NEUROGENIC BLADDER 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 bladder incontinence Related to neuromuscular impairment Interventions The school nurse will identify type of urinary elimination program. The school nurse will determine student's ability to follow elimination procedure. The school nurse will monitor student's ability for self-care. Expected Outcomes The student will be on a timed bladder voiding schedule while at school. The student will empty bladder completely and regularly. The student will use proper techniques in managing elimination and aftercare cleaning. Nursing Diagnosis: Potential for infection Related to insufficient knowledge to avoid pathogens Related to moisture, altered skin integrity, and possible incontinence. Interventions The school nurse will determine student's ability to follow elimination procedure. The school nurse will monitor amount and clarity of urine. Observe for sediment, blood, foul odor, or fever - notify parent if either is present. The school nurse will teach good hand washing and perineal care. The school nurse will encourage adequate fluid intake. Expected Outcomes The student will not experience bladder or kidney infections due to distension, retrograde urine flow, or introduction of pathogenic organisms The student will practice behaviors to prevent infection. The student will describe s/s of infection. Nursing Diagnosis: Potential for alteration of daily activities Related to hygiene, toileting. Interventions The school nurse, when needed, will arrange for assistance of other staff members, such as PE, playground time, and lunch. The school nurse will arrange for assistance as necessary for daily school activities toileting. Expected Outcomes The student will not experience difficulty with access to toileting. Nursing Diagnosis: Risk for chronic low self-esteem Related to altered toileting regimen Related to the possibility of urine odor Interventions The school nurse will encourage student to express feelings. The school nurse will monitor student's statements of self-worth. The school nurse will assist student in setting realistic goals that will increase self-esteem. The school nurse will encourage increased responsibility for self. The school nurse will assist the student in identifying the impact of peer group on feelings of self-worth. The school nurse will encourage constructive outlets for emotions. The school nurse will assist student to identify support resources in school. The school nurse will collaborate with other staff to encourage interaction with other children. Expected Outcomes The student will express feelings constructively. The student will verbalize self-acceptance. Nursing Diagnosis: Potential for change in medical status Related to medical condition. Interventions The family will provide the nurse with a copy of current medical report or doctor’s orders annually or when a change in status occurs. The school nurse will call the physician to obtain current information verbally when necessary. Release of health information will be signed annually by the parents. The school nurse will annually review this IHP with parent/guardian, nurse/trained staff. This plan may be revised/updated as appropriate to ensure most current treatment modalities for student. Expected Outcomes The student will not experience difficulty with access to toileting. 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.
