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Discharge Plan and Instruction Format



Age: 59 y.o. Sex: M

Religion: R.C.

Diagnosis: Bipolar 1% manic, MRE, PF Surgery Undergone, if any: _____NONE__ Hospital: ___VSMMC-CBS__ Rm/Ward-Bed No.: ________ Physician: __________

A. Objectives: After 4 hours of nurse client interaction, the patient will be able to: 1. Patient will be able to state that the treatment / medication have decreased his mood swings/stress. 2. Patient will be able to participate in the treatment / medication given to him and in decision-making as his physical condition allows 3. Patient will be able to apply effective and appropriate coping strategies 4. Patient will be able to value life and the meaning of life

B. I. Medication

Name of drug CARBAMAZEPIN E ( Carbatrol) CLOZAPINE (Clozaril)

Dosage & frequency 200 mg q BID 100 mg q HS

Route P.O. P.O.

Curative effects >to treat seizure >to treat acute manic and mixed episodes in bipolar disorder.

Side effects -headache, tremors, confusion, restlessness, muscle weakness -blurred vision, tinnitus, headache, tremors, weakness, vertigo, insomnia

II. Exercise / Activity

To join life support activities at least once a week. Let the patient engage in any activities that can foster interaction with other people, like continuing his daily activities/ routine activities in the past.


The patient should never be left alone to ensure that he will not relapse.

III. Treatment Keep a list of your medicines: Keep a written list of the medicines you take, the amounts, and when and why you take them. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to physician.

Prescribed treatment to be continued at home: Take your medicine as directed:

Always take your medicine as directed by physician. Call your physician if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your physician. Do not drink alcohol while taking medicine used to treat bipolar disorder. Do not use street or illegal drugs. Both alcohol and illegal drugs can affect the way your bipolar medicine works. Do not drink alcohol or use stimulants, including diet drugs. These may also trigger episodes of bipolar disorder. You may need blood tests once you are taking bipolar disorder medicine. This test checks how much medicine is in your blood. Physician use the results of this test to decide the correct amount of medicine for you. Changes in medicine are often needed as your bipolar disorder changes. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.

IV. Health Teachings

( ) clinic appointments schedule ( ) follow-up laboratory examination ( ) use of alternative medicines ( ) relapse prevention measures

( ) understanding and knowing what to do with side effects of medication ( ) Others: ____________________________________________________

V. a.) Observed signs and symptoms that need reporting:

The tendency to relapse, stressed, depression, mania and when theres suicidal tendency.

b.) Interventions / Home remedies that may be done immediately prior to seeking consultation:

Talk to the patient when you observe signs and symptoms of relapse, suicidal tendency, depression, mania or stress. Let the patient squeeze a stress ball.

VI. Diet

Diet as tolerated, avoid alcohol beverages and caffeine drinks.


( ) spiritual counseling ( ) supportive counseling ( ) grief work ( ) join organizations/ Church activities _____________________________________________________________________________________ ________________________________________. ( ) confession ( ) anger management ( ) family therapy ( ) reconciliation of conflicted relationships

C. Discharge Details

a.) Date of Discharge: September 13, 2011 b.) Time of Discharge: 3:00 pm c.) Accompanied by: The patients parents d.) Mode of Transportation: Walking with the hands holding to his mother. e.) General Condition: Not fully recovered from the state of mood swing but the patient showed improvements with his condition during his stay in the hospital. Somehow, cautious monitoring is needed.


READ and UNDERSTOOD: (translated according to patients convenience) : If all measures fail, an interpreter is asked.

___________________M.E.O.______________ PATIENT / RELATIVE (Signature over printed name)


_________________Ann Fatima Dandan_________________ STUDENT NURSE (Signature over printed name)

_____________Joy S. Bertulfo R.N. M.A.N._____________________ CLINICAL INSTRUCTOR (Signature over printed name)