JUVENILE FIBROMYALGIA SYNDROME (JFMS) 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: Chronic Pain Related to altered pain perception due to central sensitization Related to muscle stiffness and tenderness Related to exacerbating factors such as stress, physical activity, or poor sleep Interventions The school nurse will assess and document the student’s pain levels, triggers, and patterns regularly. The school nurse will provide a quiet and comfortable space for the student to rest during flare-ups. The school nurse will teach relaxation techniques (e.g., deep breathing, mindfulness) to manage pain. The school nurse will collaborate with the family and healthcare providers to ensure pain management plans are followed. The school nurse will allow flexibility in physical education activities to avoid overexertion. Expected Outcomes The student will report reduced pain intensity and frequency. The student will identify effective coping strategies for managing pain. The student will participate in school activities with minimal discomfort. Nursing Diagnosis: Fatigue Related to poor sleep quality due to pain or sleep disturbances Related to decreased physical endurance from chronic pain Related to energy expenditure from coping with symptoms Interventions The school nurse will provide scheduled rest breaks during the school day as needed. The school nurse will coordinate with teachers to modify workload or provide extensions for assignments. The school nurse will educate the student on energy-conservation strategies (e.g., prioritizing tasks, pacing activities). The school nurse will encourage consistent sleep hygiene practices at home. The school nurse will monitor for excessive fatigue and notify parents and healthcare providers if symptoms worsen. Expected Outcomes The student will demonstrate improved energy levels and participate in school activities. The student will use energy-conservation techniques effectively. The student will maintain academic performance with appropriate accommodations. Nursing Diagnosis: Disturbed Sleep Pattern Related to pain interfering with ability to fall or stay asleep Related to anxiety or stress related to chronic condition Related to lack of consistent sleep routines Interventions The school nurse will educate the student and family on the importance of a consistent bedtime routine. The school nurse will encourage stress-reduction techniques before bedtime (e.g., journaling, meditation). The school nurse will provide resources or referrals for behavioral therapy or counseling for sleep management. The school nurse will advocate for flexibility in school start times or schedules if fatigue is significant. Expected Outcomes The student will report improved sleep quality and duration. The student will demonstrate awareness of strategies to manage sleep disturbances. The student’s academic performance and alertness during the day will improve. Nursing Diagnosis: Risk for Social Isolation Related to decreased participation in social or physical activities due to fatigue or pain Related to peer misunderstandings about JFMS Related to fear of stigma or rejection Interventions The school nurse will educate teachers and peers about JFMS to reduce stigma and promote understanding. The school nurse will encourage the student to participate in modified school activities to maintain social connections. The school nurse will monitor for signs of social withdrawal or bullying and address promptly. The school nurse will collaborate with school counselors to foster a supportive peer environment. Expected Outcomes The student will engage in social and school activities comfortably. The student will feel included and supported by peers and teachers. The school environment will promote empathy and understanding of chronic conditions. Nursing Diagnosis: Knowledge Deficit Related to lack of understanding of triggers (e.g., stress, overexertion) Related to inadequate knowledge of pain management strategies Related to difficulty balancing academic and health needs Interventions The school nurse will provide education on JFMS, including symptom triggers and management strategies. The school nurse will develop a personalized care plan for school, addressing accommodations and support. The school nurse will teach the student relaxation and self-care techniques to manage symptoms. The school nurse will communicate regularly with the student, family, and healthcare providers to ensure coordinated care. Expected Outcomes The student will demonstrate an understanding of JFMS and strategies to manage symptoms. The student will adhere to self-care routines and effectively communicate needs. The student’s overall health and school experience will improve. Nursing Diagnosis: Risk for Impaired Physical Mobility Related to pain and stiffness in muscles and joints Related to fear of triggering symptoms through physical activity Related to reduced physical stamina Interventions The school nurse will collaborate with physical education teachers to modify activities based on the student’s tolerance. The school nurse will encourage gentle physical activities, such as stretching or yoga, to maintain flexibility. The school nurse will monitor the student’s mobility and provide immediate support during flare-ups. The school nurse will educate the student on recognizing limits to prevent overexertion. Expected Outcomes The student will maintain functional mobility and flexibility. The student will engage in physical activities within their tolerance level. The student will report fewer episodes of pain related to overexertion. 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.
