By Sherri Foster

Note:  This plan was created for a child with FA and severe cardiomyopathy.

INDIVIDUAL CARE PLAN FOR (                    )

__________ has a progressive neurological disorder called Friedreich's Ataxia, which presently affects his balance, motor skills, muscle strength and makes him fatigue easily. He also has a tremor. As this condition gradually progresses, __________'s balance will get even worse, he could develop diabetes, scoliosis, and eventually would require a wheelchair. ___________'s eyesight, hearing and speech could also be affected and eventually he may probably have difficulty swallowing.

__________ also has a progressive life threatening heart condition called Hypertrophic Cardiomyopathy, wherein the walls of his heart are thickening and causing his heart to have to work harder, making him fatigue easily and breathless. This condition will gradually progress making him even more fatigued and breathless, and there could be swelling, dizziness, chest pain and arrhythmia.

Signs that might indicate an emergency situation include:

1. Change in behavior that indicates dizziness or disorientation
2. Excessive fatigue and breathlessness (especially if breathlessness does not abate after short period)
3. Child complaining of chest pain

If child shows some of the above symptoms and you are in doubt of whether or not to call an ambulance: Call Mother _________________, cell ________________

Emergency Action Plan:

1. Call 911 if ___________ faints or indicates chest pain
Request Ambulance with Advanced Life Support

2. Call School First Aid Attendant, _______________
Ensure that he is kept comfortable, warm and calm

3. Call Mother _____________ , cell ___________
Call Father ______________ , pager ___________

Action Plan:

1. Classroom teacher to be aware of condition
2. Red dot on class register
3. Have photo with Individual Care Plan in staff room and medical room
4. Discussion at staff meeting regarding Individual Care Plan
5. Ensure medical alert card is updated and accompanied by ambulance
form with ____________'s weight
6. Provide parents with field trip information
7. __________ is only to be transported by parents or with a person with a cell phone

Limitations:

__________ is not to be encouraged or pushed to over-exert himself and is to be allowed to take rests or to exclude himself from activities.