DISCHARGE PLAN

Patient’s Name: N.C.B. Hospital Number: 10001010324

Age: 55 years old Room Number: Female Medical Ward
bed #2
Impression/Diagnosis: Physician: Dr. Joseph Poblacion
Cerebrovascular Disease,
Infarct, Left

Patient’s Outcome Criteria Nursing Order

Upon discharge the patient and SO
will be able to:

A. Assessment
1. Assess vital signs. −Demonstrate to patient and family
how to take the patient’s vital
signs properly and record

2. Assess self for signs and −Teach and give a list of signs and
symptoms of elevated blood symptoms for elevated blood
pressure. pressure.

3. Assess for signs of beginning −Discuss with patient and family the
pressure ulcers. signs of beginning pressure ulcers

−Reinforce teachings on the

prevention of pressure ulcers by
proper skin care and changing the
patient’s position according to the
schedule provided.

B. Planning
1. Plan ahead for scheduled OPD −Provide patient and family a copy of
visits. the scheduled visits for OPD follow
up.

2. Plan activities to facilitate rest −Instruct patient and SO to create a

periods schedule of activities providing
enough time for accomplishing of
ADLs, recreation, and ample rest.

3. Plan a menu with food within the −Emphasize the importance of

limits of prescribed diet. including patient’s preferred food

C. Implementation
Medications
Take prescribed medications as
ordered.
Environment/Exercise
Establish an environment that
promotes recovery of the patient.
Comply with rehabilitative exercises
with the help of SOs.
Treatment
Continue treatments that have been
started and ordered for continuation.
Health Teaching
Integrate required changes in
lifestyle to prevent recurrence of
stroke.
into the menu with some
modifications in preparation while
following a low purine/fat, low salt
diet.
−Explain to patient and family the
importance of adhering to
medications as ordered.
−Explain the indication of each
medication.
−Provide a list of all prescribed
medications that also contains
dosage and frequency.
−Explain particularly to SO the
importance of establishing a restful
and supportive environment in the
recovery of the patient.
−Provide the patient and SOs an
instructional guide for the
exercises the patient can do at
home.
−Demonstrate to SOs how the
exercises on the guide are done for
correct implementation
−Instruct SOs to take patient’s vital
signs before beginning with any
exercise.
−Stress the importance of treatments
ordered in the fast recovery of the
patient.
−Discuss with patient and family the
presdipositions that are present in
the patient’s and family’s life, and
how these can be modified for a
healthier way of life.

Out-Patient Visits
Comply with scheduled out-patient
appointments
Diet
Comply with prescribed diet
Spirituality
Encourage patient to continue
religious activities that are within her
capability.
D. Evaluation
Accept present state of health
Act on the health teachings that have
been rendered throughout the
process.
−Provide patient and family with
literature and referrals that can
facilitate the needed change in
lifestyle.
−Provide referral to a nearby hospital
as patient’s home is very far from
current hospital.
−Stress the positive results if patient
continues to stick to prescribed as
she is recovering from stroke and
even when she has already
recovered.
−Tell patient that resumption of some
of her religious activities can give
her a sense of well-being despite
present limitations.
−Explain that her current state is not
permanent and that acceptance of
her present state of health will
help her cope with the changes
specially with concerns on mobility
−Encourage patient to comply with
this discharge plan.
−Tell her that she will improve with
time following the discharge plan.
Stress that her recovery depends
largely on her cooperation and
compliance in the plan of care post
diacharge.