AMERICARE LLC

PHYSICIAN RECOMMENDED PLAN OF CARE

AHHS#: 375 HAMDAN AHMED NASSER AL RAISI

Sex Male
Age 10 years old
Date of birth May 16, 2009
DAMAN thiqa number 02827539
Contact person and phone number 0504131111 (Raisa-mother)
Location Abu Dhabi, UAE
Service requested 12 hour Nursing Service
Medication allergies NKDA
Date & Time prepared JUNE 02, 2020 0900H

Care Codes: 99509, 99348

Diagnoses/ Medical History:

Primary diagnosis:
Down syndrome

Secondary diagnosis:
Hypothyroidism
Obstructive sleep apnea
Obesity

Additional Background:

This 10 year old male child has a case of Down syndrome and hypothyroidism has a regular treatment of levothyroxine, he has also episodes of sleep apnea. He’s still
at risk of doing harm to himself and others. He needs monitoring to ensure patient’s safety, assist in activities of daily living and timely administration of medication.

Form Title Index Code Date Developed Revision No. Revision Date Next Revision Date
PHYSICIAN RECOMMENDED PLAN OF CARE AHHS/F/MDT/001/R03 Mar-15 03 May-18 May-20
Page 1 of 3
 AMERICARE LLC

PHYSICIAN RECOMMENDED PLAN OF CARE

Care Plan Update

JUNE 2020

This 10- year- old patient has a case of Down syndrome, Hypothyroidism and history of sleep apnea, has uncontrolled obesity and Vitamin D deficiency.
He is regularly taking Levothyroxine 100 mcg once a day and Vit.D 10,000 i.u. twice a week. Patient had an episode of aggressiveness most of the time and
have difficulties in socializing people. Performing daily activities of patient is also difficult to maintained most especially personal hygiene and body
weight as well. In his condition, the patient needs a 12 hours nursing care, it requires skilled nurse to handle his case to maintain and provide his needs,
providing him a proper diet and exercise to control his obesity, ensuring safety by keeping the patient safe especially during physical activities by strictly
implementing high fall risk prevention and the safety of others as well, closely monitoring his vital signs and most especially ensuring the proper
administration of his medication at the right time, route and dose . Patient also need a nurse who can understand his thoughts and will give adequate
attention. A nurse that can also assist the patient in performing his daily activities such as full bath, mouth care and proper skin care.

Health Need ADL Care

CODES 99509
Frequency Daily
Expected Outcomes  Patient will maintain proper hygiene, be free from pressure injury and skin will remain intact.
 Patient will be free from injuries resulting from falls.
 Patient will be free from injuries resulting from self-harm.
Nursing Interventions/Details of care The nurse on duty will ensure that the following interventions are completed during the shift:
 Assess patient and complete all ADLs including perineal care, oral care and bathing observing medical
requirements.
 Monitor vital signs at least three times per shift.
 Patient has sleep apnea. Nurses will monitor oxygen saturation especially during sleep.
 Keep perineal area clean and dry
 Ensure that privacy is maintained during activities requiring body exposure.
 Stimulate child with appropriate developmental activities to help promote child’s development and reach targeted
milestones.
 Provide oral care every after feeding and as necessary.
 Allow patient to socialize with other family members. Encourage interaction between relatives and patients.
 Prevent the patient from hurting, biting himself, head banging and other activities that may cause physical trauma.

Form Title Index Code Date Developed Revision No. Revision Date Next Revision Date
PHYSICIAN RECOMMENDED PLAN OF CARE AHHS/F/MDT/001/R03 Mar-15 03 May-18 May-20
Page 2 of 3

Training Needs of Individual/Staff
Estimated Date of Completion
Health Need
CODES
Frequency
Physician Care Plan
Estimated Date of Completion
Mary Ann A. Aninion, RN
Physician’s Signature
Form Title
PHYSICIAN RECOMMENDED PLAN OF CARE
AMERICARE LLC
PHYSICIAN RECOMMENDED PLAN OF CARE
Patient identified at High Risk for Fall as per Humpty Dumpty Tool and Protocol. Fall prevention precautions will be
initiated and observed at all times.
 In bathing, have a non-slip surface on the bathroom or use a non-slip bath mat.
 Place cushions, bumpers or guards on sharp corners of furniture.
 Keep the patient safe during activities, therapies and transfers.
 Communicate the patient’s high risk status during handovers.
 Educate family regarding fall prevention strategies.
 Post a Humpty Dumpty Falling sign near patient’s bed.
 12 Hour supervision needed. Do not leave patient unattended. Watch, listen and stay near patient.
Nurse skilled in caring for pediatric patient with complex medical needs.
Chronic condition. Will re-evaluate after 3 months or if a caregiver /family member becomes competent in this
complex level of care.
Patient Re-Evaluation
99348
2
The physician will be skilled in assessing Pediatric patients. He/She will implement interdisciplinary approach to care
such as health maintenance, management of nutrition, hydration and prevention of complications. Physician will also
follow up on the patient’s response to the therapeutic regimen. He/She will also take note of the significant
improvement of the patient. Needful recommendations to other disciplines will also be taken into consideration as well
as necessary laboratory workups.
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Nurse’s Signature
Index Code Date Developed Revision No. Revision Date Next Revision Date
AHHS/F/MDT/001/R03 Mar-15 03 May-18 May-20
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