Individualized Seizure Health Care Plan

Student's Name: DOB: Age: School Site:

Parent Name: Phone: Date of IHP:
Physician: Phone: Fax:
Specialist(s): Phone: Fax:
Type of Seizures: Frequency: Triggers:
History: A seizure occurs when there is abnormal electrical activity in the brain. Seizures may go virtually unnoticed or in severe cases, they may produce a change or loss of
consciousness and involuntary muscle spasms called convulsions. Seizures usually come on suddenly and vary in duration and severity.
Medication/Side Effects:
Nursing Diagnosis/Concern Educational Goal Plan of Action By Whom/When
1. Potential for seizures at 1. Student will maintain 1. Remain calm School Nurse, school staff, and
school optimum health, safety, 2. Prevent injury family in an ongoing manner
and well-being during • Support, protect, and cushion student’s head
the school • Ease student to the floor if sitting in a chair
• Remove any surrounding furniture
• Loosen any constrictive clothing
• DO NOT place anything into student’s mouth
• Provide privacy and remain with student
• If possible, turn student on his/her side to prevent
choking
• Do not restrain student
• Call office with description and length of seizure
• Office to call parent AND Health Services
• If needed, escort student to office after seizure ceases
so they can lie down. Student may return to class when
they feel better
3. Call 911 if seizure lasts longer than minutes
• Notify parent AND Health Services immediately
4. Log all seizure activity on the seizure log form
5. School nurse, if on scene, will administer medication as
prescribed if they are kept at school
6. Stay with student until EMS arrives and takes over
emergency care.
7. Inform EMS of when the seizure began, how long it lasted,
any medications given, and provide with a copy of the
student’s emergency card

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 Individualized Seizure Health Care Plan

The Individual Health Plan The IHP will be updated/revised Review RN Parent UAP Principal IHP team/annually
(IHP) will be reviewed annually annually to meet the health Date: Initials: Initials: Initials: Initials:
with the parent as well as needs of the student
appropriate staff members. This
plan may be revised/updated as
appropriate to ensure the most
current treatment modalities for
the student. The school nurse in
collaboration with the parent will
train and supervise all non-
medically licensed school
personnel who are delegated
responsibility for implementing
any portion of this plan as
appropriate.

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Parent Signature Date Principal Signature Date

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RN Signature Date Staff Signature Date