EOSINOPHILIC ESOPHAGITIS 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: Impaired Swallowing Related to inflammation and swelling of the esophagus Related to scar tissue formation leading to narrowing of the esophagus Related to food impaction due to strictures Interventions The school nurse will monitor the student’s ability to swallow, especially during meals. The school nurse will ensure that the student has adequate time and a calm environment to eat. The school nurse will educate staff and the student on recognizing signs of choking and appropriate first aid responses. The school nurse will work with parents and healthcare providers to manage and adjust the diet as necessary. The school nurse will have emergency protocols in place for managing acute episodes related to swallowing difficulties. Expected Outcomes The student will demonstrate safe swallowing without signs of distress or choking. The student will understand their dietary restrictions and the importance of following them. All staff will respond appropriately to any swallowing emergency. Nursing Diagnosis: Risk for Nutritional Deficiency Related to dietary restrictions or elimination diets limiting intake of essential nutrients Related to reduced food intake due to fear of pain or impaction Related to absorption issues related to gastrointestinal inflammation Interventions The school nurse will collaborate with a dietician to ensure that the student’s diet meets their nutritional needs. The school nurse will educate the student and family on nutrient-rich alternatives that align with dietary restrictions. The school nurse will monitor the student’s growth and development to assess for signs of nutritional deficiency. The school nurse will facilitate communication between kitchen staff and family to ensure dietary compliance at school. Expected Outcomes The student will maintain adequate nutritional status. The student’s growth and development will be within normal ranges for their age. The student and family will demonstrate understanding and compliance with dietary recommendations. Nursing Diagnosis: Anxiety Related to Chronic Illness Related to chronic nature of EoE leading to ongoing health concerns Related to fear of food eating and potential complications Related to social isolation due to dietary restrictions Interventions The school nurse will provide psychological support and counseling referrals as needed. The school nurse will establish a support system within the school for the student to feel safe and understood. The school nurse will educate peers and staff about EoE to promote a supportive environment and reduce stigma. The school nurse will encourage participation in activities that do not center around food to improve social interactions. Expected Outcomes The student will report reduced anxiety levels related to their condition. The student will actively participate in school activities and social engagements. The student will feel supported by peers and staff at school. Nursing Diagnosis: Knowledge Deficit Related to lack of understanding of the disease process and treatment options Related to unfamiliarity with how to manage symptoms and prevent flare-ups Interventions The school nurse will educate the student and family about EoE, its triggers, and symptoms to watch for. The school nurse will provide training on the use of medications such as proton pump inhibitors or swallowed steroids, if prescribed. The school nurse will develop a school-based action plan for managing symptoms, including when to seek help. The school nurse will regularly update school records and care plans to reflect any changes in the student’s health status or treatment. Expected Outcomes The student and family will articulate a clear understanding of EoE and its management. The student will adhere to treatment protocols and communicate effectively about their needs. The student will recognize symptoms and know when to seek assistance, minimizing the impact of flare-ups. 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? 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