LUPUS 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: Ineffective Coping Related to chronic illness impacting daily life and emotional well-being. Related to uncertainty about disease progression and management. Related to potential for flare-ups and associated symptoms. Interventions The school nurse will evaluate the student’s current coping strategies and support systems. The school nurse will identify signs of anxiety or depression. The school nurse will educate the patient about lupus, including triggers, management, and self-care techniques The school nurse will discuss the importance of medication adherence and regular follow-up The school nurse will facilitate discussions about fears, concerns, and the impact of lupus on their life. The school nurse will recommend journaling or other therapeutic outlets for emotional expression. The school nurse will encourage participation in lupus support groups or counseling services. Expected Outcomes The student will identify effective coping strategies and demonstrate their use by the next appointment. The student will openly express feelings and concerns regarding lupus management during interactions. The student will report reduced anxiety levels and improved mood over the next month. Nursing Diagnosis: Fatigue Related to chronic inflammation and immune system dysregulation. Related to sleep disturbances and pain associated with lupus. Interventions The school nurse will use standardized tools to evaluate the severity and impact of fatigue on daily activities. The school nurse will teach the patient techniques for energy management, such as balancing activity and rest. The school nurse will encourage scheduled rest periods throughout the day. The school nurse will provide information on good sleep practices to improve sleep quality. The school nurse will encourage a regular sleep routine and relaxation techniques. The school nurse will assess and address contributing factors such as pain or mood disturbances. Expected Outcomes The student will report decreased fatigue levels and improved ability to perform daily activities within four weeks. The student will demonstrate effective energy conservation techniques during follow-up visits The student will implement sleep hygiene practices and report improved sleep quality. Nursing Diagnosis: Impaired Skin Integrity Related to skin rashes and lesions associated with lupus. Related to photosensitivity leading to exacerbation of skin issues. Interventions The school nurse will conduct an assessment of skin integrity, noting any rashes, lesions, or changes. The school nurse will teach the importance of using sunscreen, wearing protective clothing, and avoiding direct sunlight. The school nurse will recommend UV-protective clothing and hats. The school nurse will encourage gentle cleansing and moisturizing to maintain skin integrity. The school nurse will advise on the use of topical treatments as prescribed. The school nurse will regularly assess skin lesions for signs of infection and educate the patient on what to watch for. Expected Outcomes The student will demonstrate knowledge of skin care practices, including sun protection. The student will report no new skin lesions or infections over the next month. The student will show improvement in skin integrity as evidenced by reduced rashes and lesions. Nursing Diagnosis: Risk for Impaired Renal Function Related to possible lupus nephritis and systemic involvement of the kidneys. Interventions The school nurse will teach the patient to recognize signs of renal impairment, such as changes in urine output or swelling. The school nurse will instruct on appropriate fluid intake as recommended by the healthcare provider. The school nurse will work with nephrologists if necessary to establish a management plan for renal involvement. Expected Outcomes The student will maintain stable renal function. The student will accurately identify and report any symptoms indicative of renal impairment. The student will verbalize understanding of the importance of monitoring renal health. 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. 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