MIGRAINE 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: Pain Related to migraines Interventions The school nurse will obtain migraine treatment plan from parents/physician The school nurse will follow migraine management plan The school nurse will support and encourage student to follow management plan The school nurse will provide quiet, dark place for rest at migraine onset and during The school nurse will assist student in identifying and managing migraine triggers The school nurse will evaluate need for medication and administer as ordered The school nurse will notify teachers of student with migraines and any potential accommodations. Permit nurse visit as needed The school nurse will refer to the student's 504 Plan as needed Expected Outcomes The student will notify staff and seek treatment at migraine onset The student will follow medical management plan for migraines The student will participate in school activities with modifications and accommodations in place as needed The student will increase their ability to recognize and manage environmental triggers Nursing Diagnosis: Risk for ineffective role performance Related to excessive absences from school due to migraines Interventions The school nurse will support and encourage student to follow medical management plan The school nurse will develop open communication with student and parents The school nurse will give positive reinforcement to student The school nurse will assist student and parent in setting attendance goals The school nurse will assist staff with modifications to classwork as needed and appropriate The school nurse will refer to 504 as needed Expected Outcomes The student will follow medical management plan for migraines The student will participate in school activities with modifications & accommodations in place as needed The student will have improved school attendance Nursing Diagnosis: Ineffective coping Related to having a chronic condition Interventions The school nurse will encourage meeting with school, outside counseling and therapists to develop coping skills The school nurse will encourage and assist student in utilizing their coping skills The school nurse will provide a place for them to work and use their coping skills The school nurse will establish open communication with student and parents The school nurse will allow student to have some control and make choices about management as appropriate The school nurse will provide positive feedback for student demonstrating coping skills and improving school attendance Expected Outcomes The student will have a support network at school The student will utilize counseling and support services both in and out of school The student will learn and use adaptive coping skills to help deal with chronic migraines The student will feel heard and supported Nursing Diagnosis: Deficient knowledge Related to recent diagnosis of migraines Interventions The school nurse will obtain migraine treatment plan from parents/physician The school nurse will assist student to understand migraine management plan and importance of following it The school nurse will support and encourage student to follow management plan The school nurse will assist student in identifying and managing migraine triggers The school nurse will assist student in evaluating need for medication and best plan for current situation The school nurse will continue to assess and reinforce education about migraines and managment of them Expected Outcomes The student and parents will demonstrate increased knowledge regarding migraines and their managment The student will have consistent managment and treatment of migraines The student will notify staff and seek treatment at early signs of migraines Nursing Diagnosis: Risk for Ineffective health maintenance behaviors Related to ineffective coping strategies Related to ineffective communication skills Related to inadequate health resources Related to difficulty with decision-making Interventions The school nurse will obtain migraine treatment plan from parents/physician The school nurse will assist student to understand migraine management plan and importance of following it The school nurse will discuss migraine management with student and assess any obstacles to following the plan The school nurse will assess family understanding of management plan and their expectations The school nurse will develop open communication with student and parents Expected Outcomes The student will have consistent management and treatment of migraines The student will follow medical management plan for migraines The student will have consistent school attendance 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.
