FRAGILE X 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: Risk for Delayed Growth and Development Related to cognitive impairment or intellectual disabilities associated with FXS Related to delays in communication, motor, or social skills Interventions The school nurse will collaborate with teachers, speech therapists, and occupational therapists to support developmental milestones. The school nurse will encourage participation in individualized education plans (IEPs) tailored to the student’s needs. The school nurse will provide sensory-friendly tools or environments to enhance learning and development. The school nurse will educate caregivers about activities and resources that promote development at home. Expected Outcomes The student will demonstrate progress toward individualized developmental goals. The student will actively participate in school-based therapies and learning activities. Nursing Diagnosis: Impaired Social Interaction Related to difficulty interpreting social cues or regulating emotions Related to anxiety in social situations common in FXS Interventions The school nurse will provide social skills training through role-playing or group activities. The school nurse will collaborate with school counselors to foster a supportive and inclusive environment. The school nurse will encourage positive peer interactions and monitor for signs of bullying. The school nurse will educate peers and teachers about FXS to promote understanding and empathy. Expected Outcomes The student will engage in positive social interactions with peers and staff. The student will report feeling supported and included in social activities. Nursing Diagnosis: Impaired Verbal Communication Related to delayed speech and language development Related to difficulty expressing needs or understanding complex instructions Interventions The school nurse will support the use of alternative communication methods, such as picture boards or speech-generating devices. The school nurse will collaborate with speech therapists to address language development goals. The school nurse will encourage positive peer interactions and monitor for signs of bullying. The school nurse will monitor for signs of frustration or withdrawal related to communication challenges. Expected Outcomes The student will use verbal and/or non-verbal communication methods effectively to express needs. The student will demonstrate progress in language and communication skills. Nursing Diagnosis: Risk for Sensory Overload Related to sensory processing challenges common in FXS Related to difficulty managing loud noises, bright lights, or crowded environments Interventions The school nurse will provide a quiet, sensory-friendly space for the student to decompress as needed. The school nurse will collaborate with occupational therapists to develop sensory integration strategies. The school nurse will educate teachers about creating a structured, low-stimulation classroom environment. The school nurse will use visual schedules or calming tools (e.g., noise-canceling headphones, fidget toys) to support the student. Expected Outcomes The student will demonstrate improved ability to manage sensory stimuli. The student will use sensory tools effectively to reduce distress during school activities. Nursing Diagnosis: Risk for Anxiety Related to challenges with transitions, changes in routine, or social interactions Related to overstimulation or difficulty coping with academic demands Interventions The school nurse will teach relaxation techniques, such as deep breathing or mindfulness exercises, to manage The school nurse will collaborate with teachers to provide consistent routines and clear expectations. The school nurse will offer a safe space for the student to go during periods of heightened anxiety. The school nurse will communicate with caregivers about signs of anxiety and effective coping strategies. Expected Outcomes The student will demonstrate reduced anxiety during transitions or stressful situations. The student will use learned coping strategies to manage feelings of anxiety. Nursing Diagnosis: Risk for Self-Harm or Impulsive Behavior Related to difficulty regulating emotions or coping with frustration Related to common behavioral challenges in FXS, such as self-injurious behaviors Interventions The school nurse will work with staff to monitor for signs of escalating frustration or emotional dysregulation. The school nurse will collaborate with staff to develop a behavior intervention plan in collaboration with behavioral therapists and educators. The school nurse and staff will teach the student safe ways to express emotions, such as using words or visuals. The school nurse will provide a safe, calm environment for the student to regain composure during emotional outbursts. Expected Outcomes The student will demonstrate a reduction in self-harm or impulsive behaviors. The student will use learned strategies to manage frustration or emotional dysregulation. Nursing Diagnosis: Risk for Low Self-Esteem Related to challenges in academic performance or social interactions Related to self-awareness of differences from peers Interventions The school nurse will provide positive reinforcement for the student’s efforts and achievements. The school nurse will encourage participation in activities where the student can excel and build confidence. The school nurse will collaborate with teachers to set realistic and achievable goals for the student. The school nurse will provide emotional support and opportunities for the student to discuss feelings of self-worth. Expected Outcomes The student will demonstrate improved confidence in their abilities. The student will participate in activities that promote self-esteem and personal growth. Nursing Diagnosis: Deficient Knowledge (Caregivers and Staff) Related to lack of understanding about Fragile X Syndrome and its associated challenges Related to unawareness of effective strategies for supporting the student Interventions The school nurse will provide education to caregivers and school staff about FXS, including common symptoms and effective interventions. The school nurse will offer training on sensory processing, behavior management, and communication strategies. The school nurse will share resources, such as community support groups or educational materials, to enhance understanding. The school nurse will serve as a liaison between healthcare providers, therapists, and school staff to coordinate care. Expected Outcomes Caregivers and staff will demonstrate understanding of FXS and effective strategies to support the student. The student will benefit from a consistent and informed approach across home and school settings. 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.
