HYPOTHYROIDISM 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? Yes No Teacher Name Homeroom Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact List is attached to IHP. 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: Activity Intolerance Related to decreased energy levels. Related to impaired metabolism. Related to muscle weakness. Interventions The school nurse will assess the student's energy levels and tolerance to activities. The school nurse will schedule rest periods to prevent fatigue. The school nurse will encourage light physical activity to gradually improve stamina. Expected Outcomes The student reports improved energy levels. The student participates in daily activities with minimal fatigue. Nursing Diagnosis: Imbalanced Nutrition: More than Body Requirements Related to decreased metabolic rate. Related to weight gain. Related to altered dietary habits. Interventions The school nurse will collaborate with a dietitian to create a balanced meal plan. The school nurse will educate the student and family on healthy eating habits. The school nurse will monitor the student’s weight and provide guidance on portion control. Expected Outcomes The student demonstrates knowledge of proper nutrition. The student maintains a stable and healthy weight. Nursing Diagnosis: Constipation Related to slowed gastrointestinal motility. Related to reduced physical activity. Related to inadequate dietary fiber intake. Interventions The school nurse will encourage a high-fiber diet and increased fluid intake. The school nurse will promote physical activity appropriate for the student's energy level. The school nurse will monitor bowel patterns and intervene as needed with stool softeners. Expected Outcomes The student reports regular bowel movements without discomfort. The student understands and applies effective strategies for managing constipation. Nursing Diagnosis: Impaired Skin Integrity Related to dry, flaky skin. Related to reduced sweat production. Interventions The school nurse will inspect the student’s skin daily for signs of dryness, cracking, or irritation. The school nurse will provide education on moisturizing and gentle skincare. The school nurse will avoid environmental factors that exacerbate dryness (e.g., cold weather, harsh soaps). Expected Outcomes The student’s skin remains intact, hydrated, and free from lesions. The student reports improved comfort and confidence in skin appearance. Nursing Diagnosis: Disturbed Body Image Related to physical changes, such as weight gain, dry skin, or hair thinning. Related to social and peer pressure. Interventions The school nurse will provide emotional support and a safe space to discuss feelings about body changes. The school nurse will encourage positive self-talk and coping strategies. The school nurse will refer to a counselor or support group if necessary. Expected Outcomes The student reports improved self-esteem and body acceptance. The student engages in social activities with greater confidence. Nursing Diagnosis: Ineffective Thermoregulation Related to decreased metabolic rate. Related to intolerance to cold environments. Interventions The school nurse will monitor for signs of cold intolerance and adjust the environment to ensure comfort. The school nurse will provide education on dressing appropriately for warmth. The school nurse will encourage warm beverages and heated environments as needed. Expected Outcomes The student remains comfortable in varying environmental conditions. The student experiences fewer symptoms of cold intolerance. Nursing Diagnosis: Knowledge Deficit Related to lack of understanding about hypothyroidism and its management. Interventions The school nurse will educate the student and family on the condition, including symptoms and the importance of treatment. The school nurse will explain the medication regimen (e.g., levothyroxine) and its role in symptom management. The school nurse will provide written resources and encourage questions to ensure comprehension. Expected Outcomes The student and family demonstrate understanding of hypothyroidism and its management. Nursing Diagnosis: Fatigue Related to reduced thyroid hormone levels. Related to impaired energy metabolism. Interventions The school nurse will assess the level and patterns of fatigue. The school nurse will balance activities with adequate periods of rest. The school nurse will collaborate with the healthcare provider to optimize thyroid hormone therapy. Expected Outcomes The student reports reduced fatigue and improved energy levels. The student engages in daily routines with greater ease. Nursing Diagnosis: Risk for Delayed Growth and Development Related to hormonal imbalances affecting physical and cognitive development. Interventions The school nurse will monitor growth parameters and developmental milestones regularly. The school nurse will collaborate with an endocrinologist and other specialists for comprehensive care. The school nurse will educate parents on the importance of treatment adherence for optimal growth. Expected Outcomes The student demonstrates appropriate growth and developmental progress for their age. The family understands the importance of consistent treatment and follow-up care. 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. 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