CANCER IHP Student's Name * First Middle Last Suffix This field is required. Please complete the following fields: First,Last. PhotoAccepted file types: jpg, gif, png, jpeg, Max. file size: 100 MB.DoB Month Incorrect Value for Month field Day Incorrect Value for Month field Year Incorrect Value for Month field Please enter a valid date. GR/LevelDaycareEEPKKN010203040506070809101112Post-GraduateWould you like to add the student's ID number? Yes No ID Campus/Building Would you like to add the student's homeroom number and teacher's name? 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Yes No ContactContact Name Add RemoveRelationship Add RemoveContact Phone Number Add RemoveContact Phone Type Add RemoveContact Phone Number Add RemoveContact Phone Type Add RemoveContact Name RelationshipChoose one:ParentGuardianOtherContact Phone Number Contact Phone TypeChoose OneHomeMobileWorkFaxContact Phone Number Contact Phone TypeChoose OneHomeMobileWorkFax Add More Treating Physician Add RemovePhysician Phone Number Add RemovePhysician Fax Number Add RemoveTreating Physician Physician Phone Number Physician Fax Number Add More Preferred Hospital City MEDICAL DIAGNOSIS(ES)Add a medication or procedure? Yes No MEDICATIONS/PROCEDURES Medication/Procedure Strength Dose ModeChoose one:OralTopicalInhaledIntranasalSQNebulizerSublingualRectalIMIVSched/PRN?Choose OneScheduledPRNTime Frequency If PRN, administer for Medication/Procedure Add RemoveStrength Add RemoveDose Add RemoveMode Add RemoveSched/PRN? Add RemoveTime Add RemoveFrequency Add RemoveIf PRN, administer for Add Remove Add More MEDICAL HISTORYASSESSMENT NursingList InterventionList OutcomesList Nursing Diagnosis: Fatigue Related to cancer treatment Related to anemia or nutritional deficiencies Related to physical deconditioning Related to emotional stress and anxiety Interventions The school nurse will encourage energy conservation techniques. The school nurse will promote balanced nutrition and hydration to support energy levels. The school nurse will work with teachers to adjust academic expectations during periods of extreme fatigue. The school nurse will encourage mild physical activity, as tolerated, to prevent deconditioning. Expected Outcomes The student will report improved energy levels and an ability to complete daily activities with fewer periods of fatigue. The student will demonstrate an understanding of energy conservation techniques and apply them effectively. The student will engage in school activities and physical activity as tolerated, without overexertion. Nursing Diagnosis: Risk for Infection Related to immunosuppression related to chemotherapy or radiation therapy Related to neutropenia Related to compromised skin integrity from treatment-related side effects Interventions The school nurse will educate the student and family about infection prevention, including proper hand hygiene and avoiding contact with sick individuals. The school nurse will ensure a clean, low-germ environment in the school setting, especially during periods of neutropenia. The school nurse will monitor the student for signs of infection and report immediately to healthcare providers. The school nurse will collaborate with school staff to allow flexibility for remote learning during periods of high infection risk. Expected Outcomes The student will remain free from infection during and after treatment. The student and family will demonstrate knowledge of infection prevention measures. School staff will support the student in maintaining a safe and clean environment. Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements Related to chemotherapy-induced nausea, vomiting, or altered taste Related to reduced appetite due to cancer treatment Related to difficulty swallowing or mouth sores Interventions The school nurse will collaborate with a dietitian to create a nutrient-rich, high-calorie meal plan tailored to the student's needs. The school nurse will provide small, frequent meals that are easy to digest and avoid foods that exacerbate nausea. The school nurse will encourage the use of antiemetics (nausea medication) before meals if prescribed. The school nurse will encourage oral hygiene and provide options for soft, bland foods if mouth sores are present. Expected Outcomes The student will maintain or gain weight appropriate for age and height. The student will tolerate meals with reduced nausea and demonstrate improved appetite. The student will maintain adequate nutrition despite treatment side effects. Nursing Diagnosis: Acute Pain Related to cancer treatment side effects Related to surgical procedures Related to tumor-related pressure or discomfort Interventions The school nurse will administer prescribed analgesics or pain-relief medications as needed. The school nurse will use non-pharmacological methods for pain relief, such as relaxation techniques, massage, or distraction. The school nurse will collaborate with the healthcare team to assess and manage pain, adjusting medications as necessary. The school nurse will provide emotional support and reassurance during periods of high pain intensity. Expected Outcomes The student will report a reduction in pain and an improved ability to engage in daily activities. The student will use prescribed and non-pharmacological pain management strategies effectively. The student’s pain will be regularly assessed and controlled according to their needs. Nursing Diagnosis: Body Image Disturbance Related to hair loss from chemotherapy Related to surgical scars or other physical changes related to treatment Related to weight changes due to medication or inactivity Related to social stigma or self-consciousness about appearance Interventions The school nurse will provide emotional support and opportunities for the student to express feelings about changes in appearance. The school nurse will encourage the use of wigs, hats, or scarves if hair loss is a concern, and support the student’s preferences for managing these changes. The school nurse will foster a positive self-image by emphasizing the student’s strengths and abilities rather than appearance. The school nurse will collaborate with school counselors to provide ongoing support for any self-esteem issues related to body image. Expected Outcomes The student will verbalize feelings about body image changes and demonstrate acceptance of physical changes. The student will participate in social and academic activities with confidence, despite changes in appearance. The student will express improved self-esteem and body image with the support of family and peers. Nursing Diagnosis: Anxiety Related to fear of cancer progression or treatment outcomes Related to uncertainty about future health and academic performance Related to separation from family or friends during hospital stays Related to disruptions to routine due to treatment schedules Interventions The school nurse will encourage open communication about fears and concerns related to the diagnosis and treatment. The school nurse will teach relaxation techniques, such as deep breathing, meditation, or visualization, to help manage anxiety. The school nurse will maintain a consistent school routine as much as possible, allowing flexibility during treatment. The school nurse will collaborate with school staff to provide emotional support and counseling services as needed. Expected Outcomes The student will demonstrate the use of relaxation techniques to manage anxiety. The student will report reduced anxiety and greater emotional stability during treatment. The student will actively engage in school activities with minimal disruptions caused by anxiety. Nursing Diagnosis: Powerlessness Related to loss of control due to medical treatments, hospital stays, and ongoing health issues Related to dependence on others for care and decision-making Related to emotional distress about the future Interventions The school nurse will involve the student in decision-making about their care and treatment whenever possible to increase feelings of control. The school nurse will educate the student about their condition and treatment options in an age-appropriate manner to reduce fear of the unknown. The school nurse will encourage small tasks or activities that the student can control (e.g., choosing clothes, deciding on hobbies or interests). The school nurse will provide consistent emotional support and validation of the student’s feelings and concerns. Expected Outcomes The student will demonstrate a sense of control over certain aspects of their treatment and daily life. The student will express an understanding of their illness and treatment options, reducing feelings of helplessness. The student will participate in activities that promote independence and self-empowerment. Nursing Diagnosis: Risk for Social Isolation Related to extended hospital stays or frequent absences from school due to treatment Related to feelings of being "different" from peers due to illness Related to fear of rejection or stigma related to the diagnosis Related to physical limitations or fatigue preventing participation in social activities Interventions The school nurse will facilitate peer support or buddy programs that connect the student with understanding classmates. The school nurse will encourage virtual participation in school activities when physical attendance is not possible. The school nurse will collaborate with school staff to help the student re-integrate into the school environment after absences. The school nurse will provide opportunities for the student to engage in extracurricular activities that align with their physical abilities. Expected Outcomes The student will maintain connections with peers and participate in social activities, even during treatment. The student will demonstrate confidence in maintaining friendships and social interactions despite illness. The student will experience reduced feelings of isolation and greater inclusion in school activities. Would you like to add another nursing diagnosis? Yes No Nursing DiagnosisNursing DiagnosisAdd your own nursing diagnosisInterventionsAdd your own nursing interventionsExpected OutcomesAdd your own expected outcomesNursing Diagnosis Add RemoveInterventions Add RemoveExpected Outcomes Add Remove Add More EVALUATIONNOTESIHP Developed ByName First Last Title Date Month Day Year Please enter a valid date. Do you want to include physician and parent signature lines? Yes Download IHP Clicking this button will download this IHP to your computer and return you to the blank IHP. Return Clicking this button will return you to the IHP to make changes.
