CONGENITAL HEART DISEASE 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: Activity Intolerance Related to reduced cardiac output or oxygenation due to congenital heart defects Related to fatigue from physical exertion Related to potential cyanosis or dyspnea with increased activity Interventions The school nurse will monitor the student’s activity level and ensure rest breaks are available during physical activities or school tasks. The school nurse will collaborate with teachers and physical education staff to create a modified physical activity plan tailored to the student’s tolerance. The school nurse will educate the student on recognizing early signs of fatigue or overexertion (e.g., shortness of breath, dizziness, or cyanosis). The school nurse will provide a safe, accessible space for the student to rest as needed during the school day. Expected Outcomes The student will participate in school activities within their tolerance level without experiencing excessive fatigue or shortness of breath. The student will recognize and report early signs of activity intolerance. The student will demonstrate improved energy management by balancing activity and rest. Nursing Diagnosis: Risk for Ineffective Tissue Perfusion Related to decreased cardiac output or oxygen delivery to tissues Related to cyanosis associated with certain congenital heart defects Related to potential arrhythmias Interventions The school nurse will monitor the student for signs of poor tissue perfusion, such as cyanosis, cold extremities, or delayed capillary refill, especially after physical activity. The school nurse will ensure that the student is seated and rests immediately if signs of poor perfusion occur. The school nurse will educate the student and staff on recognizing signs of decreased perfusion and when to alert the nurse or seek help. The school nurse will collaborate with the student’s healthcare provider to maintain updated emergency protocols for arrhythmias or perfusion-related issues. Expected Outcomes The student will maintain adequate tissue perfusion, as evidenced by normal skin color and temperature and the absence of cyanosis during the school day. The student and staff will verbalize understanding of warning signs and the importance of prompt intervention. The student will remain free from complications related to tissue perfusion. Nursing Diagnosis: Risk for Infection Related to potential need for invasive procedures (e.g., surgeries, catheterizations) leading to a weakened immune response Related to potentially impaired immune function due to reduced overall health or medication use Related to increased susceptibility to respiratory infections Interventions The school nurse will educate the student and staff on infection prevention strategies, such as regular handwashing and avoiding contact with sick individuals. The school nurse will monitor for signs of infection, such as fever, cough, or skin redness around surgical scars. The school nurse will ensure the student is up-to-date on vaccinations (including influenza and pneumococcal vaccines) with parental consent. The school nurse will collaborate with the family and healthcare providers to address infection risks proactively and notify them of any concerns. Expected Outcomes The student will remain free from infection throughout the school year. The student and staff will demonstrate understanding of and adherence to infection prevention measures. The student will promptly receive care for any signs of infection, minimizing complications. Nursing Diagnosis: Impaired Growth and Development Related to potential nutritional deficits due to increased metabolic demands from CHD Related to frequent hospitalizations or medical appointments impacting school attendance and social development Related to physical limitations due to fatigue or activity restrictions Interventions The school nurse will monitor the student’s weight, growth, and nutritional intake to identify potential deficits, collaborating with caregivers and healthcare providers as needed. The school nurse will collaborate with teachers to ensure the student has access to academic support if school attendance is affected. The school nurse will encourage participation in social activities that align with the student’s physical capabilities. The school nurse will provide emotional support to address concerns about physical differences or developmental delays. Expected Outcomes The student will achieve growth milestones appropriate for their condition, as indicated by weight and height measurements. The student will participate in academic and social activities with appropriate accommodations. The student will demonstrate improved self-confidence and engagement with peers. Nursing Diagnosis: Ineffective Breathing Pattern Related to reduced oxygenation due to cardiac defects Related to potential pulmonary congestion or increased work of breathing Related to dyspnea during physical activity Interventions The school nurse will monitor respiratory rate, effort, and oxygen saturation during the school day, particularly after physical activity. The school nurse will educate the student on breathing techniques, such as pursed-lip breathing, to improve oxygenation and reduce dyspnea. The school nurse will ensure the student has immediate access to rest breaks and avoid strenuous activities that may exacerbate respiratory distress. The school nurse will collaborate with the healthcare provider to determine whether oxygen support or additional interventions are required at school. Expected Outcomes The student will maintain a normal breathing pattern and oxygen saturation levels during the school day. The student will use appropriate breathing techniques to manage shortness of breath effectively. The student will report reduced respiratory discomfort during activities. Nursing Diagnosis: Risk for Low Self-Esteem Related to physical limitations or visible differences due to CHD or medical devices (e.g., scars, pacemakers) Related to social stigma or bullying related to physical or activity restrictions Related to feelings of being different from peers Interventions The school nurse will provide emotional support and a safe environment for the student to express feelings about their condition. The school nurse will collaborate with teachers and counselors to promote an inclusive and supportive classroom environment. The school nurse will encourage participation in extracurricular activities or hobbies that highlight the student’s strengths and interests. The school nurse will educate peers about CHD (with parental and student consent) to reduce stigma and foster understanding. Expected Outcomes The student will demonstrate improved self-confidence and acceptance of their condition. The student will actively participate in social and academic activities without fear of stigma. The student will verbalize positive feelings about their abilities and achievements. Nursing Diagnosis: Knowledge Deficit Related to limited understanding of activity restrictions, medication needs, or symptoms of complications Related to inconsistent communication between the student, caregivers, and school staff Related to anxiety or fear about the condition and its implications Interventions The school nurse will provide age-appropriate education to the student about their condition, including warning signs (e.g., chest pain, cyanosis) and when to seek help. The school nurse will collaborate with the family and healthcare providers to create an individualized health plan, ensuring all staff are informed and trained. The school nurse will teach the student to advocate for their needs, such as requesting rest breaks or reporting symptoms. The school nurse will use visual aids, handouts, or apps to reinforce understanding of CHD management. Expected Outcomes The student will demonstrate understanding of their condition and how to manage it in the school setting. The student will report symptoms promptly and adhere to school-specific protocols for managing CHD. The student and staff will feel confident in handling routine care and recognizing emergencies. 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.
