Student's Name: _____________________________________ I.D.# __________________ Medical DX: _____________________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _________
ANAPHYLAXIS________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Potential for ineffective breathing Student, staff, and parents will
R/T bronchospasm and/or
cooperate to prevent and
inflammation of the airway
manage anaphylactic episodes.
Nursing Interventions
1. IHP and EAP in place.
2. Medicate as ordered.
Outcomes
Outcomes recorded on
Dynalog entries prn.
1. Student and staff will recog1. Facilitate student, staff, and parent communication.
Potential knowledge deficit R/T nize specific sources of
2. Review student's specific IHP/EAP with student,
student's, staff's, and parent's
allergens.
staff, and parent and reassess for understanding prn.
responsibilities and interventions 2. Student and staff will recognize appropriate TX steps.
3. Student, staff, and parent will
plan appropriate modifications for
classroom/fieldtrip activities prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: __________
HEMOPHILIA_________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Potential for injury or
Risk of injury caused by
hemorrhage R/T disease process hemorrhage will be reduced.
Nursing Interventions
1. IHP and EAP in place.
2. Assess for headache, joint pain, unexplained
ecchymosis, abdominal pain, and/or change in LOC
when student is seen in clinic.
3. Educate student and staff prn R/T potentially
injurious situations.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _________
SICKLE CELL ANEMIA__________
Date NCP Initiated: __________________________________
Nursing DX
Potential for altered tissue
perfusion R/T disease process
resulting in pain, anxiety, and/or
altered urinary elimination
Goals
Student will eliminate or reduce
the occurrence of sickle cell
events A.E.B. minimal
interruptions to school
participation.
Nursing Interventions
1. IHP and EAP in place.
2. Educate student, staff, and parents prn R/T the
recognition and TX of S/S indicating or precipitating a
sickle cell event.
3. Maintain good hydration.
4. Analgesics as ordered.
5. Provide calm atmosphere in which to rest.
6. Modify physical activity prn. ( M.D. excuse may be
required. )
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _________
DIABETES____________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Outcomes recorded on
Dynalog entries prn.
Potential knowledge deficit R/T
glucose monitoring, self-injection,
meal plans, and/or sick day
management
Student and/or family will
demonstrate mastery of or
progression of proficiency in
glucose monitoring, insulin
injections, and food choices.
1. DMMP\IHP and EAP in place.
2. Unlicensed diabetic care assistant on campus.
3. Assess student's and/or family's diabetes education
needs and reinforce education prn.
4. Monitor student's and/or family's techniques prn.
5. Assist with coordination of food choices between
student, staff, and parent prn. (Include cafeteria
manager. )
6. Field trip\extracurricular activity care will be provided
by __________________________________ per
DMMP\IHP
Potential for metabolic
imbalances R/T hypo- or
hyperglycemic episodes
Student will prevent or reduce
the effects of hypo- or hyperglycemic episodes A.E.B. blood
sugars within acceptable limits as
stated in EAP or allowing
prescribed TX as stated in EAP.
1. DMMP/IHP and EAP in place.
2. Monitor blood glucose levels and urinary ketones as
ordered.
3. Sliding scale or bolus insulin as ordered.
4. Glucose source as ordered.
5. Push noncaloric p.o. fluids prn.
6. Facilitate restroom privileges prn.
7. Additional glucose monitoring may be necessary
during times of acute illness.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _____BOWEL PROBLEM (specify )_________
Date NCP Initiated: __________________________________
Nursing DX
Potential for pain R/T altered
bowel elimination
Goals
Student will eliminate or reduce
the pain associated with bowel
evacuation.
Potential for fluid imbalance R/T Student will maintain proper
altered bowel elimination.
hydration.
______________________________________
Nursing Interventions
1. IHP in place.
2. Medicate as ordered.
3. Encourage activity as tolerated to stimulate normal
bowel function.
Outcomes
Outcomes recorded on
Dynalog entries prn.
1. Encourage p.o. water prn.
2. Medicate as ordered.
Potential knowledge deficit R/T Student will demonstrate proper 1. Assess student's/family's current knowledge base
nutrition, proper elimination
steps to take to safely prevent or R/T bowel elimination and educate prn, stressing the
importance of high fiber diet, minimal use of laxatives,
habits, and/or misuse of laxatives treat diarrhea or constipation.
sufficient water intake, activities that increase GI
motility, and/or normal fecal consistency.
Student will minimize or
eliminate episodes of encopresis. 2. Assist student, staff, and parents to establish regular
bowel schedule for the student prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _____URINARY PROBLEM (specify )________
Date NCP Initiated: __________________________________
Nursing DX
Potential for impaired skin
integrity R/T incontinence or
altered urinary elimination
Goals
Student will maintain good skin
integrity.
Potential for infection R/T altered Student will not experience UTI
urinary elimination
due to distention, retrograde
urine flow, or introduction of
pathogenic organisms.
______________________________________
Nursing Interventions
Outcomes
1. Coordinate supply of clean, dry clothing/incontinence
garments prn.
2. Apply topical TX as ordered.
3. Assist student, staff, and parents prn in coordinating
regular urinary catheterization as ordered.
4. Medicate with antispasmodics as ordered.
5. Educate student, staff, and parents prn R/T the S/S
of impaired skin integrity.
6. Inform parents of S/S of impaired skin integrity, if
observed, and refer for follow-up TX prn.
Outcomes recorded on
Dynalog entries prn.
1. Educate student, staff, and parents prn on proper
perineal cleansing.
2. Assess student, staff, and parents catheterization
techniques prn and educate prn.
3. Monitor for S/S of UTI and refer for M.D. evaluation
prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ____IMMUNOCOMPROMISED (specify )_____
Date NCP Initiated: __________________________________
Nursing DX
Goals
______________________________________
Nursing Interventions
Outcomes
Outcomes recorded on
Dynalog entries prn.
Potential for infection R/T
disease process
Student will remain free from
infection.
1. Practice strict universal precautions before, during,
and after dealing with student.
2. Inform student's parents when classroom infections
pose an increased threat to compromised student. (i.e.chicken pox)
Potential knowledge deficit R/T
risk factors
Student will recognize and
minimize potential risk factors.
Assess student's, staff's, and parents' current
knowledge base and educate prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _MENTAL/BEHAVIOR IMPAIRMENT (specify )
Date NCP Initiated: __________________________________
_____________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Potential knowledge deficit R/T
DX, medication's side effects and
actions, and/or medication
administration times
Potential knowledge deficit R/T
DX, medication's side effects and
actions, and/or medication
administration times
1. Assist student and family with understanding DX and
TX prn and educate prn.
2. Assist student in developing routine schedule for
medication administration to increase student's
compliance with TX plan.
Outcomes recorded on
Dynalog entries prn.
Potential for altered sensory
Student will be able to participate 1. Monitor effects of medication and notify parents of
perceptions, coping skills, selfin daily activities with a minimum dramatic changes prn.
esteem, and/or impaired thought of side effects from medication.
processes R/T medication use
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ________
ANXIETY DISORDER____________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Potential for altered sensory
perceptions and thought
processes R/T panic attacks
Student will be able to assess
situations realistically and employ
positive coping mechanisms
A.E.B. student resuming daily
activities.
1. Provide calm atmosphere.
2. Medicate as ordered.
3. Provide appropriate reassurances.
4. Assist student to identify precipitating factors and
effective positive coping mechanisms.
Potential knowledge deficit R/T
DX, medication's side effects and
actions, and/or medication
administration times.
Student will understand
medication's actions and side
effects and appropriate
administration times A.E.B.
student coming to the clinic at
specified times for medication
administration.
1. Assist student and family with understanding DX and
TX prn and educate prn.
2. Assist student in developing routine schedule for
medication administration to increase student's
compliance with TX plan.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _________
DEPRESSION_________________
Date NCP Initiated: __________________________________
Nursing DX
Potential for injury to self or
others R/T feelings of
hopelessness
Goals
Student will not injure self or
others.
Nursing Interventions
1. Provide safe haven prn.
2. Allow time for student to verbalize feelings.
3. Provide appropriate reassurances.
4. Assist student to set realistic goals.
5. Assist student to assess situations realistically and
employ positive coping mechanisms.
Outcomes
Outcomes recorded on
Dynalog entries prn.
Potential for altered sensory
Student will be able to participate 1. Monitor effects of medication and notify parents of
perceptions, coping skills, selfin daily activities with a minimum dramatic changes prn.
esteem, and/or impaired thought of side effects from medication.
processes R/T medication use
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ____HISTORY OF SUBSTANCE ABUSE_____
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Potential for injury to self and/or Student will not injure self or
others R/T altered thought
others.
processes secondary to chemical
use
1. Report to school administrator any suspicious
activities or behaviors observed.
2. Refer for further evaluation and TX if student is
found to be chemically-involved.
Potential knowledge deficit R/T
chemical effects on body,
relationships, self-worth, and
school attendance and
performance
1. Provide appropriate educational resources.
2. School will monitor class attendance and
performance and communicate with parents prn.
Student will progress in school
A.E.B. regular attendance and
appropriate class performance.
Outcomes
Outcomes recorded on
Dynalog entries prn.
Student and/or family will
verbalize questions and/or
increased knowledge R/T
substance abuse.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ________
TOURETTE'S SYNDROME________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Outcomes recorded on
Dynalog entries prn.
Potential for altered self-image
R/T syndrome's manifestations
Student will demonstrate
appropriate coping skills to
promote a positive self-image.
1. Assist student to recognize and cope with TX
limitations.
2. Assist student to identify and use appropriate coping
skills during interactions with self and others.
3. Refer for counseling prn.
Potential knowledge deficit R/T
DX, medication's side effects and
actions, and/or medication
administration times
Potential knowledge deficit R/T
DX, medication's side effects and
actions, and/or medication
administration times
1. Assist student and family with understanding DX and
TX prn and educate prn.
2. Assist student in developing routine schedule for
medication administration to increase student's
compliance with TX plan.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ____EATING DISORDER:_________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
____ LESS THAN BODY REQUIREMENTS___
Nursing Interventions
Potential for ingesting less than
nutritional requirements R/T
eating habits or increased
metabolic needs
Student will allow monitoring of
nutritional intake prn.
1. Coordinate will student, family, and physician prn to
reinforce nutritional recommendations for student.
2. Monitor student's weight as ordered.
3. Provide for storage of snacks in clinic as ordered.
4. Refer for counseling prn.
Potential for altered self-image
R/T appearance to self and
others
Student will demonstrate
appropriate coping skills to
promote positive self-image.
1. Assist student to identify and use appropriate coping
skills during interactions with self and others.
2. Assist student to recognize and cope with TX
limitations prn.
3. Refer for counseling prn.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ________
OBESITY______________________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Potential for ingesting more than Student will allow monitoring of
nutritional requirements R/T
nutritional intake and/or activity
eating habits, decreased
prn.
metabolic needs, or decreased
physical activity
1. Coordinate with student, family, and physician prn to
reinforce nutritional and activity recommendations for
student.
2. Monitor student's weight as ordered.
3. Refer for counseling prn.
Outcomes recorded on
Dynalog entries prn.
Potential for impaired coping R/T Student will choose positive
decreased self-esteem
coping mechanisms other than
eating to increase self-esteem.
1. Assist student to identify and use appropriate coping
methods during times of stress.
2. Refer for counseling prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ________
GASTROSTOMY________________
Date NCP Initiated: __________________________________
Nursing DX
Potential for impaired skin
integrity R/T G-tube
Goals
Skin around G-tube will remain 1. Review S/S of impaired skin integrity prn with
intact without signs of irritation or caregivers and educate prn.
infection.
2. Notify parents of S/S of impaired skin integrity or
leakage at stoma site or dislodged tube, if observed.
Potential for altered nutrition R/T Student will maintain adequate
decreased patency or
nutritional status.
displacement of G-tube
Potential for altered self-image
R/T G-tube
Nursing Interventions
Outcomes
Outcomes recorded on
Dynalog entries prn.
1. Notify parents of dislodgement or decreased patency
of G-tube prn.
Student will indicate acceptance 1. Allow time for venting feeling R/T G-tube prn.
of G-tube A.E.B. verbalization of 2. Refer for counseling prn.
acceptance, not purposefully
dislodging the tube, and/or
allowing assistance with G-tube
feedings prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _________
PAIN (specify )_________________
Date NCP Initiated: _________________________________
Nursing DX
Goals
Potential for pain R/T individual's Student will be able to participate
DX
in daily activities within student's
physical limits without excessive
pain.
______________________________________
Nursing Interventions
1. Medicate as ordered.
2. Assist student in identifying and using alternative
coping mechanisms to control pain.
3. Notify parents if TX is ineffective.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ____PHYSICALLY IMPAIRED (specify )______
Date NCP Initiated: __________________________________
Nursing DX
Goals
______________________________________
Nursing Interventions
Impaired mobility R/T disease
Student will be able to participate 1. Collaborate with student, staff, and parents to ensure
process, surgical interventions, or in school activities.
safe and timely participation in daily activities.
physical trauma
Potential for impaired skin
integrity R/T pressure points
and/or decreased sensation
Student will maintain good skin
integrity.
Outcomes
Outcomes recorded on
Dynalog entries prn.
1. Assess for and inform parents of any S/S of impaired
skin integrity prn based on student's complaints.
2. Review with student, staff, and parents prn the
importance of frequent relieving of pressure points.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: __RESPIRATORY DISTRESS (specify )______
Date NCP Initiated: __________________________________
______________________________________
Nursing DX
Goals
Nursing Interventions
Outcomes
Potential for altered respiratory
function R/T airway inflammation
and/or increased mucous
production
Student will attain and maintain
near-normal respiratory function
A.E.B. reaching goals as outlined
in IHP.
1. IHP and/or EAP in place.
2. Medicate as ordered and monitor efficacy prn.
3. Provide percussion as ordered.
4. Collaborate with student, staff, and parents to ensure
safe participation in all school activities.
Outcomes recorded on
Dynalog entries prn.
Potential knowledge deficit R/T
DX, medications, and/or factors
influencing respiratory function
Student/Family will recognize
implications of DX.
1. Provide educational resources prn.
2. Assist student, staff, and parents prn in identifying
and controlling factors that influence respiratory
function.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: __________________________________ I.D.# __________________ Medical DX: _______SEIZURE DISORDER________________
Date NCP Initiated: __________________________________
Nursing DX
Potential for injury R/T seizure
activity
Goals
Student will not injure self or
others during seizure activity.
Nursing Interventions
1. IHP and EAP in place.
2. Educate staff prn R/T appropriate responses to
student having a seizure.
3. Medicate as ordered.
4. First aid and emergency care prn.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: ___VENOUS-PERITONEAL SHUNT________
Date NCP Initiated: __________________________________
Nursing DX
Goals
Potential for decreased LOC R/T Student will remain AA&OX3.
shunt obstruction
Nursing Interventions
1. Educate student and staff R/T signs of increasing
ICP and instruct them to inform R.N. prn.
2. Encourage parent to seek M.D. evaluation for any
changes in LOC.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173
Student's Name: _____________________________________ I.D.# __________________ Medical DX: _____SENSORY IMPAIRMENT (specify )_____
Date NCP Initiated: __________________________________
Nursing DX
Goals
______________________________________
Nursing Interventions
Potential for injury R/T impaired
sensory perception
Student will safely move about
and participate in school
activities.
1. Collaborate with student, staff, and parents prn to
reduce or eliminate barriers to mobility and safety.
Potential for impaired communication R/T impaired sensory
perception
Student, staff, and parents will
reduce barriers to communication.
1. Review with student, staff, and parents the IEP prn to
ensure optimal communication in the classroom and
between school and home.
Outcomes
Outcomes recorded on
Dynalog entries prn.
NCP D/C'd
_______________
(date)
September 2005
HS - 173