Form No.: HTH 213.031 Revised Date: 9/11/12

Alachua County Public Schools – Health Services CYSTIC FIBROSIS NURSING CARE PLAN

STUDENT: ____________________________GRADE: ________SCHOOL: ____________________________ DATE OF BIRTH: ____________________

NURSING DIAGNOSIS

GOALS

INTERVENTIONS

OUTCOMES

Ineffective airway clearance related to: - excessive mucus production - retained secretions - chronic infection - chronic inflammation - refusal to cough and/or use CPT therapies at school - inadequate fluid intake - pulmonary exacerbation Risk for activity intolerance related to: - impaired gas exchange - pulmonary exacerbation - inability to acknowledge early signs of fatigue Imbalanced nutrition: less than body requirements related to: - inadequate intake - increased caloric demands - decreased digestion and absorption of nutrients - pulmonary exacerbation Risk for deficient fluid volume related to: - extreme exertion during hot humid weather conditions - failure to ingest adequate fluids Ineffective therapeutic regimen management related to: - knowledge deficit - denial of early warning signs of

The student will demonstrate age-appropriate knowledge of diagnosis, symptoms, prescribed intervention/s, and medication/s and side effects. The student will (as developmentally appropriate) assist in the decision-making process regarding health management issues at school and will participate in health assessments as needed. The student/parent/guardian will assist in developing and implementing an action plan for each potential complication of the health condition, including an Emergency Care Plan for life-threatening symptoms if needed. The student will have their needed medication (if given at school) available and easily assessable. They will be able to administer medication independently (self-carrying) or with the assistance of school personnel. The student will participate in regular school/class activities, including physical education, with modifications made as necessary. The student will increase their knowledge about their health condition and skills in self-management.

In cooperation with student, parents, and other school personnel, participate in development of individualized education plan (IEP), as indicated, or 504 plan and Emergency Care Plan as needed to address accommodations needed in the school setting. Identify and obtain necessary medications, equipment, and supplies to be utilized in implementation student’s health plan. Provide in-service/education for teachers/school staff about health condition as needed. Provide an Emergency Care Plan if needed (to school personnel who work with the student) which includes what to observe and how to appropriately respond to increasing levels of symptom severity. Educate student, parents, teachers and other school personnel about the student’s health condition, monitoring of student’s symptoms, and means to implement the Emergency Care Plan and/or self-care. Assist the student to administer prescribed medications, educate about self-carrying of medication and/or interventions appropriate for their knowledge and skills according to school district policy and legal mandates.

The student will define their health condition, symptoms, prescribed intervention/s and medication/s and possible side effects (at a developmentally appropriate level). The student will identify responsibilities for self-carrying of medications and will demonstrate proper technique of self-medicating when appropriate. The student will demonstrate compliance with their health management plan and prescribed medication (individualized education plan, 504, health maintenance and Emergency Care Plan as appropriate). The student will reduce the risk of potential injury. They will identify potential sources of injury, will identify safety measures to prevent injury and follow safety policies at school. (as developmentally appropriate) The student will participate in regular classroom activities including physical education, with modifications made as necessary (hospital or homebound instruction when needed). The student will have minimal disruptions in their educational program due to their health condition and will demonstrate a good attendance pattern.

Form No.: HTH 213.031 Revised Date: 9/11/12

pulmonary exacerbation - lack of financial resources - complexity of regimen - multiple changes in medications/treatments - lack of social support system - inconsistent primary caregiver - multiple caregiver demands - family conflict Risk for noncompliance with prescribed treatment related to: - denial of need for medication/treatment - perceived ineffectiveness of medication/treatment - time involvement - cost of treatment - undesirable side effects of medication - knowledge deficit Ineffective coping related to: - severity of exacerbation - fear of future exacerbations - stress imposed by CF and its management - altered role performance - inadequate social support - ineffective parental coping Ineffective role performance related to: - absence from school due to CF - inadequate coping - frequent exacerbations - inadequate support system - impaired self-esteem Chronic low self-esteem related to: - disturbed body image - activity intolerance - perceived negative feedback from peers

The student will not sustain injury/additional injury at school. The student will describe own abilities and any limitations associated with their health condition realistically and accurately. The student will improve communication ability and skills. They will demonstrate appropriate problem-solving and communication with school personnel. The student will achieve/maintain positive self-esteem and utilize positive coping skills. The student will demonstrate improved airway clearance. The student will consume adequate fluid during the school day. The student will seek treatment for signs of pulmonary exacerbation. The student will demonstrate improved physical activity tolerance in the school setting. The student will demonstrate improved nutritional status.

Assess the student’s developmental and emotional readiness for self-carrying of medication. Make field trip modifications as needed (e.g., medications must be taken in prescribed bottle by trained individual) Discuss with student factors that increase risk of injury and inform teachers/staff of potential risk to student. As needed, assess and monitor health conditions, give medication/interventions as prescribed, and maintain accurate records. Assist the student in identifying factors that might interfere with compliance with therapeutic regimen and develop specific strategies for dealing with these barriers to compliance. Discuss with the student and parents/guardians the possible side effects of medication and importance of monitoring and reporting these, because they may interfere with adherence to the health management plan and self-care plans. Encourage the student's participation in sports, school, and peer activities to promote a sense of school engagement and sense of belonging. Assist the student to develop appropriate communication, decision-making skills and positive coping skills. Assist the student to identify motivators

The student will demonstrate an increased knowledge and self-management skill of health condition. The student will verbalize frustrations and demonstrate use of effective coping strategies that reduce anger, fear and anxiety. The student will list motivators and barriers to compliance with prescribed medications and interventions. The student will demonstrate an understanding of effects of CF on various body systems and utilize that knowledge to make health management decisions. The student will maintain signs of adequate hydration. The student will consume daily recommended ounces of fluids. The student will identify early signs and symptoms of pulmonary exacerbations. The student will take Pancreas enzymes daily with meals and snacks. The student will achieve or exceed expected gains in proportionate height and weight. The student will improve school attendance with accommodations as needed.

Form No.: HTH 213.031 Revised Date: 9/11/12

- ineffective coping - altered role performance - inadequate support system Disturbed body image related to - delayed puberty - medication The student will demonstrate an understanding of effects of CF on various body systems and utilize that knowledge to make health management decisions. side effects - gastrostomy placement - impaired nutritional status - activity intolerance - excessive gas production and fatty foul-smelling stools Risk for acute infection related to: - ineffective airway clearance - chronic inflammation of airways - introduction of new pathogen - antibiotic resistance

and barriers to self-care. Provide support and advocate for student as needed. Parent and physician will be notified when signs of a potential impending exacerbation are observed at school, such as persistent cough, chest crackles, exercise intolerance, reduced appetite, failure to gain weight, increased sputum production, and fever.

OTHER:

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Health Care Provider: _________________________________ Date: ________________ Re-evaluated _______________ Re-evaluated _______________

Health Care Provider: _________________________________ Date: ________________ Re-evaluated _______________ Re-evaluated _______________