MERCER COUNTY SCHOOL HEALTH SERVICES
ASTHMA HEALTH CARE PLAN
Student’s Name:
School:
Name of Medication(s):
Medication Time(s):
Date of Birth:
Allergies:
Triggers:
Signs/Symptoms of an Asthmatic Episode:
1) Changes in Breathing: coughing, wheezing (whistling sound made when
breathing), mouth breathing, shortness of breath, and/or rapid breathing
2) Verbal Complaints: Often a student who is familiar with asthma will know
that an episode is about to happen. The student might tell the teacher that: the
chest is tight, the chest hurts, “can’t catch my breath”, mouth is dry, neck feels
“funny”, “I don’t feel well”.
3) Other signs might be: an itchy chin or neck (student might rub chin or neck),
“clipped speech” (student may speak in short, choppy sentences)
School Staff/Nurse Responsibilities:
 Position student in an upright position leaning forward to promote breathing
 Have student use inhaler or nebulizer treatment as ordered
 Have student sip on fluids if able
 Have student begin slow, deep breathing
 Reassure student and stay with him/her
 Move student to a quiet, calm, and private environment
 Contact parents and school nurse
ASTHMA EMERGENCY ACTION – The following are possible signs of an asthma
emergency:
 Difficulty breathing, walking, or talking
 Blue or gray discoloration of the lips or fingernails
 Failure of medication to reduce worsening symptoms
THESE SIGNS INDICATE THE NEED FOR EMERGENCY MEDICAL CARE!!!
The steps that should be taken are:
 Call 911
 Call the parent/guardian and the school nurse
Student has an order to carry the inhaler:
yes
no
Student’s responsibilities for carrying respiratory inhalers:
 Demonstrates correct use of the inhaler (see below):
yes
no

Agrees to come directly to the Office (accompanied by a “buddy”) if the student
continues to have difficulty with breathing, wheezing, or is experiencing chest
tightness after using the inhaler:
yes
no
IF THE STUDENT DOES NOT DEMONSTRATE MEETING THE ABOVE
SPECIFIED RESPONSIBILITIES, THE PRIVILEGE OF CARRYING THE INHALER
WILL NOT BE ALLOWED.
Proper Use of an Inhaler:
1) Explain the benefit of device.
2) Prime the inhaler (for new or infrequently used inhalers)
3) Take the cap off and shake the inhaler.
4) Inhaler placement: tilt head back slightly, breathe out all the way, place mouthpiece
in student’s mouth (between teeth and lips closed around it – student should not block
opening with his/her tongue).
5) Press down on inhaler one time as student breathes in slowly through mouth for a
count of 10 seconds (if possible).
6) Wait about 1 minute between pugs.
Proper Use of Nebulizer:
1) Assemble equipment, wash hands and put on gloves. Obtain medication to place in
nebulizer per physician’s orders and place medication in nebulizer chamber (add
saline if indicated).
2) Position yourself near child. Turn on machine. Have child place lips over negulizer
mouth piece and breathe through his or her mouth.
3) Encourage the child to take slow, deep breaths during the treatment.
4) Tap side of nebulizer chamber to cause droplets of medication to fall back into the
chamber.
5) Nebulization treatment will be finished when all medication is gone from the
chamber.
6) If child’s symptoms do not improve after treatment, call parents, 911, and the school
nurse.
7) Disassemble and clean the nebulizer. Rinse thoroughly with warm water.
8) Document treatment on medication administration log.
School Nurse Signature:
Date: