CEREBRAL PALSY 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: Potential for injury Related to sensory-motor impairment Interventions The school nurse will maintain maximal level of skin integrity with non-restrictive clothing, safety with hot and cold, wheelchair cushions/paddings, changes of position, as needed. The school nurse will provide feeding techniques as appropriate to prevent aspiration (ie position the child upright for feedings, place foods far back in the mouth to overcome tongue thrust, use of soft/blended foods). The school nurse will maintain optimal musculoskeletal function with proper body alignment and posture to prevent deformities or contractures. The school nurse will ensure any adaptive devices/braces fit and do not promote skin breakdown. Expected Outcomes The student will be free of injury while at school. Nursing Diagnosis: Potential disturbance in self-concept Related to body image Interventions The school nurse will encourage student to identify strengths and potential. The school nurse will assist student in setting achievable goals. The school nurse will listen to student with understanding and non-judgmental acceptance. The school nurse will develop and maintain continuing communication with parents for planning and adjusting student's school care and activities. Expected Outcomes The student will express self-respect and self-confidence. Nursing Diagnosis: Self-care deficit Related to sensory-motor impairment Interventions The school nurse will teach (or work with OT/PT in teaching) use of assistive devices for eating. The school nurse will teach (or work with OT/PT in teaching) use of assistive devices for hand washing. The school nurse will teach (or work with OT/PT in teaching) use of assistive devices for grooming. The school nurse will teach (or work with OT/PT in teaching) use of assistive devices for toileting. The school nurse will encourage family to provide clothing easily managed by student. The school nurse will monitor I/O. The school nurse will record weight on health record. Student's healthcare provider will be notified if weight loss or failure to gain weight. Expected Outcomes The student will achieve maximum independence in self-care activities. Nursing Diagnosis: Potential for injury Related to motor deficits Interventions The school nurse will inspect classroom(s) for safety hazards and will educate teachers about hazards. The school nurse will ensure that all equipment is in good working condition with appropriate restraints. The school nurse will instruct student and caretakers regarding standard safety procedures (cleaning spills, use of non-slip surfaces, removal of electrical cords from walk areas, etc.). The school nurse will collaborate with OT/PT. Expected Outcomes The student will be protected from physical and environmental injury at school. Nursing Diagnosis: Health maintenance alteration Related to decreased motor skills Interventions The school nurse will discuss health maintenance with student while carrying out activities to reinforce importance. The school nurse will encourage and allow increased student control in all ADLs. Expected Outcomes The student will perform health maintenance activities according to student's level of ability. Nursing Diagnosis: Verbal communication impairment Related to neurologic status Interventions The school nurse will observe student to learn use of nonverbal clues to meet needs and desires. The school nurse will face student, speak slowly and distinctly when addressing student. The school nurse will encourage attempts at communication and allow time for response. The school nurse will collaborate with speech therapist. Expected Outcomes The student will experience decreased anxiety and frustration and needs will be met. 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.
