Type 1 Diabetes IHP 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: Risk for Unstable Blood Glucose Levels Related to insulin dependence Interventions The student’s blood glucose levels will be checked as ordered and whenever symptoms of hypo- or hyperglycemia occur. Blood glucose readings will be documented and communicated with the healthcare provider and parent/guardian as needed. The school nurse will ensure regular meals and snacks are scheduled at consistent times. The school nurse will work with the physical education teacher and coaches to accommodate glucose checks before and after physical activities. The school nurse will assist the student with insulin adjustments based on carbohydrate intake and blood glucose levels, following their healthcare provider's plan. The school nurse will teach the student and school staff to recognize signs and symptoms of hypo- and hyperglycemia The school nurse will ensure that staff are aware of protocols to respond to abnormal blood glucose levels. Expected Outcomes The student’s blood glucose levels remain within the target range as specified by the healthcare provider. The student’s experiences fewer instances of hypo- or hyperglycemia during school hours. The student demonstrates increased confidence in recognizing and managing blood glucose changes. Nursing Diagnosis: Risk for Hypoglycemia Related to insulin administration, physical activity, or missed meals/snacks. Interventions The school nurse will educate the student and staff to recognize early signs of hypoglycemia (e.g., shakiness, sweating, confusion). The school nurse will treat hypoglycemia promptly with 15 grams of fast-acting carbohydrates (e.g., glucose tablets, juice) and recheck blood glucose after 15 minutes. The school nurse will ensure glucagon is stored in an easily accessible location, and train staff on how to administer it during severe hypoglycemia. The school nurse will encourage the student to check blood glucose before, during, and after physical activities. The school nurse will provide a snack before physical activity if blood glucose is below 100 mg/dL. The school nurse will ensure that meals/snacks are adjusted based on the timing and intensity of physical activities. The school nurse will ensure that blood glucose is within a safe range to prevent hypoglycemia during activity. The school nurse will check blood glucose after physical activity to identify any changes. The school nurse will adjust insulin and snacks as needed based on post-activity blood glucose readings. Expected Outcomes The student’s hypoglycemic episodes are promptly recognized and treated, reducing the risk of severe complications. The student participates safely in physical activities without frequent interruptions due to hypoglycemia. School staff demonstrate confidence in managing hypoglycemia and administering glucagon as directed. Nursing Diagnosis: Risk for Hyperglycemia Related to missed insulin doses, illness, or increased carbohydrate intake. Interventions The school nurse will teach the student and staff to recognize signs of hyperglycemia (e.g., thirst, frequent urination, fatigue). The school nurse will check blood glucose levels if symptoms occur or if the student reports feeling unwell. The school nurse will perform ketone testing if blood glucose exceeds 250 mg/dL, per the healthcare provider's plan. The school nurse will notify the parent/guardian, as directed, if ketones are present or blood glucose remains elevated after correction doses. The school nurse will encourage increased water intake and provide regular access to water to prevent dehydration during hyperglycemia. The school nurse will allow unrestricted bathroom access for the student. Expected Outcomes The student’s hyperglycemic episodes are promptly identified and managed, reducing the risk of diabetic ketoacidosis (DKA). The student remains hydrated and avoids complications of prolonged high blood glucose. The student experiences fewer hyperglycemic episodes during school hours. Nursing Diagnosis: Knowledge Deficit Related to diabetes self-management Interventions The school nurse will provide age-appropriate education on carbohydrate counting, blood glucose monitoring, and the relationship between food, activity, and insulin. The school nurse will reinforce understanding of insulin dosing and injection techniques if the student is using a syringe or pen. The school nurse will encourage the student to participate in their care, such as calculating insulin doses and recognizing symptoms of hypo-/hyperglycemia. The school nurse will offer support and guidance to increase confidence in self-management skills. The school nurse will educate teachers, aides, and other appropriate personnel on diabetes care basics and emergency response protocols. The school nurse will provide age-appropriate education on how to use diabetes equipment (glucose monitor, insulin pump) and the importance of self-care. The school nurse will encourage the student to practice self-care skills such as blood glucose testing, recognizing symptoms, and insulin administration (as age-appropriate). The school nurse will offer positive reinforcement for independent self-management. Expected Outcomes The student demonstrates improved knowledge and confidence in managing diabetes. The student independently performs age-appropriate diabetes care tasks (e.g., glucose checks, insulin administration). School staff feel confident in supporting the student’s diabetes care needs. Nursing Diagnosis: Risk for Interrupted School Attendance Related to frequent blood glucose checks and insulin pump management may interrupt class time. Related to missed school days for medical appointments or due to diabetes-related complications. Interventions The school nurse will work with teachers to allow the student to check blood glucose levels, administer insulin, or treat symptoms as needed without penalty. The school nurse will provide a private space for diabetes management tasks, such as insulin injections or infusion set changes. The school nurse will arrange for missed classwork or assignments to be made up if the student is absent due to diabetes-related care or medical appointments. The school nurse will coordinate with parents to minimize missed school days. The school nurse will ensure diabetes supplies and snacks are available during field trips or extracurricular activities. The school nurse will assign a trained staff member to accompany the student if the parent/guardian is unavailable. Expected Outcomes The student maintains regular attendance with minimal interruptions due to diabetes-related care. Teachers accommodate the student’s needs without negatively impacting academic progress. The student participates in field trips and extracurricular activities safely and confidently. Nursing Diagnosis: Impaired Skin Integrity Related to insulin injections, infusion site changes Interventions The school nurse will educate the student on rotating injection and infusion sites (e.g., abdomen, thighs, upper arms) to prevent tissue damage The school nurse will use a site rotation chart for easy tracking The school nurse will teach and demonstrate the correct technique for insulin administration (angle of injection, site preparation). The school nurse will reinforce the importance of hygiene (proper skin preparation at injection and infusion sites). The school nurse will monitor injection sites weekly for signs of redness, swelling, bruising, or lipodystrophy. The school nurse will report any abnormalities or signs of infection to the healthcare provider promptly. Expected Outcomes The student will experience intact, healthy skin without signs of breakdown, irritation, or infection. The student will use proper rotation of injection sites to prevent lipodystrophy and tissue damage. Nursing Diagnosis: Anxiety Related to fear of insulin pump failure or improper dosing leading to serious hypo- or hyperglycemic events. Related to concerns about being different from peers due to the visible use of the pump and diabetes-related management. Interventions The school nurse will offer emotional support and reassurance to the student, helping them feel more comfortable with the use of the insulin pump and managing diabetes in front of peers. The school nurse will encourage open discussions about their concerns and work on problem-solving strategies for addressing these fears. The school nurse will teach relaxation techniques, such as deep breathing and mindfulness, to help the student manage anxiety related to diabetes care and potential emergencies. The school nurse will encourage self-confidence in using the insulin pump and empower the student to explain their condition to others as needed. The school nurse will educate peers (with the student’s consent) about diabetes and insulin pump use to foster understanding and reduce stigma. The school nurse will encourage inclusive activities where the student feels accepted and not singled out due to their condition. Expected Outcomes The student verbalizes reduced anxiety about insulin pump use and diabetes management. The student demonstrates increased confidence in managing diabetes at school and in social settings. The student has improved participation in school activities without fear of being different or experiencing pump malfunctions. 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.
