BIPOLAR 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? 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: Risk for Self-Harm Related to impulsivity during manic episodes Related to feelings of hopelessness or worthlessness during depressive episodes Related to difficulty coping with stressors Interventions The school nurse will collaborate with school counselors to develop a safety plan that includes triggers, warning signs, and coping strategies. The school nurse will provide a safe, supportive environment for the student to express feelings and concerns. The school nurse and school counselor will teach relaxation techniques (e.g., deep breathing, mindfulness) to manage emotional distress. The school nurse will maintain open communication with the student’s family and mental health providers to monitor progress and intervene promptly if risk increases. The school nurse will ensure the student knows how to access immediate help, such as a school crisis team or hotline. Expected Outcomes The student will demonstrate knowledge of and adherence to the safety plan. The student will report feeling safe and supported in the school environment. The student will identify and utilize coping strategies to manage thoughts of self-harm. Nursing Diagnosis: Ineffective Coping Related to difficulty managing mood swings and emotional regulation Related to stress from academic demands and social interactions Related to limited coping mechanisms for handling frustration or anger Interventions The school nurse will provide regular check-ins with the student to assess their emotional state and offer support. The school nurse and school counselor will teach and reinforce coping skills, such as journaling, physical activity, or mindfulness practices. The school nurse will collaborate with teachers to create a structured environment that minimizes stress and provides clear expectations. The school nurse will encourage participation in school-based mental health programs or therapy sessions. Expected Outcomes The student will identify at least two effective coping strategies and use them to manage stress or frustration. The student will report reduced emotional distress and improved ability to handle challenges. The student will actively participate in mental health programs or therapy sessions. Nursing Diagnosis: Impaired Social Interaction Related to irritability or agitation during manic episodes Related to withdrawal or isolation during depressive episodes Related to difficulty interpreting social cues or maintaining relationships Interventions The school nurse and school counselor will encourage peer support by facilitating participation in structured group activities or social skills programs. The school nurse and counselor will teach the student communication strategies, such as active listening and expressing emotions appropriately. The school nurse will educate peers and staff about bipolar disorder (with consent) to promote understanding and reduce stigma. The school nurse and school counselor will monitor the student’s interactions and provide guidance on improving relationships as needed. Expected Outcomes The student will engage in positive social interactions with peers and staff. The student will demonstrate improved communication skills in social settings. The student will feel supported and accepted within the school community. Nursing Diagnosis: Disturbed Thought Processes Related to racing thoughts or distractibility during manic episodes Related to difficulty concentrating during depressive episodes Related to cognitive effects of bipolar disorder Interventions The school nurse will collaborate with teachers to provide accommodations, such as extended time for assignments or reduced workload during mood episodes. The school nurse will encourage the use of organizational tools, such as planners, checklists, or visual schedules, to improve focus and task management. The school nurse and school counselor will provide a quiet, distraction-free space for the student to work when needed. The school nurse and school counselor will monitor the student’s thought patterns and report significant changes to caregivers or mental health providers. Expected Outcomes The student will demonstrate improved focus and task completion with appropriate accommodations. The student will use organizational tools effectively to manage academic responsibilities. The student will report improved concentration and reduced frustration during school tasks. Nursing Diagnosis: Risk for Imbalanced Nutrition Related to decreased appetite during depressive episodes Related to impulsivity leading to overeating or poor food choices during manic episodes Related to potential side effects of medications, such as appetite changes or weight fluctuations Interventions The school nurse will collaborate with the student and family to ensure access to balanced, nutritious meals and snacks at school. The school nurse will monitor the student’s eating habits and provide support or referrals if significant changes occur. The school nurse will educate the student on the importance of balanced nutrition in maintaining emotional and physical health. The school nurse will coordinate with school staff to accommodate the student’s dietary needs or preferences. Expected Outcomes The student will maintain a healthy weight and balanced eating habits during school hours. The student will demonstrate understanding of the importance of nutrition in managing mood and energy levels. The student’s eating habits will remain consistent, with minimal disruptions from mood episodes. Nursing Diagnosis: Sleep Pattern Disturbance Related to insomnia or reduced need for sleep during manic episodes Related to hypersomnia during depressive episodes Related to irregular sleep patterns impacting daytime functioning Interventions The school nurse will encourage a consistent sleep routine, including reducing screen time before bed and promoting relaxation techniques. The school nurse will educate the student on the relationship between sleep and emotional health. The school nurse will collaborate with caregivers to monitor and address sleep disturbances at home. The school nurse and school counselor will provide rest breaks or a quiet space during the school day if the student appears fatigued. Expected Outcomes The student will report improved sleep patterns and daytime energy levels. The student will demonstrate understanding of the importance of healthy sleep habits. The student will engage in school activities with reduced fatigue or irritability. Nursing Diagnosis: Low Self-Esteem Related to feelings of guilt, worthlessness, or failure during depressive episodes Related to social rejection or stigma related to bipolar disorder Related to academic challenges due to mood-related difficulties Interventions The school nurse will provide consistent positive reinforcement and acknowledge the student’s strengths and achievements. The school nurse will collaborate with school counselors to build the student’s self-esteem through individualized support or group therapy. The school nurse will encourage participation in extracurricular activities that align with the student’s interests and abilities. The school nurse will educate the student about bipolar disorder, emphasizing that it does not define their worth or potential. Expected Outcomes The student will verbalize improved self-esteem and confidence in their abilities. The student will participate in school and social activities with greater confidence. The student will identify and focus on their strengths, reducing negative self-perceptions. 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. 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