Individual Health Care Plan 2019-2020
Cardiac Alteration – Supraventricular Tachycardia
Susie Q Student DOB 9/16/2010 9yrs Allergies: NKDA NCH Cardiology 614-722-3347 Dr. Fitzsimmons
3B Mrs. Thompson
22547 Eagle Trace Columbus, OH 43214 IHP Date: 6/24/2019 Review Date:
Mother Cell 614-274-8853 Parent Approval (sign):
Father Cell 614-295-0743 Physician Approval:
Emergency Contact Grandmother Jenny Smith 614-839-0514 Nurse Approval:
History: Susie is an otherwise healthy 9 year old female with a history of SVT x 4years.First presented with Susie “telling her mother her heart was running a race.” S/P catheter ablation on 4/12/15. Susie continues to have episodic bouts of SVT. 3 of the 4 cleared with vasovagal maneuvers, one required chemical cardioversion. Susie is a fraternal twin, sister is in neighboring classroom. Older sibling in 6th grade. Susie lives at home with both parents and a family dog. Her Mother is a physician. Assessment and growth chart comparison showed Susie is 88%height, 58%weight, healthy BMI. Her teachers describe her as a good student with many friends. She is reading at grade level.
Medications: Metropolol ER 75mg, multi-vitamin
IHP: IHP is necessary for Susie because of the potential for cardiac arrhythmia while at school or participating in school activities.
Restrictions: In the absence of SVT, Susie’s cardiologist has placed no activity restrictions.If experiencing SVT it is important that Susie be cared for by the nurse and not exert herself.
| Nursing Dx. | Goal: The student will | Nursing Intervention | Evaluation |
| Risk for decreased cardiac output r/t SVT arrhythmia | Recognize when she is experiencing tachycardia | 1)Educate Susie on feelings of normal heart rate and how to take a pulse
2)Educate Susie on tachycardia and how a tachycardic pulse may feel 3) Review symptoms Susie has felt in the past with known episodes of SVT |
Susie can properly identify if she is in a normal rate as verified by a pulse check.
Susie will alert her teacher or nurse when she feels symptoms of tachycardia |
| Risk for falls r/t dizziness and poor perfusion and impaired gas exchange brought about by SVT | Place herself in a seated or lying position on the floor when she feels symptoms of her arrhythmia and alert a staff member | 1)Discuss procedure with Susie for what to do at school during an episode of SVT and why her safety is important
2)Define who are appropriate people to alert of her symptoms |
Susie can list 3 possible people she can count on and alert in the event of feeling like she has SVT. Susie demonstrates some safe places or positions in the event of SVT. |
| Risk for anxiety r/t illness / cardiac arrhythmia that can occur without warning AEB hesitation to participate with peers in activity | Participate freely in physical and social activities | 1)Inform teachers that without symptoms of SVT there are no activity restrictions
2)request teachers monitor Susie for s/sx of anxiety |
Susie participates in her school day activities without hesitation of s/sx of feeling anxious |
Emergency Action Plan for SVT
Susie Q Student (+ picture of Susie)
Age: 9rs old DOB: 9/16/2010
Grade 3
Nurse: 614-ccc-cccc Mom: 614-xxx-xxxx Dad: 614-xxx-xxxx
| IF THIS HAPPENS | DO THIS |
| Susie complains of feeling her heart race, or she appears dizzy, lethargic, pale and clammy, nauseous | Help Susie to sit or lay in a safe place on the ground
Notify the nurse Take note of the time Check Susie’s pulse |
| Susie’s pulse is >160bpm at rest | Call the nurse
Note the time While waiting for nurse instruct Susie to “bear down” (hold breath and push out without exhaling) If available send someone for a bag of ice then hold bag of ice to face and neck for 20 seconds |
| Susie’s pulse is >160bpm for 30 minutes
Nails or lips are blueish Susie is lethargic or unable to respond appropriately |
Call 911 |
| Any episode of suspected SVT | Notify mom and dad |