The following treatments and medications may be used by the District's Registered nurse (RN), or the designated employees who have documented training by a campus nurse. The acts covered in these Standing Delegated Orders are limited to the following general medical symptoms that can be addressed by the medications listed following package directions. All interventions shall be documented in the student care record. Following implementation of standing delegated orders; any variations should result in parent contact and physician referral.

FIRST AID

ABRASION- Clean with soap and water. May apply antibiotic ointment and/or antiseptic solution. Apply dressing if indicated.

BITES- (Animal/Human)- Clean area with soap and water. May use antiseptic solution/apply dressing. For animal bites: Notify Animal Control, have students/staff seek medical attention for possible rabies treatment if skin is broken or any bat/skin contact.

BURNS- Apply cool compress/water. Refer all suspected stage 2 (blisters) or higher burns to a medical provider. May apply Aloe Vera, external analgesic spray/cream, antiseptic solution for comfort on minor/old burns with SKIN INTACT. Cover with non-adherent dressing if indicated.

CHAPPED LIPS- May apply Vaseline, lip balm, aquaphor, individual protectant product (chapstick single use) to affected area for comfort.

COLD SORES/CANKER SORES- May apply oral analgesic (Orajel) for comfort.

CONGESTION- Increase water intake and rest.

DENTAL/ORAL PAIN- May apply oral analgesic for comfort.

EYE(S) WITH FOREIGN OBJECT- DO NOT ATTEMPT to remove unless it can be gently washed out with water, saline solution or removed with a cotton tipped applicator. Refer to MD as indicated, may patch eye(s) as needed.

EYE IRRITATION/REDNESS- May rinse with saline or apply cool compress for comfort, exclude if purulent drainage is present or excessive clear drainage that cannot be contained.

FEVER OF 100.0- Parent/guardian notified to pick up the child from school for temperature over 100.0 and instructed that the student should not return until fever free for 24 hours without fever reducing medications (Texas Administrative Code 97)

HEADACHE- Rest, cold pack, increase water intake.

INSECT BITES/STING- May apply sting relief products, hydrocortisone 1% cream, Sting Swab, cold compress. Observe for shortness of breath, facial swelling, and hives. If these develop; see emergency care for anaphylaxis.

LACERATION- Hold pressure to control bleeding. Clean with soap and water, if possible. Refer to the physician as indicated or if bleeding persists longer than 15-20 minutes.

NOSE BLEEDS- Apply pressure and/or ice until bleeding stops. May use bleed-cease per package directions.

SKIN IRRITATION/RASH- May apply any/or a combination of the following: cold compress, analgesic skin protection such as Calamine (not containing diphenhydramine), sting relief products or Hydrocortisone 0.5% or 1% cream. Refer to the physician if there is any systemic reaction.

SKIN/WOUND INFECTIONS- Wash with soap and water. Apply antibiotic ointment and apply dressing. Refer to a physician if indicated.

SORE THROAT- Warm salt water gargles (1/4-1/2 tsp salt in lukewarm 8 oz water), analgesic throat spray (if own provided), throat lozenges may be used for comfort.

ASTHMA-RELATED BRONCHOSPASMS- In cases of an asthma attack where a student doesn't have their inhaler, administer albuterol the stock albuterol as per the school's emergency protocol and call 911

ANAPHYLAXIS- Administer Epinephrine Jr. 0.15mg auto injector (children 33-66 lbs.) OR Epinephrine 0.3mg auto injector (over 66 lbs) for signs of anaphylaxis that may include:

• shortness of breath

• onset of wheezing

• pale/bluish skin

• weak pulse

• dizzy

• hoarse/tight throat/trouble swallowing

• significant swelling of lips/tongue

• hives/redness all over body

• repetitive vomiting/diarrhea

• confusion

• OR as ordered on student Anaphylaxis Management Plan/Orders.

District will ALWAYS - CALL 911 when Epinephrine is used, then contact parent/guardian. May repeat dose if no response to epinephrine in 10min and EMS has not arrived. Prepare to administer CPR if needed.

AUTOMATED EXTERNAL DEFIBRILLATION- In accordance with the American Heart Association current Heartsaver Guidelines, an AED for should be readily available for anyone with possible cardiac issues including, but not limited to:

• Pressure, tightness, pain, or a squeezing/aching sensation in chest or arms that may spread to your neck, jaw or back

• Nausea, indigestion, heartburn, or abdominal pain

• Shortness of breath

• Cold sweat

• Fatigue Lightheadedness or sudden dizziness

AED use (Automated External Defibrillation) will be initiated in accordance with American Heart Association current guidelines.

SEIZURES- Provide first aid. DO NOT put anything in mouth, DO NOT restrain, move any objects away from the student and protect the head. Contact 911 for student:

• without a known history of a seizure disorder OR

• seizures lasting longer than 5 minutes OR

• back-to-back seizures unless student's seizure action plans state otherwise

SUSPECTED NARCOTIC OVERDOSE- Naloxone (Narcan) 4mg nasal spray (2 units per box) will be available at all campuses for administration of a suspected opioid overdose. Symptoms may include:

• Person not waking up or respond to your voice or touch and/or

• breathing is very slow (Less than 12-14 breaths/min), irregular or has stopped

• pinpoint pupils

• Fingernails and lips turning blue,

• slow heart rate (under 50/min) Call 911, administer Narcan nasally, and begin CPR until respirations are restored or EMS arrives.

APPROVED MEDICATIONS

The following medications are approved for use/treatment of all students in Overton School District

• Orajel

• Caladryl Lotion

• Hydrocortisone Cream

• Sting Swab

• Triple Antibiotic Ointment

• Saline

• Petroleum Jelly

• Aquaphor

• Isopropyl Alcohol

• Burn Jel

• Aloe Vera

• Analgesic Throat Spray (if own provided)

• 911 Spray

• ST37

Additional Services Available/Provided by Overton ISD District Nurse

Vision and hearing screening done yearly for PK-5th grade, 7th graders and any other student referred for screening

Scoliosis screening 5th and 7th grade girls and 8th grade boys

Goodside health virtual appointments (parents register in advance for this)

Flu shots and other required vaccines by Aurora Concepts

Per doctor's orders

• Daily vital signs

• G-Tube feedings 

Diabetes care

• glucometer checks

• insulin administration

• hypoglycemia and hyperglycemia treatment

• carbohydrate calculation for school meals