1.

Cardiac Failure
- Weight monitoring: teach client the importance of measuring and recording daily weights and report
unexplained increase of 3-5 pounds. A sudden weight gain can mean your heart failure is getting worse.

- Diet: sodium restriction to decrease fluid overload and potassium rich foods to replenish loss from
medications; do not restrict water intake unless directed.
Limit your salt as directed by your healthcare provider by doing the following:
 Limit canned, dried, packaged, and fast foods.
 Don't add salt to your food.
 Season foods with herbs instead of salt.
 Watch how much liquids you drink. Drinking too much can make heart failure worse. Talk with your
healthcare provider about how much you should drink each day.
 Limit the amount of alcohol you drink. It may harm your heart. Women should have no more than 1
drink a day. Men should have no more than 2 a day.
 Ask that your meals have no added salt when you eat out.
- Activity: Simple activities such as walking or gardening can help. Exercising most days of the week can make
you feel better. Don't be discouraged if your progress is slow at first. Rest as needed. Stop activity if you get
symptoms such as chest pain, lightheadedness, or shortness of breath.

-Tobacco: Smoking increases your chances of having a heart attack by harming the blood vessels that provide
oxygen to your heart. This makes heart failure worse. Quitting smoking is the number one thing you can do to
improve your health.

- Medication regime: explain the importance of following all medication instructions

- Follow-up care: Have a follow-up appointment as instructed. Depending on the type and severity of heart
failure you have, you may need follow-within 7 days from hospital discharge. Keep appointments for checkups
and lab tests that are needed to check your medicines and condition.

2. Acute Myocardial Infarction

- Exercise : Your healthcare provider may tell you to get more exercise if you haven't been physically active.
Depending on your case, your provider may recommend an exercise program that is best for you. Warm up 5
to 10 minutes before exercising and cool down 5 to 10 minutes after exercising.

Diet: Your healthcare provider will tell you what changes you need to make to your diet. You may need to see
a registered dietitian for help with these diet changes. These changes may include:

 Cutting back on how much fat and cholesterol you eat

 Cutting back on how much salt (sodium) you eat, especially if you have high blood pressure
 Eating more fresh vegetables and fruits
 Eating lean proteins such as fish, poultry, beans, and peas, and eating less red meat and processed
meats
 Using low-fat dairy products
 Using vegetable and nut oils in limited amounts
 Limiting how many sweets and processed foods such as chips, cookies, and baked goods you eat
 Limiting how often you eat out. And when you do eat out, making better food choices.
 Not eating fried or greasy foods, or foods high in saturated fat
- Explain cardiac rehabilitation program if ordered. Cardiac rehabilitation is a medically supervised program to
help people who have heart disease. It's designed to improve heart recovery and your ability to function. It also
helps prepare you for activities of daily living.

- Explain medication regime as prescribed; identify side effects to report (provide written instructions for later
report (provide written instructions for later reference)

- Stress the importance of immediate reporting of chest pain or signs of decreased CO2

3. Acute Pulmonary Failure

- Quit smoking
- Protect yourself from infection: Wash your hands often. Get a flu shot every year.
- Weight monitoring: teach client the importance of measuring and recording daily weights and report
unexplained increase of 3-5 pounds

- Diet: sodium restriction to decrease fluid overload and potassium rich foods to replenish loss from
medications; do not restrict water intake unless directed

- Medication regime: explain the importance of following all medication instructions

- Instruct client and family to maintain elevation of the head of the client at least 45 degrees; position increases
chest expansion and mobilizes fluid from the chest into more dependent areas

4. Stroke
Thinking and Speaking: Tips for making clothing easier to put on and take off are: Velcro is much easier than
buttons and zippers, all buttons and zippers should be on the front of a piece of clothing.
Use pullover clothes and slip-on shoes.

Avoid constipation:
 Drink more fluids.

 Stay active or become more active as much as possible.

 Eat foods with lots of fiber.

Medication: Have all of your prescriptions filled before you go home. It is very important that you take your
medicines the way your provider told you to. Do not take any other drugs, supplements, vitamins, or herbs
without asking your provider about them first.

5. Acute Renal Failure

- Dietary and fluid restrictions, including those that may be continued after discharge

- Nutrition: Your healthcare provider may tell you to eat food low in sodium (salt), potassium, phosphorus, or
protein. A dietitian can help you plan your meals.

- Signs of complications such as fluid volume excess, CHF, and hyperkalemia

- Monitor weight, blood pressure, pulse, and urine output

- Avoid neprotoxic drugs and substances: NSAIDs, some antibiotics, radiologic contrast media, and heavy
metals; consult care provider prior to taking any care provider prior to taking any OTC drugs OTC drugs

- Recovery of renal function requires up to 1 year; during this period, nephrons are vulnerable to damage from
nephrotoxins

6. Increased Intracranial Pressure

- Teach the client at risk for increased ICP to avoid coughing, blowing the nose, straining for bowel
movements, pushing against the bed side rails, or performing isometric exercises

- Advice the client to maintain neutral head and neck alignment

- Encourage the family to maintain a quiet environment and minimize stimuli

-Educate the family that upsetting the client may increase ICP

7. Metabolic Emergencies (DKA/HHNK)

DKA
 Take your insulin and other diabetes medicines on time and in the right dose

 Test your blood sugar before meals and at bedtime or as often as your doctor advises.
  Teach others at work and at home how to check your blood sugar. Make sure that someone else knows
how do it in case you can't.

 Eat regular meals that spread your calories and carbohydrate throughout the day. This will help keep
your blood sugar steady

HHNK

- - Instruct client and family about HHNK, symptoms to report, and administration of new medications

- Provide patient and family education to foster prevention of future episodes

8. Massive Bleeding

- Explain procedures to the client

- Support the family by explaining emergency measures and interventions

- Instructions on monitoring vital signs at home, including heart rate, blood pressure, and respiratory rate.

- Understanding prescribed medications and their role in preventing or managing bleeding.

- Importance of attending follow-up appointments with healthcare providers.

9. Extensive Burns
- Environmental safety: use low temperature setting for hot water heater, ensure access to and adequate
number of electrical cords/outlets, isolate household chemicals, and avoid smoking in bed

- Use of household smoke detectors with emphasis on maintenance

- Proper storage and use of flammable substances

- Evacuation plan for family

- Care of burn at home

Diet:

 Resume your usual diet.

 Eat a well-balanced diet.

- When outside, use a #15 or greater sunscreen and wear protective clothing. Apply 30 minutes before going
out in the sun. Reapply every 30 minutes if perspiring.

Prescriptions related to burn care:

 Pain Medication may be prescribed.

 Take 30 to 45 minutes prior to dressing changes or scheduled appointment on the Burn Unit.

 Antibiotics may be prescribed; take as directed.

10. Poisoning
- Assist the client and family in seeking the appropriate referrals and provide client education to further
complications or incidence of overdose

- Ensure that the client and family understand discharge instruction for follow up care or reason for admission

- Securely store medications, household cleaners, and chemicals out of reach of children and pets.

-Teach basic first aid measures, such as removing contaminated clothing, rinsing the skin or eyes with water,
and seeking fresh air.

-Do not induce vomiting unless instructed by a healthcare professional or Poison Control.
11. Multiple Injuries
Wound Care:

 Keep wounds clean and dry.

 Change dressings as instructed by healthcare providers.

 Watch for signs of infection, such as increased redness, swelling, or discharge.

Pain Management:

 Take prescribed pain medications as directed.

 Use ice or heat packs as recommended for pain and swelling.

 Follow any specific guidelines for over-the-counter pain relief if advised by your healthcare provider.

Activity Restrictions:

 Limit physical activities based on the severity and type of injuries.

 Follow any weight-bearing restrictions or limitations on movement.

 Use assistive devices, such as crutches or a brace, if prescribed.

Medications:

 Take prescribed medications as directed.

 Follow any specific instructions regarding antibiotics or other medications.

Follow-up Appointments:

 Schedule and attend all follow-up appointments with healthcare providers.

 Ensure you understand the purpose of each appointment and any necessary preparations.

Physical Therapy/Rehabilitation:

 If applicable, follow through with any prescribed physical therapy or rehabilitation exercises.

Gradually increase activity levels under the guidance of a physical therapist.

Nutrition:

 Follow any dietary recommendations provided by healthcare professionals to support healing and overall
health.

Signs of Complications:

 Be aware of signs of complications, such as increased pain, swelling, numbness, or changes in skin
color.

 Seek medical attention promptly if you experience any unexpected symptoms.

Assistance at Home:

 Arrange for help at home if needed, especially if mobility is limited.

 Ensure a safe and accessible environment at home.

References:
https://www.scribd.com/doc/55354481/Acute-Biologic-Crisis
https://www.saintlukeskc.org/health-library/discharge-instructions-heart-failure
https://www.mountsinai.org/health-library/discharge-instructions/stroke-discharge
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221
https://www.saintlukeskc.org/health-library/discharge-instructions-copd
https://www.mountsinai.org/health-library/discharge-instructions/stroke-discharge
https://www.drugs.com/cg/acute-kidney-injury-discharge-care.html
https://uihc.org/educational-resources/home-care-instructions-burns