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Asthma IHP (1)

IHP Form

Step 1 of 2 - Form

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Student's Name*
First Middle Last Suffix
Photo
Accepted file types: jpg, gif, png, jpeg.
DoB
MM
DD
YYYY

EXP: 12/01/1974
GR/Level
Would 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 Country
Emergency Contact List is attached to IHP.
- Yes
- No
Contact
Contact Name
Relationship
Contact Phone Number
Contact Phone Type
Contact Phone Number
Contact Phone Type
Contact Name
Relationship
Contact Phone Number
Contact Phone Type
Contact Phone Number
Contact Phone Type
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Treating Physician
Physician Phone Number
Physician Fax Number
Treating Physician
Physician Phone Number
Physician Fax Number
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Preferred Hospital
City
MEDICAL DIAGNOSIS(ES)
Add a medication or procedure?
- Yes
- No
MEDICATIONS/PROCEDURES
Medication/Procedure
Strength
Dose
Mode
Sched/PRN?
Time
Frequency
If PRN, administer for
Medication/Procedure
Strength
Dose
Mode
Sched/PRN?
Time
Frequency
If PRN, administer for
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MEDICAL HISTORY
ASSESSMENT
NursingList
InterventionList
OutcomesList
Nursing Diagnosis: Ineffective airway clearance
- Related to chronic airway inflammation causing bronchoconstriction and excessive mucus production
Interventions
- The school nurse will obtain and have on hand AAP from identified healthcare provider and incorporate plan into IHP, EAP, and 504 plans.
- The school nurse will identify Student’s asthma severity by monitoring peak flows and asthma signs and symptoms to help establish priorities for interventions.
- The school nurse will identify and obtain necessary medications, medication devices, and asthma supplies for Student.
- The school nurse will provide training and monitoring of designated school staff in activation of EAP when needed
- The school nurse will monitor availability of prescribed medications and devices to Student on her person and in health office for emergencies and bus and field trips.
- The school nurse will, in collaboration with Student and other school personnel, promote a healthy school environment by: - reducing and eliminating allergens and irritants (e.g., no furry pets in classroom; avoiding strong odors or use of chemicals, cleaning supplies, perfumes, painting in classroom and other areas; controlling moisture and mold by reporting and wiping up spills as soon as possible; keeping student indoors on days of poor air quality or extreme cold or heat). - reinforcing student’s efforts to avoid and control exposure to triggers. - communicating with Student, parent(s), and school nurse about concerns about exacerbations or signs of poor asthma control.
- The school nurse will educate student and appropriate school personnel about expectations for good asthma control and components of student’s EAP, including the importance of adherence to therapeutic regimen, proper medication administration, trigger control/avoidance, and actions to take for worsening symptoms.
- The school nurse will periodically assess the effectiveness of the AAP, IHP, EAP, and 504 plan and revise, modify, or refer as needed for full school participation.
- The school nurse will assess Student’s developmental and emotional readiness for self-carrying of quick-relief medication.
Expected Outcomes
- Student will demonstrate good asthma control (e.g., decreased number of days per week with symptoms, fewer night awakenings) and improved participation in school activities within 6 weeks.
Nursing Diagnosis: Impaired gas exchange
- Related to airway inflammation,bronchoconstriction, and excessivemucus production due to asthma
Interventions
- The school nurse will obtain and have onhand AAP from identified healthcareprovider and incorporate plan into IHP,EAP, and 504 plans.The school nurse will identify Student’s asthma severity by monitoringpeak flows and asthma signs andsymptoms to help establish priorities forinterventions.
- The school nurse will identify and obtainnecessary medications, medicationdevices, and asthma supplies for John Brown.
- The school nurse will provide training andmonitoring of designated school staff inactivation of EAP when needed.
- The school nurse will monitor availabilityof prescribed medications and devices toStudent on her person and in healthoffice for emergencies and bus and fieldtrips.
- The school nurse will, in collaborationwith Student and other schoolpersonnel, promote a healthy school environment by: - reducing and eliminating allergens andirritants (e.g., no furry pets in classroom;avoiding strong odors or use ofchemicals, cleaning supplies, perfumes,painting in classroom and other areas;controlling moisture and mold byreporting and wiping up spills as soon aspossible; keeping student indoors ondays of poor air quality or extreme cold orheat) - reinforcing student’s efforts to avoid andcontrol exposure to triggers - communicating with Student,parent(s), and school nurse aboutconcerns about exacerbations or signs of poor asthma control.
- The school nurse will educate studentand appropriate school personnel aboutexpectations for good asthma controland components of student’s EAP,including the importance of adherence totherapeutic regimen, proper medicationadministration, trigger control/avoidance,and actions to take for worseningsymptoms.
- The school nurse will periodically assessthe effectiveness of the AAP, IHP, EAP,and 504 plan and revise, modify, or referas needed for full school participation.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
Expected Outcomes
- Student will demonstrate goodasthma control (e.g., decreased numberof days per week with symptoms, fewernight awakenings) and improvedparticipation in school activities within six weeks.
Nursing Diagnosis: Activity intolerance
- Related to exacerbation of symptoms associated with exercise-induced bronchospasm
Interventions
- The school nurse will obtain and have onhand AAP from identified healthcareprovider and incorporate plan into IHP,EAP, and 504 plans.
- The school nurse will identify Student’s asthma severity by monitoringpeak flows and asthma signs andsymptoms to help establish priorities forinterventions.
- The school nurse will identify and obtainnecessary medications, medicationdevices, and asthma supplies for Student.
- Maintain and monitor availability of quick-actingrelief medications to Studentby: - self-carry medication. - easily accessible medication throughdesignated school staff. - ongoing monitoring of storagemedication and staff training.
- The school nurse will provide training andmonitoring of designated school staff inactivation of EAP when needed.
- The school nurse will monitor availabilityof prescribed medications and devices to Student on her person and in healthoffice for emergencies and bus and field trips.
- The school nurse will educate studentand appropriate school personnel aboutexpectations for good asthma controland components of student’s EAP,including the importance of adherence totherapeutic regimen, proper medicationadministration, trigger control/avoidance,and actions to take for worseningsymptoms.
- The school nurse will periodically assessthe effectiveness of the AAP, IHP, EAP,and 504 plan and revise, modify, or referas needed for full school participation.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
Expected Outcomes
- Student will demonstrate goodasthma control (e.g., decreased numberof days per week with symptoms, fewernight awakenings) and improvedparticipation in school activities within six weeks.
Nursing Diagnosis: Disturbed sleep pattern
- Related to nighttime asthma symptoms
Interventions
- The school nurse will obtain and have onhand AAP from identified healthcareprovider and incorporate plan into IHP,EAP, and 504 plans.
- The school nurse will identify Student’s asthma severity by monitoringpeak flows and asthma signs andsymptoms to help establish priorities forinterventions.
- The school nurse will identify and obtainnecessary medications, medicationdevices, and asthma supplies for John Brown.
- The school nurse will provide training andmonitoring of designated school staff inactivation of EAP when needed.
- The school nurse will monitor availabilityof prescribed medications and devices toStudent on her person and in healthoffice for emergencies and bus and fieldtrips.
- The school nurse will educate studentand appropriate school personnel aboutexpectations for good asthma controland components of student’s EAP,including the importance of adherence totherapeutic regimen, proper medicationadministration, trigger control/avoidance,and actions to take for worseningsymptoms.
- The school nurse will periodically assessthe effectiveness of the AAP, IHP, EAP,and 504 plan and revise, modify, or referas needed for full school participation.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
Expected Outcomes
- Student will demonstrate goodasthma control (e.g., decreased numberof days per week with symptoms, fewernight awakenings) and improvedparticipation in school activities within sixweeks.
Nursing Diagnosis: Deficient knowledge
- Related to lack of education about asthma and asthma management.
Interventions
- The school nurse will maintain andmonitor availability of quick-acting reliefmedications to Student by: - self-carry medication - easily accessible medication throughdesignated school staff - ongoing monitoring of storagemedication and staff training. The school nurse will assess knowledgedeficits and learning needs of Student and family related to asthma andits management.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
- The school nurse will provideopportunities for Student to makedecisions regarding asthma management.
- The school nurse will address asthmaknowledge deficits as indicated (e.g.,etiology, signs and symptoms, peak flowmeter use and interpretation, treatmentregimen, proper use of inhaler, self-carryresponsibilities, avoidance/control oftriggers, actions to take for worseningsymptoms and for acute exacerbations)via one-to-one instruction andparticipation in group asthma educationclass.
Expected Outcomes
- Student will articulate an ageappropriateunderstanding of asthma andthe proper use of medications (controllerand quick-relief, as needed), includingself-carry responsibilities, within two weeks.
- Student will identify actions to takeand strategies to use to managesymptoms as identified in the AAP within two weeks.
Nursing Diagnosis: Ineffective health management related to
- insufficient knowledge of therapeuticregimen
- insufficient social support
- perceived benefit
- perceived barrier
Interventions
- The school nurse will assess knowledgedeficits and learning needs of Student and family related to asthma andits management.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
- The school nurse will provideopportunities for Student to makedecisions regarding asthmamanagement.
- The school nurse will address asthmaknowledge deficits as indicated (e.g.,etiology, signs and symptoms, peak flowmeter use and interpretation, treatmentregimen, proper use of inhaler, self-carryresponsibilities, avoidance/control oftriggers, actions to take for worseningsymptoms and for acute exacerbations)via one-to-one instruction andparticipation in group asthma educationclass.
- The school nurse will help studentidentify factors that interfere withcompliance with the therapeutic regimenand develop strategies to deal with thebarriers.
Expected Outcomes
- Student will articulate an age-appropriateunderstanding of asthma andthe proper use of medications (controllerand quick-relief, as needed), includingself-carry responsibilities, within 2 weeks.
- Student will identify actions to takeand strategies to use to managesymptoms as identified in the AAP within2 weeks.
Nursing Diagnosis: Readiness for enhanced self-care related to:
- expressed desire to enhance knowledge of self-care strategies
- expressed desire to enhance independence with life
Interventions
- The school nurse will maintain andmonitor availability of quick-acting reliefmedications to Student by: - self-carry medication - easily accessible medication throughdesignated school staff - ongoing monitoring of storagemedication and staff training.
- The school nurse will assess knowledgedeficits and learning needs of Student and family related to asthma andits management.
- The school nurse will assess Student’s developmental and emotionalreadiness for self-carrying of quick-reliefmedication.
- The school nurse will provideopportunities for Student to makedecisions regarding asthmamanagement.
- The school nurse will address asthmaknowledge deficits as indicated (e.g.,etiology, signs and symptoms, peak flowmeter use and interpretation, treatmentregimen, proper use of inhaler, self-carryresponsibilities, avoidance/control oftriggers, actions to take for worseningsymptoms and for acute exacerbations)via one-to-one instruction andparticipation in group asthma educationclass.
Expected Outcomes
- Student will articulate an age-appropriateunderstanding of asthma andthe proper use of medications (controllerand quick-relief, as needed), includingself-carry responsibilities, within 2 weeks.
- Student will identify actions to takeand strategies to use to managesymptoms as identified in the AAP within2 weeks.
Nursing Diagnosis: Anxiety related to
- experiencing a chronic illness and exacerbations of symptoms that can be life-threatening
- insufficient knowledge of therapeutic regimen
- decisional conflict
Interventions
- The school nurse will maintain andmonitor availability of quick-acting reliefmedications to Student by: - self-carry medication - easily accessible medication throughdesignated school staff - ongoing monitoring of storagemedication and staff training.
- The school nurse will assess knowledgedeficits and learning needs of Student and family related to asthma andits management.
- The school nurse will ask student abouthis or her sense of well-being; encouragediscussion of feelings; promote masteryof new skills through manageableincremental learning with demonstrationand return-demonstration; and usepositive reinforcement as student takeson increasing responsibility for self-management.
- The school nurse will observe for signs ofpoor coping (e.g., declining academicperformance, poor decision-making) andintervene or refer as needed to school’ssocial worker.
Expected Outcomes
- Student will report feeling greaterconfidence in self-management andimproved well-being within 2 weeks.
Would you like to add another nursing diagnosis?
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Nursing Diagnosis
Nursing Diagnosis
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Interventions
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EVALUATION
NOTES
IHP Developed By
Name
First Last
Title
Date
MM
DD
YYYY

EXP: 01/15/2022
IHP Updated By
Name
First Last
Title
Date
MM
DD
YYYY

EXP: 01/15/2022
IHP Updated By
Name
First Last
Title
Date
MM
DD
YYYY

EXP: 01/15/2022
Approved? (Admin-only)
- Approved

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Asthma IHP (1)

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