PROGNOSIS

CRITERIA POOR FAIR G JUSTIFICATION

OOD
The duration of illness is rated
fair since the client has
1. Duration of  experienced a major stroke
illness 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
2. Onset of  progressing symptoms of
illness stroke.

This is rated poor since among

the precipitating factors
3. Precipitating  present with the client, stress
factors 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.
4. Willingness to Brought by the grave
take the  consequence of stroke and the
medications/com desire to achieve optimal
pliance with functioning, the client and her
therapeutic family is serious with
regimen. complying with the
therapeutic regimen thus, this
rated good.
This disease is common
 among men and women aged
5. Age 65 and up, the client is 53
years old which makes her
indirectly vulnerable to the
said disease.
This is rated poor the
6. Environment  environment where she
resides is populated and
GENERAL PROGNOSIS

Poor = 1 Rating scale:

Poor = 0 – 1.6
Fair = 3
Fair =1.7 – 3.3
Good =5 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.

∗ 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.