The handbook presents California guidelines for training school personnel to provide skilled nursing procedures such as tracheostomy suctioning and misting for students with special health needs. The workbook begins with an overview of the anatomy and function of the respiratory system, specifically breathing mechanics. Part 2 considers the rationale and performance of tracheostomy suctioning using a sleeved catheter. Essential steps and precautions are outlined from student and equipment preparation through actual suctioning and recordkeeping. Illustrations depict the procedures. The final part describes the purposes and procedures for using the mist machine which is necessary to counteract low humidity and/or dry lung linings. Each of the sections include post-tests to test knowledge on the procedures. (CL) .