SPINA BIFIDA 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 infection Related to insufficient knowledge to avoid pathogens Related to catheterization, moisture, altered skin integrity, possible incontinence Related to self-esteem/personal identity Related to neurological deficits Related to sensory deficit and weight distribution. Related to neurologic dysfunction Interventions The school nurse will determine student's ability to follow catheterization/elimination procedures. The school nurse will monitor amount and clarity of urine. Observe for sediment, blood, foul odors, 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 the signs and symptoms of infection. Nursing Diagnosis: Potential disturbances in self-concept Related to insufficient knowledge to avoid pathogens Related to catheterization, moisture, altered skin integrity, possible incontinence Related to self-esteem/personal identity Related to neurological deficits Related to sensory deficit and weight distribution. Related to neurologic dysfunction Interventions The school nurse will encourage student to identify existing 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: Impaired physical motility Related to insufficient knowledge to avoid pathogens Related to catheterization, moisture, altered skin integrity, possible incontinence Related to self-esteem/personal identity Related to neurological deficits Related to sensory deficit and weight distribution. Related to neurologic dysfunction Interventions The school nurse will orient the student to school facilities. The school nurse will establish daily routine to prevent complications: exercise, positioning, use of wheelchair, walker, orthotics, etc. The school nurse will provide assistance for student as needed as she/he moves about the building. The school nurse will collaborate with adaptive PE plan. The school nurse will collaborate with OT/PT. The school nurse will notify transportation services, as needed. Expected Outcomes The student will achieve highest level of mobility. Nursing Diagnosis: Potential for skin integrity impairment Related to insufficient knowledge to avoid pathogens Related to catheterization, moisture, altered skin integrity, possible incontinence Related to self-esteem/personal identity Related to sensory deficit and weight distribution. Related to neurological deficits Related to neurologic dysfunction Interventions The school nurse will help student maintain adequate hydration. The school nurse will educate student/designated staff on skin care, keeping skin clean and dry, repositioning intervals, and hot/cold injury prevention. The school nurse will monitor pressure points for denuded skin, erythema, lesions. The school nurse will perform/monitor student's CIC per physician's orders. The school nurse will instruct student, family, and appropriate staff about risk factors and prevention of injury. Expected Outcomes The student will maintain intact tissue and collateral circulation. Nursing Diagnosis: Urinary pattern alteration Related to insufficient knowledge to avoid pathogens Related to catheterization, moisture, altered skin integrity, possible incontinence Related to self-esteem/personal identity Related to neurological deficits Related to sensory deficit and weight distribution. Related to neurologic dysfunction Interventions The school nurse will establish plan for bladder training with family and healthcare team. The school nurse will assist with specific bladder elimination procedures as ordered The school nurse will assess student's readiness to learn self-catheterization. The school nurse will regulate fluid intake on a specific schedule, per physician's orders, to encourage voiding at appropriate times. The school nurse will monitor skin integrity. The school nurse will monitor urine for signs and symptoms of infection Expected Outcomes The student will maintain adequate fluid balance and will be free of urinary complications 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.
