IX. DISCHARGE PLANNING: Medications Give adequate instruction about the importance of following medication and dietary regimens.

. 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) Exercise Promote rest and deep breathing exercise. 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. So that the patients condition can remain stable as long as possible. -Gastro Esophageal Disease. -Pneumonia -Chestpain Reflux

Health Teachings

To check for unusualities. For immediate treatment. To attain therapeutic effects. For monitoring and avoidance of complications. To prevent serious complications wherein the length of time that these treatments are necessary. To decrease myocardial workload.

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.

To improve cardiac activity.

To have enough rest.

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

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.

NURSING CARE PLAN

CUES SUBJECTIVE: As verbalized by the patient sakit ikalibang, usahay kalibangun ko pero diko kalibang.

NURSING DIAGNOSIS Constipation related to altered dietary and fluid intake and prescribed medication

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

INTERVENTIONS INDEPENDENT: 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).

RATIONALE

EVALUATION 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.

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

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

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

OBJECTIVE: Distended abdomen Palpable abdominal mass Percussed abdominal dullness

LONG TERM: 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. 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 DIAGNOSIS SUBJECTIVE: Patient verbalized usahay ga sakit ug mayo akong dughan paingun sa likod sa akong li-og mao maka tarong. nga dili ko ug trabaho Acute Pain related SHORT TERM: to biological factors, specifically underlying disease process. INEPENDENT: comfort 1)To provide non- Goals were partially management longer demonstrated behaviours indicating in/ 2) To reduce by epigastric However, still reported leg apparently worsened of Nonetheless, patient from duty. assessment to time of showed pain at area. patient and pain which OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Within one hour of 1)Provide effective intervention, patients

nursing measures such as pharmacologic pain met since patient no backrubs/massage, touch, and reported therapeutic

pain is controlled/ repositioning and patients SO(s) will be able to nonthat enumerate pharmacologic methods provide relief.

reduced in intensity quiet environment. 2) Instruct use

encourage such as

of tension

relaxation techniques promoting focused relaxation breathing/ pursed-lip breathing.

from edema on left

demonstrated relaxed manner and tolerance when OBJECTIVE: pain, grimacing guarding on affected pt. facial and behavior area LONG TERM: Within course patients patient demonstrate relaxed manner and uninterrupted sleep/ rest. the of entire duty, 3) Encourage SOs to felt like socialization conversation patient. 4) Identify ways of avoiding as chest or splinting during episodes, body minimizing pain such techniques coughing and 4) To encourage of divert patients through singing, or with attention from pain diversional activities 3) To to pain nonusing

pharmacologic measures like when distract her attention is attention diverted from pain through socialization, singing and rest.

complains of chest

patients

reported will

from pain felt

pain is relieved and

with pain scale of 7/10 , 10 being the highest.

non-pharmacologic management pain

using firm mattress, good mechanics. 5) Encourage

adequate periods.

rest 5) To prevent

fatigue which may DEPENDENT: 6)Administer analgesics, ordered. as 6) To maintain level aggravate pain

acceptable pain

of pain or relieve