INDIVIDUALIZED HEALTHCARE PLAN FOR A STUDENT …

1 Box . INDIVIDUALIZED HEALTHCARE plan FOR A STUDENT with sickle CELL anemia . STUDENT Name: Address: Date of Birth: Parent(s) Name: Address: Telephone: NURSING DIAGNOSIS: Fatigue: related to sickle cell anemia resulting in reduced stamina and en- durance as evidenced by STUDENT complaint of lethargy and putting head down in class. GOALS/OUTCOMES: The STUDENT will participate in regular school/class activities, including PE with modifications as needed. NURSING INTERVENTIONS: Encourage STUDENT to participate to level of tolerance; allow STUDENT time to rest after activities. Collaborate with PE teacher or classroom teacher to provide alternate activities for STUDENT if active participation is not realistic. EVALUATION: STUDENT is able to participate in gym class and recess. Instead of participating in full contact sports, he is encouraged to be the scorekeeper. NURSING DIAGNOSIS: Risk for Ineffective Tissue Perfusion: renal, gastrointestinal due to vasoocclu- sion of vessels in kidney, pancreas and gallbladder, leading to impaired function in abdominal organs.

2 GOALS/OUTCOMES: STUDENT will be able to attain and maintain adequate hydration and urinary elimina- tion to support renal function, and will be able to accurately describe gallstone pain to teachers/nurse. NURSING INTERVENTIONS: Educate STUDENT and staff on location of typical gallstone pain (right upper quadrant and right shoulder). Encourage STUDENT to report right upper quadrant pain, nausea, vomiting, and/or right shoulder pain to staff/nurse. Encourage fluid intake during school day and allow water bottle to be used in each class. Promote liberal bathroom privileges. Notify parents of right quadrant pain. EVALUATION: STUDENT promptly reports any abdominal pain to staff. STUDENT is allowed unlimited water and juice containers at desk and has liberal bathroom passes. NURSING DIAGNOSIS: Risk for Altered Cardiovascular Tissue Perfusion due to pooling of blood in spleen resulting in unstable cardiovascular status.

3 GOALS/OUTCOMES: STUDENT 's blood pressure will remain within normal limits. STUDENT 's abdomen will be soft with no reported complaints of pain. NURSING INTERVENTIONS: Assess STUDENT 's abdomen for pain for distension; auscultate bowel sounds. Monitor vital signs for tachycardia or decrease in blood pressure. Assess level of alertness, and signs of pallor; measure capillary refill time. EVALUATION: STUDENT has no complaints of abdominal pain. Blood pressure within normal limits. NURSING DIAGNOSIS: Risk for Ineffective Cardiopulmonary Tissue perfusion due to vasoocclusion of blood vessels leading to unstable respiratory status. GOALS/OUTCOMES: The STUDENT will be free of dyspnea, tachypnea, fever, cough, and chest pain during the school day. STUDENT 's blood pressure will remain stable and nail beds will be pink with brisk capillary refill. NURSING INTERVENTIONS: Educate STUDENT and staff to immediately report alterations in respiratory status.

4 Educate STUDENT and staff to immediately report STUDENT complaints of chest pain as it is an emergency and can signal acute chest syndrome. Nurse will check vital signs, pulse oximetry, capillary refill, and do immediate respiratory assessment; alterations in respiratory status or chest pain will be reported. Nurse will immediately call parents and activate EMS if respiratory status worsens. (continued). Copyright 2013 National Association of School Nurses 1. Box (Continued). EVALUATION: STUDENT 's respiratory status remains stable with no signs of pallor or increased capillary refill. NURSING DIAGNOSIS: Risk for peripheral neurovascular dysfunction due to vasoocclusion of blood vessels in central nervous system resulting in cerebral ischemia. GOALS/OUTCOMES: STUDENT will have normal neurological exam. STUDENT should be able to speak and understand language. STUDENT will remain free of: headache and dizziness; balance difficulties; unilateral muscle weakness; tingling of extremities; loss of vision; blurred vision; or memory difficulties.

5 NURSING INTERVENTIONS: Conduct neurological exam and vital signs. Call parents immediately and activate EMS if neuro status changes and stroke is suspected. EVALUATION: STUDENT has stable neurological status. NURSING DIAGNOSIS: Risk for Infection due to splenic damage as a result of repeated infarcts result- ing in frequent bacterial infections. GOALS/OUTCOMES: STUDENT will be afebrile; will be free of cough, malaise, loss of appetite, nausea, vomiting, or increased pain. NURSING INTERVENTIONS: Educate STUDENT and staff to report any signs and/or symptoms of illness. Contact parents immediately if STUDENT has any of the above symptoms and refer STUDENT to primary care provider or emergency department if needed. Review immunizations to make sure they are up to date. Encourage the pneumococcal vaccine as recommended per the American Academy of Pediatrics. EVALUATION: STUDENT has not been absent from school over the last 3 months and has had no visits to health clinic.

6 Mother reports no illnesses over last 3 months. NURSING DIAGNOSIS: Acute pain due to sickled cells preventing tissue oxygenation resulting in discomfort as evidenced by reports of pain, facial grimacing, and decreased physical activity. GOALS/OUTCOMES: STUDENT will participate in developing and utilizing pain management plan . NURSING INTERVENTIONS: Identify with STUDENT , family and staff possible triggers that bring on painful sickle cell crisis. Possible triggers to consider are: fever, infection, exposure to extreme cold, physical exhaustion, and unusual stress or anxiety. Note any swelling over joints or bones. Use develop- mentally appropriate pain scale to document pain level. Help STUDENT utilize guided imagery for mild pain. Administer medications as prescribed by primary care provider for moderate to severe pain. Assess STUDENT for respiratory depression if opiates are administered. Assess STUDENT pain relief 1 hour after pain medication is administered.

7 EVALUATION: STUDENT utilizing relaxation and guided imagery for mild pain in health clinic once over the last 3 months with pain scale down from 3 to 1 of a 1-10 pain scale. STUDENT has not been absent for last 3 months. Smiling and talkative with staff and friends during school day. NURSING DIAGNOSIS: Disturbed sensory perception reduced circulation in retina and inner ear lead- ing to visual and auditory disturbances as evidenced by difficulty seeing the whiteboard and responding to questions asked by teacher in the classroom. GOALS/OUTCOMES: STUDENT will pass vision and hearing screening. NURSING INTERVENTIONS: Conduct routine visual screenings up to age 10, and refer STUDENT to ophthalmologist for annual retinal examinations. Conduct routine audiological screens. Notify parents of abnormal visual or auditory screening results. Refer STUDENT for further visual or auditory examination if fails screenings per state requirements.

8 2 Copyright 2013 National Association of School Nurses Box (Continued). EVALUATION: Routine screenings conducted and STUDENT passed both vision and auditory tests. NURSING DIAGNOSIS: Potential for Impaired Social Interaction due to a home environment of over- protection; leading to potential over dependency and social isolation. GOALS/OUTCOMES: STUDENT will participate in classroom activities and extracurricular projects. STUDENT will interact with peers and build friendships. NURSING INTERVENTIONS: Check in with STUDENT often to show interest and support in STUDENT . Encourage teachers to choose child for extra classroom jobs, assign leadership roles to STUDENT and encourage extracurricular activities. Provide support for parents; act as teacher/expert to answer questions, provide community resources and provide feedback on child's social interactions at school. EVALUATION: STUDENT chatting with friends each morning before school starts.

9 Walking in hall with friends, and eating with a group of classmates. Mother of STUDENT given a list of community resources to help support family cope with sickle cell anemia . Adapted from MacLean, M (2010). IHP for sickle Cell anemia . Graduate STUDENT at Wright State University College of Nursing & Health. Dayton, Ohio. Copyright 2013 National Association of School Nurses 3.