CARDIOVASCULAR DISORDERS 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 Decreased Cardiac Output Related to impaired cardiac function due to structural or functional abnormalities in the heart (e.g., congenital heart defects, arrhythmias) Related to increased workload on the heart (e.g., due to hypertension or valve dysfunction) Interventions The school nurse will regularly check the student’s blood pressure, heart rate, and respiratory rate to assess cardiac function. The school nurse will collaborate with the student's healthcare provider and PE staff to modify physical activity and ensure that the student does not engage in strenuous activities that could strain the heart. The school nurse will teach the student and staff about the student’s limitations and the importance of adhering to activity restrictions to prevent undue stress on the heart. The school nurse will ensure an individualized EAP is in place for sudden cardiac events, such as arrhythmias, including clear instructions on how to respond. Expected Outcomes The student will remain free from signs of decreased cardiac output (e.g., fatigue, dizziness, shortness of breath). The student will comply with activity limitations to prevent overexertion and associated risks. Nursing Diagnosis: Risk for Activity Intolerance Related to fatigue or shortness of breath due to decreased cardiac function Related to medication side effects that may reduce stamina or energy levels (e.g., diuretics, beta-blockers) Interventions The school nurse will monitor the student’s response to physical activities and modify the level of exertion based on tolerance. The school nurse will encourage regular rest breaks to prevent fatigue and avoid overexertion. The school nurse will work with staff to adapt physical education or classroom activities based on the student’s energy levels. The school nurse will be vigilant for signs of activity intolerance, such as dizziness, excessive sweating, or shortness of breath, and assist the student if needed. Expected Outcomes The student will participate in activities without undue fatigue or discomfort. The student will use breaks effectively to manage energy levels. Nursing Diagnosis: Risk for Ineffective Tissue Perfusion Related to poor circulation due to cardiovascular disease (e.g., atherosclerosis, peripheral artery disease) Related to decreased blood flow to tissues during physical exertion Interventions The school nurse will observe for signs of decreased perfusion, such as pale or cool extremities, delayed capillary refill, or diminished pulse in extremities. The school nurse will educate the student to elevate legs when resting to improve venous return and prevent swelling. The school nurse will work with the healthcare provider to adjust medication or treatment if tissue perfusion issues are noted. The school nurse will, if the student has peripheral vascular disease, provide guidance on proper foot care to prevent ulcers and infections. Expected Outcomes The student will show no signs of inadequate tissue perfusion (e.g., good skin color, normal pulse, and capillary refill time). The student will adhere to lifestyle modifications to improve circulation. Nursing Diagnosis: Risk for Fluid Volume Excess Related to conditions such as heart failure or kidney dysfunction affecting fluid regulation Related to use of medications like diuretics that can impact fluid balance Interventions The school nurse will track the student’s daily fluid intake and output to ensure balance and prevent fluid overload. The school nurse will regularly assess weight to detect sudden changes that may indicate fluid retention. The school nurse will if applicable, work with the dietitian to ensure the student’s meals are low in sodium to minimize fluid retention. The school nurse will coordinate with the student's healthcare provider to ensure appropriate management of medications and fluid restrictions. Expected Outcomes The student will maintain a balanced fluid volume, showing no signs of fluid overload (e.g., edema, rapid weight gain). The student and caregivers will understand and follow fluid management recommendations. Nursing Diagnosis: Risk for Anxiety Related to fear of disease progression or potential cardiovascular events Related to stress related to the management of a chronic condition (e.g., taking medications, adhering to lifestyle changes) Interventions The school nurse will offer reassurance and a listening ear for any concerns related to the cardiovascular condition. The school nurse will educate the student on stress-relieving techniques, such as deep breathing, guided imagery, or mindfulness exercises. The school nurse will create an environment where the student feels comfortable expressing their fears or anxieties about their condition. The school nurse will, if anxiety is significantly affecting the student’s well-being, refer the student to counseling services for further support. Expected Outcomes The student will report feeling less anxious and more in control of their condition. The student will demonstrate the ability to use relaxation techniques to manage anxiety. Nursing Diagnosis: Risk for Knowledge Deficit Related to lack of understanding about the cardiovascular condition, its management, or lifestyle modifications Related to need for education on medications, diet, and exercise tailored to the cardiovascular condition Interventions The school nurse will offer age-appropriate information about the cardiovascular disorder, including the impact on the body and necessary lifestyle adjustments. The school nurse will ensure the student and caregivers understand how to manage prescribed medications, including dosage, timing, and potential side effects. The school nurse will educate the student about the importance of maintaining a healthy diet, regular exercise (appropriate to their condition), and weight management. The school nurse will provide written resources or visual aids to reinforce key information about the student’s cardiovascular condition and how to manage it. Expected Outcomes The student and caregivers will demonstrate understanding of the cardiovascular condition and its management. The student will actively participate in maintaining their health through diet, medication, and lifestyle changes. Nursing Diagnosis: Risk for Social Isolation Related to physical limitations or restrictions due to the cardiovascular condition Related to feelings of self-consciousness or fear of judgment due to the visible effects of the disease or its treatments Interventions The school nurse will support the student in engaging in age-appropriate, non-strenuous activities with peers to maintain social connections. The school nurse will, with the family’s consent, educate peers about the condition to foster empathy and reduce stigma. The school nurse will observe for signs of social withdrawal or reluctance to engage in activities and intervene if needed. The school nurse will encourage the student to form friendships based on shared interests rather than solely focusing on the condition. Expected Outcomes The student will maintain social relationships and participate in peer activities. The student will report feeling included and accepted by peers. Nursing Diagnosis: Risk for Impaired Skin Integrity Related to use of medications such as anticoagulants, which may increase the risk of bruising or bleeding Related to decreased mobility or circulation that could result in pressure ulcers or skin breakdown Interventions The school nurse will regularly inspect the student’s skin, especially areas prone to breakdown or bruising. The school nurse will encourage the student to change positions frequently to avoid prolonged pressure on any part of the body. The school nurse will use barrier creams, appropriate clothing, or padding as needed to protect vulnerable skin areas. The school nurse will work with the student’s healthcare team to adjust medications or manage side effects that may affect skin integrity. Expected Outcomes The student will maintain intact skin without signs of bruising, breakdown, or infection. The student will use strategies to prevent skin damage from pressure or medications. 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.
