Rachel Gallagher, RN, CPNP, NCSN DPI School Nurse Consultant [phone] [e-mail]

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Rachel Gallagher, RN, CPNP, NCSNDPI School Nurse
Consultant(608) 266-8857Rachel.gallagher_at_dpi.wi.
gov

• Save a Life with
• Rectal Diazepam
• Diastat

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Audio difficulties

• Make sure the volume is turned up (volume button
  beneath the speakers picture)
• Make sure the volume on the computer is turned up
  (volume icon located on the right hand side of
  your computer taskbar)
• Contact your IT department
• If audio and visual is lost during the program,
  go back to http//media2.wi.gov/dpi/catalog/,
  and click on the Student Services Prevention and
  Wellness Team link on the left, then when the
  SSPW Team page of archived programs appears,
  select the program link desired.
• If problem persists contact Rachel Gallagher
  [phone].

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Training

• Knowledge training - webcast
• Competency checklists are available at
  http//dpi.wi.gov/sspw/schlnurse.html

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Outline

• What is a seizure, status epilepticus, and acute
  repetitive seizures?
• What is the prevalence of epilepsy?
• What are the goals of seizure management?

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Outline

• What are the school responsibilities for
  management of student with epilepsy?
• What are the steps in the administration of
  rectal diazepam - Diastat?
• What are the side effects of rectal diazepem -
  Diastat?

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What is a seizure?

• An abnormality resulting in a sudden episode of
  uncontrolled electrical activity in the brain. If
  the abnormal activity remains confined to one
  area, the person may experience tingling or
  twitching of only a small area of the body, such
  as the face or an extremity. If the electrical
  activity spreads throughout the brain,
  consciousness is lost and a tonic clonic or
  generalized seizure results. Recurrent seizures
  are called epilepsy.
• Causes of seizures may be many, including
  neurological or medical problems including head
  injury, infection, stroke, brain tumor, metabolic
  or alcohol.

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What is status epilepticus and acute repetitive
seizures?

• Status Epilepticus
• Continuous seizure activity
• Seizure activity lasting gt5 minutes (Lowenstein,
  1999 DeLorenzo, 1999)
• Delays in treatment (5-10 minutes) dictates
  outcome of SE emergencies.
• Acute Repetitive Seizures
• Intermittent seizure activity lasting 30 minutes
  or more with a return to consciousness (Bleck,
  2002).

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What is the prevalence of epilepsy?

• 1.5 million Americans active epilepsy
• 325,000 children (up to age 14) have active
  epilepsy (EPA, 2006)
• 300,000 per year newly recognized seizure

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More data

• 90 of seizures last less than 2 minutes
• The longer the seizure, increases the likelihood
  of long term complications and mortality
• 126,000 to 195,000 estimated cases per year of
  status epilepticus 42,000 death each year in
  U.S.

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What are the goals of seizure management?

• The time of seizure onset to initial treatment is
  critical in attaining seizure control and timely
  administration of effective seizure treatment is
  essential to preventing neuronal damage and
  permanent cerebral injury (Bleck, 1999).
• Prompt treatment of prolonged seizures prevents
  status epilepticus and decreases mortality or
  death (Pellock, 2004).

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What are the school responsibilities for
management of student with epilepsy?

• Identification of students with epilepsy.
• Develop school policy and procedure for epilepsy
  management.
• Emergency and Individual Health Care Plan
• Training of staff on first aid, medications, and
  emergency action plan.
• Minimize impact to the students education.
• Obtain medical provider and parent authorization.
• Verification of dosage.

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Verification of Dosage
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Recommended dosage by weight
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5 Rights or the 5R

• Right Student
• Right Medication
• Right Dosage
• Right Time
• Right Route
• Right Documentation 5Rs 2
• Right Reason

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What are the steps in the administration of
rectal diazepam - Diastat?

• 1. Time seizure and determine need to administer
  medication.
• 2. Have another adult call 911.
• 3. Wash hands (if time allows) and apply gloves.
• 4. Confidentially remove clothing from buttocks
  and drape.
• 5. Push up on cap with thumbs to remove cap.
• 6. Lubricate the tip by inserting it into water
  soluble lubricant.

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Steps cont.

• 7. Move the student to side-lying position,
  facing you with upper leg forward exposing
  rectum.
• 8. Separate the buttocks to expose the rectum.
• 9. Insert the syringe gently into the rectum
  until the rim is snug against the rectal opening.
• 10. With syringe still in rectum administer the
  medication by depressing plunger over the count
  of three.
• 11. Slowly count to three before removing syringe
  from rectum.

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Step cont.

• 12. Remove syringe from rectum.
• 13. Immediately hold buttocks together and count
  to three again, to prevent leakage of medication.
• 13. Note time.
• 14. Monitor seizure and respiratory effort.
• 15. Begin CPR as needed.
• 16. Notify school nurse and parent.
• 17. Keep student on their side.
• 18. If not already done, call 911.
• 19. Remove gloves, wash hands and secure
  supplies.

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The Three 3

• Depressing plunger or inserting medication
• Hold the syringe in rectum
• Hold buttocks together

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• Demonstration
• The three threes

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Emergency Medical Services or 911

• School District Decision Local Control
• School Districts Are Responsible for Emergency
  Nursing Services
• Medical Provider and Parent Directives

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What are the side effects of rectal diazapem -
Diastat?

• COMMON side effects of Diastat decreased
  coordination diarrhea dizziness drowsiness
  headache nervousness stomach pain stuffy nose.
• SEVERE side effects can occur when using Diastat
  severe allergic reactions (rash hives
  itching difficulty breathing tightness in the
  chest swelling of the mouth, face, lips, or
  tongue) anxiety hallucinations mental or mood
  changes muscle spasms or twitching new or
  worsened seizures overexcitement low blood
  pressure, shortness of breath sleep
  disturbances trouble sleeping wheezing.
• Closely monitor students receiving Diastat

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Documentation

• Follow your school districts procedures for
  documentation.

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Questions!!!

• School Nurse
• Medical Provider
• Parent

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Contact

• Any comments regarding this webcast?
• Any suggestions on future school nursing topics?
• Contact
• Rachel Gallagher
• [phone]
• E-mail rachel.gallagher_at_dpi.wi.gov

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• Take Test.Upon Completion, take test to nurse or
  administrator for scoring.