DOWN SYNDROME 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: Delayed Growth and Development Related to intellectual disability Related to hypotonia Related to physical developmental delays Interventions The school nurse will collaborate with teachers and therapists to implement individualized education plans (IEP). The school nurse will encourage play-based activities to support motor, cognitive, and social skills. The school nurse will encourage consistent routines and reinforcement to enhance learning. The school nurse will educate caregivers on appropriate developmental milestones and stimulation techniques. Expected Outcomes The student will demonstrate progress toward developmental milestones appropriate for their abilities. The student will actively participate in learning and play activities with peers. Nursing Diagnosis: Impaired Verbal Communication Related to delayed language development Related to oral-motor difficulties Interventions The school nurse will use alternative communication methods (e.g., sign language, picture boards). The school nurse will encourage speech therapy sessions to improve articulation and language skills. The school nurse will model simple, clear language during interactions. The school nurse will encourage peer and teacher interactions to promote communication. Expected Outcomes The student will effectively communicate basic needs and emotions using verbal and/or nonverbal methods. The student will show improvement in expressive and receptive language skills. Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements Related to feeding difficulties due to hypotonia or oral-motor delays Related to increased caloric needs for growth and activity Interventions The school nurse will collaborate with a dietitian to create a balanced, nutrient-dense meal plan. The school nurse will monitor weight and growth patterns regularly. The school nurse will encourage small, frequent meals if large meals are difficult to manage. The school nurse will provide oral-motor exercises to improve feeding skills. Expected Outcomes The student will maintain a weight appropriate for their age and height. The student will consume meals with minimal difficulty and adequate nutrition. Nursing Diagnosis: Risk for Ineffective Coping Related to difficulty adapting to changes in routine Related to challenges in social and academic environments Interventions The school nurse will teach coping strategies, such as deep breathing or using visual schedules. The school nurse will provide a safe and structured environment to reduce anxiety. The school nurse will collaborate with the family and school staff to maintain consistency in routines. The school nurse will refer the family to support groups for Down syndrome. Expected Outcomes The student will demonstrate the ability to adapt to minor changes in routine. The student will engage positively with peers and school staff. Nursing Diagnosis: Risk for Social Isolation Related to difficulty initiating and maintaining peer relationships Related to limited social skills Interventions The school nurse will encourage peer interaction through group activities and play. The school nurse will encourage participation in inclusive classroom settings. The school nurse will teach age-appropriate social skills using role-play. The school nurse will provide positive reinforcement for social engagement. Expected Outcomes The student will actively participate in group activities. The student will form meaningful relationships with peers. Nursing Diagnosis: Risk for Impaired Skin Integrity Related to hypotonia leading to poor mobility Related to dry skin or sensitivity common in Down syndrome Interventions The school nurse will encourage regular skin assessments and hygiene practices. The school nurse will use hypoallergenic moisturizers to prevent dry skin. The school nurse will promote physical activity to improve circulation. The school nurse will educate caregivers about signs of skin breakdown. Expected Outcomes The student will maintain intact, healthy skin. The student will show no signs of pressure ulcers or irritation. 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.
