POTS 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: Activity Intolerance Related to orthostatic intolerance leading to dizziness, weakness, and fatigue. Related to increased heart rate and blood pressure instability upon standing. Related to low exercise tolerance due to cardiovascular symptoms. Interventions The school nurse will assess the student’s tolerance for activities, noting any changes in vital signs or symptoms like dizziness or palpitations. The school nurse will educate the student on the importance of pacing activities and incorporating frequent rest periods. The school nurse will encourage non-upright activities initially, such as seated or recumbent exercises, to improve cardiovascular conditioning without causing symptoms. The school nurse will teach strategies for energy conservation, such as sitting while performing tasks and avoiding sudden position changes. The school nurse will collaborate with physical therapy for a tailored exercise program that gradually increases endurance. Expected Outcomes The student will report decreased dizziness and fatigue during daily activities. The student will demonstrate an ability to engage in light activity without a significant increase in symptoms. The student will increase tolerance for physical activities, showing gradual improvement in stamina. Nursing Diagnosis: Risk for Deficient Fluid Volume Related to high salt and fluid intake requirements due to POTS, with a risk of inadequate fluid intake. Related to potential for dehydration, especially in warm weather or during illness. Related to blood pooling in lower extremities causing reduced circulating volume. Interventions The school nurse will assess fluid intake and monitor for signs of dehydration, such as dry mouth, decreased skin turgor, and urine output. The school nurse will educate the student on the importance of increasing fluid and salt intake to support blood volume. The school nurse will recommend electrolyte-enhanced drinks to help with hydration and maintain sodium balance. The school nurse will encourage the student to monitor and log daily fluid intake to ensure adequate hydration. The school nurse will advise against diuretic foods and drinks, such as caffeine, which may exacerbate fluid loss. Expected Outcomes The student will maintain adequate hydration, as evidenced by normal skin turgor, stable vital signs, and clear urine. The student will report increased fluid intake and demonstrate an understanding of the role of hydration in managing POTS symptoms. The student will avoid dehydration, with no signs of orthostatic intolerance worsening due to fluid imbalance. Nursing Diagnosis: Risk for Injury related to Dizziness and Syncope Related to orthostatic hypotension and syncope risk due to POTS. Related to dizziness and lightheadedness upon standing, leading to potential falls. Related to blood pooling in the lower extremities causing instability. Interventions The school nurse will teach the student to change positions slowly (e.g., moving from lying to sitting, then standing). The school nurse will recommend wearing compression stockings to reduce blood pooling in the legs. The school nurse will encourage the student to avoid standing for prolonged periods; if unavoidable, suggest periodic muscle contractions (e.g., toe-tapping or shifting weight). The school nurse will ensure the student has access to stable furniture or walls for support when standing up. The school nurse will educate on recognizing early signs of dizziness and syncope, encouraging the student to sit or lie down if symptoms occur. Expected Outcomes The student will demonstrate safe mobility techniques, minimizing sudden position changes. The student will experience fewer episodes of dizziness or syncope, improving stability. The student will avoid injury, showing an understanding of strategies to prevent falls and support balance. Nursing Diagnosis: Fatigue Related to increased cardiovascular workload due to tachycardia, even with minimal activity. Related to poor sleep quality due to discomfort and symptoms of POTS. Related to decreased endurance and energy levels due to orthostatic intolerance. Interventions The school nurse will assess the student’s level of fatigue and factors that exacerbate or alleviate it. The school nurse will educate the student on creating a daily routine that balances rest and activity. The school nurse will encourage the use of strategies to improve sleep quality, such as a consistent sleep schedule and a quiet, dark environment. The school nurse will promote pacing techniques to prevent overexertion, with planned rest breaks. The school nurse will support the student in setting realistic goals, breaking larger tasks into smaller, manageable steps. Expected Outcomes The student will report improved energy levels and reduced fatigue with daily activities. The student will demonstrate effective use of rest breaks and pacing techniques. The student will show increased ability to complete daily tasks with fewer symptoms of exhaustion. Nursing Diagnosis: Ineffective Health Maintenance Related to lack of knowledge about managing POTS symptoms and lifestyle modifications. Related to challenges with adhering to dietary, fluid, and activity recommendations. Related to potential emotional stress from dealing with chronic illness and limitations. Interventions The school nurse will provide education on POTS, including symptom management, dietary recommendations, and the importance of fluid and salt intake. The school nurse will encourage the student to establish a structured routine for meals, hydration, and exercise to aid in symptom management. The school nurse will teach stress management techniques, such as mindfulness or relaxation exercises, to reduce anxiety related to symptoms. The school nurse will refer the student to support groups or counseling services to address the emotional impact of managing a chronic condition. The school nurse will educate on the importance of regular follow-up appointments with healthcare providers to monitor symptoms and adjust management as needed. Expected Outcomes The student will demonstrate knowledge of POTS management, including dietary, hydration, and activity modifications. The student will report increased adherence to lifestyle modifications that aid symptom control. 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.
