AUTISM SPECTRUM DISORDER 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: Impaired Social Interaction Related to difficulty interpreting verbal and non-verbal communication cues. Related to challenges with peer interactions due to differences in social skills. Interventions The school nurse and school counselor will provide a safe and structured environment for social interactions. The school nurse and school counselor will facilitate social skills training or groups to practice interactions. The school nurse will educate peers and staff about autism to promote understanding and support. Expected Outcomes The student will show increased comfort and participation in social interactions. The student will develop specific social skills as demonstrated by interactions with peers. Nursing Diagnosis: Impaired Verbal Communication Related to limited ability to express needs and thoughts verbally. Related to possible presence of language delay or non-verbal status. Interventions The school nurse will use communication aids (e.g., picture boards, apps, sign language) tailored to the student’s needs. The school nurse and school counselor will train staff on how to use and support alternative communication methods. The school nurse will regularly assess and adapt communication strategies to meet the student's evolving needs. Expected Outcomes The student will effectively use an alternative communication method to express needs. School staff will understand and facilitate the student’s preferred mode of communication. Nursing Diagnosis: Sensory Processing Disorder Related to over- or under-reactivity to sensory input. Related to difficulty integrating sensory information. Interventions The school nurse will work with occupational therapists to implement sensory integration strategies. The school nurse will create a sensory-friendly environment in the nurse’s office and recommend adaptations in the classroom. The school nurse will educate teachers on the signs of sensory overload and appropriate interventions. Expected Outcomes The student will demonstrate reduced signs of distress related to sensory overload. The student will engage more fully in academic and social activities with appropriate sensory accommodations. Nursing Diagnosis: Risk for Self-Injury Related to behavioral responses to stress or sensory overload. Related to communication difficulties leading to frustration and potential aggression. Interventions The school nurse will monitor the student for signs of stress or agitation. The school nurse and school counselor will develop and implement a behavior intervention plan that includes de-escalation techniques. The school nurse will educate staff on recognizing early signs of distress and appropriate interventions. Expected Outcomes The student will show decreased frequency and severity of self-injurious behaviors. Staff will effectively intervene early to prevent injury. Nursing Diagnosis: Altered Nutrition: Less Than Body Requirements Related to selective eating patterns and food preferences. Related to sensory sensitivities affecting intake of a variety of foods. Interventions The school nurse will collaborate with a nutritionist to ensure dietary needs are met. The school nurse will work with parents and staff to introduce new foods gradually. The school nurse will monitor growth and weight to assess nutritional status. Expected Outcomes The student will maintain or achieve a healthy weight. The student will incorporate a wider variety of foods into their diet. Nursing Diagnosis: Knowledge Deficit (Parents and Staff) Related to lack of understanding of autism’s impact on the student’s health and education. Related to need for strategies to support the student’s unique learning and health needs. Interventions The school nurse will provide training sessions for parents and staff on autism-specific topics. The school nurse will distribute educational materials on autism. The school nurse will serve as a resource for ongoing support and information. Expected Outcomes Parents and staff will demonstrate increased knowledge of autism and effective support strategies. The student’s individual needs will be better supported across home and school environments. 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.
