Diabetes Health Care Plan Template Page 3
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Student Name: ______________________________ DOB: ____________________ School: _____________________
School Nurse: _________________
__________ Date of IHP: _____________________
Nursing Diagnosis/Concern
Educational Goal
Plan of Action
By Whom/When
Instruct teacher/staff on signs & symptoms of hyperglycemia/diabetic
School Nurse-as needed
Ketoacidosis (high blood sugar over extended period of time due to
lack of insulin)
__ extreme thirst
__ blurred vision
__ frequent urination
__ drowsiness
__ dry skin
__ nausea
__ hunger
__ difficulty breathing
***Follow Individual Emergency Health Management Plan for
Student.
School Nurse, Staff,
Provide praise and reinforcement for self-management skills.
tudent will demonstrate in-
Alteration in self-esteem due to:
Parent/guardian-ongoing
A. Provide referral and access to youth diabetes group.
diabetes care requirements; developmental level
creased adaptation to and psy-
B. Promote verbalization of feeling re: illness.
and needs; dysfunctional grieving; embarrassment;
chological comfort with body
C. Monitor and support behaviors of positive adaptation
stigma associated with having chronic illness;
changes and lifestyle require-
lifestyle changes created by diabetes & manage-
ments.
Consult physician and provide counseling referral if adjustment is
ment
non-progressive or dysfunctional.
Clarify misconceptions about diabetes
Provide support for student, family and staff in adaptation to diabetes
through referral, listening, teaching and regular communication.
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