Examples of High Health Needs

These examples describe students' high health needs and the paraprofessional care they require. The examples show how students meet Criteria 1 - 4 above.

The examples are fictional and not based on any individual child or student.

A. The student needs support during and after seizures that are unable to be effectively managed by medication.

For example, the student needs:

• to be removed to a quiet area to sleep and monitored for further seizure activity, vomiting or other post-seizure effects
• medication to be administered during or after the seizure (e.g. rectal suppositories), and/or ambulance called and family notified
• toileting and showering following seizures
• supervision to prevent injury in all curriculum areas where safety issues would arise if a seizure occurred e.g. swimming, technology (in particular: food, electronics, production and process), science, and Education Outside The Classroom
• support with eating and to prevent choking because of continuous seizure activity

Example

Jonno has seizures at least twice, and up to ten times, during a school day. All attempts to manage his seizures by medication and diet have been unsuccessful. Seizures last between three and 15 minutes. They are more frequent if he is tired, stressed or 'off colour'. Rectal medication needs to be administered for seizures lasting more than five minutes (currently an average of twice a week). After a seizure, he requires support with showering, and removal to a quiet area to sleep (between half an hour to one hour). When he is sleeping at school a person stays with him at all times.

B. The student needs help with mobility or personal care arising from severe fatigue directly related to a medical condition.

For example a student with:

• cancer who is undergoing therapy (e.g. radiotherapy, chemotherapy) and suffers from severe fatigue, headaches, nausea and vomiting, and is unable to self propel a wheelchair. Care is for pushing the wheelchair between classes, monitoring pain and fatigue levels, administering appropriate medications, and cleaning up after vomiting
• a terminal cardiac/lung condition requires help to propel a manual wheelchair and with frequent toileting (transfers and dressing)
• a severe tremor in upper left body as a result of brain injury requires care to prevent injury when using equipment, to monitor for frequent headaches and supervise appropriate treatment for pain.

Example

Kathryn has extreme fatigue as a consequence of partial renal failure and associated malnutrition and high blood pressure. It is anticipated that she will have chronic needs until a transplant is possible in 'about two years time' (paediatrician, 10/00). Kathryn needs help with toileting because of extreme oedema. She has difficulty getting on and off the toilet and cleaning herself as her genital area is swollen and sensitive, and often needs cleaning after a cough or sneeze.

A timetable of medication and nutrition supplements needs to be followed during school hours. Kathryn needs a wheelchair for outings as she suffers extreme fatigue if she walks more than 50 metres; she is unable to propel the chair herself. She also needs frequent rests during the school day.

C. The student needs support to protect them from (or manage the effects of) exposure to injury, infection or allergen that would result in a medical crisis.

For example a student with:

• severe allergies, asthma, or eczema as a reaction to common allergens in the school environment. The student needs supervision to prevent contact with allergens and emergency treatment procedures if they go into anaphylactic shock.
• bone marrow disease requires supervision to prevent injury because of the severe effects of bruising or bleeding.

Example

Lars has a number of severe allergies the most serious of which is to latex. This can lead to anaphylactic shock. Sensitivity to latex is reported as being such that even the presence of a rubber band in a room can set off symptoms. Close supervision is a priority, and careful monitoring of the environment to ensure it is latex free.

The school has undertaken to manage the wider environment, with a goal of eradicating latex contaminants as much as possible. However Lars' combined allergies limit the environments he can be in and the materials he uses. His breathing and mobility are seriously affected by his allergies, varying from hour to hour and day to day depending on the status of his condition.

In the home setting he is independently mobile for 15 - 20% of the time. At school he will require daily support for the use of inhalant medication, to push his wheelchair when needed, and to monitor the environment. Exposure to latex will require immediate crisis intervention.

D. The student is dependent on specialised medical appliances, apparatus or equipment such as oxygen bottles or tracheotomy tubes. The equipment must be monitored for safety reasons in all environments and requires an instant response if the equipment fails.

For example the student:

• is on continuous oxygen connected by tube to an oxygen bottle and requires physical help by an adult to carry the equipment in all environments.
• is fed via gastrostomy tube with several feeds occurring during school hours and requires the tube to be held by an adult. The student is unable to safely self manage the appliance because of their developmental stage.
• has a tracheostomy and tube inserted in the neck. Fluid needs to be regularly removed from the opening to prevent blockages and ensure the free passage of air. Care is for supervising breathing and preventing blockages especially when the student is eating. The student is too young to self-manage.
• has severe breathing difficulties and uses a nebuliser more than three times each day and requires help to use the equipment safely.

Example

Keri had a tracheostomy and is fitted with a tube in her neck. If problems occur she needs a person available who can immediately replace the old tube with a new one. The tube needs to be suctioned 2-3 times during the school day - more often in cold, windy weather and when heaters are on.

Keri requires help at meal times - suctioning the tube before eating and monitoring food intake. She needs a person trained in CPR to be close to her at all times to monitor her safety, e.g. check that the tube is not accidentally dislodged, and take emergency action if it is required.

An emergency plan is in place and an emergency kit on hand.

E. The student has safety or personal care needs in the school setting arising from an ongoing high health condition.

For example a student:

• requires catheterising daily during school hours and has been unable to develop self-management of this task despite a number of training programmes over the years. Care is for safe catheterisation.
• has had surgery for anal reconstruction and continues to have frequent uncontrolled bowel motions throughout the day. The student is young and requires an adult to carry out hygienic cleaning procedures. In the longer term it is expected the student will learn to self-manage.

Example

Paulina will be starting school soon - she has been on visits and is excited about participating next term. She has a history of medical interventions and procedures associated with situs invertous kidney, bowel and bladder. She had reconstructive surgery completed early this year, with a mertropinoff and 'Mickey G' button, both situated on her abdomen. Bowel flushing through the 'Mickey G' will be permanent and will be done once a day at home.

At this stage there is bowel leakage during the day (about 3-4 times a week) after which Paulina requires cleaning and a change of clothes. This is expected to resolve within the next year. She also requires catheterising at morning tea and lunch times, a task she is unable to do herself. Because she has frequent urinary tract infections catheterising is painful, and she is very anxious at these times. Medical staff expect that Paulina will managing her own continence by age eight years.