Domain 2 Module: Relevant Medical Information (10 test questions) Flashcards by adam flora

the globe

Collects and absorbs; light rays so they can form a clear image on the retina

Outer layer
Conjunctive
Sclera
Cornea

Inner layer
Anterior chamber
Posterior chamber
vitreous

Orbit

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thin, transparent membrane; lines the inside of the eyes/sclera; does not cover cornea

Protective barrier (alerts for foreign bodies)

Lubricates front of eye

Indicates ocular/physical health

Conjunctiva

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white part of the eye; dense; provides protection

Maintains shape of globe

Provides protection to inner structures

Provides attachment points for extraocular muscles

Sclera

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highly organized group of cells and proteins; contains no blood vessels; receives nourishment from tears

Refract and transmit light

Provides most of the eye’s optical power

If loses elasticity or is damaged, it won’t be able to function properly and blurred images will be transmitted to the retina

Cornea

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space in front of cornea, but behind the iris; contains iris, trabecular meshwork, canal of Schlemm

Anterior Chamber

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Small space between back of iris and lens

Posterior Chamber

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Clear fluid inside anterior and posterior chamber; provides nourishment and support.

Aqueous Humor

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composed of ciliary muscle

Involved in controlling lens accommodation and IOP

Ciliary Body

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colored part of the eye

Regulates light entering the eye

Iris

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hole in the middle of the iris

Constricts in bright light (becomes smaller)

Dilates in dim light (becomes larger)

Pupil

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extends where iris meets the cornea

Drains/filters the eye

Trabecular Meshwork

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located between the retina and sclera

Nourishes retina

Removes waste

Contains many blood vessels and capillaries

Choroid

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refracts and focuses light

Helps create a sharp image on retina

Can change shape

Lens

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light sensitive nerve tissue

Breaks down images into brightness, position, color, and movement

Converts images into electrical signals and sends those signals to the brain

Retina

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Peripheral retina; active in low light

Responsible for night vision

Poor perception of color and detail

Rods

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light receptor cells

Active in high light and color

Detects color and detail

Cones

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central part of the retina

Responsible for detecting color and fine detail

Clear visual acuity

Macula

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visual pathway; no photoreceptor cells; cannot process light

Optic Nerve

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carries impulses for sight from the retina to the brain

each nerve fiber corresponds to specific parts of the retina

once information gets to the optic nerve, it gets sent
to the brain via the Visual Pathway

damage in this area: loss of vision in affected eye

optic pathway

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where nasal fibers of each optic nerve cross

separates information from the right visual field and the left visual field

right half of the visual field goes to the left side of the brain

left half of the visual field goes to the right side of the brain

images projected on the retina are inverted

damage in this area: hemianopia: loss of half the visual field (temporal loss)

damage AFTER chiasm: temporal loss in one eye, nasal loss in the other

Optic Chiasm

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contains visual cortex

info from each part of the retina is combined and interpreted

organized into layers and columns

responsible for vision and visual perceptions

damage in this area: temporal loss in one eye, nasal loss in the other

“macular sparring”: when the macula is left in tact

Occipital Lobes

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the area at the side of each cerebral hemisphere

contains major portions of optic radiations

complex visual analysis

allows for categorization of objects; “memory library” of images

Temporal Lobes

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upper mid part of each cerebral hemisphere

responsible for body sensations

responsible for spatial information

right parietal lobe – understanding spatial aspects of the world, recognizes shapes, being aware of ones body in space

Posterior parietal Lobes

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What it is:
Progressive, degenerative damage to the central part of the retina
Affects the cones
Wet: abnormal blood vessel grow and leak under the macula
Dry: degeneration of retina

Causes:
Age
Genetics

Functional implications
Central acuity loss
Blind spot
Photophobia
Pool color vision
Normal peripheral vision

Adaptations:
Eccentric viewing
Magnification
Large print
Diffused less intense light
Direct light
Telescopes
Tinted lenses
CCVT
Adjustable lighting
Reduce/eliminate glare
High contrast
Treatments:
Wet: shots in the eye to stop the bleeding

Considerations for older adults with
Rehab interventions can affect coping mechanisms related to psychological adjustment
Age related visual impairment can be linked to functional impairments, specifically in instrumental activities in daily living (getting dressed, eating, appearance)
Successful adaptations to visual impairments may affect perception of older adults’ functional disabilities

ARMD

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What it is: Progressive: night blindness 🡪peripheral loss 🡪tunnel vision 🡪complete blindness Degeneration of rods (light sensitive cells in retinal periphery) Can be found in: Ushers and Lebers Causes: Genetics Risk Factors: Age (teens/young adults) Gender (more common in males) Functional implications Loss of peripheral vision Night blindness Tunnel vision Decreased acuity and depth perception Retinal scarring (causes spotty vision) Cataracts possible May be accompanied with myopia, cataracts, keratoconus Adaptations: High illumination Reduce glare Absorptive lenses Prism glasses CCVT High contrast Teach organized search patterns Treatments: None – take precautions to prevent retinal detachment

What it is: Decrease in retinal blood vessel development in preemie babies Leads to bleeding, scarring, and detachment Can range from minimal damage to complete blindness Causes: Low birthweight Born before 31 weeks High duration and administration of oxygen Risk Factors: Low birthweight Born before 31 weeks Overall health of infant Functional implications Decreased visual acuity Severe myopia Possible retinal detachment Spotty vision Strabismus Retinal scarring Field loss Possible glaucoma Adaptations high illumination magnification telescopes CCTV Treatments: Vitamin E therapy Cryotherapy Vitrectomy Some cases resolve themselves

ROP

What it is: Collection of Eye disease that causes increased pressure in the eye because of blockage in the normal flow of fluid in the aqueous humor Damages optic nerve Caused by: Changes in the uveal tract Trauma Medication reaction Surgery Genetics Risk factors: 55+ family history diabetes Race (higher prevalence in African American or native American) Functional Implications: Fluctuating vision – can lead to stress and fatigue Tunnel vision Peripheral field loss Poor night vision Photophobia Difficulty seeing large objects in close range Decreased sensitivity to contrast Pain/headaches Eye redness Hazy cornea Wide open pupil Degeneration of optic disc Poor spatial awareness Adaptations: Sunglasses, eye shades Lamps with adjustable lighting Reduce glare Increase contrast Magnifiers CCVT Treatment: Eye drops Surgery Trabeculectomy – removing portion of trabecular meshwork to improve drainage Iridotomy – laser creates hole in iris

Glaucoma

What it is: Diabetes can cause changes in blood vessels of the retina Causes hemorrhaging in the retina and vitreous Neuropathy in feet and hands Retinal detachment and full blindness possible Proliferative: formation of new blood vessels Non-proliferative: beginning stages, blood vessels become weak Caused by: Diabetes Genetics Retinal hemorrhage Glaucoma Cataracts Optic neuropathy Functional Implications: Sensitive to glare Double vision Lack of accommodation Fluctuating acuity Diminished color vision Defective visual fields Floaters Retinal detachment Neuropathy – unable to tactilely discriminate Adaptations: Good lighting Good contrast Magnification Reduce glare Pay attention to diet Tinted lenses Take care of feet to prevent infections Wear comfortable well-fitting shoes at all times Avoid bending, lifting, straining, rapid movement – can affect DR Treatment: Diet Insulin Surgery Vascular photocoagulation – abnormal/leaky blood vessels sealed/destroyed by light Retinal photocoagulation – laser used to destroy oxygen starved area of retina creating regressing of abnormal/weak blood vessel growth

Diabetic Retinopathy

What it is: Damage to the visual cortex (in the brain) Problem with how information is transmitted from the eye to the brain and how the brain interprets that information. Ocular structures remain intact. Disorders associated with CVI: CP, epilepsy, hydrocephalus, learning disabilities, deafness. Common with CVI: optic nerve atrophy, optic nerve hypoplasia, retinal abnormalities Causes: Lack of oxygen (anoxia) at birth Head injury Infections that affect nervous system Functional implications (depends on type of CVI) Fluctuation in visual functioning Loss of ability to understand information the eye is giving you Visual neglect Eye may look normal Inattention to visual stimuli Preference of touch over vision Difficult with visual clutter or when things are too close together Difficult discriminating figure-ground May have more central vision, peripheral vision Light gazing Photophobia Slower processing/response time May easily become overwhelmed Inability to coordinate visual information with other senses Visual Midline Shift Syndrome- shift in concept of midline following stroke or TBI Adaptations: High illumination – spotlighting/indirect lighting sources are beneficial for clarity Eliminate visual clutter Eliminate glare Routines Repetition Bright contrast Consistent visual cues Combination of reading media Determine which sensory system works best Prevent visual overload Provide simple images and tasks Encourage tactile exploration Demonstrate via hand-over-hand Eliminate distractions Yoked Prisms Treatments: None

CVI

congenital abnormality; optic disc is small, sometimes surrounded with a halo; vision may or may not be reduced Small optic cup. Usually results in low visual acuity. Additional cognitive disabilities often present. Frequent in children.

Optic Nerve hypoplasia

progressive retinal degeneration in both eyes; night blindness in childhood followed by loss of peripheral vision to finally blindness; hereditary

Rod/Cone

degeneration of retinal receptors results in loss of color and central vision, followed by loss of night vision

Cone/Rod

malignant Intraocular tumor that develops from retinal & visual cells; hereditary; vision loss can be total or scotomic

Retinoblastoma

Farsightedness

Hyperopia

Nearsightedness

Myopia

uneven focus of light between both eyes

Astigmatism

What it is: Gradual hardening of the lens elasticity Causes: Age Functional implications Reduced ability to accommodate Adaptations Good lighting High contrast

Presbyopia

Central acuity loss Blind spot Photophobia Pool color vision Normal peripheral vision

ARMD

Loss of peripheral vision Night blindness Tunnel vision Decreased acuity and depth perception Retinal scarring (causes spotty vision) Cataracts possible May be accompanied with myopia, cataracts, keratoconus

Decreased visual acuity Severe myopia Possible retinal detachment Spotty vision Strabismus Retinal scarring Field loss Possible glaucoma

ROP

Fluctuating vision – can lead to stress and fatigue Tunnel vision Peripheral field loss Poor night vision Photophobia Difficulty seeing large objects in close range Decreased sensitivity to contrast Pain/headaches Eye redness Hazy cornea Wide open pupil Degeneration of optic disc Poor spatial awareness

Glaucoma

Sensitive to glare Double vision Lack of accommodation Fluctuating acuity Diminished color vision Defective visual fields Floaters Retinal detachment Neuropathy – unable to tactilely discriminate

Diabetic Retinopathy

Fluctuation in visual functioning Loss of ability to understand information the eye is giving you Visual neglect Eye may look normal Inattention to visual stimuli Preference of touch over vision Difficult with visual clutter or when things are too close together Difficult discriminating figure-ground May have more central vision, peripheral vision Light gazing Photophobia Slower processing/response time May easily become overwhelmed Inability to coordinate visual information with other senses Visual Midline Shift Syndrome- shift in concept of midline following stroke or TBI

CVI

Fluctuating vision Blurred vision Impaired color/night vision Photophobia Field loss Blind spot Nystagmus Lack of depth perception

Optic Nerve Atrophy

Decreased visual acuity Additional cognitive disabilities often present

Optic Nerve hypoplasia

Progressive decreased night vision Followed by central loss, color, and detail vision

Rod/Cone

Loss of central, color and detail vision first Followed by loss of night vision

Cone/Rod

If one eye – lack of depth perception and Field loss If both eyes – total blindness

Retinoblastoma

refractive ability too weak, eye is too sort, power must be increased to form a point on retina Inability to see close Blurred image on retina when viewing close objects May need to move objects farther from the eye for clear image If uncorrected Brain receives poor, blurred image Impacts development of the visual system Reduced attention to objects at near

Hyperopia

refractive ability too strong, eye too long; power must be taken away to form a point on retina Can’t see distance Blurred image on retina when viewing objects at a distance May need to bring object closer to eye for clear image If uncorrected: Brain receives poor, blurred image Impacts development of visual system Visual world “collapses” – reduced/inattention to distant objects/activities May not be able to be fixed High Myopia: Detached retina Reduced central vision Lack of depth perception Photophobia

Myopia

Light rays entering the eye are bent unequally Prevents formation of a sharp image on the retina Inability of the eye to focus sharply at any distance

Astigmatism

Reduced ability to accommodate Affects the elderly

Presbyopia

Both Eyes together

Right Eye

Left Eye

shows the quietest sounds you can just hear. The red circles represent the right ear and the blue crosses represent the left ear. Across the top, there is a measure of frequency (pitch) from the lower pitched sounds on the left going to higher pitched sounds on the right. These sounds are measured in Hertz. Down the side of the audiogram, there is a measure of loudness. At the top of the graph are the very quiet sounds, going down to moderate, and then very loud sounds. This loudness is measured in a scale called decibels (dB). Any points that are heard at 20dB or quieter are considered to be within the normal range

Audiogram

strength of sound amplitude measured in decibels measure of sound pressure level relative strength of sound waves (transmitted vibrations), which we perceive as loudness or volume

Intensity

pitch the rate of particle vibration measured in cycles per second measured in Hertz For sound, this means the number of pressure waves per second that would move past a fixed point. It is also the same as the number of vibrations per second the particles are making as they transmit the sound.

frequency

portion of a particle in its vibrating cycle

Phase

sensation of frequency high pitch = high frequency relates to the frequency, or how many times a second the particles vibrate. The distance between one wave and the next gives the wavelength. For sounds all travelling at the same speed, high-frequency (high-pitched) sounds have waves very close together. Low-frequency sounds have a greater distance between each wave.

Pitch

unit used to measure the intensity of a sound or power level of electrical signal by comparing it with a given level on a logarithmic scale not linear

Decibel

air conduction test unmasked left ear

air conduction test unmasked Right ear

bone conduction test right ear

bone conduction test Left ear

affecting both sides

Bilateral

dysfunction of the outer/middle ear usually treated with medication/surgery loudness deficit functional implications soft speaking voice (they hear their voice louder than normal) excellent speech discrimination when speech is loud enough lower frequencies tend to be affected temporary

conductive hearing loss

dysfunction of the inner ear/auditory nerve usually permanent untreatable loudness deficit distorted hearing – nerve endings in the cochlea/nerve pathways damaged; messages do not effectively reach the brain middle ear structures in tact functional implications inappropriately loud voice tinnitus frequency loss – high frequency (most common) speech sounds distorted background noise makes listening more difficult hearing aids may help Hearing aids, cochlear implants, and other listening devices are notorious for distorting, changing, and generally making sounds unusable for orientation and mobility tasks. Many assistive devices are designed and set to enhance the human voice for communication, not to retrieve environmental sounds. In fact, they may be intentionally blocking distal environmental input. Also, no assistive listening device can reach far into the environment (such as hearing a car 300 feet away). vertigo gradual deterioration difficulty distinguishing near vs. far (location acuity loss) specific sounds seem unnaturally loud difficulty understanding speech patterns

sensorineural hearing loss

combo of conductive and sensorineural hearing loss treatment may be available for the conductive loss both high and low frequency losses

Mixed hearing loss

help people with communication disorders to express themselves. These devices can range from a simple picture board to a computer program that synthesizes speech from text.

augmented communication (def.)

If the bone conduction hearing thresholds are normal, but there is a loss of hearing for air conduction sounds, this is called a conductive hearing loss.

conductive hearing loss

When there is no difference between the air conduction and the bone conduction thresholds it indicates that the hearing loss is due to a problem in the cochlea.

sensorineural hearing loss

gap between the air conduction and the bone conduction thresholds, however the bone conduction thresholds still indicate a hearing loss as they are not within normal limits. This would suggest that there is a problem in both the cochlear and the middle ear

mixed hearing loss

conduction through the entire outer ear mechanism: including auricle, external ear canal, tympanic membrane and ossicles/middle ear.

air conduction threshold

Bone conduction refers to sound vibration transmitted to the inner ear through the skull.

bone conduction threshold

-10 to 15 dB HL

Normal Hearing

16 to 25 dB HL

slight hearing loss

26 to 40 dB HL

mild hearing loss

41 to 55 dB HL

moderate hearing loss

56 to 70 dB HL

moderately severe hearing loss

71 to 90 dB HL

severe hearing loss

>90

profound hearing loss

What eye diseases are associated with diabetes?

Diabetic Retinopathy Glaucoma Cataracts

What are the considerations when developing an O&M instruction program for persons with diabetes?

Monitor blood sugar and note instances of low/high Lethargy Neuropathy Hands- make it difficult to get feedback from cane Feet – make it difficult to detect drop offs Rapid changes in vision likely Bad vision days make indicate low blood sugar Pressure sores common Wear comfortable sneakers Monitor for pain, swelling, bruising, blistering, tenderness, discoloration of the skin Keep a diabetic information sheet Student name, address, phone number School/agency name, address phone number Doctor name and phone number Emergency contact Type of insulin, amount taken, time of day given Typical symptoms of student and how student wants to handle them Time of day likely to have reaction

varying amount of hemorrhage, swelling of optic nerve blurry vision or field loss may occur Kaposi’s sarcoma Vascular tumor Purple/red growth on eyelid May block visual field Toxoplasmosis Infection Retinal inflammation Retinal destruction due to cysts Cryptococcal meningitis Damages optic nerve and brain Central nervous system infections Second most common cause of blindness Can lead to diplopia, blurred vision, difficulties in eye movements HIV retinopathy Microvascular disorder “cotton wool spots” microanuerysms retinal hemorrhaging field loss retinal detachment

Eye Diseases related to aids

What are the implications of AIDS for O&M instruction?

Decreased functioning of immune system can lead to neurological complications Neuropathy Can make walking difficult Brain damage can lead to strokes, dementia, headaches, and behavioral changes Confusion, seizures, vision loss, and memory and cognitive defects may also be seen Prevent yourself from becoming infected Practice good hygiene Reschedule if you are sick Practice “universal health precautions” Students willingness and ability to participate may vary from day to day or even hour to hour Confirm all meetings several hours before appointment Goals may need to be reassessed and modified as students physical condition changes Because of privacy las, you may not know if a student has HIV/AIDS and it might be difficult to accurately plan lessons and goals Vision impairment comes in the later stages Students may be facing their own mortality Can greatly impact motivation

nature of seizures depends on location and duration changes in consciousness, motor activity, sensory phenomena, inappropriate behavior internal stimuli stress fatigue lack of sleep fever electrolyte imbalance excess fluid/salt intake not taking medications external stimuli bright/flashing lights visual patterns fire alarms vestibular olfactory cognitive, emotional, or decision making tasks partial can last several minutes student may experience confusion guide student to safe place stay close until seizure ends and wait until student can respond normally during seizure, student may last out if restrained generalized if grand mal loosen clothing get a pillow do not insert anything into mouth lay student on side when finished to keep airway open if petite mal wait until episode is finished eyes may stare ahead or roll back can’t wake them up

seizure disorder

Inflammatory disease that affects joints and surrounding areas Can be unpredictable Can be a result of wear and tear on body Vision implications Dry eye Scleritis – inflammation/redness of white part of eye Uveitis/iritis – can cause severe pain, blurred vision, photophobia Adaptations Build up diameter of cane grip Lightweight cane Wrap joints in warm towels for 7-10 minutes to reduce pain Avoid overexertion or fatigue Symptoms mat increase in cold weather Tinted lenses Organize home to minimize impact on joints Most frequent items at easy reach Plan rest breaks during work Use tools that eliminate bending (for cooking – microwave, stove) Avoid lifting or carrying heavy items Use something with wheels to move items from room to room Avoid doing labor in the morning when symptoms are worse Warm bath/shower can reduce joint pain Treatments: Medications (prescription/non-prescription)

Arthritis

What it is: Involves both heart and blood vessels Heart not pumping blood efficiently Risk Factors: High blood pressure High cholesterol Smoking Inactivity Diabetes stress Symptoms: blood circulation impaired fluid may gather in body tissues swollen feet and ankles shortness of breath Vision implications: Hypertensive retinopathy – changes in retina caused by high blood pressure, can damage optic nerve and cause retinal blood vessels to harden and swell, can range from blurred vision to total blindness Retinal artery blockage – “stroke in the eye” Retinal vein blockage – bleeding of blood vessels Adaptations Talk with doctor and eye doctor before physical activity Some conditions can be affected by bending, lifting, straining, rapid movement Simplify everyday tasks to conserve energy Plan rest when working

high blood pressure/ Cardiovascular disease

congestive heart failure generally, people have poor endurance, shortness of breath, and chest pain be alert to signs of stress assess exercise tolerance keep a list of medications and be aware of side effects and precautions minimize stress remember cardiac status may change from day to day extreme hot or cold can affect condition

heart Condition

factors that can trigger asthma inhaled allergens dust, wool, feathers drastic weather changes extreme hot/cold strenuous exercise respiratory infections medications when teaching minimize potential for triggered attacks have the following information available in case of an attack brief history of student’s asthma and symptoms of an attack factors that make asthma worse list of medications contact info of doctor and emergency contact description of treatment plan, including recommended actions

asthma

low blood sugar (treat with fruit drink or sugar) Symptoms: can occur suddenly; inappropriate responses, confusion and inattention, drowsiness, pale complexion, perspiration, headache, crankiness, lack of coordination, loss of judgement, sudden hunger, rapid pulse, nausea, vomiting, dizziness

Hypoglycemia

high blood sugar (treat with insulin) Symptoms: dry, hot skin, excessive urination, excessive thirst, drowsiness, lethargy, deep/labored breathing, fruity smelling breath, blurry vision

Hyperglycemia

insulin

Hyperglycemia

give fruit drink/sugar.

Hypoglycemic

seizures

record keeping, determine cause if possible, administer treatment if given permission & available, call EMT for severe reactions

allergic reactions

document any behavioral incidents that occur in an attempt to better anticipate or reduce behaviors seek support from behavior specialist employ recommended behavioral strategies Know the signs of increasing agitation or instability. Know effective ways to deflate the situation. Know effective behavior management strategies. Avoid confrontation. Position yourself so that you can watch for cues. Use a teamwork situation, remain in good communication with the individual and team, implement good planning, good backup systems, maintain good records, consider time and length of lessons, use task analysis, sequenced instruction, consider environment, use motivation, be aware of prompting, implement choice making. Document all behavior incidents.

frequent aggressive behavior

be prepared obtain as much baseline information as possible type of seizure common for student description of what it looks like typical frequency or duration known triggers typical behavior following a seizure have info on medications and their side effects record a detailed description of seizure include: time, length, if aura occurred, if student lost consciousness, student behavior following seizure, injuries, and if first aid was given get help if seizure lasts more than 5 minutes another seizure starts immediately after first one ends student can’t be woken up student has several seizures in a row and does not regain conscious throughout any of them student is pregnant or has another health condition

Seizures

ABCs: Assess the faller and the situation (look for danger). Begin care measures, stop the bleeding, don't move potentially injured body parts. Call for help (enlist onlookers to provide help) Assess the risk for falls. Teach the traveler how to respond after a fall (yell for help, listen to environment and orient toward pedestrians, request and allow help to get up or out of the way of danger.

Falls

Emotional/behavioral incidents

be aware of student’s allergies look for symptoms of an allergic reaction administer epi pen in thigh and call 911

allergic reactions