Chronic Disease Management and Students with Special Health Care Needs
Plans, not labels
Three documents drive services: the IEP under IDEA (special education eligibility, measurable goals, related services such as school nursing); the 504 plan under Section 504/ADA (a disability substantially limiting a major life activity, requiring accommodations but not specialized instruction); and the Individualized Health Care Plan (IHCP), nursing's own plan, which can stand alone or nest inside either. Know which document authorizes what: 504 accommodations do not require IDEA eligibility, and a medical diagnosis alone does not create IEP eligibility.
Chronic condition management
- Asthma: asthma action plan, quick-relief inhaler access (self-carry laws), spacer technique, green/yellow/red zones.
- Diabetes: diabetes medical management plan, glucose monitoring, carbohydrate counting, hypoglycemia treatment (15 g fast-acting carbohydrate, recheck in 15 minutes), glucagon availability.
- Seizures: seizure action plan, rescue medication, and timing the event.
- Anaphylaxis: epinephrine auto-injector, emergency care plan, 504 accommodations for allergen avoidance.
- Technology-dependent students: tracheostomy care, gastrostomy feedings, catheterization, ventilator support - tasks may be delegated to trained unlicensed assistive personnel only after the RN documents competency and state law permits the delegation.
Traps
Items that let the nurse "delegate nursing judgment" - never delegable. Items confusing 504 with IEP. Items assuming a student with a chronic condition must be homebound. Watch for medication errors around self-carry versus clinic-stored drugs, and for field trip planning that omits the plan and supplies.
Rule of thumb
The RN may delegate a task to a competent, trained person; the RN retains accountability for assessment, teaching, evaluation, and all nursing judgment. Document competency before the first delegated procedure and reassess at least annually.