TUBEROUS SCLEROSIS COMPLEX 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: Risk for Seizures Related to neurological manifestations of TSC, including cortical tubers, which increase the likelihood of seizures. Related to history of seizures, a common symptom of TSC. Interventions The school nurse will ensure an individualized seizure action plan is in place and shared with school staff. Make sure staff are trained in recognizing and responding to seizures. The school nurse will observe for any pre-seizure symptoms (e.g., staring, changes in behavior) and document any incidents. The school nurse will ensure the student takes prescribed anti-seizure medications as needed during school hours and monitor for side effects. The school nurse will equip the student with safety measures, such as padding around areas where seizures may occur (e.g., playground, classroom). Expected Outcomes The student will experience fewer or no seizure episodes while at school. School staff will respond appropriately to any seizure episodes, ensuring student safety. The student and caregivers will demonstrate adherence to prescribed seizure management plans. Nursing Diagnosis: Impaired Skin Integrity Related to presence of angiofibromas and other skin lesions, which are common in TSC and can cause irritation or infection. Related to risk of injury from scratches or trauma to the skin lesions. Interventions The school nurse will provide the student and caregivers with proper skin care instructions to prevent irritation and infection from lesions. The school nurse will encourage routine skin checks to identify any new lesions or signs of infection, such as redness or discharge. The school nurse will educate the student to avoid scratching or picking at lesions. The school nurse will use bandages or dressings as needed to prevent further injury. Expected Outcomes The school nurse will encourage regular visits with the student’s dermatologist for ongoing skin management. Nursing Diagnosis: Risk for Learning Difficulties Related to cognitive and developmental impairments associated with TSC, including intellectual disabilities. Related to learning difficulties related to the neurological impact of TSC. Interventions The school nurse will work with teachers and school counselors to develop an Individualized Education Plan (IEP) or a 504 plan to support the student's learning needs. The school nurse will ensure that cognitive assessments are conducted regularly to identify areas where additional support or adaptations are needed. The school nurse will offer resources or suggestions to the student’s caregivers about how to support learning at home and encourage engagement in schoolwork. The school nurse and counselors will refer the student to behavioral therapy or cognitive therapy if indicated. Expected Outcomes The student will demonstrate progress in learning and academic achievements as per their IEP goals. Teachers and caregivers will provide the student with appropriate accommodations and educational strategies. Nursing Diagnosis: Risk for Impaired Social Interaction Related to physical manifestations of TSC (e.g., visible skin lesions, developmental delays) may lead to self-consciousness and potential social isolation. Related to behavioral symptoms, such as impulsivity or difficulty with communication, may also interfere with social interactions. Interventions The school nurse will encourage participation in inclusive school activities that are tailored to the student's abilities, fostering peer engagement. The school nurse will educate classmates (with the family's consent) about TSC to promote understanding and empathy. The school nurse will work with school counselors to provide social skills training and help the student navigate peer interactions. The school nurse will be vigilant for signs of bullying or exclusion and promptly address any concerns with staff and caregivers. Expected Outcomes The student will participate in social activities and engage with peers in a positive manner. The student will report feeling included and supported by classmates and staff. The school environment will foster understanding and acceptance of the student’s condition. Nursing Diagnosis: Risk for Impaired Communication Related to speech and language delays that may accompany TSC. Related to cognitive impairments affecting verbal and non-verbal communication abilities. Interventions The school nurse will work with speech-language pathologists to ensure the student receives appropriate support for communication development. The school nurse will, if needed, provide alternative communication methods (e.g., communication boards or devices) to help the student express their needs. The school nurse will encourage the student to participate in small group activities or peer interaction settings to enhance social communication skills. The school nurse will regularly monitor the student’s ability to communicate effectively and work with the education team to adapt classroom strategies. Expected Outcomes The student will show improvement in their ability to communicate effectively, both verbally and non-verbally. The student will demonstrate progress in participating in classroom discussions and social interactions. Nursing Diagnosis: Risk for Constipation Related to gastrointestinal symptoms such as constipation, which can be associated with TSC. Related to medication side effects, such as those from antiepileptic drugs, that can exacerbate constipation. Interventions The school nurse will keep track of the student's bowel habits at school and assess for signs of constipation or discomfort. The school nurse will encourage a diet rich in fiber and fluids to promote healthy digestion and prevent constipation. The school nurse will, if applicable, monitor the student's use of medications (e.g., antiepileptics) that may contribute to constipation and collaborate with the healthcare provider for adjustments. The school nurse will ensure that caregivers and school staff are aware of any dietary or medication adjustments that may help manage constipation. Expected Outcomes The student will experience regular, comfortable bowel movements without signs of constipation. The student will follow dietary recommendations and participate in activities to prevent gastrointestinal issues. Nursing Diagnosis: Risk for Impaired Skin Integrity Related to seizure activity leading to potential injury or trauma to the skin. Related to long-term use of anticonvulsant medications that may lead to dry skin or rashes. Interventions The school nurse will ensure that the student’s school environment is safe, with protective padding where needed during seizures. The school nurse will regularly assess the student’s skin for signs of dryness, irritation, or rash related to seizure medications. The school nurse will encourage hydration and the use of moisturizing skin creams to prevent dryness. The school nurse will ensure that caregivers and school staff are aware of potential side effects from medications that may affect skin health. Expected Outcomes The student will have intact skin with no signs of injury from seizures or medication-related dryness. The student and caregivers will demonstrate good skin care practices. 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.
