DEPRESSION 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: Risk for Suicide Related to feelings of hopelessness or worthlessness. Related to history of self-harm or suicidal ideation. Related to lack of a support system or feelings of isolation. Interventions The school nurse will assess the student for any suicidal ideation, intent, or plan; ensure safety precautions are in place if risk is identified. The school nurse will establish a therapeutic rapport with the student to encourage openness about feelings. The school nurse will collaborate with mental health professionals for immediate counseling or psychiatric support. The school nurse will encourage the student to identify supportive individuals in their life. The school nurse will teach coping skills for managing intense emotions, such as mindfulness or grounding exercises. Expected Outcomes The student will verbalize feelings of hope or positive future outlook. The student will engage with mental health resources as needed. The student will identify at least two supportive individuals they can reach out to during distress. Nursing Diagnosis: Chronic Low Self-Esteem Related to negative self-perception and critical self-talk. Related to past experiences of failure or social rejection. Related to difficulty accepting positive feedback or accomplishments. Interventions The school nurse will encourage the student to set small, achievable goals and celebrate successes, no matter how minor. The school nurse will support the student in identifying and challenging negative self-thoughts, replacing them with positive affirmations. The school nurse will provide positive reinforcement when the student demonstrates positive self-regard or completes tasks. The school nurse will encourage journaling to help the student recognize their strengths and accomplishments. The school nurse will refer to counseling services for cognitive-behavioral therapy to address negative thought patterns. Expected Outcomes The student will verbalize at least one positive quality about themselves. The student will demonstrate improved self-esteem by setting and achieving small goals. The student will show an increased willingness to accept positive feedback from others. Nursing Diagnosis: Social Isolation Related to withdrawal from social activities and peers. Related to feelings of unworthiness or self-blame that limit social engagement. Related to anxiety or discomfort in social situations. Interventions The school nurse will encourage gradual re-engagement in social activities, starting with low-pressure gatherings. The school nurse will support the student in identifying and connecting with a support network of friends or family. The school nurse will educate on the importance of social interaction for emotional well-being. The school nurse will provide resources on campus support groups, clubs, or activities that align with the student's interests. The school nurse will offer counseling or mental health support to address social anxiety. Expected Outcomes The student will engage in at least one social activity or interaction per week. The student will verbalize a decreased sense of isolation and increased connection to others. The student will demonstrate improved comfort in social situations. Nursing Diagnosis: Disturbed Sleep Pattern Related to rumination and worry that disrupt sleep onset. Related to physical symptoms of depression, such as fatigue, that impact rest. Related to irregular sleep schedule due to variable energy levels and motivation. Interventions The school nurse will assess the student’s sleep habits and educate on the importance of a consistent sleep-wake cycle. The school nurse will encourage a calming pre-sleep routine, such as reading or listening to soft music, to promote relaxation. The school nurse will limit stimulants like caffeine and screen exposure in the evening. The school nurse will recommend relaxation techniques, such as deep breathing or progressive muscle relaxation before bed. The school nurse will track the student's sleep patterns and work with counseling if insomnia persists. Expected Outcomes The student will report an improved ability to fall asleep and remain asleep through the night. The student will maintain a consistent sleep schedule with fewer disruptions. The student will report feeling more rested, contributing to improved mood and energy levels. Nursing Diagnosis: Hopelessness Related to persistent depressive thoughts or feelings of despair. Related to perception of limited control over life circumstances or future. Related to lack of purpose or goals contributing to feelings of despair. Interventions The school nurse will help the student identify short-term, achievable goals to instill a sense of purpose. The school nurse will encourage journaling about daily experiences, including positive moments or things they’re grateful for. The school nurse will foster a supportive environment for the student to discuss feelings openly without judgment. The school nurse will collaborate with a counselor to explore and set realistic, future-oriented goals. The school nurse will use cognitive-behavioral techniques to reframe negative thoughts into manageable perspectives. Expected Outcomes The student will verbalize at least one realistic goal or aspect of life that brings hope. The student will report feeling a sense of accomplishment or progress towards goals. The student will express an improved outlook on the future. Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements Related to loss of appetite related to depressive symptoms. Related to fatigue and low motivation interfering with meal preparation and eating. Related to poor self-care habits due to lack of energy or interest. Interventions The school nurse will assess the student’s nutritional intake, and encourage small, frequent meals if appetite is low. The school nurse will provide education on quick, easy-to-prepare meals and snacks that offer balanced nutrition. The school nurse will encourage the student to establish a regular eating schedule to maintain energy levels. The school nurse will monitor weight, BMI, and lab values related to nutrition as needed. The school nurse will refer the student to a dietitian or counselor if persistent poor appetite continues. Expected Outcomes The student will demonstrate improved eating habits by consuming regular meals. The student will report increased energy levels associated with balanced nutrition. The student will achieve and maintain a healthy weight and nutritional status. 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.
