DISCHARGE PLANNING

CONGESTIVE HEART FAILURE

Medications include:
Anticoagulants or Thrombolytic agents - These blood-thinning medicines may be prescribed to prevent the formation of blood clots and reduce the risk of stroke in patients with Valvular Heart Disease Digitalis - Digitalis makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms Ace Inhibitors - Ace (angiotensin converting enzyme) inhibitors are used to treat heart failure by lowering blood pressure. This is achieved by inhibiting the formation of a chemical called angiotensin that raises blood pressure by causing arteries to constrict Beta-blockers - Beta-blockers work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle Calcium Channel Blockers - Calcium Channel Blockers reduce the frequency and severity of chest pain. They reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure Diuretics - Diuretics, also referred to as water pills, increase the excretion of fluids in the body through the urine helping to prevent fluid build-up and congestion in the lungs Antibiotics - Anti-infective agents such as antibiotics may be prescribed prior to invasive medical or dental procedure to prevent a serious infection called bacterial endocarditis Cardiac glycosides help your heart beat strongly and decrease abnormal heartbeats. Blood thinners prevent blood clots Aspirin or clopidogrel (Plavix) or another blood thinner

Warfarin (Coumadin). If you are taking warfarin, you will need to have regular blood tests. You may be able to use a device to check your blood at home.

Do not smoke cigarettes or use illegal drugs Cardiac Rehabilitation. Daily weight: Activity: Regular Exercise

Do not stand or sit in the same spot for too long. Move around a little bit. Walking is a good exercise for the lungs and heart after surgery. Take it slowly at first. Climbing stairs is okay, but be careful. Balance may be a problem, so hold onto the railing. Rest part way up the stairs if you need to. Begin with someone walking with you.

You can do light household chores, such as setting the table or folding clothes. Stop if you feel short of breath, dizzy, or have any pain in your chest. Do not do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine, twisting, or lifting weights.

Lifestyle Modifications
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:

Healthy Diet Choices - Eating a low fat, low salt, low cholesterol diet while avoiding excessive intake of alcohol and caffeine

Don't Smoke - If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit

Reduce stress through exercise - Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of wellbeing. Always discuss with your doctor before beginning any new exercise program

Weight Loss - Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice

Sexual activity

Return to sexual activity gradually Usually it is okay to start after 4 weeks, or when you can easily climb 2 flights of stairs or walk a half-mile.

Keep in mind that anxiety, and some medicines, may alter arousal and performance for both men and women.

Men should not use medicines for impotence (Viagra, Cialis, or Levitra) until their doctor says it is okay

Exercise and diet

Choose plenty of fresh fruits and vegetables. They contain only small amounts of salt. Choose foods that are low in salt, such as fresh meats, poultry, fish, dry and fresh legumes, eggs, milk and yogurt. Plain rice, pasta and oatmeal are good low-sodium choices. However, the sodium content can increase if salt or other high-sodium ingredients are added during their preparation. Season with herbs, spices, herbed vinegar and fruit juices. Avoid herb or spice mixtures that contain salt or sodium. Use lemon juice or fresh ground pepper to accent natural flavors. Try orange or pineapple juice as a base for meat marinades. See "Salt-Free Herb Blends," below, for other ideas. Modest exercise keeps the body strong, and can help reduce high cholesterol and blood pressure, which are risk factors for heart disease. Maintaining a healthy weight is important for cardiac health. Salt (sodium) restriction of only 2-3 grams per day can lessen fluid retention and improve symptoms related to heart valve disease. A low salt diet means that salt should not be added to food, and high sodium foods like deli meats, nuts, canned soup, and fast food should be avoided

COMMUNITY ACQUIRED PNUEMONIA MR

Medicines:

Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your antibiotics exactly as ordered by your primary healthcare provider. Do not stop taking your medicine unless directed by your primary healthcare provider. Never save antibiotics or take leftover antibiotics that were given to you for another illness.

Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs Bronchodilators: to help open the air passages in your lungs, and help you breathe more easily.

Antipyretics: This medicine is given to decrease a fever. Steroids: Steroid medicine may help open your air passages so you can breathe easier Inhalers and nebulizers: An inhaler gives your medicine in a mist form so that you can breathe it into your lungs. This type of medicine may also be given using a nebulizer, or "breathing treatment machine". Using inhalers and nebulizers the right way takes practiceAntifungal medicine: This medicine helps kill fungus that may be causing your pneumonia.

Antiviral medicine: This is given to treat pneumonia if it is caused by a virus.

Breathing treatments and support:

Deep breathing and coughing: . Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up mucus from your lungs. Sit up regularly or get out of bed to help you breathe easier and get better faster.

Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose.

Self-care:

Avoid the spread of germs

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Wash your hands often with soap and water. Use gel hand cleanser when there is no soap and water available. Do not touch your eyes, nose, or mouth unless you have washed your hands first. Cover your mouth when you cough.

Cough into a tissue or your shirtsleeve so you do not spread germs from your hands. If you are sick, stay away from others as much as possible.

Drink enough liquids:

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Men 19 years old or older should drink about 3 liters of liquid each day (close to thirteen 8 ounce cups). Women 19 years old or older should drink about 2.2 liters of liquid each day (close to nine 8 ounce cups). Liquids help thin your mucus, which may make it easier for you to cough it up. While you are sick, do not drink alcohol.

Get vaccinated:
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The pneumococcal vaccine is given to adults aged 65 years or older to prevent pneumococcal disease, such as pneumonia. People aged 19 to 64 years at high risk for pneumococcal disease also should get the pneumococcal vaccine. It may

need to be repeated 5 years later. Get an influenza (flu) vaccine every year as soon as it becomes available.

Quit smoking:
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Do not smoke, and do not allow others to smoke around you. Smoking increases your risk of lung infections and CAP. Smoking also makes it harder for you to get better after a lung infection.

Rest: Rest when you feel it is needed. Slowly start to do more each day. Return to your daily activities as directed.

TUBERCULOSIS
Continue medication as Prescribe by the Doctor: 1. 2. 3. 4. 5. DIET: Zectin 1cap 30 mg bid Rosvastatin 1 tab 10 mg after super Allupurinol 100 mg 1 tab bid Flixotide 1 neb q12h Combevent 1 neb q4h Get vaccinated and avoid socializing with people who have a persistent cough. Make sure that you eat well and enjoy plenty of sunlight and exercise. Seek medical attention if you develop a cough that persists for more than three weeks. Drink warm fluids and avoid cold fluids Avoid cold weather as much as you can Eat healthy food that contain essential nutrients Stop smoking is very important Take the medications regularly in very strict way

Vitamin A found in cod liver oil may have helped treat the disease by boosting the immune systems response to the bacteria. Consume an adequate amount of fruit and vegetables but stay within the correct calorie level for a healthy weight. On a 2000calorie diet, eat 2 cups of fruit and 2 and half cups of vegetables per day. Eat more or less according to your calorie needs. Eat a variety of fruit and vegetables each day. Choose from all five vegetable sub-groups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. Consume 3 or more ounce-equivalents of whole-grain foods each day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half your grains should come from whole grains. Eating at least 3 ounce-equivalents of whole

grains per day can reduce the risk of heart disease, may help with weight maintenance, and will lower your health risk for other chronic diseases. Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. Adults and children can consume milk and milk products without worrying that these foods lead to weight gain. There are many fat-free and low-fat choices without added sugars that are available and consistent with an overall healthy dietary plan. If a person has difficulty drinking milk ...choose alternatives within the milk food group, such as yogurt or lactose-free milk, or consume the enzyme lactase prior to the consumption of milk products. For people who must avoid all milk products (e.g. individuals with lactose intolerance, vegans), non-dairy calcium-containing alternatives may be chosen to help meet calcium needs.

Dietary Fat

Eat less than ten percent of calories from saturated fats and less than 300 mg/day of cholesterol, and eat as few trans-fats (hydrogenated fat) as possible. Maintain your total intake of fats/oils at between 20-35 percent of calories, with most fat coming from polyunsaturated and monounsaturated fat, such as oily fish, nuts, and vegetable oils. Regarding meat, poultry, dry beans, and milk or milk products, choose lean, low-fat, or fat-free options.

Carbohydrates Protein

Eat fiber-rich fruits, vegetables, and whole grains as often as possible. Consume foods and drinks with little added sugars or caloric sweeteners.

Eat lean meats and poultry. Bake, broil, or grill food. Eat a variety of protein rich foods, with more fish, beans, peas, nuts and seeds.

Sodium and Potassium

Eat less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. Choose low-sodium foods, and do not add salt when cooking. Also, eat potassium-rich foods, such as fruits and vegetables.

Patient Teaching & Home Health Guidance for Patient with Pulmonary Tuberculosis

Improve ventilation by opening windows in room of affected person, and keeping bedroom door closed as much as possible.

Instruct patient to cover mouth with fresh tissue when coughing or sneezing and to dispose of tissues promptly in plastic bags. Discuss Tuberculosis TB testing of people residing with patient. Investigate living conditions, availability of transportation, financial status, alcohol and drug abuse, and motivation, which may affect compliance with follow-up and treatment. Initiate referrals to a social worker for interventions in these areas. Report new cases of Tuberculosis TB to public health department for screening of close contacts and monitoring. Review possible complications: hemorrhage, pleurisy, symptoms of recurrence (persistent cough, fever, or Hemoptysis). Instruct patient on avoidance of job-related exposure to excessive amounts of silicone (working in foundry, rock quarry, sand blasting), which increases risk of reactivation. Encourage patient to report at specified intervals for bacteriologic (smear) examination of sputum to monitor therapeutic response and compliance. Instruct patient in basic hygiene practices and investigate living conditions. Crowded, poorly ventilated conditions contribute to development and spread of Tuberculosis TB. Encourage regular symptom screening and follow-up chest X-rays for rest of life to evaluate for recurrence. Show the patient and family how to perform postural drainage and chest percussion. Also teach the patient coughing and deep-breathing exercises. Instruct him to maintain each position for 10 minutes and then to perform percussion and cough. Instruct patient on prophylaxis with isoniazid for people infected with the tubercle bacillus without active disease to prevent disease from occurring, or to people at high risk of becoming infected.

References: Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patiens with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines