Individualized Healthcare Plan
Medical Diagnosis:
Allergy:
Brownsville ISD: Health Services
Student Name:
DOB:
School Nurse:
Date of IHP:
NURSING DIAGNOSIS
1. Risk for ineffective breathing pattern
related to bronchospasm and
inflammation of airways.
STUDENT GOALS
Student will be able to identify symptoms
of a severe allergic reaction.
Student will be safe in all school
environments.
2. Effective therapeutic regimen
management related to:
 Ability to develop and implement IHP
and ECP.
 Ability to seek help from others
The student will participate in the
development and implementation of
health care plan at school.
The student will prevent allergic reactions
from occurring.
.
Home Campus:
PLAN OF ACTION
BY WHOM/WHEN
EXPECTED OUTCOMES
1. Establish trusting, open communication
with student to provide health counseling
opportunities to review symptoms of
reactions.
School Nurse, staff, office personnel ongoing
Student will identify symptoms of an
allergic reaction.
2. Hold in-service with school staff about
significance of allergic
reaction/anaphylaxis.
School nurse , other personnel as needed
Student will share information about her
allergy with her teachers and other school
personnel.
School Nurse, staff, office personnel ongoing
Student will tell school personnel when
symptoms of an allergic reaction are
present.
Student will describe steps to take if an
allergic reaction occurs.
1. Provide necessary health counseling
opportunities for student to participate in
self-care.
 Review symptoms and sources of
allergens
 Review treatment methods,
including how/when to report
allergic symptoms to school
personnel.
2. Develop and implement an allergy ECP.
 Include mild and severe reaction
plans.
 Include student, parent,
appropriate school personnel, and
health care provider.
 Coordinate school plan with home
plan.
 Provide teachers with copies of
emergency plan.
 Make modifications to plan as
necessary.
Identify persons who have access
to medications and know where
they are stored and who have been
trained to administer the
medications.
 If food allergy: notify food service
personnel of need for alternative
food choices.
Actively participate in healthcare
management and ECP at school.
School Nurse
Allergy Health Care Plan
NURSING DIAGNOSIS
3. Risk for powerlessness related to:
uncertainty of an allergic reactions in the
school environment.
STUDENT GOALS
The student will be safe in the school
environment.
The student will prevent allergic reactions
from occurring.
PLAN OF ACTION
BY WHOM/WHEN
Provide health counseling opportunities to
review treatment plan, including
how/when to report allergic symptoms to
school personnel.
School Nurse
Provide health education regarding
significance of specific allergy to student
teachers and school personnel.
School Nurse
Provide health education for student to
develop ability to self-medicate if
appropriate.
School Nurse
EXPECTED OUTCOMES
Student will tell school personnel when
symptoms of an allergic reaction are
present.
Student will demonstrate positive
interactions with her peers in all school
settings, including classroom, cafeteria and
playground.
Student will participate in all school
activities with modifications as needed.
Student will demonstrate proper selfadministration of epi-pen, if ordered.