TRANSPLANT 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: Risk for Infection Related to use of immunosuppressive therapy to prevent organ rejection Related to compromised immune system increasing vulnerability to pathogens Interventions The school nurse will educate the student and caregivers on infection prevention strategies, including proper hand hygiene and avoiding contact with sick individuals. The school nurse will collaborate with school staff to ensure the student is not exposed to contagious illnesses (e.g., flu, colds). The school nurse will monitor for signs of infection, such as fever, redness, or swelling, and notify caregivers immediately. The school nurse will encourage routine cleaning and disinfection of shared spaces in the classroom. Expected Outcomes The student will remain free from signs of infection during the school day. The student and caregivers will demonstrate understanding of infection prevention practices. Nursing Diagnosis: Risk for Organ Rejection Related to immune system response to the transplanted organ Related to nonadherence to prescribed immunosuppressive therapy Interventions The school nurse will administer or supervise medication administration during school hours if needed and ensure adherence to the prescribed schedule. The school nurse will educate the student and caregivers about the importance of following medication schedules strictly. The school nurse will monitor for early signs of rejection (e.g., fatigue, pain, changes in organ function) and act promptly. The school nurse will ensure an emergency action plan (EAP) is in place, developed in collaboration with the student’s healthcare provider. Expected Outcomes The student will adhere to the prescribed medication regimen. The student will remain free from signs or symptoms of organ rejection. Nursing Diagnosis: Risk for Impaired Skin Integrity Related to healing surgical site Related to increased susceptibility to skin irritation or infection due to immunosuppression Interventions The school nurse will assess the surgical site regularly (if accessible) for signs of redness, swelling, or discharge. The school nurse will teach proper wound care techniques to the student and caregivers. The school nurse will recommend the use of loose-fitting, breathable clothing to reduce irritation near the surgical site. The school nurse will communicate with caregivers and healthcare providers about any concerns related to wound healing. Expected Outcomes The student will maintain intact skin with no signs of irritation or infection. The student and caregivers will demonstrate proper wound care techniques. Nursing Diagnosis: Fatigue Related to recovery from surgery and the chronic nature of immunosuppressive therapy Related to increased metabolic demands during healing Interventions The school nurse will provide a quiet space where the student can rest if fatigue becomes overwhelming during the school day. The school nurse will collaborate with teachers to adjust the student’s schedule or workload to align with their energy levels. The school nurse will encourage proper hydration, nutrition, and rest to support recovery and energy levels. The school nurse will monitor for excessive fatigue and communicate with caregivers about possible adjustments to the care plan. Expected Outcomes The student will report improved energy levels during the school day. The student will participate in school activities with minimal fatigue. Nursing Diagnosis: Risk for Social Isolation Related to restrictions on physical activities and social interactions due to the transplant Related to self-consciousness about their medical condition Interventions The school nurse will encourage the student to participate in non-strenuous group activities to maintain peer interactions. The school nurse will collaborate with teachers and staff to foster an inclusive environment. The school nurse will provide emotional support to the student, helping them navigate feelings of self-consciousness or isolation. The school nurse, with the family’s consent, educate peers about transplants to reduce stigma and promote understanding. Expected Outcomes The student will actively engage in school and social activities. The student will report feeling included and supported by peers and staff. Nursing Diagnosis: Risk for Noncompliance Related to complexity of medication schedules Related to side effects of medications or lack of understanding of their importance Interventions The school nurse will educate the student and caregivers about the critical role of adherence to immunosuppressive therapy. The school nurse will use visual aids, alarms, or charts to help the student and caregivers manage medication schedules effectively. The school nurse will address barriers to compliance, such as side effects, by communicating with the healthcare provider for possible adjustments. The school nurse will provide positive reinforcement for adherence to the treatment plan. Expected Outcomes The student will adhere to prescribed medication schedules and follow treatment guidelines. The student and caregivers will demonstrate understanding of the importance of compliance in preventing complications. Nursing Diagnosis: Risk for Anxiety Related to fear of organ rejection or complications Related to stress related to lifestyle changes and medical dependence Interventions The school nurse will provide reassurance and support by discussing the steps in place to ensure the student’s health and safety. The school nurse will teach relaxation techniques, such as deep breathing or mindfulness, to reduce stress. The school nurse will encourage open communication about fears and concerns. The school nurse will refer the student to counseling services if anxiety significantly impacts their school performance or emotional well-being. Expected Outcomes The student will demonstrate reduced anxiety and improved coping strategies. The student will report feeling more confident about managing their condition. Nursing Diagnosis: Deficient Knowledge Related to lack of understanding about transplant care and potential complications Related to unawareness of necessary precautions or the importance of treatment adherence Interventions The school nurse will provide age-appropriate education about the transplant, including signs of complications and the importance of adherence to treatment. The school nurse will share resources with caregivers and staff, such as educational materials and support group information. The school nurse will teach the student and caregivers how to recognize and report symptoms of infection or rejection. The school nurse will conduct periodic reviews of the student’s care plan with caregivers and staff to ensure understanding and consistency. Expected Outcomes The student and caregivers will demonstrate understanding of transplant care and management. School staff will implement appropriate accommodations and precautions to support the student’s health. 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.
