LATEX ALLERGY 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: Potential for severe allergic reaction and/or life threatening episode Related to latex allergy Interventions The school nurse will inform necessary staff of student's allergy status. The school nurse will educate staff members about severe allergies. The school nurse will, in compliance with confidentiality guidelines, inform classmates and parents about the presence of a child with an allergy in the class. The school nurse will post allergy awareness signs in appropriate areas, including but not limited to clinic, classroom, and cafeteria. Expected Outcomes The student will remain free from exposure to diagnosed allergens while at school. Nursing Diagnosis: Potential for change in medical status Related to allergen exposure Interventions The school nurse will obtain from parents a list of the student's previous allergic responses/reactions (hives; swelling; hay fever s/s; asthma s/s; respiratory distress; anaphylactic shock; other). The school nurse will encourage age-appropriate student to self-monitor exposure to allergens. Teacher will closely monitor for exposure to allergens. The school nurse will immediately assess and intervene if student is exposed to allergen and/or experiencing symptoms of an allergic response. The school nurse will administer medication per physician's orders. Expected Outcomes The student/teacher will immediately notify the school nurse of suspected exposure of allergen and/or any signs of change in physical/mental status. Nursing Diagnosis: Potential for altered health maintenance Related to knowledge deficit Interventions The school nurse will provide student/parent information and health counseling regarding allergies and management of allergic reaction at level of student's understanding. The school nurse will provide information, support, and consultation regarding management of student's allergy condition to appropriate staff. The school nurse will lead/provide inservice training to appropriate staff on the use of epinephrine auto-Injectors and signs and symptoms of impending allergic response/reaction. The school nurse will provide information sheets, in a secure area, to be used in the absence of regular teacher(s). Expected Outcomes The student will voice/demonstrate age-appropriate abilities to participate in the management of health and safety needs required for educational environment. 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.
