First Aid

CHAPTER 12 First Aid



Chapter Outline



Abdominal Pain


Bee, Wasp, Yellow Jacket, and Hornet Stings


Warm-Blooded Animal Bites


Human Bites


Insect Bites


Tick Bites


Bleeding


Blisters


Bruises


Burns


Chemical Burns


Chemical Burns of the Eye


Dislodged Contact Lens


Diabetes Mellitus


Eye Injury


Foreign Body in Eye


Fainting


Severe Fall


Flesh Wounds/Lacerations


Fractures


Headache


Head Injury


Epistaxis (Nosebleed)


Foreign Body in Nose


Heat Cramps


Heat Exhaustion


Heatstroke/Sunstroke


Shock


Splinters


Sprains and Strains


Tooth Injuries


When student illness or injury occurs in the school setting, the school nurse is called on to provide leadership. The school nurse must be knowledgeable to provide the necessary care and to direct others in providing first aid daily and in emergency and disaster situations. A school emergency plan for all students and staff should be in place. Individualized health care plans (IHCP) and emergency care plans (ECP) should be available for all medically involved students (e.g., diabetics, asthmatics). These plans allow the nurse to be free from all tasks except caring for the involved student, while others are helping with the necessary telephone calls and other duties. Documentation must follow all incidents regardless of severity. Universal Precautions must be followed when providing health and emergency care to students and staff.


This chapter provides information for basic first aid for numerous common emergency situations. Box 12-1 lists supplies that are useful for first-aid kits. When a nurse cannot be at the school site when an emergency arises, teachers or other school personnel must know how to handle such situations. The nurse can use this chapter as a teaching tool for training school staff, thereby ensuring provision of appropriate health care and sound advice. Nursing practices vary by state, county, and school district; so nurses must be aware of, and compliant with, individual school policies and procedures.



Box 12-1 Nurse’s Health Office Supplies


The Following Items Are Listed by A or B When Useful for the Following Kits:



A First-aid kit for classroom


B First-aid kit for field trips


First-aid manual for classroom or field trip (A, B)


Vinyl gloves (A, B)


Mild soap


Antiseptic solution


Sodium bicarbonate


Hypoallergenic adhesive tape, several sizes (B)


Elastic (Ace) wraps, 2- and 4-in (B)


Gauze rolls, stretch (B)


Gauze squares, different sizes


Triangular bandage


Adhesive bandages (Band-Aids), various sizes; Steri-Strips, butterfly bandages (A, B)


Cotton balls (A, B)


Cotton applicators


Tongue blades (A)


Combine dressings (ABD pads) for heavy bleeding (B)


Topical skin powders and adhesives for lacerations or wounds (B)


Splints: small, medium, and large


Tweezers


Cold packs, instant


Moistened towelettes


Antibacterial hand soap (B)


Sunscreen (B)


Eye cup


Eye pads


Bottle of eye irrigation solution


Contact lens case (B)


Paper cups


Red plastic bags


Small plastic bags, resealable plastic bag (A, B)


Scissors (A, B)


Thermometer


Matches


Penlight (B)


Blanket: lightweight and washable


Bleach


Sanitary napkins


Disposable protective gown or apron


Protective eyeglasses


Mouth-to-mouth resuscitator with one-way valve (A, B)


The following are used by school nurses under the direction of a health care provider (HCP) and with parents’ signed consent:



1. Autoinjector pen with epinephrine (EpiPen, Twinject) and epinephrine solution and syringes.


2. Antihistamines such as diphenhydramine (Benadryl).


3. Acetaminophen.


Some medications may be stored in a locked container in the classroom or carried on the student if requested and authorized by the parents. The nurse must check individual state, county, and school district policies regarding particular medications, storage methods, and disposal procedures.



ABDOMINAL PAIN




I. Immediate First Aid


A. Have the student lie down; keep student warm and quiet.

B. Obtain appropriate history regarding onset, circumstances, and duration of pain; note presence of fever, nausea, vomiting, guarding, abdominal rigidity, constipation, or diarrhea.

C. Determine type of pain: dull, diffuse, sharp, localized, continuous, or intermittent.

D. Do not give student anything to eat or drink.

E. Notify parents and urge them to seek immediate medical care for their child if pain is severe, persistent, or if student health history indicates a pathological condition.


BEE, WASP, YELLOW JACKET, AND HORNET STINGS


Any stings by bees, wasps, yellow jackets, or hornets can present a life-threatening emergency; therefore, special precautions are necessary when administering first aid. If a child is known to be sensitive or allergic to bee stings, keep an emergency bee-sting kit at the school site, keep it available when students are outside, and take it on all field trips. Some students are allowed to keep an epinephrine injection, such as an Epipen or Twinject, with them. More than one individual, including the student, should be trained in the proper administration of the injection.


If a student is stung and has history of allergies or severe reaction, give injection and quickly activate EMS, especially if generalized or local symptoms continue after injection, such as throat and chest tightness, wheezing, swelling of the face, abdominal pain, or nausea and vomiting.



I. Immediate First Aid


A. Remove stinger as soon as possible, keeping it intact by brushing it out as gently as possible with thumbnail, credit card, straight-edged object, or a piece of cardboard. Speed is essential. Do not delay removal, because it will prolong pain and venom will continue to enter the body.

B. Pinching or using tweezers to remove a stinger may release more venom into the body.

C. Wash with soap and water.

II. Symptoms of Allergic Systemic Reaction: Mild Reaction


A. Flushed skin and itching.

B. Stinging and swelling.

C. Apply ice, ice water, cold washcloth, or paste of sodium bicarbonate (baking soda).

D. Administer antihistamine, unless contraindicated on student health records; some states, school districts, or counties require a medical order that may be either generic or child-specific.

E. Notify parents.

III. Symptoms of Systemic Allergic Reaction: Severe Reaction


A. Flushed skin, puffy face, mouth, or eyelids.

B. Hives or extensive skin rash.

C. Difficulty breathing or swallowing; hoarseness.

D. Sneezing, coughing, or asthmalike wheezing.

E. Gastrointestinal complaints.

F. Generalized swelling, dizziness, nausea, weakness, paleness, faintness, or confusion.

G. For severe reaction, call 911 and give epinephrine injection, unless contraindicated on student health records; some states, school districts, and counties require a medical order that may be either generic or child-specific.

IV. Prevention


A. If highly allergic to bees and insects, avoid wearing strong-smelling perfumes and carrying or standing near sweet drinks and foods that attract bees; trash containers on school playgrounds may attract bees. Allergic students should wear light-colored clothing.


WARM-BLOODED ANIMAL BITES




I. Immediate First Aid


A. Capture the animal, if this can be done safely; if not, have someone follow the animal so that authorities can capture it later. The animal must be kept under observation for 14 days to rule out rabies.

B. Wear gloves and use universal precautions. Rinse wound immediately under running water; scrub wound thoroughly with soap and water; repeat procedure three to four times. Cleaning the bite is important to wash the animal’s saliva from the wound.

C. Notify parents; inform them of the importance of consulting their HCP.

D. Report the bite to a state or county health department and follow their instructions. The incubation period for rabies in humans is usually several weeks to months but it ranges from days to years (CDC, 2007).


HUMAN BITES


Wounds caused by human bites, especially if they are deep and penetrating, are extremely dangerous, because it exposes the person to bacteria and blood-borne pathogens.



I. Immediate First Aid


A. Wear gloves and use universal precautions.

B. If wound is bleeding freely, allow bleeding for 3 to 4 seconds, then irrigate the wound under running water.

C. Wash wound with water and soap, preferably antiseptic soap.

D. Let wound dry and apply sterile dressing.

E. Further treatment depends on hepatitis B immunization information for both individuals.

F. Human immunodeficiency virus (HIV) transfer is a threat; victim, perpetrator, or both may need testing, depending on county, district, or school policy or HCP’s recommendation.

G. Notify parents and urge them to contact their physician; alert parents to signs of possible infection.


INSECT BITES


Bites from insects such as mosquitoes, fleas, and chiggers can cause swelling, irritation, and redness. Chiggers are tiny red mites that live in tall grass and weeds, and they are usually found on a person’s legs and around the belt line; itching lasts 5 to 6 days but can persist for months. Impetigo can occur as a result of scratching the bites.



I. Immediate First Aid


A. Wear gloves and use universal precautions.

B. Wash with soap and water.

C. If the bite is swollen or inflamed, cover it with an ice pack or cool compress.

D. If no systemic allergic reaction occurs, follow procedures for bee and wasp stings.

E. Notify parents.


TICK BITES


Ticks can transmit bacteria that cause several diseases, including Lyme disease, which has been diagnosed in almost every state (seeChapter 4, Chronic Disease). Another disease is Rocky Mountain spotted fever, which occurs in temperate zones: symptoms include headache, fever, and muscle pain followed by a skin rash.


Ticks are small, brown, blood-sucking mites (arachnids) that are found in shrubs, grasses, vines, brush and heavily wooded areas. They attach themselves to humans and animals and adhere tenaciously to the skin or scalp. All parts of the tick must be removed. If mouth fragments or proboscis are left in the skin, local symptoms will develop. Evidence suggests that the longer the infected tick remains attached, the greater the chance of disease transmission.



I. Immediate First Aid


A. Carefully and quickly remove the tick with fine-tipped tweezers or gloved fingers in one motion; grasp close to the skin, and be certain to remove all parts of the insect. Save tick for identification if possible to identify the likelihood of serious disease transmission; place in a container of alcohol to kill and preserve the tick.

B. Gently scrub the bite area with soap and warm water to remove any bacteria present on the skin.

C. Do not apply heat (lighted match or cigarette) to the tick’s body or cover it with any type of oil, alcohol, or other such liquids. These methods may leave tick parts in the wound, injure the victim’s skin, or cause complications.

D. If the student must stay in school, and the tick cannot be removed, cover it with a dressing. The tick should be removed as soon as possible, because the risk of infection increases between 24 to 72 hours after the tick attaches to the skin.

E. Observe for rash, headache, fever, and difficulty walking.

F. Notify parents and educate them regarding disease transmission, signs of infection, and necessity of contacting HCP.

II. Prevention


A. Wear hat, long sleeves, and pants; tuck pants into socks or boots and tuck shirt into pants.

B. Use insect repellent; DEET, an active ingredient in many repellents, is safe and most effective repellent when instructions are followed (EPA, 2007).

C. Examine for ticks after possible exposure, checking limbs, scalp, nape of neck, under arms, around waist, and on clothing.

D. Wear white or light-colored clothing.


BLEEDING




I. Immediate First Aid


A. Put on gloves and use universal precautions. If gloves are unavailable, use other protective material and wash hands thoroughly as soon as possible.

B. Place thick, sterile gauze pad directly over wound; if sterile material is not available, use cleanest cloth or material.

C. If bleeding is severe and continuous, apply pressure directly over the wound until bleeding stops; elevate wound above victim’s heart level if possible.

D. Do not remove impaled object.

E. Never remove initial dressing; if additional dressings are needed, place them over the old dressing; continue direct hand pressure even more firmly if bleeding persists.

F. Monitor for signs and symptoms of shock.

G. Activate EMS for severe bleeding or bleeding that does not stop with first aid.

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Sep 16, 2016 | Posted by in NURSING | Comments Off on First Aid

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