STROKE 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: Impaired Physical Mobility Related to hemiparesis (weakness on one side of the body) or hemiplegia (paralysis on one side) Related to muscle weakness or spasticity from stroke-related brain damage Related to impaired balance and coordination Interventions The school nurse will collaborate with physical and occupational therapists to develop a rehabilitation plan aimed at improving mobility and muscle strength. The school nurse will encourage the student to participate in range-of-motion exercises and strengthening activities that promote recovery. The school nurse will ensure the student has access to mobility aids, such as a walker, wheelchair, or splints, as needed. The school nurse will modify the school environment to ensure safety, including ramps, handrails, and accessible seating arrangements. Expected Outcomes The student will demonstrate improved physical mobility, including better balance, coordination, and strength. The student will use mobility aids effectively to navigate the school environment safely. The student will participate in physical therapy and daily activities with minimal assistance. Nursing Diagnosis: Impaired Verbal Communication Related to aphasia (difficulty speaking or understanding language) caused by stroke-related brain damage Related to dysarthria (difficulty with speech articulation due to muscle weakness) Related to cognitive impairment affecting language processing Interventions The school nurse will collaborate with a speech-language pathologist to implement a communication therapy plan that targets the student’s specific speech deficits. The school nurse will use alternative communication methods, such as picture boards, communication devices, or sign language, to help the student express needs. The school nurse will provide extra time for the student to communicate and encourage the use of simple, clear language in conversations. The school nurse will encourage the student to participate in speech therapy sessions regularly to improve communication skills. Expected Outcomes The student will demonstrate improved verbal communication or effective use of alternative communication methods. The student will participate in academic and social conversations with minimal frustration. The student will demonstrate increased confidence in expressing needs and ideas, with or without assistive communication devices. Nursing Diagnosis: Risk for Aspiration Related to dysphagia (difficulty swallowing) caused by impaired muscle function in the throat and esophagus Related to reduced gag reflex or inability to coordinate swallowing Related to weakness or paralysis of the facial and throat muscles Interventions The school nurse will collaborate with a speech therapist to conduct a swallowing assessment and create a safe eating plan for the student. The school nurse will modify the student’s diet to include soft, pureed, or thickened liquids as needed to reduce the risk of choking or aspiration. The school nurse will encourage upright positioning during meals and provide supervision while eating. The school nurse will educate the student and caregivers about the importance of safe swallowing techniques and recognizing signs of aspiration (e.g., coughing, choking). Expected Outcomes The student will demonstrate safe swallowing techniques and eat meals without signs of aspiration. The student will maintain adequate nutritional intake without experiencing choking or respiratory complications. The student and caregivers will verbalize understanding of aspiration precautions and follow appropriate dietary modifications. Nursing Diagnosis: Impaired Cognitive Function Related to brain damage from the stroke affecting memory, attention, problem-solving, or executive function Related to difficulty with concentration and information processing Related to delayed cognitive development due to the stroke Interventions The school nurse will collaborate with the student’s teachers to implement an individualized education plan (IEP) that accommodates cognitive challenges and provides extra time for tasks. The school nurse will use memory aids (e.g., checklists, calendars, or visual schedules) to help the student stay organized and complete school tasks. The school nurse will break down tasks into smaller, manageable steps to improve focus and task completion. The school nurse will encourage cognitive exercises, such as puzzles, games, or memory tasks, to support cognitive rehabilitation. Expected Outcomes The student will demonstrate improved cognitive function, including memory, attention, and problem-solving abilities. The student will effectively use memory aids and organizational tools to complete school tasks. The student will participate in academic activities with appropriate support and accommodations. Nursing Diagnosis: Self-Care Deficit Related to motor impairments from hemiplegia or muscle weakness affecting daily living activities Related to cognitive impairment affecting the ability to plan or remember self-care tasks Related to fatigue or reduced endurance following the stroke Interventions The school nurse will collaborate with occupational therapists to teach the student adaptive techniques for activities of daily living (ADLs), such as dressing, grooming, and feeding. The school nurse will encourage the use of assistive devices (e.g., adaptive utensils, clothing fasteners) to promote independence. The school nurse will educate caregivers and teachers on how to assist the student with self-care tasks while promoting as much independence as possible. The school nurse will create a structured daily routine to help the student remember and complete self-care activities. Expected Outcomes The student will demonstrate improved independence in performing self-care tasks with or without adaptive devices. The student will participate in daily self-care activities with minimal assistance from caregivers. The student will develop greater confidence and self-esteem through the ability to complete personal care tasks. Nursing Diagnosis: Risk for Falls Related to impaired balance, coordination, or motor function due to stroke Related to weakness or paralysis affecting mobility Related to use of mobility aids or assistive devices Interventions The school nurse will conduct a fall risk assessment and modify the school environment to minimize hazards (e.g., clear walkways, provide handrails, ensure proper lighting). The school nurse will provide education to the student and caregivers about fall prevention strategies, such as using mobility aids correctly and avoiding uneven surfaces. The school nurse will collaborate with physical therapists to improve balance, strength, and coordination through targeted exercises. The school nurse will supervise the student closely during transitions between activities, especially in high-risk areas like stairs or uneven surfaces. Expected Outcomes The student will demonstrate safe use of mobility aids and navigate the school environment with minimal risk of falls. The student will maintain balance and coordination during daily activities with fewer episodes of instability. The student will participate in physical therapy to improve strength and reduce fall risk. Nursing Diagnosis: Ineffective Coping Related to emotional distress related to physical and cognitive limitations after the stroke Related to frustration or fear about changes in appearance, abilities, or academic performance Related to social isolation due to difficulties with communication or mobility Interventions The school nurse will provide emotional support and encourage open communication about feelings related to the stroke and recovery process. The school nurse will collaborate with school counselors and mental health professionals to offer counseling or therapy for emotional support. The school nurse will encourage participation in social activities, using peer support or structured group activities to promote inclusion. The school nurse will help the student set realistic goals for recovery, celebrating small achievements to boost confidence and self-esteem. Expected Outcomes The student will verbalize feelings related to the stroke and demonstrate effective coping strategies. The student will participate in school and social activities with greater confidence and reduced emotional distress. The student will engage in therapy or counseling sessions to address emotional challenges and improve coping skills. 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.
