DISCHARGE PLAN

Medication: Explain the purpose of clients medications including supplements. Proper teaching avoids misconceptions. Include significant others in teaching the dosage and proper administration or use of clients medications as prescribed by the physician The use of over the counter drugs instead of the prescribed ones can be avoided if constant reminders are obtained from people whom the client trusts. Inform client about the adverse effects of his medications. This is to avoid misconceptions about taking the drug. Instruct client and significant others to report any unusualities pertaining to the use of the drugs. To provide immediate management regarding the drugs action to the patient. Exercise: Encourage patent to include brisk walking in his daily routine at least 30 minutes everyday. This promotes good circulation and distribution of blood through out the body. Instruct patient to return gradually in daiy specific tasks. To give enough time for total recovery. Teach relaxation techniques and exercises. This alleviates stress and anxiety which can be brought by the changes in his health status. 96

Treatment: Instruct client to continuously comply with treatment regimen. To obtain the desired effects of the drug. Instruct significant others to provide an environment conducive for recovery. This alleviates stress and faster recovery. Instruct the patient to have adequate rest and sleep. To prevent fatigue. Instruct client to consult his physician before attempting to use any over the counter drugs. To avoid risk of complications or reoccurrence of disease. Hygiene: Always do proper hand washing before eating or as needed. This prevents the transmission of disease-causing pathogens. Maintain good oral hygiene. Promotes good appetite. Instruct client and significant others to have precautions when treating a wound. This prevents the spread of the disease. Makes patient less prone to infection. Bathe regularly. It keeps the patient clean and less susceptible to disease-causing pathogens.

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Out-patient orders: Instruct patient to comply with check-ups. Further assessment or orders can still be made. Instruct patient and caregiver to report signs of unusualities such as generalized weakness. Early report of unusualities comes with prompt management. Do not force in resuming to daily activities. This is needed to provide more time for recovery. Diet: Eat only foods that are well cooked and prepared. To avoid complications of his disease which can be often obtained in food. Avoid foods which are likely to cause allergy. Avoid foods that are high in sodium and fat. Patient is already hypertensive. Limit foods and drinks that are high in sugar. To avoid further increase in glucose levels which could cause complications. Include fruits and vegetables in diet. This provides the needed nutritional requirements of his body.

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PROGNOSIS
According to Black (2007), Hepatitis B can be prevented through vaccines containing moderate level of anti-HBs or with Hepatitis B immune globulin. For post exposure prophylaxis in people who are not vaccinated , a combination of Hepatitis B immune globulin and HBV vaccine is recommended. By 3-6 weeks, nearly all clients with acute viral hepatitis demonstrate results on liver function tests, however, in the clinical course, morbidity and mortality of viral hepatitis may vary considerably. In most cases, clients recover in 3 to 16 weeks, although results on liver function testing are abnormal for a longer time. Most clients recover completely. The mortality rate is less than 1%, this rate is reportedly higher in older adults, which indicates a fair prognosis of our client.

It is also stated that the outlook for hemolytic anemia depends on its cause and severity, as well as the underlying health of the affected person. Cases that are caused by medications or infections usually go away quickly. People with autoimmune hemolytic anemia usually respond well to corticosteroids or intravenous immune globulin. In general, even people with more severe forms of these illnesses can expect a longer life span than was previously possible. In some people, a bone marrow transplant may be possible. Our client have not undergone such procedure and does not indicate such, thus prognosis is fair. According to Bare (2004), severe acute hepatitis B can occur in about 1 percent of cases, and often is linked to the simultaneous transmission of another hepatitis virus, called hepatitis delta virus. Death rates in these rare cases of severe disease can exceed 80 percent. In most other cases of less severe hepatitis B, people recover completely after the short-term infection, except for the small percentage of patients who go on to develop chronic hepatitis. Prognosis can be considered poor in the later stage since the disease was already diagnosed since 1992.

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In people with chronic hepatitis B, the outlook depends upon the severity of chronic liver inflammation, which can be determined through a liver biopsy. People with mild liver damage have a good prognosis, though some eventually develop cirrhosis or cancer. People with chronic active hepatitis and cirrhosis have a poorer prognosis, with a 55 percent chance of dying within five years. According to Dewitt (2004), Hepatitis B can have an acute or chronic form. The vast majority (95%) of people who are infected with hepatitis B recover within 6 months and develop immunity to the virus. People who develop immunity are not infectious and cannot pass the virus on to others. Still, blood banks will not accept donations from people who test positive for the presence of HBV antibodies. Outcome varies widely among the various hemolytic anemias and is dependent on the causative disorder. If no serious comorbid conditions exist (e.g., leukemia, myeloma), the prognosis of hemolytic anemia is generally good. Overall, mortality resulting from hemolytic anemia is low.

Removal of the spleen (splenectomy) effectively stops the entrapment and removal of normal red blood cells by an enlarged spleen (hypersplenism), thereby boosting the number of red blood cells in the circulation. Splenectomy, however, does not correct the original red blood cell defect or condition affecting the red blood cells. Transfusion of red blood cells temporarily increases the number in circulation. Folic acid supplements will help increase hemoglobin levels, helping to counteract the effects of the hemolytic process. Up to 80% of individuals with immune hemolytic anemia respond to steroid treatment, and up to 50% respond to other immunosuppressive medications. The effects of the removal of plasma (plasmapheresis), which contains the destructive antibodies, are short-term, but life-saving in a hemolytic emergency. Conclusion: 100

Hepatitis B is a preventable and treatable disease. The primary way of preventing it is through immunizations. In the United States, sexual contact is the most common means of transmission, followed by using contaminated needles for injecting illicit drugs, tattooing, body piercing, or acupuncture. Additionally, hepatitis B can be transmitted through sharing toothbrushes and razors contaminated with infected fluids or blood. Godex was given to the patient as a supplement which is thought to aid the functioning of the liver. His Hemolytic anemia was managed with blood transfusion. This d Generally, the patient still has a fair prognosis.

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