Member-only Free CE

More than 70 hours of I/DD-specific online CE is available FREE to DDNA members. This courseware is approved by DDNA for the continuing education of its members and can be used for certification renewal. The courses are only free for DDNA members. (If you are not a DDNA member and would like to pay to take these courses, they are available at www.healthsoftonline.com.)

To access these free courses, members must be logged in and go to the member-only free CE page.

For a printable description of all the courses, download the PDF

For individual course descriptions, click on the name of the course from the list below.

• Syndromes and Conditions I

  There are many conditions or syndromes that result in developmental disabilities. This module provides a basic overview of autistic spectrum disorders (autism, Asperger's syndrome, PDD-NOS), cerebral palsy, Down syndrome, and fetal alcohol syndrome. Because these syndromes and conditions have varying causes, people with these developmental disabilities may present with a wide range of physical attributes, behavioral attributes, and medical conditions. While all people with developmental disabilities should receive the same health screening and care recommended for the general population, this module highlights specific nursing and medical assessments and interventions that may be needed depending on the specific type of syndrome or condition.

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• Syndromes and Conditions II

  There are many conditions or syndromes that result in developmental disabilities. This module provides a basic overview of fragile X syndrome, pediatric HIV infection, metabolic disorders (Tay-Sachs disease and phenylketonuria), neural tube defects (anencephaly, spina bifida, hydrocephalus), and Prader-Willi syndrome. Because these syndromes and conditions have varying causes, people with these developmental disabilities may present with a wide range of physical attributes, behavioral attributes, and medical conditions. While all people with developmental disabilities should receive the same health screening and care recommended for the general population, this module highlights specific nursing and medical assessments and interventions that may be needed depending on the specific syndrome or condition.

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• The History of Developmental Disabilities Nursing

  This module explores the history of the nursing care of clients with developmental disabilities, from the early days of segregation and institutionalization to the present, when clients receive inclusive services in the community from a multidisciplinary team that includes nurses who specialize in developmental disabilities. Because the care of clients with developmental disabilities is continually evolving in our complex society, nurses must understand how legal, ethical, and regulatory foundations historically have influenced client care. Nurses also must be aware of changing environmental factors, such as education, finances, and technology, that impact lifespan, quality of life, and access to accommodations that increase clients' ability to participate fully in life. Today, the practice of developmental disabilities nursing promotes an equal and caring partnership among nurses, caregivers, and clients.

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• Developmental Disabilities Nursing Today

  Today, clients with developmental disabilities are seen in all nursing practice settings, from hospitals and outpatient settings to various community settings, including homes and schools. To meet the needs of these clients, specialty nursing practice in developmental disabilities has evolved. This module introduces a Role Partnership/Context Model of nursing care, which emphasizes the equal partnership among the nurse, the caregiver, and the client as all partners work together to maximum quality of life and minimize limitations associated with the disability. The impact of environmental factors (attitudinal, financial, ethical/legal, educational, vocational, political/regulatory, and technological), personal factors (lifespan, personality, culture, values), and caring factors on the context of the partnership relationship is examined. The module also introduces five key concepts that guide nurses who care for people with developmental disabilities. As a vehicle for considering caring interventions within the Role Partnership/Context model, a scenario is presented that involves a young woman with mental retardation who, accompanied by her mother, receives nursing services at a woman's health clinic. The module concludes with an overview of the various nursing roles and practice settings in developmental disabilities nursing today.

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• Susan Webster: A Fifteen Year Old with Spina Bifida

  Spina bifida is a congenital condition in which the spinal cord is not properly closed so that the meninges or spinal cord is exposed a birth. It can result in neurological deficits, including paralysis and hydrocephalus. In this case scenario, a school nurse welcomes a 15-year-old girl with spina bifida to her new school at the beginning of the school year. The girl ambulates with crutches and self-catheterizes, so she needs some accommodations in the school setting. The school nurse offers the girl choices about which bathroom best meets her needs, and the girl decides to use the bathroom in the nurse's office. As the relationship between the school nurse and the girl develops, the nurse assesses that the girl is excessively fatigued by the demands of ambulating with crutches on a large campus and helps the girl approach her parents about using a wheelchair at school. The nurse also helps the girl to engage in creative problem solving when she feels lonely, and helps her develop skills to handle teasing from other students.

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• James Russell: An Adult with Down Syndrome

  People with Down syndrome live longer today than in the past because of improved quality of life, better environmental settings, and medical advances. This fact, coupled with the fact that Alzheimer's disease occurs at a higher rate in people with Down syndrome, increases the likelihood that they and their families will be confronted with this diagnosis. This scenario is about a middle-aged man with Down syndrome who lives at home and works in a hospital. As co-workers, health workers, and the man's aging parents become aware of his behavior changes at work and at home, a possible diagnosis of Alzheimer's disease is considered. Nurses support the family and other caregivers as the man undergoes a thorough health assessment that includes a differential diagnosis for Alzheimer's. Nursing interventions that promote the success of medical/behavioral treatment plans and that support the family as it considers options for long-term care are described.

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• Tammie Johnson: A Three Year Old with Lead Poisoning

  Lead poisoning is one of the most common pediatric health problems in the United States. Lead exposure can damage children's brains and other organ systems causing developmental problems, such as reduced IQ and attention span, hyperactivity, impaired growth, learning disabilities, hearing loss, and other health, intellectual, and behavior problems. In this module, a public health nurse providing preschool immunizations listens as a mother describes her daughter's behavior and developmental regression. The nurse recognizes that the child lives in an environment that poses a risk for lead exposure and recommends screening, which is positive for lead. The module reviews identification of and primary prevention of environmental risks for lead exposure, federal criteria for lead level screening, classification of blood lead concentrations, and medical interventions required for each level. The module also reviews points that should be included in an individualized teaching plan for reducing lead exposure and promoting healthy growth and development.

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• Sabrina Jackson: A Young Adult with Cerebral Palsy

  This case scenario involves a young woman with moderate athetoid cerebral palsy who has abdominal pain and seeks treatment in an emergency department (ED). After describing how the woman ordinarily manages the effects of mobility and speech limitations in her daily life, the case scenario presents the barriers to communication and mobility that the woman encounters when she arrives in the ED with her college roommate. The case scenario compares and contrasts appropriate and inappropriate staff responses to the woman's dysarthria as she communicates her needs. It also demonstrates how a respectful partnership between the woman and the nurse fosters a problem-solving approach as they adapt the usual ED diagnostic and treatment process to meet the woman's needs for accommodations. Throughout the case scenario, there is an emphasis on removing barriers to health care in the ED.

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• Jimmy Young: A Four Year Old with Cerebral Palsy

  This case scenario involves a four-year-old boy with spastic diplegic cerebral palsy who lives in a specialized foster care home. The boy, who is nonverbal and functions at a 3 to 4 month developmental level, has been receiving early intervention services and it is now time for him transition to preschool. When asked what type of preschool would be best for the boy, the home health nurse helps the family to engage in a decision-making process that address the needs of both the boy and the family, and suggests home-based interventions that will help facilitate the transition. The home health nurse further supports a successful transition by arranging and participating in an individualized education plan (IEP) meeting that includes the family, the nurse at the preschool, and other multidisciplinary team members. During the transition, all partners work together to identify and resolve problems with equipment, feeding, bowel habits, mobility, and behavioral adjustment in the new environment. As the school year passes, the team continues to work successfully on improving mobility, communication, social interaction, sensory integration, and behavior.

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• Matthew Green: A Young Adult with Asperger's Syndrome

  Asperger's syndrome (AS) is a developmental disability on the autistic spectrum most often noted during the early school years. It is characterized by impairments in social interaction and communication, and by repetitive behavior patterns. This case scenario presents a young man with AS who is transitioning from living at home to living away at college, and now also must transition to managing his own health care when he develops an ear infection. This module shows how the young man's mother partners with him to help him seek appropriate health care, and then partners with the nurse practitioner at the college health center to provide information about accommodations specific to her son's needs. Common characteristics of AS and appropriate nursing interventions in response to these characteristics are illustrated during nursing assessment, treatment, and discharge teaching, with a focus on enhancing self-reliance in medical self-care within a supportive caring partnership.

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• Howard McGuire: A Middle-Aged Man with Mental Retardation and a Mental Health Condition

  In this case scenario, a middle-aged man with a dual diagnosis of mental retardation and mental illness finds himself in a homeless shelter after running away from a group home. Through careful assessment and respectful communication, the nurse at the homeless shelter learns that the man, who is dealing with the recent death of his mother, has obsessive compulsive disorder, which has made him unable to tolerate living in the group home. The nurse builds trust and helps the man to accept care from an Independent Service Coordinator. The man, the nurse, and the service coordinator build a caring relationship that supports the man as he identifies his preferences, explores his options for obtaining services, and makes appropriate health and lifestyle choices. Nursing interventions that help the man to increase his ability to advocate for himself, and to interpret and convey his experiences and needs, are described.

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• Tommy Banks: An Eight Year Old with Fragile X Syndrome

  Fragile X syndrome is the most common inherited cause of mental retardation. More common in males, it causes characteristic physical features, communication dysfunction, and behavioral problems, such as ADD and autistic-like behaviors. In this case scenario, the elementary school nurse provides care for a boy with fragile X, who is anxious and distressed after a playground injury. Unable to reach the boy's parents, the nurse asks the boy's older sister to help reassure him. The nurse notes that the sister assumes the role of interpreter and comforter for her brother, and recognizes that this is a large responsibility for a child. By encouraging the girl to talk about her feelings, the nurse assesses a need for sibling support. The need for sibling support in this family becomes further apparent when the nurse also learns that the injured boy's younger brother has been acting-out and ridiculing him at school. This module also includes the personal account of an adult who has three siblings with fragile X syndrome as she shares her memories of feeling lonely, anxious, angry, and guilty as a result of having siblings with severe developmental disabilities.

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• Marta Perez: A Young Adult with Phenylketonuria

  Phenylketonuria (PKU) is a genetic disease in which phenylalanine builds up in the body causing brain damage and mental retardation. Today, newborns are routinely screened for PKU, which can be controlled by severely limiting the intake of protein. In the past, it was believed safe to discontinue the PKU diet during childhood, but studies show that adults who go off the diet develop problems, including reduced intellectual functioning, abnormal changes in the brain and nerves, poor social adaptation, and an increased incidence of mental illness. This case scenario involves a newly married woman with PKU who grew and developed without brain damage or mental retardation because she restricted her intake of phenylalanine until adolescence, at which time she went off the diet. She now returns to the PKU Clinic because she wants to have a baby, which means she must resume the diet to prevent prenatal damage to the baby from maternal PKU. As she discusses her feelings about this with the clinic nurse, she also reveals that she is having problems concentrating and feels depressed. The nurse helps the woman express her feelings, teaches about foods and medications that are safe to include in the diet, provides referrals to support resources, and helps the woman to develop a plan of self-care that includes goals, methods, and measures of success.

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• Katie Allen: An Eight Year Old with Fetal Alcohol Syndrome

  Fetal alcohol syndrome (FAS) is a group of birth defects including mental retardation, deficient growth, and defects of the skull, face, and brain that can occur in the infants of women who drink alcohol during pregnancy. This case scenario is about an eight-year-old girl with FAS who has trouble concentrating, is highly impulsive, tends to withdraw from others, becomes easily anxious, does not remember to follow rules, and has occasional anger outbursts. A parish health nurse intervenes when the girl has trouble behaving at church and is ostracized by church members. The nurse works with the girl's foster mother to increase the sensitivity of church members to children who have developmental disabilities by providing education about FAS. The nurse also advocates for the girl's right to participate as a fully included member of her faith community. The nurse works with Sunday school teachers to develop strategies that improve the girl's ability to participate appropriately in an inclusive classroom. This case scenario also highlights how the nurse can play a role in the primary prevention of FAS by informing women of the risks of drinking alcohol during pregnancy.

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• Jessica Rubinger: An Adult with Tuberous Sclerosis

  Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder that causes mental retardation, seizures, tumors and cysts, an increased risk of malignancy, calcium deposits in the brain, and skin manifestations. In this case scenario, a 32-year-old woman is diagnosed with breast cancer. Although the woman lives in a group home, her mother is her legal guardian. The nurse consultant for the group home accompanies the woman and her mother to the surgeon's office to provide support when options for treatment are discussed. The nurse advocates for the woman with the physician to make sure that the woman is offered the same treatment options as women without disabilities. She then listens as the woman's mother talks through her concerns about the various treatment options and makes a decision about which treatment she thinks is best for her daughter. The case scenario covers basic concepts related to developmentally appropriate pre-operative preparation, pre-operative diagnostic testing for a person with TSC, nursing assessment of nonverbal signs of distress and discomfort, and discharge instructions. The case scenario also discusses how nurses should prepare familiar caregivers who work in community residential facilities to serve as "sitters" with residents are hospitalized.

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• A Summer Camp Experience for Children with AIDS

  Children with HIV/AIDS may exhibit failure to thrive, developmental delays, and, in some cases, cognitive impairments. This scenario takes place in a summer camp for children who have chronic or life-threatening illnesses. It considers the role of the camp nurse as she interacts with camp staff, who are acting as caregivers, and with three campers, each of whom is dealing with a different issue related to his or her illness. Doug, who also has cerebral palsy and learning impairments, has been told that his HIV status is a secret not to be discussed with anyone outside his immediate family. Katrina, who has missed much school because of chronic pulmonary problems, has been told by her family that she has cancer because they do not want to disclose her HIV status to her. Abby, who has just learned that she is HIV positive after the death of her mother from AIDS, has been acting out and refuses to take any medication. After educating camp staff about HIV/AIDS, the camp nurse develops a therapeutic relationship with each of the three campers, assesses their needs and concerns, and intervenes appropriately.

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• Gene Cosens: A Young Adult with Prader-Willi Syndrome

  Prader-Willi syndrome (PWS) is a genetic condition characterized by uncontrolled appetite causing obesity, mental retardation, and other physical characteristics. It can cause significant limitations, which make it difficult for an adolescent to achieve independence and self-determination. For the past two years, a nineteen-year-old man has been a resident of a group home for people with Prader-Willi syndrome. Before moving to the home, it became increasingly difficult for the man's parents to provide the extensive supervision that he required. He aggressively had begun to pressure neighbors for food during the day, and sneak out at night while his parents slept to forage in garbage cans. These behaviors resulted in a 50-pound weight gain over three months. In this case study, nurses and caregivers work to maximize the man's self-determination and quality of life, while maintaining an optimal level of health and safety within the limits imposed by the nature of PWS. The conflicting goals implied in this statement highlight an ethical dilemma regarding the right of people with PWS to decide for themselves what and how much to eat. In this case scenario, this dilemma is resolved when the nurse, caregiver, and young man work together to establish a safe and caring environment.

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• Ruth Fingold: An Older Adult with Mental Retardation in a Long Term Care Setting

  This case scenario presents an older woman with cognitive limitations who lives alone in a supervised apartment. After a fall, she is hospitalized for a fracture and needs rehabilitation in a long-term care facility (LTCF) until she becomes able to care for herself independently again. After comparing and contrasting how psychosocial factors affect older adults both with and without developmental disabilities, the case scenario explores issues related to informed consent and competence. The importance of including the woman's community caregivers and social support network in the long-term care decision-making process is highlighted. The case scenario discusses federal and state requirements for screening people with developmental disabilities before admission to an LTCF to determine whether LTCF placement is appropriate, including PASAAR (Pre-Admission Screen and Annual Resident Review) and collection of a Minimum Data Set (MDS) to be used in developing a Resident Assessment Profile (RAP) for care planning. During the woman's stay in the LTCF, her community-based nurse and caregivers collaborate with the nursing staff at the LTCF to resolve problems and to develop a discharge plan that assures adequate community support.

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• James Dunn: A 50-Year-Old Man Who is Deaf/Blind and Has Mental Retardation

  This case scenario involves a man who has cognitive, visual, and hearing limitations as a result of having had measles encephalitis as a child. Nurses caring for persons who have cognitive and sensory limitations need to be especially alert for early signs of health problems. In this case, the man is evidencing signs that he has hip pain, which is reported to the nurse by the caregiver. After assessing the man's hip, the nurse decides that he needs to be evaluated by a physician. The nurse then teaches the caregiver how to advocate for the man when he visits the physician by anticipating possible events, providing any needed written instructions, and rehearsing with the caregiver. The nurse also completes a Passport Profile, which contains written information about the man that will be useful to the physician. The nurse at the physician's office welcomes the man and his caregiver, and learns from the caregiver some basic information about how the man communicates and moves around without being able to see, hear, or speak. After the physician sees the man, the nurse provides the caregiver with medication and home management teaching.

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• Davey Lee: A Four Year Old with Tay-Sachs Disease

  Tay-Sachs disease (TSD) is a genetic disorder in children that causes progressive destruction of the central nervous system and death in early childhood. There is no treatment or cure for TSD and, with the deterioration of developmental skills, the progression of losses can be devastating to the family. This case scenario begins as the family, which has cared for their child with great care and competence, is experiencing fatigue caused by the child's increasing care needs. The nurse helps the family to reconcile their preference to provide the child's care themselves with their need for rest and support. In turn, the family helps the nurse to understand how their child experiences the world and communicates. The module also discusses end-of-life care, nursing support as the family anticipates and plans for the death of their child, and introduction of home hospice services.

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• An Infant With Down Syndrome: From Hospital to Home

  This educational offering is a simulation of antepartal, intrapartal, and postpartal care of a family with a newborn who has Down syndrome. Nurses working with families who give birth to a baby diagnosed with Down syndrome must understand the characteristics of Down syndrome and ways to support the family during a critical time. This program describes the experience of a woman, her husband, their baby, and the team who provides their care. Learners receive an overview of Down syndrome, including associated medical problems, and the implications for nursing care of the infant with Down syndrome and his/her family.

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• Five Students With Down Syndrome: A Day in the Life of a School Nurse

  Children with Down syndrome are first and foremost children. They have the same desires and dreams as any children. They want to feel pride in their accomplishments, be the best they can be, and feel accepted and included. They are capable of many things, and have individual talents and personalities. Although they may develop certain medical issues that occur in higher frequency than in children who do not have Down syndrome, most are generally healthy. By focusing on what might be a typical day in the life of a school nurse who cares for children with Down syndrome, this offering presents a variety of case scenarios that will provide nurses with the means to anticipate and assess needs, and to intervene appropriately to influence the physical, emotional, psychosocial, educational, and functional lives of children with Down syndrome and their families.

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• Care of the Young Adult with Down Syndrome: A Time of Transition

  This module considers the nurse's role in the family-centered care of young adults with Down syndrome and reviews potential health problems that can affect adolescents and young adults with Down syndrome. Adolescence to adulthood is a time of transitions, with dramatic physical and emotional changes occurring as young people mature and establish their independence. These transitions can be especially challenging for young people with Down syndrome because mental retardation and other disabilities can impede the usual progression from childhood to adult autonomy. This module uses Down syndrome as a model for describing how nurses can help people with cognitive and functional limitations to make adolescent-to-adult transitions in four areas: to work from school, to independent living from living at home with family, to managing their own health care, and to developing adult sexuality and relationships.

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• Walter Makuch: An Aging Adult with Down Syndrome

  Research shows that people with Down syndrome show aging changes in many body systems 10 to 20 years earlier than do other people. Some aging changes associated with Down syndrome currently are not preventable or curable, e.g., Alzheimer's disease. Other aging changes, such as sleep apnea, obesity, and hearing loss, are secondary conditions. Nursing assessment and intervention when early signs of secondary conditions present can help maintain function and quality of life. This module is a case scenario that follows an older man with Down syndrome over eight years as he moves to a group home after his mother's death, to a hospital for care of an acute illness, to a long-term-care facility for rehabilitation, and, ultimately, back to the group home to age in place with hospice care. During this time, the nurse assesses and intervenes when secondary conditions affect his health, behavior, and ability to function. Particular attention is given to the differentiation of Alzheimer's disease and the manifestation of Alzheimer's-like symptoms in the older adult with Down syndrome. This module also discusses future planning, advocacy for aging in place, and end-of-life care for older people with developmental disabilities.

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• A Caring Approach to Behavioral Issues

  This module discusses behavioral assessments and interventions that the nurse can use when caring for people with developmental disabilities, who, as a group, are at higher risk for behavioral disorders and psychiatric illnesses than the general population. Two case scenarios are threaded through the module: one scenario about a young woman with Down syndrome who lives in a group home and has behaviors that make control of her diabetes difficult, and a second scenario about a man with an intellectual disability who is displaying aggressive behavior in his workplace. As each scenario progresses, it shows the causes of each client's behavior and how the nurse uses a "whole-person" approach to intervene in modifying behavior and promoting positive health care choices. In addition to the case scenarios, the module also discusses variables that can affect behavior and how various factors can affect the evaluation of behavior in people who have developmental disabilities. After discussing dual diagnosis (having both a developmental disability and a mental illness) and co-morbid psychiatric conditions, the module presents an overview of the role of the nurse in psychopharmacologic and behavioral interventions, including education and support of caregivers involved in behavioral observations and interventions.

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• A Framework for Caring Communication

  Clients with developmental disabilities who have cognitive, speech, motor, or sensory limitations may require accommodations to communicate in healthcare situations. After reviewing the effect of context on communications, this module examines how eleven different communication skills and fourteen communication barriers can either promote or impede developmentally appropriate therapeutic communication among nurses, clients, and caregivers. The module discusses syndromes and conditions that commonly cause communication challenges, and describes behaviors that can serve as communication, with special emphasis on how these behaviors can help nurses to assess subjective indicators of pain and other discomfort in clients who are nonverbal. Augmentative and alternative communication methods, including gestures, low-tech, and high-tech communication aids are discussed. This module emphasizes "person-first" language and offers multiple suggestions for ensuring that the nurse respectfully promotes mutually understood communication in clinical situations.

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• Promoting Caring Partnerships: Delegation to Direct Care Staff

  Nurses who work in developmental disabilities delegate much direct care to unlicensed caregivers. This module presents a caring approach to delegation in which the nurse uses appropriate delegation to ensure that clients' basic needs are met through administration of human care essentials by licensed and unlicensed caregivers. The module builds a foundation for the steps that lead to appropriate delegation by examining practical clinical applications of the concepts of authority, responsibility, accountability, and competence. It emphasizes how the nurse must ensure that each task is delegated under the right circumstances and to the right person, and that the nurse uses correct direction, communication, and supervision. Using situations that commonly occur in the care of clients with developmental disabilities, the module describes how to overcome barriers to delegation by nurses and how to integrate caring concepts into supporting caregivers as they carry out legal, safe, and appropriate delegation.

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• Promoting Understanding of Neurological Assessment

  Clients with developmental disabilities can be affected by a wide range of neurological disorders due to brain damage occurring before, during, or after birth. This module focuses on how the nurse can help caregivers to understand their importance as aware observers and prompt reporters of changes from the client's usual neurological baseline. The module explains various components of neurological assessment (mental status; cerebellar function; and cranial, motor, and sensory nerve function). It correlates abnormal neurological findings to common syndromes and conditions in clients with developmental disabilities, and then describes how and what nurses can teach about the implications of these findings to help caregivers modify care based on each client's need for accommodations to overcome neurological limitations.

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• Promoting Understanding of Developmental and Functional Assessment

  Developmental and functional assessment is an ongoing process of screening for developmental disabilities, identifying risks for later developmental problems, evaluating a client's current competencies, and considering the best ways to help the client develop further. Beginning with antepartal testing and continuing through the lifespan, this module discusses the nurse's role in taking a developmental history, conducting developmental screening, and translating the results of formal developmental testing into interventions that help to potentiate development, decrease limitations, and increase quality of life. This module places special emphasis on helping caregivers to modify their care of clients with developmental disabilities care based on the results of cognitive, physical, and functional assessments. The concept of learned helplessness also is discussed, as are interventions to increase self-reliance and independence in clients.

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• A Caring Approach to Teaching Medication Administration Tasks

  Administering medications to clients with developmental disabilities requires special skills. These clients can have complex medication regimens, and nurses may have to adapt usual medication administration techniques to accommodate limitations caused by disabilities. Additionally, nurses must be knowledgeable about state statutes that regulate the delegation of medication administration tasks to unlicensed caregivers. This module focuses on how nurses can teach caregivers a safe and caring approach to carrying out delegated medication administration tasks. Disability-specific guidelines for topics such as psychotropic side effects are provided, tips and techniques for all routes of medication administration are offered, and strategies for promoting independence in self-medication for capable clients are presented. The module also emphasizes legal and quality assurance issues related to medication administration, including requirements for recognizing and reporting medication errors.

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• A Caring Approach to Seizure Care

  Many clients with developmental disabilities have seizures, so nurses caring for this population must be knowledgeable about seizure management. Because caregivers are more likely than nurses to be present when a client has a seizure, it is imperative that nurses teach caregivers about how to recognize and document seizures, and how to provide client care during and after seizures. This module focuses on how nurses can best help caregivers to understand what seizures are, how they are diagnosed and classified, and what factors can precipitate them. The module emphasizes a caring approach to employing seizure precautions and ensuring client safety during a seizure, including use of individualized seizure management protocols for providing client care and recognizing when a seizure requires emergency medical care. The caregiving implications related to client use of antiepileptic medications and other treatments for epilepsy are discussed. Additionally, the module presents strategies for facilitating and advocating for community inclusion for people with developmental disabilities.

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• The Head-to-Toe Observation Form

  "The Head-to-Toe Observation Form" provides a systematic approach to making and reporting 85 different observations about potential changes in health status for people living in community residential settings. This module teaches nurses how to instruct caregivers in the use of this Form with people with developmental disabilities to ensure 1)early detection of injuries and illnesses 2) prompt reporting of urgent conditions, and 3) promotion of physical, mental, and social health. In addition to providing explanations of what should be observed and why it should be observed for each of the 85 health observations, the module also describes how to implement use of the Form with caregivers in residential facilities. Nurses also can print free copies of the Head-to-To Observation Form, Administrative Follow-Up Form, and Passport Profile (information for health providers) for use in their facilities.

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• Health Care Protocols 1

  The Health Care Protocol modules are designed to increase the knowledge and skills of registered nurses (RNs) who are responsible for designing and evaluating nursing care plans for clients with developmental disabilities residing in community care facilities. Nurses will learn to use Health Care Protocols to help manage client care through early detection of emerging and urgent health problems and referral to the appropriate health provider, if needed. The emphasis is on the partnership relationship among the client, the caregiver who is making and reporting changes in the client's health status, and the nurse who must assess the situation and determine the most appropriate course of action.
  Module One reviews six critical health issues that influence the care of people with developmental disabilities, including co-morbidities, fever, hand washing, safety, skin care, seizure disorders, and swallowing problems. The module then describes selected health problems, including protocols for deciding whether the problem can be managed with home treatment, or whether it requires referral to a health care provider or emergency services. The health problems covered in Module One include allergies (allergic rhinitis and anaphylaxis), diabetes mellitus (hypoglycemia, hyperglycemia, and chronic complications), and eye/ear/nose/throat problems (excessive cerumen, ear infections, eye infections, eye trauma, sore throat, nose bleeds). Module One also discusses the provision of birth control services to sexually active and competent adults with developmental disabilities. The Health Care Protocols can be printed and used as guidelines in community residential facilities.

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• Health Care Protocols 2

  Module Two describes selected health problems, including protocols for deciding whether the problem can be managed with home treatment, or whether it requires referral to a health care provider or emergency services. The health problems covered in Module Two include feeding and digestive problems (constipation, diarrhea, dehydration, dysphagia, gastroesophageal reflux disorder, gastrointestinal bleeding, and vomiting), fever, genitourinary problems (urinary tract infections, kidney stones, and sexually transmitted diseases), musculoskeletal injuries, and changes in neurological status. Module Two also discusses health care advocacy for people with developmental disabilities, including immunization and screening for secondary conditions. The Health Care Protocols can be printed and used as guidelines in community residential facilities.

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• Health Care Protocols 3

  Module Three describes selected health problems, including protocols for deciding whether the problem can be managed with home treatment, or whether it requires referral to a health care provider or emergency services. The health problems covered in Module Three include pain (indicators of pain and pain management), respiratory problems (asthma, choking, shortness of breath, upper respiratory infections, influenza, sinusitis and pneumonia), and skin conditions (bruises, scrapes, lacerations, punctures, blisters, boils, burns, rashes, bacterial infections, fungal infections, parasites, psoriasis, and pressure sores). Module Three also discusses silent clues that can indicate the presence of health problems in people who cannot communicate verbally, and discusses the action to take if health observations indicate that a person with developmental disabilities could be a victim of abuse or neglect.

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