DISCHARGE PLAN

 Medications:
-instructed to take the following medications, as to the right dose, route and timing.:
1. MV + Fe (Heralink) 1 cap OD PO AC for 1 month
- encouraged to take meds religiously.
- encouraged to finish the whole course of the drug therapy.

 Environment
- Encouraged to maintain a safe environment by keeping any hazards such as sharp objects and chemicals away from
reach of children.
- Encouraged to keep floor dry to avoid accidents,
- Encouraged to stay in a well ventilated room and avoid crowded areas.
- Encouraged to maintain cleanliness of the environment by minimizing allergens such as pollens and dust.
- Instructed to maintain a quiet environment conducive for rest.

 Treatment
- instructed to come back for follow-up check-up on
- instructed to visit doctor when unusualities are noted.

 Health Teachings
- Instructed to return for follow-up check up on July 30, 2010 at CVGH OPD.
- Encouraged to do handwashing before and after contact with baby.
- Encouraged to avoid heavy work and stress.
- Encouraged to have adequate rest and sleep as much as possible
- Instructed to feed baby every 2 hours or per demand.
- Instructed to burp baby every after feeding.
- Instructed to expose baby to early morning sunlight around 6-7am for 30 minutes.
- Instructed to clean nipples with plain water and not with soap or alcohol
- Instructed to perform perineal care twice a day.
- Instructed to keep neonate within sight and always place pillows on the side to prevent falls.
- Encouraged oral fluids.
 Observable Signs and Symptoms
- instructed patient to report to the nearest hospital or contact the attending physician if any s/s are observed:
1. Heavy and rapid bleeding.
2. Fever and chills
3. Abnormal and foul smelling vaginal discharges.

 Diet
- Encouraged to eat foods that are high in protein such as red meat, beef, fish and milk.
- Encouraged oral fluids.
- Encouraged to eat foods rich in Iron such as green leafy vegetables, liver, organ meats.
- Encouraged to eat foods rich in Vit. C such as citrus fruits, guava
- Encouraged to eat a high fiber diet such as pineapple, oats
- Instructed to avoid alcoholic beverages.

 Spirituality
- Encouraged patient to pray and thank the Lord for the blessings that He has given.
- Encouraged to go to mass every Sunday together with her family.
- Encouraged to pray everyday together with the family.
 Drug Study

1. Mefenamic Acid (Proxyl) 500mg/cap with cap 6 hours PO x 4doses.

Classification: NSAID
Action: Anti-inflammatory, analgesic, and antipyretic activities related to inhibition of prostaglandin synthesis; exact mechanisms of
action are not known.
Indications: Relief of moderate pain when therapy will not exceed 1 week. Treatment of primary dysmenorrhea.
Contraindications: Contraindicated to hypersensitivity to mefenamic acid, aspirin allergy, and as treatment of perioperative pain with
coronary artery bypass grafting.
Use caution with asthma, renal or hepatic impairment, peptic ulcer disease, GI bleeding, hypertension, heart failure, pregnancy,
lactation.
Adverse effects:
CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmic effects
Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence
GU: Dysuria, renal impairment
Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia,
thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia
Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasms, rhinitis
Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock
Nursing considerations
Assessment
History: Allergies; renal, hepatic, CV, GI, conditions; pregnancy; lactation
Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P,
edema; R, adventitious sounds; liver evaluation; CBC, clotting times, LFTs, renal function tests; serum electrolytes, stool guaiac.
Intervention
Give with milk or food to decrease GI upset
Arrange for periodic ophthalmologic examinations during long-term therapy
2. Vitamin B complex
Classification: Vitamins and minerals
Action: A coenzyme that stimulate metabolic function and is needed for cell replication, hematopoiesis, and nucleoprotein and myelin
synthesis
Indication: Treatment of Pemicious anemia
Contraindication: Hypersensitive to vitamin B 12 or cobalt
Adverse effects:
• Peripheral vascular thrombosis, heart failure, transient diarrhea, pulmonary edema, itching, transitory exanthema, urticari,
anaphylaxis, anaphylactoid reactions with parenteral administration, pain or burning at injection site
Nursing Considerations:
Before
• Determine reticulocyte count, Hct, Vit. B 12, iron, folate levels before beginning therapy.
• Obtain a sensitivity test history before administration
• Avoid IV administration because faster systemic elimination will reduce effectiveness of vitamin
During
• Don’t give large doses of Vit. B 12 routinely; drug is lost through excretion
• Don’t mix parenteral in the same syringe with other drugs

After
• Protect Vit. B 12 from light. Don’t refrigerate or freeze
• Monitor patient for hypokalemia for first 48 hours, as anemia correct itself.
• Give potassium supplements as needed.
3. MV + Fe (Heralink) 1cap OD PO AC for 1 month
Classification: Pre & Post Natal Vitamins
Action: Provides elemental iron, an essential component in the formation of hemoglobin
Indication: Megaloblastic, Macrocytic, and Fe-defiency, anemias, anemia due to pregnancy or malabsorption syndrome, anemia of
nutritional origin.
Contraindications: Patients hypersensitive to drug. Patients with hemosiderosis, primary hemochromatosis, hemolytic anemia,
(unless patient also has iron deficiency anemia), peptic ulceration, ulcerative colitis, or regional enteritis and in those receiving
repeated blood transfusions.
Adverse Reactions: nausea, epigastric pain, vomiting, constipation, black stools, anorexia
Nursing Considerations:
Best taken between meals. Drugs can be given with some food to reduce GI upset, although absorption may be decreased.
Oral iron may turn stools black. Although this unabsorbed iron is harmless, it could mask melena.
Monitor hemoglobin level, hematocrit, and reticulocyte count during therapy.
Tell patient to take tablets with juice or water, but not with milk or antacids.
Inform parents that as few as 3 to 4 tablets can cause iron poisoning in children.
Encourage oral fluids.
Report if severe abdominal cramping occurs.
4. Ferrous Sulfate
Classification: Multivitamins
Action: Absorption of iron is enhanced when stored iron is depleted or when eythropoesis occurs at an increased rate.
Food decreases iron absorption by up to two-thirds
Indication: Megaloblastic, macrocytic and Fe deficiency anemia, anemia due to pregnancy or malabsorption syndrome anemia of
nutritional origin
Contraindication: Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, and ulcerative colitis. Hemolytic anemia,
pyridoxine-responsive anemia, and liver cirrhosis.
Adverse effects
Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea, dark colored stools
Nursing consideration
Instruct patient not to take iron with cheese, yogurt, eggs, tea ,coffee and cereals for these may interfere with iron absorption