS RIDE TO AND FROM SCHOOL:

Goal: 1. Student will participate fully in the educational program. 2. The following adaptations or precautions will be needed during times of minimal adult supervision; such as, when student is on playground, walking across campus, in the cafeteria, on a field trip, etc.: ______

Problem: Absence seizures Plan: Has a history of absence (petit mal) seizures a. A person with absence seizures may appear as if they are staring off and daydreaming. The person will not respond when addressed. b. Other signs of absence seizures activity include: lip smacking, eye fluttering or eye rolling. c. Possible warning and or behavior changes prior to seizure can include: ______1. Possible triggers that should be avoided: ______2. No emergency intervention is required for these seizures. 3. School staff should document all observed seizure activity in the seizure log. a. If seizures are increasing, notify school nurse and collaborate with parent/guardian. b. If student becomes sleepy after the seizure, notify school nurse. c. Parents should be encouraged to share the school seizure log with student's doctor. Goal: Appropriate identification and reporting of seizure activity. Problem: Potential need for medication for management of seizure disorder Plan: ____Student will come to the nurse’s office for supervised administration of the following medication(s) according to written health care provider’s orders, and a completed Medication Authorization Form per parent/guardian. ____ Student requires medication to be given only at school in the event of a seizure. _____Student does not require medication to be given at the onset of a seizure. Medication: Dose: Route: Time: • All Harrison County School District Medication Policies and Procedures will be followed for administration of medication. • Student will be reminded to come to the nurse’s office for medication if the student does not report within 15 minutes of scheduled time of medication administration. • Parent will maintain an adequate supply of medication at school. • Parent will be given a 5-day notice when supply of medication needs replacement. • Staff will follow Seizure Emergency Action/Care Plan. Goal: Prevention of seizure activity Problem Potential for seizure medication side effects Plan: 1. Student, school nurse, and school personnel will recognize and report any adverse side effects of seizure medication. 2. Student and school personnel will be educated on the side effects of the seizure medication individual student is prescribed. 3. Parent will be notified if there are any concerns regarding the medication which might require medical follow up. 4. Although extremely rare to need immediate emergency intervention due to seizure medication side effects; if the above student needs emergency care, emergency protocol is to be followed. Goal: Early recognition and reporting of side effects. Problem: The Individual Health Care Plan (IHP) will be reviewed annually with the parent/guardian as well as appropriate staff members. This plan may be revised and/or updated as appropriate to ensure the most current treatment modalities for the student. The school nurse will train and supervise all non-medically licensed school personnel who are delegated for implementing any portion of this plan as appropriate. Plan: The IHP will be reviewed, as outlined in the Mississippi Board of Nursing Assisted Self Administration Curriculum. Goal: The IHP will be updated and revised annually to meet the health needs of the student, to provide the best educational outcome for learning as in partnership with current Health Care Provider Orders.

______Parent Signature Date

______School Nurse Signature Date