VI.

DISCHARGE CARE PLAN

VI. DISCHARGE CARE PLAN

MEDICATION

 Instruct the patient to make sure to take the medications as prescribed and follow
instructions properly.
 Instruct the patient to notify the physician if there is any adverse effect of the drug and
if the symptoms still persist
o Do not stop taking any medications on your own. Talk to your healthcare
provider first.
 Provide clear instruction about taking her medication.
 Instruct patient to avoid taking medicines with sodium content.
 Emphasized the importance of taking her supplements and other doses.

EXERCISE

 Instruct the patient to have daily exercise like walking with assistance from the SO as
much as possible. But avoid doing heavy and strenuous exercises.

TREATMENT

 Encourage the patient to participate in the continuous treatment for faster recovery.
 Instruct the family of the patient for the arrangement that should be made to help the
patient around the house.
 Adhere to the medications given.
 If patient feels uncomfortable pain, report immediately to the health provider.

HEALTH TEACHING

 Advise patient to quit smoking and drinking alcohol.

 Instruct patient to avoid tight socks that slow blood flow to the legs and cause clots.
 Instruct patient to weigh self-daily and record
 Instruct patient to assume a position that shifts fluid away from the heart.
 Advise the patient to visit health care clinics next time if there are health issues in order
to have a prescribed dosage of drug and proper medicine.
 Explain to the patient the importance of having a good guidance from the doctor before
doing

DIET

 Advise the mother to follow the modified diet given by the health care provider and
follow all dietary suggestion.
 Instruct patient to eat foods high in potassium to prevent hypokalemia.
 Instruct patient to avoid eating foods that are high in sodium content.
  Encourage the patient to drink at least 8 cups of water a day to keep the body fresh and
hydrated.
 Instruct patient to have small, frequent meals decrease the amount of energy needed
for digestion.

SPIRITUAL

 Encourage significant others and the mother to visit church every Sunday.

MEDICATION  Instruct the patient to make sure to take the

medications as prescribed and follow instructions
properly.
 Instruct the patient to notify the physician if there is
any adverse effect of the drug and if the symptoms still
persist
o Do not stop taking any medications on your
own. Talk to your healthcare provider first.
 Provide clear instruction about taking her medication.
 Instruct patient to avoid taking medicines with sodium
content.
o Some medicines are high in sodium. Always
read the sodium content and warnings before
taking any over-the counter medicine. Avoid
headache or heartburn medications that contain
sodium carbonate or bicarbonate. Ask
healthcare provider to recommend the over-
the-counter medications that are best for you.
 Emphasized the importance of taking her supplements
and other doses.

** To be added:
 Instruct the patient to keep a list of all medications
being taken (including prescription and over-the-
counter drugs, vitamins, supplements, and herbal
remedies).
o Bring the list it with you to all medical
appointments. Also show it to the pharmacist
when purchasing over-the-counter remedies.
Some can interfere with your prescription
medications. Refill medications with plenty of
time before they run out.
o Instruct patient to use a pill box to help him
remember to take his medications and take
them at the right times.
EXERCISE  Instruct the patient to have daily exercise like walking
 with assistance from the SO as much as possible. But
avoid doing heavy and strenuous exercises.
o Having heart failure does not mean restricting
activity. In fact, exercise is essential to help
strengthen the heart. It helps increase energy
levels and make the whole body healthier.
Studies show that moderate exercise helps
decrease the risk for needing hospitalization for
worsening heart failure.
o It releases stress and calms you.
o It can improve your mood and help you think
more clearly.
o It may help control cravings for tobacco and
nicotine.
o It can help control your appetite.
o It can help you reach and maintain a healthy
weight.
o It can lower your blood pressure.
o It can increase your HDL (good) cholesterol
level.
o It can help reduce your risk of developing heart
disease and stroke.
o It can help control blood sugar by improving
how your body uses insulin.
Example plan:
o Begin with a few minutes of warm-up activities.
o Avoid performing physical activities outside in
extreme hot, cold, or humid weather.
o Ensure that you are able to talk during the
physical activity; if you are unable to do so,
decrease the intensity of activity.
o Wait 2 hours after eating a meal before
performing the physical activity.
o Stop the activity if severe shortness of breath,
pain, or dizziness develops.
o End with cool-down activities and a cool-down
period.
 For example, objects that need to be taken upstairs
can be put in a basket at the bottom of the stairs
throughout the day. At the end of the day, the person
can carry the objects up the stairs all at once. Likewise,
the person can carry cleaning supplies around in a
basket or backpack rather than walk back and forth to
obtain the items. Vegetables can be chopped or peeled
while sitting at the kitchen table rather than standing
at the kitchen counter.
TREATMENT  Encourage the patient to participate in the continuous
 treatment for faster recovery.
 Instruct the family of the patient for the arrangement
that should be made to help the patient around the
house.
 Adhere to the medications given.
 If patient feels uncomfortable pain, report immediately
to the health provider.
HEALTH TEACHINGS  Advise patient to quit smoking and drinking alcohol.
o Each puff of a cigarette increases heart rate
and blood pressure and robs the body of
needed oxygen.
o No form of tobacco is safe. This includes e-
cigarettes, cigars, chew, snuff, bidis, and clove
cigarettes.
o Patients with heart failure should have a
conversation with their healthcare provider
about whether they can drink alcohol. Patients
might be instructed to abstain from alcohol
completely, especially if alcohol intake
contributed to their heart failure (alcohol-
induced cardiomyopathy)
 Instruct patient to avoid tight socks that slow blood
flow to the legs and cause clots.
o Some physicians might recommend
compressions socks, so ask your doctor if one
have questions. Avoid temperature extremes as
much as possible, too. Dress in layers so that
the patient can add or remove garments as
needed.
 Instruct patient to weigh self-daily and record
o Obtain weight at the same time each day (eg,
every morning after urination). Keep a record
and report weight gain of ≥ 2–3 lb (0.9–1.4 kg)
in 1 day or 5 lb (2.3 kg) in 1 week.
 Instruct patient to assume a position that shifts fluid
away from the heart.
o The number of pillows may be increased, the
head of the bed may be elevated (20- to 30-cm
[8- to 10-inch] blocks may be used), or the
patient may sit in a comfortable armchair. In
this position, the venous return to the heart
(preload) is reduced, pulmonary congestion is
alleviated, and impingement of the liver on the
diaphragm is minimized. The lower arms are
supported with pillows to eliminate the fatigue
caused by the constant pull of their weight on
the shoulder muscles
 o Elevate (raise) legs above the level of
heart. This will help with fluid that builds up in
the legs or ankles. Elevate legs as often as
possible during the day. Prop legs on pillows or
blankets to keep them elevated comfortably.
Try not to stand for long periods of time during
the day. Move around to keep blood circulating.
 Advise the patient to visit health care clinics next time
if there are health issues in order to have a prescribed
dosage of drug and proper medicine.
 Explain to the patient the importance of having a good
guidance from the doctor before doing actions.

OPD  Instruct the patient to contact the physician if there are

any untoward signs and symptoms occurs.
o Report immediately to the physician or clinic
any of the following:
 Gain in weight of ≥ 2–3 lb (0.9–1.4 kg)
in 1 day, or 5 lb (2.3 kg) in 1 week
 Loss of appetite – Unusual shortness of
breath with activity
 Swelling of ankles, feet, or abdomen
 Persistent cough
 Development of restless sleep
 Increase in number of pillows needed to
sleep
 Instruct patient to consult physician if flu and
pneumonia vaccines aren’t yet taken.
o Flu and pneumonia pose greater dangers for
people who have heart failure (or any heart
condition) than for healthy people. Pneumonia
is a lung infection that keeps the body from
using oxygen as efficiently as it should. The
heart has to work harder to pump oxygenated
blood through the body. If one has heart
failure, you should avoid putting this extra
stress on your heart. Ask the doctor or another
healthcare professional about getting a yearly
influenza (flu) vaccine and a one-time
pneumococcal vaccine. (The latter guards
against the most common form of bacterial
pneumonia.)
 Instruct the patient to attend every follow up checkup.
 Instruct the mother to report immediately to the doctor
if the wound becomes inflamed, tender or starts to
discharge.
DIET  Advise the mother to follow the modified diet given by
the health care provider and follow all dietary
 suggestion.
 Instruct patient to eat foods high in potassium to
prevent hypokalemia.
o Profuse and repeated diuresis can lead to
hypokalemia (i.e., potassium depletion). Signs
are weak pulse, faint heart sounds,
hypotension, muscle flabbiness, diminished
deep tendon reflexes, and generalized
weakness. Hypokalemia poses new problems
for the patient with HF because it markedly
weakens cardiac contractions
o To reduce the risk for hypokalemia, the nurse
advises patients to increase their dietary intake
of potassium. Dried apricots, bananas, beets,
figs, orange or tomato juice, peaches, and
prunes (dried plums), potatoes, raisins, spinach,
squash, and watermelon are good dietary
sources of potassium.
 Instruct patient to avoid eating foods that are high in
sodium content.
o Patients with heart failure typically need to
restrict sodium intake. Sodium increases fluid
retention, which increases blood pressure and
puts a greater strain on the heart. It also
increases fluid buildup leading to swelling in the
legs and feet and shortness of breath.
o The AHA recommends no more than 1,500 mg
of sodium daily for patients with mild heart
failure. Patients with more severe heart failure
may need to restrict it even further.
o One teaspoon of salt contains 2,300 mg of
sodium and sodium is hidden in many foods
(especially prepared and fast foods).
 Encourage the patient to drink at least 8 cups of water
a day to keep the body fresh and hydrated.
 Instruct patient to have small, frequent meals decrease
the amount of energy needed for digestion.
** Provide meal plan.
** Provide instructions on how to detect presence of sodium
in food.
SPIRITUALITY  Encourage significant others and the mother to visit
church every Sunday.