SCOLIOSIS 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? Yes No Teacher Name Homeroom Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact List is attached to IHP. 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: Impaired Physical Mobility Related to spinal curvature causing discomfort or pain Related to use of a brace or physical restrictions due to scoliosis Interventions The school nurse will collaborate with the student’s healthcare provider to understand activity limitations and necessary accommodations. The school nurse will assist in developing a plan with physical education teachers for modified or alternative physical activities. The school nurse will provide support for the proper use and adjustment of a scoliosis brace during the school day. The school nurse will monitor for complaints of pain or discomfort and recommend rest breaks as needed. Expected Outcomes The student will participate in physical activities appropriate to their abilities without exacerbating symptoms. The student will report reduced discomfort and improved mobility during school activities. Nursing Diagnosis: Risk for Impaired Skin Integrity Related to prolonged use of a scoliosis brace Related to friction or pressure from the brace Interventions The school nurse will encourage regular skin assessments in areas where the brace contacts the skin. The school nurse will educate the student and caregivers on proper skin hygiene and care, especially under the brace. The school nurse will recommend the use of soft, breathable clothing under the brace to minimize friction. The school nurse will communicate with the healthcare provider if skin irritation or breakdown occurs. Expected Outcomes The student will maintain intact and healthy skin with no signs of irritation or breakdown. The student and caregivers will demonstrate proper skin care practices. Nursing Diagnosis: Risk for Altered Body Image Related to visible use of a scoliosis brace Related to self-consciousness about posture or physical appearance Interventions The school nurse will provide emotional support and reassurance to boost the student’s confidence. The school nurse will encourage participation in activities that highlight the student’s strengths and abilities. The school nurse will collaborate with counselors to address feelings of self-consciousness or anxiety about appearance. The school nurse will educate peers (with the student’s and caregivers’ consent) about scoliosis to promote understanding and reduce stigma. Expected Outcomes The student will verbalize positive feelings about themselves and their abilities. The student will participate in social and school activities with confidence. Nursing Diagnosis: Risk for Social Isolation Related to limited participation in physical activities or social events due to scoliosis Related to fear of being judged for wearing a brace Interventions The school nurse will encourage the student to engage in inclusive activities where physical limitations are not a barrier. The school nurse will work with teachers and peers to foster a supportive and accepting environment. The school nurse will provide opportunities for the student to discuss feelings of isolation and offer solutions. The school nurse will connect the student with support groups or peers who have similar experiences. Expected Outcomes The student will report feeling included and supported by peers and teachers. The student will actively engage in social and academic activities. Nursing Diagnosis: Risk for Noncompliance Related to discomfort or inconvenience of wearing the brace Related to lack of understanding about the importance of treatment adherence Interventions The school nurse will educate the student and caregivers on the importance of wearing the brace as prescribed to prevent worsening curvature. The school nurse will address concerns about discomfort and provide strategies to improve comfort (e.g., clothing adjustments, breaks when appropriate). The school nurse will use positive reinforcement to encourage adherence to wearing the brace. The school nurse will collaborate with the healthcare provider to explore alternative solutions if noncompliance persists. Expected Outcomes The student will adhere to the prescribed brace-wearing schedule. The student will report improved comfort while wearing the brace. Nursing Diagnosis: Deficient Knowledge Related to lack of understanding about scoliosis, its progression, and treatment Related to unawareness of coping strategies or available resources Interventions The school nurse will provide age-appropriate education about scoliosis, its effects, and the importance of treatment. The school nurse will offer resources to caregivers, such as educational materials or information about support groups. The school nurse will teach the student strategies for managing symptoms, such as stretching and proper posture. The school nurse will collaborate with teachers to ensure academic accommodations, such as extra time for tasks requiring movement. Expected Outcomes The student and caregivers will demonstrate understanding of scoliosis management. The student will actively participate in their treatment plan and use learned strategies to manage symptoms. Nursing Diagnosis: Disturbed Sleep Pattern Related to discomfort or difficulty sleeping while wearing a brace Related to musculoskeletal pain due to scoliosis Interventions The school nurse will discuss sleep concerns with the student and caregivers to identify contributing factors. The school nurse will recommend positions or supports, such as pillows, to improve comfort during sleep. The school nurse will encourage adherence to pain management strategies, such as stretching before bedtime. The school nurse will communicate with the healthcare provider for further evaluation if sleep disturbances persist. Expected Outcomes The student will report improved sleep quality and reduced discomfort at night. The student will demonstrate adherence to strategies that enhance restful sleep. Nursing Diagnosis: Chronic Pain Related to musculoskeletal strain due to spinal curvature Related to prolonged sitting or standing during school hours Interventions The school nurse will provide a quiet space where the student can rest if pain becomes overwhelming. The school nurse will collaborate with the student’s teacher to allow periodic stretching or movement breaks. The school nurse will teach the student simple stretching exercises to relieve tension during the school day. The school nurse will communicate with caregivers about any recurring or severe pain that may require medical evaluation. Expected Outcomes The student will report decreased pain during school hours. The student will use strategies, such as stretching, to manage pain effectively. 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.
