Discharge Planning and NCP's

IX. DISCHARGE PLANNING: Medications

 Give adequate instruction about the importance of following medication and dietary regimens.

 So that the patient’s condition can remain stable as long as possible.

Medications for Maintenance: 1. Pantoprazole (Pamtoloc) 40 mg Cap, OD, PO 2. Azithromycin (Zithromax) 500 mg , OD, PO 3. Isordil 5 mg, Tab, SL (sublingual)

-Gastro Esophageal Disease. -Pneumonia -Chestpain

Reflux

Exercise  Promote rest and deep breathing exercise.

Health Teachings

 Do active range of motion with slow progressions in frequency and provide assistance if needed.  Moderate physical activity on most days of the week for at least 30 minutes such as: brisk walking, dancing, gardening, etc. to prevent myocardial infarction.  Provide patient and relative written and verbal information regarding the following: 1. Monitor Blood Pressure regularly 2. Seek medical advice from health care provider in case of complication. 3. Encourage strict medication compliance and to take medications as directed. 4. Compliance to follow-up examinations. 5. Providing support. The patient and family needs assistance, explanation, and support every time patient requires treatment . 6. Indicate enough bed rest. 7. Cardiac Rehabilitation Program such as: walk daily, avoid activities that tense

 Effective deep breathing and coughing will help clear and maintain a patent airway, and prevent airway collapse.  To improve cardiac activity.  To improve cardiac activity.

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To check for unusualities. For immediate treatment.

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To attain therapeutic effects.

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For monitoring and avoidance of complications. To prevent serious complications wherein the length of time that these treatments are necessary. To decrease myocardial workload.

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muscles, avoid working with arms overhead, gradually return to work, avoid extremes in tempearature, and avoid tension. 8. Advise patient to get atleast 7 hours of sleep each night and take 20 to 30 minutes rest periods twice per day. 9. Advise patient to limit her caffeine intake. Outpatient Follow-up Diet

 Follow-up 2 weeks after discharge for the doctor to know  Diet should be low salt and low fat.

Spiritual Care

 Encourage patient to have faith and pray to God.  Encourage the patent to spend a time of silence in a day for a moment of prayer.  Strengthen faith and communicate with God.

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To improve cardiac activity.

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To have enough rest.

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Caffeine causes vasoconstriction thus increases blood pressure.  For health status monitoring.  To avoid atherosclerosis that would lead to hypertension.  NaCl elevates blood pressure. 

NURSING CARE PLAN

CUES

NURSING DIAGNOSIS

OBJECTIVES

INTERVENTIONS

SUBJECTIVE:

Constipation related to altered dietary and fluid intake and prescribed medication

SHORT TERM:

INDEPENDENT:

Within one hour of effective nursing intervention, patient will be able to verbalize behaviors/ techniques that promote bowel movement.

1) Discuss and identify elements that usually stimulate bowel activity (walking, laxatives, etc.) and any interfering factors/problems (ex. unable to defecate unless in own home).

As verbalized by the patient “ sakit ikalibang, usahay kalibangun ko pero diko kalibang.”

2) Instruct client in/encourage a diet of balanced fiber and bulk such as fruits, vegetables and whole grains.

RATIONALE

EVALUATION

1) To identify the problems that should be addressed and to aid in planning appropriate interventions

Goals were met since patient was able to demonstrate behaviors that indicated understanding such as taking in highfiber food and fruits and was finally able to defecate on the first night of duty.

2) To improve consistency of stool and facilitate passage through colon

OBJECTIVE:

LONG TERM:

Distended abdomen

Within the entire course of duty, patient will be able to establish/regain normal pattern of bowel functioning and demonstrate behavioral modifications that prevent recurrence of problem.

Palpable abdominal mass Percussed abdominal dullness

3) Promote adequate fluid intake of at least 2000ml/day, including high-fiber fruit juices; suggest drinking warm, stimulating fluids like hot water.

3) To promote passage of soft stool

4) Encourage activity/exercise within limits of individual ability.

5) Restrict intake of caffeinated beverages like coffee, tea, cola, chocolate.

4) To stimulate contractions of the intestines and promote peristalsis

5) Diuretic effect can reduce fluid available in the bowel, increasing risk of dry/hard formed stool

DEPENDENT: 6) Administer stool softeners, mild stimulants or bulk-forming agents, as ordered. 7) Administer enemas, as indicated.

6) To aid in passage of stool

7) To remove impacted stool

NURSING CARE PLAN ASSESSMENT

NURSING

OBJECTIVES

INTERVENTIONS

RATIONALE

EVALUATION

DIAGNOSIS SUBJECTIVE:

Acute Pain related SHORT TERM:

Patient verbalized “ usahay ga sakit ug mayo

akong

dughan paingun sa

to

biological

factors, specifically underlying disease process.

INEPENDENT:

Within one hour of 1)Provide effective

nursing measures such as pharmacologic pain met since patient no

intervention, patient’s

backrubs/massage,

reported therapeutic

likod sa akong li-og

pain is controlled/ repositioning

mao

nga

maka tarong.”

comfort 1)To provide non- Goals were partially

reduced in intensity quiet environment.

trabaho

ug

and patient’s SO(s) be

able

enumerate

to non-

pharmacologic methods provide relief.

that

Instruct

encourage

demonstrated

and

ko

will

use

behaviours indicating

in/ 2)

To

of tension

relaxation techniques promoting such

as

focused relaxation

breathing/ pursed-lip breathing.

longer

touch,

dili

2)

management

reduce by

pain

at

epigastric

area.

However,

patient

still

showed

reported

of

and pain

from edema on left leg

which

apparently worsened

from

assessment to time of Nonetheless, patient

duty.

demonstrated relaxed manner and tolerance when OBJECTIVE:

pt.

complains of chest pain,

facial

grimacing guarding on

and behavior

affected

area

with pain scale of

LONG TERM: Within

the

entire

course

of

duty,

patient’s

reported

pain is relieved and patient

will

demonstrate

7/10 , 10 being the

relaxed manner and

highest.

uninterrupted sleep/ rest.

divert

patient’s

attention from pain felt

through

diversional activities like

or

conversation

with

3)

To

patient’s

distract her

minimizing pain such as

chest

splinting

techniques

during

coughing

episodes,

using firm mattress, and

good

body

mechanics. 5)

Encourage

attention

through

from pain felt

socialization, singing and rest.

4) Identify ways of or

non-

4)

To

encourage

non-pharmacologic management pain

is

attention diverted from pain

patient.

avoiding

using

measures like when

singing,

socialization

pain

pharmacologic

3) Encourage SO’s to

to

of

adequate

rest

periods.

5)

To

prevent

fatigue which may aggravate pain

DEPENDENT: 6)Administer analgesics, ordered.

as 6)

To

maintain

“acceptable”

level

of pain or relieve pain