GERD 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: Risk for Aspiration Related to esophageal sphincter dysfunction allowing gastric contents to rise into the esophagus and potentially the airway Related to episodes of reflux during eating or lying down Interventions The school nurse will encourage the student to eat meals while sitting upright and to remain upright for at least 30 minutes post-meal. The school nurse will collaborate with school staff to adjust the student's meal times to prevent reflux episodes during physical activities or post-lunch rest. The school nurse will communicate with the student's healthcare provider regarding effective management strategies and any needed medication during school hours. Expected Outcomes The student will demonstrate correct eating posture to minimize reflux. The student will experience fewer or no episodes of aspiration during the school day. Nursing Diagnosis: Impaired Nutrition: Less Than Body Requirements Related to avoidance of meals due to fear of reflux pain Related to Dietary restrictions limiting intake of necessary nutrients Interventions The school nurse will collaborate with a dietitian to develop a meal plan that meets the student's nutritional needs while avoiding reflux triggers. The school nurse will teach the student about the importance of smaller, more frequent meals and which foods to avoid. The school nurse will regularly assess the student's growth parameters and overall health to ensure they are receiving adequate nutrition. Expected Outcomes The student will maintain or achieve a healthy weight for their age and height. The student will report adherence to a nutrition plan that minimizes GERD symptoms. Nursing Diagnosis: Risk for Esophageal Damage Related to chronic exposure to stomach acid due to reflux Related to delay in treatment or inadequate management of GERD Interventions The school nurse will keep a log of reflux episodes and symptoms to aid in managing the condition effectively. The school nurse will assist with administration of antacid or acid-blocking medications as prescribed, ensuring the student takes them at appropriate times. The school nurse will provide updates to healthcare providers about the student's condition and any concerns regarding esophageal health. Expected Outcomes The student will demonstrate reduced frequency and severity of GERD symptoms. The student will maintain esophageal health with no signs of progressing damage. Nursing Diagnosis: Pain Management Related to frequent or severe acid reflux causing esophageal irritation and pain Related to stress or anxiety exacerbating GERD symptoms Interventions The school nurse will teach the student relaxation techniques such as deep breathing or guided imagery to manage stress, which can exacerbate GERD. The school nurse will offer strategies such as drinking water or using prescribed antacids when experiencing discomfort. The school nurse will help the student identify personal triggers for reflux episodes, such as specific foods or activities, and develop strategies to avoid them. Expected Outcomes The student will report effective management of pain associated with GERD. The student will actively use learned techniques to reduce stress and manage symptoms. Nursing Diagnosis: Knowledge Deficit Related to lack of understanding about GERD, its triggers, and its management Related to misconceptions about diet and lifestyle impacts on GERD Interventions The school nurse will provide the student and caregivers with information about GERD, including dietary recommendations, lifestyle modifications, and the importance of medication adherence. The school nurse will work with the student to create a personalized management plan that includes strategies for dealing with symptoms at school. The school nurse will offer access to reputable sources and materials for additional learning and support. Expected Outcomes The student and caregivers will demonstrate an understanding of GERD and how to manage it 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.
