NEUROFIBROMATOSIS 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 Impaired Skin Integrity Related to presence of multiple cutaneous neurofibromas Related to skin irritation or trauma due to neurofibroma locations Interventions The school nurse will perform regular skin assessments to monitor for irritation, redness, or signs of infection around neurofibromas. The school nurse will educate the student and caregivers about proper skin care and measures to avoid trauma (e.g., wearing protective clothing or avoiding tight clothing). The school nurse will encourage the student to report any new or rapidly changing skin lesions. The school nurse will collaborate with healthcare providers for treatment of problematic lesions, such as those causing irritation or infection. Expected Outcomes The student will maintain intact skin with no signs of irritation or infection. The student and caregivers will demonstrate proper skin care practices. Nursing Diagnosis: Risk for Delayed Growth and Development Related to potential for learning disabilities associated with NF Related to cognitive or developmental delays Interventions The school nurse will collaborate with teachers and special education staff to create an individualized education plan (IEP) tailored to the student's needs. The school nurse and counselors will monitor the student’s developmental milestones and academic performance, referring to specialists as needed. The school nurse will support participation in therapies such as speech, occupational, or physical therapy to address delays. The school nurse will provide resources and education to caregivers on activities to promote development at home. Expected Outcomes The student will demonstrate progress toward individualized developmental and academic goals. The student will actively participate in therapies and classroom activities. Nursing Diagnosis: Risk for Impaired Social Interaction Related to visible skin lesions or physical changes due to neurofibromas Related to potential self-consciousness or peer misunderstanding Interventions The school nurse will provide emotional support to the student to address feelings of self-consciousness. The school nurse will collaborate with school counselors to foster an inclusive and supportive classroom environment. The school nurse will educate peers and staff (with the family’s consent) about neurofibromatosis to reduce stigma and promote understanding. The school nurse will encourage the student to participate in group activities to build confidence and foster peer relationships. Expected Outcomes The student will engage in social and classroom activities without fear of judgment. The student will report feeling supported and accepted by peers and staff. Nursing Diagnosis: Risk for Acute Pain Related to nerve compression caused by neurofibromas Related to musculoskeletal complications, such as scoliosis Interventions The school nurse will monitor for signs of pain, such as complaints of discomfort or changes in behavior. The school nurse will provide a quiet space for rest or relaxation during episodes of pain. The school nurse will communicate with caregivers and healthcare providers about effective pain management strategies, including medication or physical therapy. The school nurse will educate the student on techniques to alleviate pain, such as gentle stretching or heat application. Expected Outcomes The student will report reduced pain levels during school hours. The student will use appropriate pain management strategies as needed. Nursing Diagnosis: Risk for Fatigue Related to increased energy demands due to chronic illness Related to discomfort or pain interfering with rest Interventions The school nurse will allow rest breaks during the school day to manage fatigue. The school nurse will collaborate with teachers to adjust the student’s workload or schedule as needed. The school nurse will encourage proper hydration and healthy snacks to support energy levels. The school nurse will communicate with caregivers about strategies to improve sleep quality at home. Expected Outcomes The student will report improved energy levels during school activities. The student will participate in academic and extracurricular activities with minimal fatigue. Nursing Diagnosis: Risk for Anxiety Related to concerns about the progression of neurofibromatosis Related to fear of judgment or stigma due to visible symptoms Interventions The school nurse will provide a safe space for the student to discuss concerns and fears. The school nurse will teach relaxation techniques, such as deep breathing or mindfulness exercises, to manage anxiety. The school nurse will refer the student to school counseling services for additional emotional support if needed. The school nurse will communicate with caregivers about strategies to help the student cope with anxiety at home. Expected Outcomes The student will demonstrate reduced anxiety and improved emotional well-being. The student will use learned coping strategies to manage stress. Nursing Diagnosis: Risk for Deficient Knowledge (Caregivers and Staff) Related to lack of understanding about neurofibromatosis, its symptoms, and management Related to unawareness of the impact on learning or physical health Interventions The school nurse will provide educational materials and resources to caregivers and school staff about neurofibromatosis. The school nurse will offer training sessions for staff on recognizing and addressing the unique needs of students with NF. The school nurse will collaborate with healthcare providers to clarify any specific concerns or recommendations. The school nurse will encourage open communication between caregivers, teachers, and healthcare providers. Expected Outcomes Caregivers and staff will demonstrate a clear understanding of neurofibromatosis and its management. The student will benefit from informed and consistent support at home and school. Nursing Diagnosis: Risk for Noncompliance Related to difficulty following medical recommendations or attending follow-up appointments Related to lack of understanding of the importance of consistent monitoring Interventions The school nurse will reinforce the importance of attending follow-up medical appointments to monitor NF progression. The school nurse will provide reminders to caregivers about upcoming appointments or necessary interventions. The school nurse will address barriers to compliance, such as transportation or scheduling conflicts, by connecting caregivers with resources. The school nurse will collaborate with the healthcare team to create a manageable care plan for the family. Expected Outcomes The student and caregivers will adhere to the recommended medical follow-up and treatment plan. The student will experience fewer complications related to delayed care or noncompliance. 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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