Demographics and Health History

Demographics

Health history

• Patient is a known case of AML (Acute Myelogenous Leukemia) diagnosed on February2015.

• Three days prior to admission, patient consulted at the out patient department for scheduling of 1st
cycle chemotherapy. Lamivudine 100mg/tab OD, Acyclovir 400mg/tab BID, Fluconazole 200mg/tab
OD, Cotrimoxazole 800mg+ 160mg tab OD.?? CBC and Blood transfusion requested. April 6
schedule of 1st chemotherapy.

Past Health History

• Has no past surgeries, or injuries that needed hospitalization

• (-) HTN, DM, Asthma, PTB, thyroid disease

• Blood transfusion: March 2015

• Has no allergies

• Immunization status: Unrecalled

Family Health history

• No history of HTN, DM, PTB, Thyroid disease, Asthma, CVD

Psychosocial Health History

• The patient is a carpenter

• Worked previously as driver, “mananahi”

• Non-smoker, Occasional alcohol drinker, denies illicit drug use

• Diet: mixed diet

• Food Preference: Vegetables and fish

• Goes to regular check-ups

• Has good interpersonal relation with family and peers

Discharge Plan
Medications:

• Discuss about the importance of taking medications on time to the patient.

• Instruct the patient to take all prescribed medications and avoid taking medications which were not
prescribed.

• Describe to the patient the medications to be received and why does she need to take it.

• Make patient aware of the side effects of the drugs to be taken.

• Emphasize on the time the drug is to be taken and its frequency.

Medication Dose,Time and Frequency

1.Levofloxacin - 700mg/tab 1 tab OD
2.Clindamycin (last dose: 4/23) (9am)
3.Moxifloxacin eye drops - 310 g/cap 1 cap q8hrs
(last dose:
4/21)(8am,4pm,12am)
- 1Drop OD (last dose:
4/22) (9am)
Exercise:

• Encourage patient to do moderate exercise as tolerated.

• Eg: walking, riding a bicycle, playing badminton

• Improve: fatigue, anxiety and self-esteem

• Helps: Heart and blood vessel fitness, muscle strength and body composition

• Emphasize importance of increasing the level of activity.

• If experiencing extreme fatigue, anemia (low red blood cell count), or a lack of muscle coordination
(ataxia), advise patient not to exercise.

• If immune system is compromised and white blood cell count is low (lower than 3,500 white blood
cells per microliter of blood), avoid public gyms, yoga studios, and other public places until white
blood cell count is at a safe level.

• If patient experiences any shortness of breath, pain, or tightness in chest, stop exercising
immediately. Advise to seek doctor and report what happened ;to develop a plan of movements
that are proper for the patient
Treatment:

• There were no specific home treatments ordered for the patient.

• If there were:

• Discuss to patient and relatives treatment to be continued at home and the purpose for doing it.

• Teach relative for proper way of doing home treatments like: CBG monitoring, Wound care etc

Hygiene:

• Emphasize to the patient to always do hand washing. Wash use soap and warm water, and spend
at least 20 seconds each time. When to wash?

• - Before and after eating and kitchen preparation

• - Before and after using the toilet

• - After handling money or other "public objects"

• - After handling animals, cleaning cages and cat boxes, etc.

• - anyone visiting should wash their hands

• Wipe "front to back" when using the toilet. (Consider gentle cleaning with a wet washcloth)

• - Daily shower or bath

• - Gentle but thorough dental care after every meal

• Avoid breaks in skin

• Use gloves when gardening.

• Use an electric shaver rather than a blade.

• Use care when using sharp instruments, including nail scissors.

• Care for cuts promptly, washing carefully and covering with bandage and antibiotic
cream.

• Avoid people with colds or other infectious illnesses

• Avoid children who may be exposed to childhood infections

• Avoid large crowds - try to shop or go to the theatre at less-crowded times

• Emphasize importance of oral hygiene.

OPD/ Follow-ups

• Remind patient and relatives of scheduled follow-ups.

• April 24, 2015 (pm) : schedule of follow-up

• Emphasize the need of frequent follow-ups to improve condition and promote wellness.

• Consult physician if fever (100.5 degrees Fahrenheit or higher) occurs 7-10 days after
chemotherapy

Diet:

Every meal:
• 1/2 vegetables and/or fruits
• 1/4 protein
• 1/4 whole grains
• A small amount of healthy fats
• Plenty of water

Spiritual/Sexual/Psychological

• Since client is a Roman Catholic, show support on her belief on how her faith can contribute to the
improvement of her condition.
• Reassure patient of the current status of his condition.

• Remind relatives to allow patient express his feelings and opinions about his condition.

• Encourage relatives to listen to the patients stories and respect whatever he tells them

• Tell patient that sexual activity may resume as interest, energy and comfort levels allow it.

Sources:

• http://www.baymoon.com/~gyncancer/library/weekly/aa082701a.htm

• http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and-Family-Support/Nutri
tion-Services.aspx#Meal_Planning

• http://www.chemocare.com/chemotherapy/health-wellness/tips-for-managing-eating-problems.as
px#.VTjPEtKqp8M

• http://www.caregiverslibrary.org/caregivers-resources/grp-diseases/hsgrp-chemotherapy/chemot
herapy-and-oral-hygiene-article.aspx

• http://www.breastcancer.org/tips/exercise/treatment/chemo_targeted