COLOSTOMY/ILEOSTOMY 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 risk for impaired skin integrity Related to ostomy placement. Interventions The school nurse will instruct necessary staff on student’s colostomy/ileostomy, care, and potential problems. The school nurse will empty pouch when it is 1/3 to 1/2 full or leaking. The school nurse will support surrounding skin when gently removing appliance. The school nurse will inspect stoma/peristomal skin area with each emptying and pouch change. Note irritation, discolorations, bleeding and rashes. The school nurse will gently clean the stoma with water and pat dry while avoiding rubbing. The school nurse will apply skin barrier, as ordered, with pouch changes. Expected Outcomes The student will maintain intact skin integrity. Nursing Diagnosis: Potential for complications Related to colostomy/ileostomy. Interventions The school nurse will check for leaking or poor seal if strong odor is noted. The school nurse will evaluate physical activities to determine possible cause of pouch loosening. The school nurse will assess the pouch's seal and fullness. The school nurse will monitor protruding/sunken stoma and notify parent. The school nurse will monitor stoma for bleeding. Parent to be contacted if bleeding cannot be stopped with mild pressure with a sterile pad. The school nurse will monitor the stoma for pinkness. If discolored, dark or black, parent will be contacted immediately. The school nurse will monitor for skin irritation around stoma. The school nurse will monitor for presence of pain at site. If reported, check for skin irritation or bleeding. If rash noted, parent will be contacted due to possible yeast infection. The school nurse will notify parent If stoma swelling, vomiting, decreased stool, cramping, or abdominal pain is observed. Expected Outcomes The student will adjust to body image/presence of ostomy as evidenced by expressing acceptance, exhibiting no s/sx of discomfort or distress related to ostomy Nursing Diagnosis: Potential for disturbed body image Related to ostomy placement. Interventions The school nurse will encourage student to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, etc. The school nurse will encourage and provide opportunity for patient to deal with ostomy through participation in self-care. The school nurse will maintain positive approach during ostomy care activities. The school nurse will empty pouch when 1/3 to 1/2 full or leaking, and maintain effective cleaning of pouch to decrease odor. The school nurse will ensure that ostomy appliance is covered and provide deodorizers as needed to maintain dignity. The school nurse will teach/instruct ostomy care techniques and allow to participate at own pace. Expected Outcomes The student will adjust to body image/presence of ostomy as evidenced by expressing acceptance, exhibiting no s/sx of discomfort or distress related to ostomy Nursing Diagnosis: Potential for alteration in bowel elimination (constipation/diarrhea) Related to colostomy/ileostomy placement. Interventions The school nurse will empty pouch as ordered or when leaking. The school nurse will monitor stool output for change in color, consistency, odor, and amount from his/her usual output pattern. The school nurse will document changes and report to parent. The school nurse will observe self-care and redirect as necessary to ensure proper technique. The school nurse will review dietary pattern and amount/type of fluid intake. Expected Outcomes The student will maintain normal baseline stool output. Nursing Diagnosis: Deficient knowledge Related to ostomy placement. Interventions The school nurse will observe student for possible lack of understanding of ostomy placement or care. The school nurse will educate the student at his/her level about the care of the stoma and possible complications. Expected Outcomes The student and family will collaborate with the school nurse to facilitate optimum health and safety necessary for learning. Nursing Diagnosis: Potential for change in medical status Related to ostomy placement. Interventions Parent/guardian will provide school staff with a copy of current medical report or doctor’s orders annually or when change in status occurs. The school nurse will call the physician to obtain current information verbally when necessary per signed authorization by parent. This Individual Health Plan (IHP) will be reviewed annually with the parent/guardian and appropriate staff members. This plan may be revised/updated as appropriate to ensure the most current treatment modalities for student. Expected Outcomes The student and family will collaborate with the school nurse regarding any changes in the student's medical status and/or care. 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.
