I work in preschool that serves both typically developing students and children with disabilities. This preschool started out just serving children with special needs, but one family immediately started putting pressure on the directors to upon their doors to typical children as well.
This school opened its doors a few months after our middle daughter (the one with Down syndrome) was born. Our daughter’s services were initially being provided through another agency (UCP), I didn’t even know this new preschool (we will call Rustling Leaves Preschool) that also served infants and toddlers even existed, so, we didn’t question our daughter’s initial placement. (Parent’s you have the right to choose your child’s program, and you are supposed to be given information about all the relevant agencies.) But I digress.
We were touring preschools for our first born and found one that was about 15 minutes away, east of us. The director asked to take a peek at the baby strapped to my chest in a kangaroo pouch. She exclaimed, “Oh, how sweet! Will you enroll her with us in a few years?” I said, “Um… She has Down syndrome. Are you prepared to work with a child with special needs?” She laughed and explained she started out in life as a special ed teacher and she would be happy to have Sheila. She even assured me that she would be prepared to hire an extra staff person to act as a 1:1.
Immediately, I knew where I wanted Sheila to go when it was time for preschool. For her to be welcomed into a typical preschool and to be surrounded by typically developing children seemed like a much saner option for her than to attend a self-contained classroom of children with various disabilities. Sheila was a little mimic and since children with DS learn visually, having typical role-models made more sense. This preschool we will call Rainbow Delight.
When Sheila was around 18-months-old, her OT (occupational therapist) suggested we visit Wind in the Pines, practically in our backyard (seven minutes away), before committing her to a classroom 30 minutes away. A classroom 30-minutes away by car would translate to a 50–60-minute bus ride. After her initial evaluation at the Rustling Leaves Preschool we did make a change. Based on the evaluation, it was determined that my now 2-year-old with DS would enter a center-based program in a self-contained classroom. We were putting her on a bus and sending her off into the big bad world. But she was the only one on the bus and we couldn’t have had a better driver. She was a grandmotherly type figure that would put seasonal decorations on the inside of the roof of the van, so, Sheila had something to look at. She would chatter to her or play children’s tapes – yes, this was the era of cassette players in vehicles.
The next year Sheila would attend Rainbow Delight, the lovely preschool her older sister attended for two years in the morning. A bus would pick Sheila up there and transport her to Rustling Leaves Preschool in the afternoon. The owner of RLP suggested it would be too much for a three-year-old. I suggested that perhaps I knew my hyper, no-nap Sheila better than she did. I stated we could always call another IFSP meeting a few months in, if this was not working.
A few years later I was working for Rustling Leaves Preschool. They already had an (unsupervised) LPN working in the program. I had let it drop that they were putting the LPNs license at risk and since one of the directors was serving on the licensing board, they hired me as a consultant to meet in-person with the LPN 1-hour per week and be available on call for any emergencies. Once all three of our children where in school, I started part time in Rustling Leaves second site.
I started doing health care plans for children long before the state licensing agency mandated Individual Health Care plans (which according to the licensing agency any teacher or TA can write). Since I work in a program where OTs, PTs, and Speech often include a medical history section that sometimes perpetuated misunderstandings or simply wrong medical history, and we sometimes have kiddos with complicated medical conditions with comorbidities, I decided to start doing Nursing Summaries. It is part of gathering information and creating the IHP, EAP, or HA. It creates a current document with more accurate medical information for the therapists to include in their reports.
What do they look like?
NURSING SUMMARY
Child’s Name: School Year:
Date of Birth: County of Residence:
Date of Report: Parent/Guardian:
Chronological Age: Parent/Guardian:
Address: Primary Care Provider:
Phone: Written By:
One or two paragraphs of medical history: depending on child and how complicated their history is followed by a bullet point list of their diagnosis with a brief description.
Example of Bullet List:
Hemodynamic (in)stability is a descriptive term that means there is a stable blood flow. There are a number of factors that can affect how blood flows through the body. The blood vessels and heart will make adjustments to deliver enough oxygen to support the body’s needs in an efficient system. Any condition that affects your circulatory system make this less efficient.
Common signs or symptoms of hemodynamic instability
Fainting Abnormal heart rhythm (arrythmias)
Shortness of breath Decrease in urine output
Dizziness Low blood pressure (hypotension)
Chest pain Confusion
Restlessness Loss of consciousness
Cool Skin Pale skin, or blue tinge to skin (cyanosisHypoplastic Left Heart Syndrome (HLHS) is one of those conditions that affects hemodynamic stability. It is a rare heart defect and is present at birth. This condition means the left side of the heart is very underdeveloped. Treatment is required urgently. This can include either staged surgeries to repair or a heart transplant to replace.
Staged Surgeries include
Descriptions of Stage 1 Norwood procedure, Stage 2 The Hemi-Fontan or Glenn operation, Stage 3 the Fontan procedure and a list of complications
Post-op Stroke acute multifactor embolic stroke occurred following his third surgery. This is a stroke that occurs from an embolism(s) that break away from some other part of the body travel to the brain.
G-Tube placement this happens when a child is unable to get enough nutrition by mouth. As any infant it was required when he was unable to safely swallow liquids. Anything that interrupts the ability of a child to get adequate nutrition orally, such as paralysis of vocal cords, or acute phase post-stroke may necessitate nutritional support via a g-tube.
Hospitalization/Surgeries
Bullet list of Name of hospital with date
Medical Disciplines
Bullet list of Practitioners / Practice Name / Location
· Name of PCO Name of Practice City/State
· Name of Cardiologist Name of Practice City/State
· Name of Heart Surgeon Name of Practice City/State
· Name of Neurologist Name of Practice City/State
· Name of Hematologist Name of Practice City/State
· Name of Ophthalmologist Name of Practice City/State
Medications
Bullet list of medications
Summary and Recommendations these two sections are if you are recommending a nurse 1:1 for the child. The summary goes into detail about about all the nursing tasks—including the need for ongoing assessments. The recommendation states why this warrants the need for nurse. This particular child had “normal” O2 sats in the high 80s-low 90s. This in itself is a concern with frequent drops into the mid to low 80s, he also had a G-tube and feedings. Hence the need for a bit extra in this report.
NURSING CARE UPDATE: associated risks and nursing care needs
· Meeting Nutritional and fluid needs
· At risk for Social Isolation
· At risk for Hemodynamic instability
· At risk for Impaired Gas Exchange
· At risk for Activity Intolerance related to his cardiopulmonary status
· Delays in Growth and Development
· At risk for Activity Intolerance
· At risk for Skin Integrity Impairment
· At risk for Infection
Current Treatments:
· Daily Health Checks including skin checks
· Ongoing assessment for hemodynamic stability
Þ Observation of breathing and O2 saturation
Þ Observation of color and coolness of hands & feet
· Monitoring Nutrition & Hydration
Þ G-Tube Flushes or replacement of fluids if ordered
Þ Assistance with eating and drinking
Þ Maintenance of fluid balance—I&O
· Assistance with feedings to prevent choking/aspiration
· Assistance with ADLS
· Mobility Assistance
Þ Position changes throughout the day
Þ Sitting, standing frame
Þ passive and active range of motion
This is an example of one of our most complex cases that required a 1:1. For other children that have a level of need that does not rise to the need for a 1:1, I do not include the additional summary and recommendation near the end of the report.
I was known for writing a Nursing Summary and doing an Emergency Action Plan for Sheila when she reached adult services, and her program site didn’t initially have a nurse. When they did move to a site with nurses, they were LPNs, so, I continued updating her information.