Chronic+Health+Impairments

= Asthma =


 * Asthma is a chronic condition that is the result of the body's antibodies reacting to antigens and causing swelling, mucus secretion, and muscle tightening in the lungs. This can cause repetitive episodes of coughing, tightness in the chest, shortness of breath and wheezing. [[image:82155250.jpg width="238" height="154" align="right"]]
 * Asthma has no set pattern and its symptoms can vary from mild to severe, can differ from person to person, can flare up intermittently, and can change from one episode to the next
 * The cause of asthma is not known and there is currently no cure
 * One out of eight Canadian children has asthma. In Ontario it is nearly one out of five. As a result, every school will have a number of children with asthma and there are likely to be several children in each classroom with asthma as well.
 * According to the Asthma Society of Canada, asthma is the most common childhood disease and is the leading cause of school absenteeism

= What the Classroom Teacher Needs to Know: =
 * 1) Ensure that you know which students in the class have asthma and/or use inhaler medication
 * 2) Allow students with asthma easy access to their inhalers - either allow them to carry the inhaler themselves, or keep it in an easy to access location in the classroom, in the event of an emergency [[image:200249490-001.jpg width="206" height="205" align="right"]]
 * 3) Be aware of the signs and symptoms of respiratory distress and have an emergency action plan
 * //Serious Medical Conditions Protocol Registration// form
 * The Asthma Society of Canada's "asthma in schools" website has a "Managing Asthma Episodes" poster available for download at the following address: []
 * 1) Identify and reduce common asthma triggers from the classroom environment
 * Common colds and viruses (encourage frequent handwashing)
 * Dust (do not encourage asthmatic students to clean the chalkboard; ensure the janitorial staff keeps the classroom clean)
 * Animal dander, saliva and urine (no classroom pets)
 * Strong odours (i.e.perfume/aftershave, hairsprays, cleaning products, paint fumes, art supplies such as markers and glue)
 * Extreme temperatures (hot or cold) and high levels of humidity
 * 1) Sensitize other students in the class to the nature of allergic reactions and the symptoms of respiratory distress
 * 2) Remain calm if an asthma attack occurs

= Accommodations/ Modifications: =
 * Be aware of what types of physical limitations need to be set (i.e. restricted physical activity) *this information should be on the //Serious Medical Conditions Protocol Registration// form
 * Be aware of the physical environment of the classroom. Keep student away from windows (outdoor allergens) and dusty places (the chalkboard) [[image:84303884.jpg width="204" height="134" align="right"]]
 * Allow frequent washroom and water fountain breaks and/or allow the student to keep a bottle of water at his/her desk
 * Develop an effective system for helping the student keep up with school work as frequent absences may occur
 * Consider possible strategies for if/when frequent absences are a problem

= Diabetes =

> > ** What the Classroom Teacher Needs to Know: ** = Accommodations/ Modifications: = >> = Cystic Fibrosis =
 * There are three main types of diabetes. **Type 1 diabetes**, usually diagnosed in children and adolescents, occurs when the pancreas is unable to produce insulin. Insulin is a hormone that controls the amount of glucose in the blood. Approximately 10 per cent of people with diabetes have type 1 diabetes. [[image:mdl037.jpg width="173" height="204" align="right"]]
 * The remaining 90 per cent have **type 2 diabetes**, which occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 diabetes usually develops in adulthood.
 * A third type of diabetes, **gestational diabetes**, is a temporary condition that occurs during pregnancy. It can result in an increased risk of developing diabetes in both mother and child.
 * Type 1 diabetes control means frequent monitoring of the level of glucose in the blood in order to keep it as close to normal as possible. The variables of control are: food, exercise and insulin.
 * Generally, food makes glucose levels rise, and exercise and insulin make glucose levels fall
 * Ensure correct instructions, action plans, and routines are left for supply teachers
 * Be prepared to recognize and respond to the symptoms of hypoglycemia and hyperglycemia
 * The emergency situation you are most likely to encounter when dealing with a student with Type 1 diabetes is low blood sugar (hypoglycemia). This may be caused by eating too little, not eating soon enough after a previous meal, too much physical activity without eating, or too much insulin. Symptoms, listed below, can appear very suddenly and in various combinations
 * headache, sweating, shakiness, pale & moist skin, cold & clammy, weakness or dizziness, fatigue, blurred vision, shallow breathing, inability to concentrate, loss of coordination, mental confusion, seizure, loss of consciousness
 * Treatment: If the student is awake and can swallow, provide sugar immediately (i.e. 1/2 cup of juice, soda or 2-4 glucose tablets). The student should be feeling better within 10 minutes. Parents should be notified.
 * Hyperglycemia (high blood sugar) can also occur. This is the result of too much food, too little physical activity or not enough insulin, and can be determined through testing blood with a glucose meter. Symptoms can include:
 * Increased thirst, weakness or fatigue, blurred vision, frequent urination, loss of appetite
 * Treatment: If this occurs, the parent should be notified
 * Ketoacidosis is a diabetic emergency. In most cases, very high blood sugar levels are present with ketoacidosis. Symptoms include:
 * dehydration, labored breathing, vomiting, abdominal pain, fruity smelling breath, weakness or fatigue
 * Treatment: A student in this condition can easily lapse into a coma, hence 911 should immediately be called and the child's parents notified
 * A student with diabetes will often require frequent midday snacks. Allow this student to keep snacks with them and eat in class or be excused to eat in the hallway
 * Allow student to leave the classroom to test blood sugar levels [[image:77519254.jpg width="184" height="272" align="right"]]
 * Allow student to make frequent trips to the washroom
 * Students with diabetes can participate in all forms of physical activity, however they may require an extra snack or beverage beforehand
 * Diabetic students should not have exercise scheduled just before a meal (no physical education before lunch)
 * Parents/Guardians should be alerted of class activities and schedule changes in advance (OCDSB recommends 2 days minimum)
 * Advanced planning is required to create a safe environment when taking diabetic students on field trips. Suggested supplies include:
 * a cell phone or other means for getting help in an emergency, a copy of the Emergency School Help Plan and/or a copy of the student's //Serious Medical Condition Protocol Registration,// student's diabetic kit (glucose,monitor, supplies, insulin), extra snacks
 * A field trip can be associated with extra activity and excitement for a child. These can also cause low blood sugar, and chaperones and staff need to be alert for this and treat accordingly


 * Cystic Fibrosis (CF) is an inherited and fatal disease that results in an abnormal amount of mucus throughout the body, affecting the lungs and digestive tract, which results in the blockage of air sacks in the lungs, and causes the lungs to overinflate and to then collapse
 * Cystic Fibrosis occurs in approximately 1 in 3500 live births and is the most common fatal inherited disorder affecting young Canadians
 * It affects each individual differently with varying degrees of severity and a person's health can change considerably from month to month or even day to day
 * Former life expectancy for people with this disease was only into the teenage years, the current median age of survival for individuals with this condition is 35.1 years
 * Management of this disease focuses on keeping the lungs clear to ease breathing, and treating digestive problems (malabsorption of fats, proteins and carbohydrates)

= What the Classroom Teacher Needs to Know: = > = Accommodations/ Modifications: = > = Cancer =
 * Students will have likely been diagnosed before beginning school and will have an IEP in place
 * Be sure to notify parents of any changes you notice in attention, fatigue, or behaviour
 * With the approval of the student and the family you may choose to educate the rest of the class about this condition in order that classmates can become a part of the student's support network
 * Students with CF are much more sensitive to viruses and bacteria. Encourage proper hygiene amongst all students and encourage sick students to remain at home
 * The student must often take digestive enzyme medications with snacks and meals. Many students are self conscious about this and may skip medications in order to avoid taking them in front of classmates - allow for a private place in which the student can take his/her meds
 * Digestive enzyme medications can cause intestinal upset, diarrhea and gas. Seat the student near the door and provide open and free access to washroom facilities. *If a more private washroom is available in the school, the student should be allowed to use this rather than public washrooms
 * Allow extra time for eating
 * Persistent coughing is unavoidable and necessary. Allow a free pass to leave the classroom to get a drink and/or allow the student to keep a bottle of water with them at all times
 * Individuals with CF are encouraged to spit coughed up mucus into a tissue. Seat CF students near a wastebasket and allow them to keep a box of tissues on or near their desk
 * A child with CF may find it harder to participate in group situations and/or to perform solo in front of the entire class. Consider modifying assignments to accommodate these needs and help to strengthen the student's self image by encouraging him/her to excel at what he/she can do best
 * Absenteeism will be more frequent and can be for prolonged periods. Develop an effective system for helping student keep up with school work. **Even while in school, some students with CF require time out of class during the day to receive airway therapy to clear the lungs of mucus


 * Childhood cancer can take many different forms, although common types include: leukemia, lymphoma, tumours of the central nervous system, bone tumours and brain tumours [[image:57422239.jpg width="203" height="301" align="right"]]
 * Treatment for cancer includes chemotherapy, radiation, surgery and/or bone marrow transplantation

= What the Classroom Teacher Needs to Know: =
 * Educate yourself about the student's specific type of cancer, treatment and anticipated side effects
 * Be aware of and respect the wishes of the student and parents regarding what they want classmates and other school personnel to know about the student's illness
 * Be aware of the psychological effects of cancer and be prepared to deal with issues such as anxiety, behaviour problems, emotional difficulties, peer relationship difficulties, and frustration related to school difficulties
 * Request a schedule of upcoming medical appointments and scheduled absences to help the student prepare ahead for absences
 * Prepare for a student's terminal illness and potential death - be prepared to deal with this issue with students

= Accommodations/ Modifications: =
 * Allow student to wear a hat or head scarf in class to cover hair loss due to chemotherapy and/or radiation
 * Allow frequent trips to the washroom and for a drink as student may be nauseous, dehydrated or have intestinal issues due to side effects from chemotherapy
 * Extreme fatigue is a common side effect both during and after chemotherapy and radiation. Consider modifications to a student's course load or work load, allow frequent breaks
 * Consider modifications to the Physical Education curriculum. Post-treatment, many students are unable to participate in contact sports, strenuous exercise and long distance running
 * Provide two sets of textbooks - one for home and one for school. Many backpacks can weigh 40lbs or more which is too heavy for a student dealing with fatigue and stamina issues
 * Some cancers and treatments cause students to permanently or temporarily have a harder time concentrating, remembering things, understanding what they read, and or writing
 * For students experiencing neuropathy (weakness, cramps, spasms, loss of coordination) in their hands, consider providing them with an extra set of notes, or allowing the use of a computer or tape recorder
 * Consider the use of a scribe for test taking
 * Use word banks, graphic organizers and mind maps to assist with short term memory loss and word retrieval deficits
 * Present information both orally and visually to facilitate student understanding and break tasks down into easy to follow steps
 * Allow extended time to complete class work, tests and quizzes.
 * Moderate the workload with an emphasis on quality versus quantity
 * Be prepared to provide more one-on-one assistance
 * Make use of such resources as Student Success, Guidance counsellors, Student support counsellors, homework clubs, etc.
 * Students with cancer often have high rates of absenteeism due to hospitalizations, treatments, and treatment side effects. Develop a plan to ensure student is able to keep up with course work

= Other Relevant Information =

= Administration of Medication: =
 * In order for a student to take or receive medication at school, an //Administration of Oral Medication// or //Self Administration of Oral Medication// form must be completed and signed by the parent/guardian or student over 18 years of age and the physician. This form outlines the type of medication to be administered, required dosage, and action to be taken in the event of possible hazards or side-effects
 * The completed form will be returned to the Principal and will be kept on file in the office and in the student's OSR

= Home Instruction :=
 * Home instruction is provided to assist students in maintaining academic standing during periods of prolonged absence due to illness, accident or personal crisis, or to supplement part-time school attendance during a treatment program and/or a program of gradual introduction to full-time attendance
 * To apply for home instruction, it is the responsibility of the parent or student over 18 years or age to complete the Application Form for home instruction, attach the medical certificate, and submit it to the school principal
 * The principal then chooses to approve or disprove the application and submits it to the administrator of special education for final approval
 * Guidelines for length and quantity of home instruction vary by Board. For example, the Renfrew County District School Board allows for a maximum period of three months of home instruction that may not exceed ten hours per week. The Ottawa-Carleton District School Board allows up to a maximum of 6 months of instruction, but only allows five hours per week of instruction
 * It is the school principal who arranges for the services of a home instruction teacher, who is expected to be a qualified teacher
 * The responsibilities of the home instruction teacher are to be clearly outlined by the principal and it is the responsibility of the classroom teacher to provide textbooks, and an outline of course content to be covered while the student is away

= Dealing With Death: =
 * Students may have questions about a classmate's illness and the probability of their death
 * Respond honestly with a vague answer such as "nobody knows, some people as sick as (name) have died, but other people have gotten better and are just fine" and/or "we do not know what might happen to (name) but she/he and his/her doctors are working very hard to make (name) well
 * Make use of guidance counsellors and student support counsellors
 * Be aware of "Pastoral Care" services
 * Pastoral care involves being with, listening to, and extending a helping hand to any student who needs or wishes it
 * Many school boards offer a version of this service - RCDSB and OCDSB both offer this service
 * The Coordinating Committee for Pastoral Care in Secondary Schools seeks to involve representatives from all faith communities including: Aboriginal, Baha'i, Buddhism, Christianity, Hinduism, Judaism, Islam, and Sikhism
 * Pastoral care workers are available on a voluntary and part-time basis to students and staff
 * Principals may initiate the program in their schools through coordination with the Pastoral Care Coordinating Committee