Sample Discharge Planning 4u734l

DISCHARGE PLANNING A case of JTR, 22 years old, female, single, Filipino, Roman Catholic was itted on October 1, 2010 for complaints of fever and vomiting with the final diagnoses of Systemic Lupus Erythematosus and hypokalemia. She decided to go home against medical advice as of October 4, 2010. Subjective “Muuli nalang mi kay dili nami ka-afford sa gasto sa ospital.”, as verbalized by patient. Objective - Seen packing things - Signed HAMA form - Received directions from physician Analysis Noncompliance related to cost of hospital stay Planning After 15 – 30 minutes of health teaching, the patient will be able to enumerate activities that will enhance her independence in the performance of her ADL’s with safety and infection precautions. Interventions A = Instructed patient to minimize with individuals with respiratory tract infections and other communicable diseases M = Emphasized to patient the importance of adhering to the prescribed therapeutic regimen = Enumerated accepted herbal medicine that could possibly serve as alternatives to prescribed drugs E = Avised patient to gradually resume to usual activities as tolerated = Advisedto schedule periods of uninterrupted rest T = Taught methods to alleviate pain such as warm compresses and topical liniments. H = Encouraged ptient and SO to maintain a clea and safe environment at all times. O = Referred patient to social services and groups that could assist them financially and pyschologically D = Encouraged a high protein diet = Advised patient not to sip meals = Identified foods rich in potassium and vitamins and minerals for the patient. Evaluation Goal was met. “Muadto lang unya mi sa social worker, basig makatabang pa na namo.”, patient verbalized.