University of San Carlos

College of Nursing
Cebu City

DISCHARGE PLAN

Name: Arreglado, Bernardo Age: 77 Sex: Male Religion: Roman Catholic

Diagnosis: Pneumonia Surgery undergone, if any: No surgeries underwent
Hospital: Severo Verallo Memorial District Hospital Physician: Dr. Loblin
Rm/Ward-Bed No.: Hallway

A. OBJECTIVES
1. To maintain a patent airway
2. To maximize breathing capacity
3. To relieve the patient of his secretions
4.

B.
1. MEDICATIONS

Name of Drug Dosage & Frequency Route Curative Effects Side Effects
Salbutamol 2 mg q.i.d. P.O. Dilates Tachycardia,
bronchioles nausea
Cefuroxime 250 mg b.i.d. P.O. Antibiotics Phlebitis,
sodium Thrombophlebitis

2. EXERCISE / ACTIVITY
Type of Activity allowed / to be continued:
Deep Breathing Exercises
Light Activities
Procedure or Steps:
1.) Sit up straight as you prepare to do these exercises. Keep your backbone fully upright
with your shoulders pulled back as you get into position.
2.) Inhale slowly and deeply. Slowly fill your lungs with air. Think about how pure, fresh
and cleansing this “new” air is for your body.
3.) Focus on how your lungs feel as they fill with air. Notice how they expand. Pay
attention to how your diaphragm moves to make room for more air in your lungs.
4.) Exhale slowly. Release the air from your lungs until they are completely empty. Feel
your lungs contracting as your expel all of the “old” air from your body.

Use of Equipment (if any): No equipments necessary

Restrictions: Strenuous Activites

3. TREATMENT
- Comply with medications
- Increase Fluid Intake
- Utilize Deep Breathing Exercise for at least twice a day

4. HEALTH TEACHINGS
( ) clinic appointment schedules ( ) use of alternative medicines
( ) follow-up laboratory examinations ( ) relapse prevention measures
( ) understanding and knowing what to do with side effects of medications
( ) Others: Health Teaching on Deep Breathing Exercise
 5. a. Observed signs & symptoms that need reporting:
- Increase dyspnea, Elevated Body Temperature and presence of adventitious sounds.

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

consultation:
- Use of Lagundi herbal meds
- Increase Fluid Intake
- Position to High Fowlers
- Adequate bed rest

6. DIET
a. Prescribed Diet:
- Diet as Tolerated

b. Restrictions:
- No restrictions

7. SPIRITUAL AND PSYCHOLOGICAL NEEDS

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

C. DISCHARGE DETAILS
a. Date and Time of Discharge:
b. Accompanied by:
c. Mode of Transportation:
d. General Condition upon Discharge:

THESE DISCHARGE INSTRUCTIONS WERE EXPLAINED TO THE PATIENT

AND/OR RELATIVE

Read and Understood: (translated according to patient’s convenience)

: If all measures fail, an interpreter is asked

_____________________________________
PATIENT / RELATIVE
(Signature over printed name)

Validated:

_____________________________________
STUDENT NURSE
(Signature over printed name)

_____________________________________
CLINICAL INSTRUCTOR
(Signature over printed name)