ࡱ> LNK' bjbjff 16!h!hP P $t1('''''''$ *,'^''YYY 'Y'YYN$$'o"&0'(01(&Ti-i-`$'i-$'xY''1(i-P X :  SAMPLE DIABETES Individual Health Care Plan (IHP) Page _____ of _____ For health needs that may result in an emergency and/or need management or monitoring. Student Name:___________________________________ Medical Diagnosis: Part of IEP: Yes No School: Date Initiated: Grade: _____________________________ Health Care Provider: By: Date Reviewed: By: Underline areas of concern: Medical management, dental management, safety, vital functions, elimination, mobility, rest, comfort.  NURSING ASSESSMENT NURSING DIAGNOSIS NURSING INTERVENTIONS EVALUATION The school nurse will: Student Outcomes- The student will: The student is very knowledgeable regarding their diabetes management. They most often can recognize hypoglycemic states. Their primary symptom of low glucose levels is being belligerent. They have a very supportive family. They manage their blood sugar with and insulin pump and continuous glucose monitor. High Risk for Physiological Injury due to development of acute complications related to hypoglycemia (low blood sugar) or ketoacidosis (high blood sugar) (NANDA 1.6.1) Hypoglycemic Management (NIC 2G 2130) Activities: School nurse will develop emergency action plan - and instruct staff in how to respond to low blood sugar levels School nurse will observe _____- check his blood sugar levels bi-weekly. Hyperglycemia Management (NIC 2G 2120) Activities: School nurse will train staff and supervise student in administration of insulin. School nurse will observe ____ self-administer insulin bi-weekly.1. ____will recognize and treat early signs of hypoglycemia appropriately and know how to recognize and respond to early signs of ketoacidosis. 2. ____ will manage or have assistance managing hypoglycemic reactions. 3. ___ will have minimal low blood sugar reactions in school. 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L^`LhH. ^`hH. ^`hH. PL^P`LhH. hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo(B?OUSMquH);h}o>>tp>z/$Z VsRV2I9JdAjQgRF&o(>V jQE+J4=Ck         a.+:#$<)1+.,A.-hD]qDiOGEJ"hP_U/W=D^%bnvcMA~61 H4g@P@UnknownG.[x Times New Roman5Symbol3. .[x Arial1.K`PLato5. .[`)TahomaC.,.{$ Calibri Light7..{$ CalibriA$BCambria Math"hb'g':[GIYIY!0KQ@P  $PEJ2!xx :* "INDIVIDUAL HEALTH CARE PLAN (IHCP)BDUSDWilson, Louise F. DPI`                Oh+'0 4@ ` l x $INDIVIDUAL HEALTH CARE PLAN (IHCP)BDUSD Normal.dotmWilson, Louise F. DPI3Microsoft Office Word@G@ W@$@IY ՜.+,0( hp   Beaver Dam Unified School Dis #INDIVIDUAL HEALTH CARE PLAN (IHCP) Title  !"#%&'()*+,-./0123456789:<=>?@ABDEFGHIJMRoot Entry F OData 1Table$-WordDocument16SummaryInformation(;DocumentSummaryInformation8CCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q