DISCHARGE PLAN Raquipo, Mark M.

Group12

1. Diagnosis: Choledocholithiasis, Obstructive Jaundice Medications Strictly adhere to medication regimen specially the prescribed home medications: Ranitidine Dulcolax

Exercise Teach patient about deep breathing and controlled coughing execises. Deep Breathing Exercise > While on sitting position, place palms across from each other, down andalong lower borders of rib cage to feel the rise and fall movement. > Inhale fully through the nose, hold for 2 3 seconds and exhale slowly through the mouth. Controlled Coughing Exercise > Splint the surgical wound with pillow. > Take a deep breath, hold for 3 seconds, and cough deeply 2- 3 times. Encourage bed exercises.

>Frequent gluteal and quadriceps muscle setting exercise during the day help to prepare the client for later ambulation. Instruct patient to turn frequently when lying every two hours.

T-rea tment Surgical Wound Care

H- ealth Teaching Instruct patient to comply with the given diet. (Comprehensive health teaching for patients diet: c/o Dietary.)

Surgical Wound Care.

Keep the dressing clean and dry. May wash the wound with sterile normal saline water, then apply antibacterial ointment or povodine iodine (betadine) ointment, and change the dressing daily. Teach patient about deep breathing and controlled coughing exerciseto avoid pressure on the wound.

O- PD Follow-up D-iet No special diets or other precautions are needed after surgery. Eat regular, balanced meals Eat regular meals that contain some fat. Eat plenty of whole grains and fiber, and haveregular servings of food that contain calcium (found in green, leafy vegetables and milkproducts). Limit saturated (animal) fat and foods high in cholesterol. Spiritual Advise patient to continue normal way of living, not to be discouraged and to have strong faith in God. Follow up on July 18, 2012 at MCU-OPD; 10am Look for Robert Abangan

2. Diagnosis: s/p Colostomy, Ex Lap Medications

y

Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed. Take your medicine as directed: Your stool may pass through your intestine more quickly than before you had your colostomy. So, some medicines are not absorbed (used up) by your intestine. Call your caregiver if you see pills in your ostomy pouch or stool. You should not use laxatives because your bowel movements (BM's) are already soft.

y y

Exercise

Advice patient with exercises suited for his/her condition. y Endurance: Walking: Empty pouch before walking Prevents constipation y Balance/Flexibility: Yoga: Tell instructor the presence of colostomy y Strength: Prevent parastomal hernia Strengthen abdominal muscle after surgery

Treatment Instruct patient how to do colostomy care, changing pouch, irrigating. Health Teaching Contact caregiver if:
y y y y y y y y y

You have a fever. Unusual odor that lasts longer than a week. Your skin around the stoma is red and irritated and you do not know what to do. You have nausea, vomiting, pain, cramping, or bloating. You have diarrhea. Your bowel habits change, like having little or no stool output. Your stoma size changes or becomes narrow (stenosis). Your stools are black or bloody. You have questions or concerns about your colostomy, medicines, or colostomy supplies.

OPD Diet:
y

Follow up on July 18, 2012 at MCU-OPD; 10am

Look for Robert Abangan

Can eat regular diet. Choose healthy foods from all the food groups. To avoid constipation, eat foods such as oatmeal, whole-grain breads and cereals, fruits and vegetables. There may be some foods that you cannot tolerate very well. If a food gives you cramps or diarrhea, do not

include that food in your diet. Try the food again in a few weeks. Eat small portions first and then gradually increase your portion sizes.
y

You may want to avoid foods that cause gas and odor. Some foods that may cause gas and odor are vegetables such as broccoli, cabbage, and cauliflower. Other foods include beans, eggs, and fish. You can also reduce gas by eating slowly and not using straws to drink liquids. Foods that may help to control odor and gas in some people are fresh parsley, yogurt and buttermilk. Drink at least 8 to 10 (eight ounce) cups of water each day. Follow your caregiver's advice if you must limit the amount of liquids you drink. Healthy liquids to drink are water,

Spiritual Advise patient to continue normal way of living, not to be discouraged and to have strong faith in God.

3. Diagnosis: s/p Sigmoidectomy, Colorectal Mass Medication: Strictly adhere to medication regimen specially the prescribed home medications: Amlodipine Hydrocortisone Telmisartan Metronidazole

Exercise Gradually increase your activity each day. There are generally no restrictions on walking, climbing stairs or riding in a car. Ask your physician regarding resumption of physical sexual activity. Your physician will advise you about when to return to work. Treatment Health Teaching Call physician if you experiences: Problems with the incision, including increasing pain, swelling, redness or drainage. Increasing abdominal pain. Nausea or vomiting. Fever or chills. Constipation (no bowel movement for three days).

y y y y y

y y

Diarrhea (more than three watery stools within 24 hours). Bleeding from the rectum, wound or stoma.

OPD Typically, you will be asked to schedule a follow-up office visit one to four weeks after surgery. Follow up on July 18, 2012 at MCU-OPD; 10am Look for Robert Abangan

Diet y y May go back to normal diet. Eat foods with more fiber.

Spiritual Advise patient to continue normal way of living, not to be discouraged and to have strong faith in God.