Disclaimer: This toolkit is intended to provide resources for school nursing practice as it relates to the care of students with cardiac conditions in Oregon schools. This is not medical nor nurse practice advice and is not prescriptive, as it relates to individual students or individual nursing practice. These resources do not override individual assessment and clinical judgement. Nurses are responsible for their own assessment and practice.

Cardiac resources and responsibilities for school nurses fall into multiple categories of individual and population care, primarily including:

  • Cardiac Alterations and Case Management
  • Academic Implications of Chronic Cardiac Conditions
  • Health Promotion and Cardiac Screening
  • Emergency Response Planning

Cardiac Alterations

Pediatric heart (cardiac) conditions or cardiac alterations is a broad term used to describe several different conditions associated with the heart in children. Cardiac alteration/conditions in children can be identified as congenital and acquired.

Congenital Heart Defects

A congenital heart defect is a structural problem of the heart that a child is born with.  The severity of heart defects is broad, ranging from benign and not requiring treatment, to complex requiring multiple surgeries and interventions over years or a lifetime. Congenital heart defects may be categorized in a variety of ways, such as cyanotic and acyanotic. (Friedl, n,d.; Papakonstantinou  et al., 2020).  Congenital heart defects may be found in isolation or in combination with other defects, syndromes or conditions (Garcia & Peddy, 2018). Congenital Heart Defects include Atrial Septal Defect, Coarctation of the aorta, Pulmonary Atresia and Truncus arteriosus, for example (CDC, 2022a).

Acquired Heart Disease

Acquired Heart Diseases are more frequently seen in adults than children, and often refer to the development of coronary artery disease, but acquired heart disease also occurs  in children most commonly as a result of infection, such as rheumatic heart disease or Kawasaki Disease. Other acquired heart conditions such as myocarditis, pericarditis, endocarditis, cardiomyopathy and arrhythmias may occur secondary to infection complications or  underlying congenital anomalies (Doernbecher Children’s Hospital, 2022; Friedl, n.d.; Papakonstantinou  et al., 2020).

In the school setting it is important to understand the basic physiology of an underlying cardiac condition in a student. This enables the nurse to understand and prepare staff to identify potential complications, restrictions, or interventions.

Children with cardiac alterations may present with complications differently and require different interventions depending on whether or not :

  • The condition is structural or electrical.
  • Medications or devices (pacemaker) are used as therapeutic interventions.
  • There has been significant loss of developmental milestones.
  • Activity limitations or restrictions are necessary.
  • The condition is regarded as progressive.
    (CDC, 2018; Papakonstantinou  et al., 2020)

Academic Implications of Chronic Cardiac Conditions

For children with heart defects in the school setting, it is critical to determine what physical symptoms a student may experience, what  medications are necessary to remain at school, accommodations needed, medical planning, restrictions, and educational planning for a child who has had developmental impact related to their underlying health (Children’s National, 2022).

It is critical to note that children with heart defects may be more likely than children without heart defects to:

  • have difficulty with learning, focusing, and communicating;
  • miss more than 10 days of school in one year; and
  • have trouble participating in sports or clubs.

Children with heart defects who don’t have any other birth defects are more likely to need special education services than children without heart defects. Certain conditions requiring special education needs are more common among children with heart defects:

  • intellectual disability;
  • problems with hearing or seeing;
  • developmental delay;
  • learning disability; and
  • limited alertness in school.
    (CDC, 2022; Downing, Oster & Farr, 2017;  Razzaghi, 2015, Farr, Downing & Riehle-Colarusso, 2018).

Children with unstable or progressive heart conditions may require mediation, individual planning, physical accommodations or emergency plans (CDC, 2022b)

Prevention & Screening

Sudden cardiac death is a leading cause of death in young athletes and significant among non athletes as well. In sudden cardiac death there is often no advance warning or signs/symptoms that would suggest the child is at risk. The American Academy of Pediatrics (2021) suggests that all children should be screened every 3 years regardless of their athletic status. (Erickson & Solerno, 2021; Erickson et al., 2021).  According to Yow & Sharma (2022):

In patients younger than 35, the most common cause of sudden cardiac death is a fatal arrhythmia, usually in the context of a structurally normal heart. In patients from birth to 13 years, the primary cause is a congenital abnormality. In patients aged 14 to 24 years, the cause of sudden cardiac death is attributed to hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), congenital coronary anomalies, genetic channelopathies, myocarditis, Wolff-Parkinson-White syndrome, and Marfan syndrome.

Although screening is recommended by primary care providers (PCP), school age children can benefit from population based youth cardiac screening which can be facilitated by a school nurse.

Emergency Response Planning

Emergency response planning is a critical element of school safety. Emergency response planning includes implementation of strategies such as:

  • CPR trained Staff
  • AED programs
  • Standardized Cardiac Protocols [Under Templates]
  • Cardiac Emergency Response Plan (CERP)
  • Cardiac Screening Programs

CPR Trained Staff

AED Programs

An automated external defibrillator (AED) is a portable electronic device that analyzes cardiac rhythm and prompts a user to deliver a shock when necessary. Its purpose is to jolt an abnormal heart rhythm such as ventricular fibrillation back to normal sinus rhythm.

In 2005 the Oregon Legislature passed Oregon Revised Statutes ORS 327.364. The goal of the grant program was to provide automated external defibrillators in at least two public school facilities in each school district. This bill authorized the Oregon Department of Education to seek funds and assistance from the United States Government and its agencies or from any other source, public or private, for the establishment of a grant program. This law also contains a Good Samaritan clause which protects well intentioned citizens using an AED in aid of another from potential lawsuits from any resulting injury. This law also recognizes that AEDs require ongoing maintenance, training, signage and 9-1-1 policy.

During the 2010 Special Session, the Legislature passed ORS 339.345. This bill requires each school campus to have at least one automated external defibrillator (AED) on premises. Compliance was required on or before January 1, 2015 (OHA, 2023).

Oregon AED Information

Base Camp AED Donation Program

Standard Cardiac Protocols

Standard Protocols or Procedures are the actions that staff should take based on symptoms observed or reported at school.  A standard cardiac protocol would outline steps to take for standard first aid response when an individual presents with cardiac related symptoms. This is less comprehensive than a CERP plan and the target audience is all staff as opposed to Emergency Response Teams.

There is a modifiable template for a Standard Cardiac Protocol in the templates section.

Cardiac Emergency Response Plan (CERP)

CERP is  a part of emergency response planning and a document that  establishes specific steps to take in a cardiac emergency  to reduce death from cardiac arrest in school settings.  A carefully orchestrated response to cardiac emergencies will reduce deaths in school settings, and ensure that chaos does not lead to an improper or no response. Preparation is the essential key to saving lives (American Heart Association, 2023).

The following resources can assist in CERP development. There is also a modifiable plan in the template section.

Cardiac Screening

Providence Play Smart

Evidence Based Practice

Basic Disease Information

Although there may be relative consistency in assessing acute or chronic complications of many heart conditions,  the physiology of conditions can vary greatly.  It is encouraged that the nurse understand the individual physical conditions students experience who are being managed, specifically in conjunction with other conditions.  Below is a non-exhaustive list of resources for the pathophysiology of a variety of chronic cardiac conditions.

Open Pediatrics

Nationwide Children's

Cincinnati Children’s

Cleveland Clinic

Mayo Clinic

Legal Practice Standards

At the forefront of nurse case management for school nurses, is the understanding of scope of practice as it relates to case management and delegation of nursing tasks in a community setting:

Nurse Practice

Oregon Revised Statutes pertaining  First Aid and CPR in Schools.

  • Oregon Revised Statute ORS 339.866 Self-administration of Medication by Students
  • Oregon Administrative Rule OAR 581-021-0037 Administration of Medication

Public Access Practice Resources

As well, the professional nurse in the school setting should understand the existing resources and  framework for care of students with cardiac alterations.

Note: the following are national or regional resources that serve as a reference; they may or may not be consistent with Oregon law and do not supersede Oregon Nurse Practice.

American Heart Association

Centers for Disease Control and Prevention(CDC)

Children’s Health

Children's National

School Nursing 101

Sudden Cardiac Arrest Foundation

Professional Development

Nurses must ensure that they have proficiency in areas of practice in which the delegate. The following include free Continuing Education resources for nursing related to cardiac issues

NASN Learning Center

Khan Academy
Cardiac Physiology

Heart Disease/Defects



Blood Pressure

Valvular Conditions

Heart Failure


Cardiogenic Shock

National Library of Medicine

  • Mubarik A, Sharma S, Law MA. Bicuspid Aortic Valve. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Warrington SJ, Mahajan K. Cardiac Trauma. [Updated 2022 Apr 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Amin H, Siddiqui WJ. Cardiomegaly. [Updated 2022 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Malik A, Brito D, Vaqar S, et al. Congestive Heart Failure (Nursing) [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  • Ossa Galvis MM, Bhakta RT, Tarmahomed A, et al. Cyanotic Heart Disease. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Gupta A, Mendez MD. Endocarditis. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Kritzmire SM, Cossu AE. Hypoplastic Left Heart Syndrome. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Mejia E, Dhuper S. Innocent Murmur. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Owens AM, Plewa MC. Kawasaki Disease. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Hampton T, Alsaleem M, Murphy-Lavoie HM. Patent Foramen Ovale. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Sana MK, Ahmed Z. Pulmonary Atresia With Ventricular Septal Defect. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Heaton J, Kyriakopoulos C. Pulmonic Stenosis. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Brown JC, Gerhardt TE, Kwon E. Risk Factors For Coronary Artery Disease. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Farzam K, Rajasurya V, Ahmad T. Sudden Death in Athletes. [Updated 2022 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Patti L, Ashurst JV. Supraventricular Tachycardia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Diaz-Frias J, Guillaume M. Tetralogy of Fallot. [Updated 2022 Jan 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Szymanski MW, Moore SM, Kritzmire SM, et al. Transposition Of The Great Arteries. [Updated 2022 Sep 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Minocha PK, Phoon C. Tricuspid Atresia. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Bhansali S, Phoon C. Truncus Arteriosus. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Chhabra L, Goyal A, Benham MD. Wolff Parkinson White Syndrome. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Yow AG, Rajasurya V, Sharma S. Sudden Cardiac Death. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

UAP Training

In the state of Oregon there is specific training required for the care of students with medications.

Oregon Department of Education (ODE)


American Heart Association

Cincinnati Children

Vital Signs


The following templates are modifiable for use by school nurses as it relates to their practice and should be used consistently with Oregon State Board of Nursing, Delegation Laws, and local school policy.

Population Based Templates

Population based protocols are important for conditions where there may be a large representation of students who do not have individual plans due to lack of health maintenance or lack of medication at school, or no prior diagnosis. For these situations a standardized plan is critical. The below templates are described above under emergency response planning.

School Based Standard Cardiac Protocol

Cardiac Emergency Response Plan (CERP). 

Individualized Health Plans

An individualized health plan is the totality of the plan that includes all applicable procedures for students with chronic disease. Because these are intended to be individualized, the attached is an example of a compiled IHP:

  • Sample IHP (Bicuspid Aortic Valve and Aortic Aneurysm)
  • Sample IHP (Congestive Heart Failure and Hypertension)

Nursing Care Plan

For districts that use nursing care plans, the following editable template is available:

Teacher Notification

Teacher notifications, sometimes referred to as health status notifications,  or health information page can be used or combined with emergency action plans to ensure that all staff working with a student with cardiac conditions are informed of the diagnosis and immediate actions when necessary, These are abbreviated documents to provide critical information, but less comprehensive information than a complete individualized health plan (IHP) .

Cardiac Teacher Notifications [Note these should be personalized for students based on their complete set of diagnoses and symptoms experienced]:


Procedures also greatly vary by student health status, needs, level of care and type of regimen. The following are sample templates for specific procedures. A complete student  assessment should be made to determine appropriate procedures:


Prescriber  Order Templates



American Heart Association (2023). Cardiac Emergency Response Plan - Schools.

Centers for Disease Control and Prevention ( 2018) Children with heart conditions have special healthcare needs.

Centers for Disease Control and Prevention ( 2022) Specific Congenital Defects.

Centers for Disease Control and Prevention.(2022)  Learning and educational needs for children and young adults with heart defects.

Children’s National. (2022). Children and Adolescents with Congenital Heart Disease (CHD): Information for School Teams,disabilities%20or%20special%20education%20needs.

Doernbecher Children;s Hospital. (2022) Acquired heart conditions in children

Downing KF, Oster ME, Farr SL. (2017). Preparing adolescents with heart problems for transition to adult care, 2009-2010 National Survey of Children with Special Health Care Needs. Congenital Heart Disease. 12(4):497-506.

Garcia RU, Peddy SB. (2018)  Heart Disease in Children. Primary Care;45(1):143-154. doi: 10.1016/j.pop.2017.10.005. PMID: 29406940.

Erickson, C., Salerno, J. (2021). Policy: Incorporate cardiac risk screening for all youth at least every 3 years.  American Academy of Pediatrics.

Christopher C. Erickson, Jack C. Salerno, Stuart Berger, Robert Campbell, Bryan Cannon, James Christiansen, Kody Moffatt, Andreas Pflaumer, Christopher S. Snyder, Chandra Srinivasan, Santiago O. Valdes, Victoria L. Vetter, Frank Zimmerman .(2021). Section on Cardiology and Cardiac Surgery, Pediatric and Congenital Electrophysiology Society (PACES) Task Force on Prevention of Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics; 148 (1): e2021052044. 10.1542/peds.2021-052044

Farr SL, Downing KF, Riehle-Colarusso T, Abarbanell G.(2018). Functional limitations and educational needs among children and adolescents with heart disease. Congenital Heart Disease. 13:633-639.

Friedl, E (n.d.) Congenital vs. Acquired Heart Defects.

Mayo Clinic. (2022). Congenital heart defects in children.

Oregon Health Authority (2023) Automated External Defibrillator.

Papakonstantinou NA, Kanakis MA, Bobos D, Giannopoulos NM.(2020). Congenital, acquired, or both? The only two congenitally based, acquired heart diseases. J Card Surg. 36(8):2850-2856. doi: 10.1111/jocs.15588. PMID: 33908651.

Razzaghi H, Oster M, Reefhuis J. (2015). Long-term outcomes in children with congenital heart disease: National Health Interview Survey. J Pediatr. 2015;166(1):119-124.

Riehle-Colarusso T, Autry A, Razzaghi H, Boyle CA, Mahle WT, Braun KV, Correa A. ( 2015).  Congenital heart defects and receipt of special education services. Pediatrics;136(3):496-504

Spillmann, R., Polentarutti, S., Ehrler, M. et al. (2021). Congenital heart disease in school-aged children: Cognition, education, and participation in leisure activities. Pediatr Res.

University of California San Francisco. (2022). Acquired heart disease.

Yow AG, Rajasurya V, Sharma S. Sudden (2022). Cardiac Death. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: