Prognosis And Discharge Plan- Maia

PROGNOSIS

CRITERIA

POOR

1. Duration of illness

2. Onset of illness

3. Precipitating factors

FAIR

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5. Age

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JUSTIFICATION The duration of illness is rated fair since the client has experienced a major stroke which left the client hemiplegic but the client is recovering from being unconscious to being an alert one. And the time for the client to fully achieve her optimum level of wellness is going in a smooth way. The stay of the client and the complication she had developed are not that life threatening and through therapy there is a high possibility of complete recovery. The onset of illness is rated poor. The client has experienced abrupt and progressing symptoms of stroke.

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4. Willingness to take the medications/com pliance with therapeutic regimen.

6. Environment

G OOD

This is rated poor since among the precipitating factors present with the client, stress and hypertension had directly triggered the stroke. Days before the attack, the client was much stressed brought by the demolition of their home. She has also a long term hypertensive with poor compliance in taking medications. Brought by the grave consequence of stroke and the desire to achieve optimal functioning, the client and her family is serious with complying with the therapeutic regimen thus, this rated good. This disease is common among men and women aged 65 and up, the client is 53 years old which makes her indirectly vulnerable to the said disease. This is rated poor the environment where she resides is populated and

GENERAL PROGNOSIS Poor = 1 Fair = 3 Good =5

Rating scale: Poor = 0 – 1.6 Fair

=1.7 – 3.3

Good =3.4 – 5

Evaluation: Poor: 1 x 3 = 3 Fair: 3 x 2 = 6 Good: 5 x 2 = 10 Mean: 3+6+10= 19 19 / 7 = 2.71 = FAIR PROGNOSIS

General Prognosis: Despite the duration and onset of the illness, as well as the precipitating factors present, the client has the general prognosis of fair. The medical attention sought by the client and her family has proved to be the best and only choice there is. The client with the right sided weakness is undergoing rehabilitation session to regain her functioning, Aided by the full support from her family a fair prognosis will ensure a positive recovery and attainment of optimum level of functioning.

Discharge Planning MEDICATION: 1. Discuss all take home medications to the client and her significant others. The brand and generic names, dosages, frequency, as well as the action of each drug. ®This enables them to know what drugs are to be taken and its desired dosages. Exact amount and proper timing is necessary to endure the effectiveness of the medications. 2. Warn them about the side effects of the medications. And teach

them how watch for those side effects. Also explain and differentiate side effects from the adverse effects of the medication for further guidance. ®Side effects are those expected effects of the drugs aside from its therapeutic actions. Warning them ahead of time prevents confusion and anxiety. Adverse reaction may have a life-threatening effect to the patient. Immediate consultation is necessary to prevent untoward injuries brought about by its adverse reaction that might cause death. 3. Encourage to take drugs with food if not contraindicated or take

them 1 hour or 2 hours after meal. ®Some drugs may cause GI irritation if taken with empty stomach. 4. Inform family about food and other medications that cause interactions with the drugs the patient is currently taking. ®There are some drugs or foods that when taken together, may cause untoward reactions or may cause ineffectiveness of the drug.

5. Instruct the patient not to stop the medications abruptly or even adjust the dosage without consulting the physician. ® It may aggravate the condition of the client. 6. Encourage and instruct the client and her family to comply with the medication regimen prescribed by the physician. ® To prevent further deterioration of the client’s condition and recurrence of another attack.

EXERCISES: 1. Maintain a good and safety environment. ® This may facilitate fast recovery and prevent recurrence of the disease influenced by unhealthy environment. It may also prevent the patient from injury. 2. Encourage client to have a complete bed rest, as indicated. ® Bed rest is recommended to patients because it increases the strength allowing nutrition and oxygen to be used for healing process rather than energy needs. 3. If client is lying on bed for hours, instruct family members to turn patient to sides every 2 hours. ® Turning to sides facilitates blood circulation and prevents depressed areas to suffer from bedsores. 4. Encourage passive range of motion such as stretching of extremities. Advance her exercises to achieve optimum recovery but also allowing rest periods for each session.

® This helps loosen the joint structures, promote wellness and improve circulation. It would prevent aggravation and exhaustion of the muscles and joints. 5. Help the person solve problems and discover new ways to do things. ® To promote self-reliance and optimal functioning. 6. Help with communication, if the person has speech problems. Include the stroke survivor in conversations even when the person cannot actively participate. ® To promote self-esteem and stimulate her thinking ability. 7. The patient and family should coordinate with hospital social workers for rehabilitation. ® To provide optimum health and to provide the patient efficient support group. 8. Advise client for therapies such as: ∗

Physical therapy which involves using exercise and other physical means such as massage, as prescribed. ® To help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis.

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Speech therapy.

® Helps patients regain the ability to speak. ∗

Occupational therapy

® Helps patients regain independent function and relearn basic skills such as, buttoning a

shirt, preparing

a meal and bathing.

TREATMENT: 1. Explain purpose of the treatment to be continued at home. ®This adds knowledge to the family that the treatment does not only end at the hospital but it needs to be continued at home for faster recovery. 2. Determine the caregivers who will work as a partner with the patient to provide daily care and assistance at home, and teach them the skills they will need. ® These promotes comfort and mastery in rendering quality health care to the client.

HYGIENE: 1. Encourage the family to bath the patient everyday. ®Bathing washes out dirt and microorganisms from the body, and prevents from acquiring infection. 2. Instruct client to brush her teeth using her right hand, every after meal. ®This prevents lodging of bacteria leading to tartar formation, halitosis and tonsillitis which may cause heart complications. 3. Encourage family members to trim client’s nails, unless contraindicated.

® To prevent and control the medium of bacterial growth. OUTPATIENT ORDERS: 1. Remind the client and her watchers on their follow up check-up with their physician. ® To detect any complication and to evaluate the effectiveness of the treatment. 2. Advise client and watchers to decide about special equipment to be used. ® Even after rehabilitation and surgery, some patients continue to have trouble walking, balancing, or performing certain activities of daily living. Special equipment can sometimes help. Here are some examples: Cane: Many people who have had strokes use a cane when walking. For people with balancing problems, special canes with three or four "feet" are available. Walker: A walker provides more support than a cane. Several designs are available for people who can only use one hand and for different problems with walking or balance. Ankle-foot orthotic devices (braces): Braces help a person to walk by keeping the ankle and foot in the correct position and providing support for the knee. Wheelchair: Some people will need a wheelchair. Wheelchairs come in many different designs. They can be customized to fit the user's needs and abilities. Find out which features are most important for the stroke survivor.

3. Encourage watchers to make sure that the patient has a safe place to live after discharge. ® To prevent any accidents to happen. 4. Stress out to the family to seek immediate consultation if adverse reaction of drugs occurs. ®Adverse reactions are life-threatening. Immediate medical attention is necessary to prevent further damage and complications. 5. Encourage them to carry out follow up diagnostic regimen. ® To evaluate worsening condition of the client that needs medical attention. 6. Inform family members to report any signs of abnormalities such as recurrent attacks of stroke, sudden increase of blood pressure and contractures as soon as possible. ® To prevent further complication.

DIET: 1. Encourage increase oral fluid intake at least 8 to 10 glasses per day. ®Promotes well-being and facilitates in cleansing the body. 2. Instruct client and family members to have the client avoid fatty and salty foods such as fried meats, “bagoong”, and dried fishes. ®These foods lead to trigger hypertension of client to attack. 3. Encourage family members to prepare and have the client eat foods rich in protein, vitamin C, potassium, carbohydrates and calcium, if not contraindicated with her condition.

® To boost the immune system. Vitamin C helps in prevention of infections; protein helps in tissue repair; potassium promotes in heart muscles; carbohydrates replenish used energy and calcium has important role in blood coagulation. 4. Advise not to skip meals and eat at regular intervals. ® To meet the daily nutritional requirement of the body. 5. Advise to consult a dietician that would help in planning the right food for the client. ® Dieticians will ensure the promotion of the right food for a person.