TRAUMATIC BRAIN INJURY 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: Impaired Physical Mobility Related to motor impairments resulting from brain injury (e.g., weakness, lack of coordination, or paralysis) Related to muscle stiffness or contractures due to limited movement after the injury Interventions The school nurse will work with physical and occupational therapists to implement individualized therapy goals, such as exercises for range of motion and strengthening. The school nurse will ensure that the classroom is wheelchair-accessible and that seating arrangements allow for optimal posture and comfort. The school nurse will ensure that the student has the necessary mobility aids (e.g., cane, walker, wheelchair) and teach staff on proper use. The school nurse will adapt physical activities in physical education (PE) or extracurricular activities according to the student's physical abilities. Expected Outcomes The student will demonstrate improved mobility with appropriate support and adaptations. The student will safely navigate the school environment using mobility aids. Nursing Diagnosis: Risk for Ineffective Cerebral Tissue Perfusion Related to swelling, bleeding, or other damage in the brain that can disrupt blood flow and oxygen supply Related to post-traumatic complications, such as increased intracranial pressure (ICP) Interventions The school nurse will assess for signs of increased ICP, such as altered consciousness, changes in pupil response, or vomiting. The school nurse will ensure that vital signs, including blood pressure and oxygen saturation, are regularly checked and recorded. The school nurse will work with the student’s healthcare providers to monitor recovery progress and adjust school activities as needed. The school nurse will ensure the student receives prescribed medications (e.g., diuretics, anticonvulsants) and monitor for side effects. Expected Outcomes The student will demonstrate stable cerebral perfusion, evidenced by normal neurological assessments. The student will be free from signs of complications such as increased ICP or seizure activity. Nursing Diagnosis: Acute Pain Related to headache, muscle soreness, or joint pain resulting from TBI Related to post-injury healing processes that may cause discomfort (e.g., headaches, muscle tightness) Interventions The school nurse will regularly assess the student’s pain using an age-appropriate pain scale and adjust interventions as needed. The school nurse will administer pain medications as prescribed or provide non-pharmacological interventions such as ice packs or relaxation techniques. The school nurse will keep track of environmental factors that may exacerbate pain, such as bright lights or loud noises, and work with staff to minimize these triggers. The school nurse will maintain communication with the student’s medical team to ensure pain management strategies are effective. Expected Outcomes The student will experience reduced pain and discomfort, enabling them to focus on school activities. The student will use appropriate pain management strategies as needed. Nursing Diagnosis: Risk for Cognitive Impairment Related to damage to areas of the brain involved in memory, attention, and processing Related to cognitive changes following the injury, such as deficits in concentration, memory, and executive function Interventions The school nurse will track the student’s cognitive abilities (e.g., memory, attention span) and collaborate with educational staff to identify areas needing support. The school nurse will work with teachers to implement individualized accommodations (e.g., extended time for assignments, reduced distractions) to support the student’s learning. The school nurse will help the student develop memory aids and organizational tools, such as written reminders or visual schedules. The school nurse will ensure that the student is not overwhelmed with academic demands and gradually reintegrates into the classroom environment. Expected Outcomes The student will make progress in academic tasks with appropriate accommodations. The student will demonstrate improved cognitive function and academic performance over time. Nursing Diagnosis: Impaired Social Interaction Related to changes in mood, behavior, or communication skills due to brain injury Related to self-consciousness or frustration stemming from cognitive or physical impairments Interventions The school nurse will offer a safe space for the student to express any feelings of frustration, isolation, or sadness related to their condition. The school nurse will educate classmates (with the family’s consent) about TBI and its effects to promote understanding and empathy. The school nurse will help the student engage in social or extracurricular activities that match their current abilities, ensuring inclusion. The school nurse will be alert for signs of social withdrawal or changes in behavior, and address them with counseling support, if needed. Expected Outcomes The student will engage in positive social interactions and participate in peer activities. The student will feel included and supported by their peers and school staff. Nursing Diagnosis: Risk for Self-Image Disturbance Related to visible effects of the injury, such as scars, physical disabilities, or changes in behavior Related to emotional distress stemming from changes in appearance or abilities Interventions The school nurse will offer emotional support and encourage the student to express concerns about their appearance or abilities. The school nurse will praise the student for their strengths and progress, reinforcing their abilities beyond physical appearance. The school nurse will, with the family’s consent, provide education to peers about the student’s condition to reduce stigmatization and promote empathy. The school nurse will, if necessary, refer the student to counseling for further support in adjusting to changes in body image or self-esteem. Expected Outcomes The student will demonstrate improved self-esteem and acceptance of their body image. The student will actively engage in activities, feeling confident and valued by peers. Nursing Diagnosis: Risk for Noncompliance Related to difficulty understanding or adhering to post-injury care instructions, including medication and rehabilitation regimens Related to cognitive impairments that may affect memory and self-care skills Interventions The school nurse will offer simple, clear instructions for the student and caregivers regarding medication, follow-up appointments, and physical rehabilitation. The school nurse will use reminders such as charts, alarms, or written instructions to help the student manage medications or daily routines. The school nurse will assist the student in managing prescribed medications, ensuring that they are taken at the correct times. The school nurse will maintain regular communication with the family to ensure that the student’s post-injury care plan is followed consistently. Expected Outcomes The student will adhere to prescribed medication and rehabilitation regimens. The student and caregivers will demonstrate a clear understanding of post-injury care. Nursing Diagnosis: Risk for Altered Sleep Pattern Related to pain, discomfort, or neurological changes following TBI that interfere with sleep Related to emotional distress, such as anxiety or nightmares, which may disrupt sleep Interventions The school nurse will observe the student for signs of sleep disturbances, such as difficulty falling asleep, waking frequently, or excessive daytime sleepiness. The school nurse will encourage a consistent sleep schedule, and recommend creating a quiet, dark environment for sleep. The school nurse will communicate with the student's healthcare team about any sleep disturbances that may require intervention, such as medication adjustments or sleep aids. The school nurse will address any anxiety, nightmares, or emotional stress that may be impacting sleep by providing reassurance and relaxation techniques. Expected Outcomes The student will maintain healthy sleep patterns with adequate rest. The student will demonstrate improved alertness and participation in school activities. 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.
