urgent health concern? please call telephone care...

Patient Care Plan

John SmithLEFT HOSPITAL:

12/6/2016

BRING THIS PLAN TO ALL MEDICAL APPOINTMENTS

© COPYRIGHT 2016 ENGINEERED CARE, INC.

URGENT HEALTH CONCERN?PLEASE CALL TELEPHONE CARE AT: (800) 455-0057

FOR ROUTINE CONCERNS:

Dr. Jane Doe(444) 444-4444


My Contacts

HOME CARE SERVICES

Generic Home Health Tel: (555) 555-5555

VETERANS CRISIS LINE

The Veterans Crisis Line connectsVeterans in crisis and theirfamilies and friends withqualified, caring Department ofVeterans Affairs responders

Veterans and their loved ones can call 1-800-273-8255and Press 1, chat online at www.veteranscrisisline.net,or send a text message to 838255 to receiveconfidential support 24 hours a day, 7 days a week,365 days a year.

© COPYRIGHT 2016 ENGINEERED CARE, INC. JOHN SMITH

Congestive Heart Failure

Heart failure, also called congestive heart failure (CHF), is a serious condition in which the heart does notadequately pump enough blood to the rest of the body.

THINGS YOU NEED TO DOCall your doctor if you have weakness, cough, or sudden weight gain and swelling.•

Take your medications as prescribed.•

Limit salt intake.•

Don't smoke.•

Walk or stay active on the days that you are feeling well.•

Get enough rest, including after exercise, eating, or other activities.•


Heart Failure Warning Signs

Green Zone:

This is your green zone.Being in this zone means that yoursymptoms are under control.

You have:•No shortness of breath•No weight gain more than 2 pounds (Your weight may change 1 or 2 pounds some days)•No swelling of your feet, ankles, legs. or stomach•

Yellow Zone:

This is your warning zone.If you have any of these problemsyou should contact your medicalteam at:1-800-455-0057

You are experiencing:•You have a weight gain of 3 pounds in 1 day or a weight gain of 5 pounds or more in 1 week.•More shortness of breath•More swelling of your feet, ankles, legs, or stomach•Feeling more tired. No energy•Dry hacky cough•Dizziness•Feeling uneasy, you know something is not righ•It is harder for your to breathe when lying down. You need to sleep sitting up in a chair.•

Red Zone:

This is your emergency zone.Seek help immediately!

Go directly to your local emergency room, or call 911, if:•You are struggling to breathe or have unrelieved shortness of breath while sitting still•You have chest pain•You have confusion or can't think clearly•


Limiting Fluids

Your doctor has prescribed fluid restriction for you. This means you need to limit the amount of fluids that you drink. If your kidneys are healthy, they balance the amount of fluid that enters and leaves your body. If your body cannot maintain this fluid balance because of illness or injury, you may need to limit the amount you drink

Measuring Fluid

Drink the amount of fluid recommended by your

doctor. Don't drink more or less.

•

1 cup = 8 oz = 240 cc = 240 ml•

4 cups = 32 oz = 1,000 ml (or cc) = 1 liter•

6½ cups = 50 oz = 1,500 ml (or cc) = 1.5

liters

•

8-1/3 cups = 67 oz = 2,000 ml (or cc) = 2

liters

•

1 can of soda = 1½ cups = 12 oz = 360 ml (or

cc)

•

2 cups = 500 ml (or cc)•

Limiting Fluid

Drink only when you are thirsty.•

You can try rinsing your mouth with cold water

or mouthwash (without swallowing), chew

sugar-free gum or hard candy to feel less

thirsty.

•

Drink from a small glass or cup•

Divide fluids up during the day; divide them

between meals

•

Take your medicine with your liquids at meals•

Avoid salty foods.•


Medication Tips

It’s easy to forget to take your medicine, especially when you take a lot of pills. But, to get the best results frommedicines, always take them as directed. The tips on these pages can help you keep track

Staying on Schedule

Every medicine has a different purpose. So,

each one needs to be taken as prescribed.

Don’t skip pills or stop taking a medicine, even

when you feel fine.

•

Take your medicine at set times. You could take

it each morning with breakfast or right before

you go to bed. Some medicines may need to be

taken at certain times of the day, or with food.

Ask your doctor if this is the case for any of

your medicines.

•

When traveling, keep all medicines in your

carry-on bag. This way you’ll have them in case

you and your checked luggage get separated.

•

SafetyTips

Get help organizing your pills if you need it.

Taking more than one medicine can be

confusing. A family member or friend can help

prevent you from making a mistake that could

be dangerous to your health

•

Fill all your prescriptions at the same drug

store. This way, your records are all in one

place

•

Ask your pharmacist or doctor for a “fact sheet”

or other patient information when you start a

new medicine

•

Give a copy of your medicine list to a family

member or close friend. Hold copies of each

•


other’s lists in case of emergency

JOHN SMITH

My Meds

What do I need to take? How do I take this?

SODIUM BICARBONATE 325MG TAB TAKE TWO TABLETS BY MOUTH ONCE A DAY FOR CHRONIC KIDNEY DISEASE

You have 3 refills remaining. Use this number to order a refill of this medication: 6xxxxx

SHARPS DISPOSAL CONTAINER 1 QUART SIZE USE THIS AS DIRECTED


ROSUVASTATIN CA 20MG TAB TAKE ONE-HALF TABLET BY MOUTH AT BEDTIME FOR CHOLESTEROL

You have no refills for this medication.

POLYETHYLENE GLYCOL 3350 ORAL PWDR TAKE 1 CAPFUL = 17 GRAMS BY MOUTH TWO TIMES A DAY MIX WITH 8OZ OF WATER FORCONSTIPATION


PIMECROLIMUS 1% TOP CREAM APPLY SMALL AMOUNT TOPICALLY TWICE A DAY AS NEEDED FOR RASH ON FACE


NOVO FINE 30 DISPOSABLE NEEDLE USE NEEDLE FOUR TIMES A DAY BEFORE MEALS AND AT BEDTIME



My Meds (continued)


MIRTAZAPINE 15MG TAB TAKE ONE TABLET BY MOUTH AT BEDTIME FOR SLEEP


MELATONIN 3MG CAP/TAB TAKE ONE PILL BY MOUTH AT BEDTIME FOR SLEEP


LEVOTHYROXINE NA (SYNTHROID) 0.075MG TAB TAKE ONE TABLET BY MOUTH ONCE A DAY BEFORE A MEAL. FOR THYROID. DO NOT GIVEWITHIN 30 MINUTES OF SEVELAMER.


LANCET,SOFTCLIX USE FOR FINGER STICK AS DIRECTED TO CHECK BLOOD GLUCOSE


INSULIN,GLARGINE 100 UNT/ML 3ML SOLOSTAR INJECT 10 UNITS UNDER SKIN ONCE A DAY BEFORE A MEAL. FOR DIABETES


INSULIN,ASPART 100UN/ML NOVO FLEXPEN 3ML INJECT 3UNITS UNDER SKIN THREE TIMES DAILY BEFORE MEALS TAKE 15 MINUTESBEFORE MEALS FOR DIABETES



My Meds (continued)


HYDROPHILIC (EQV AQUAPHOR) TOP OINT APPLY SMALL AMOUNT TOPICALLY THREE TIMES A DAY FOR SKIN PROTECTION FOR DRYSKIN


HYDROCHLOROTHIAZIDE 25MG TAB TAKE ONE-HALF TABLET BY MOUTH ONCE A DAY FOR FLUID RETENTION


FUROSEMIDE 80 MG TAB TAKE ONE TABLET BY MOUTH TWO TIMES A DAY FOR FLUID RETENTION


FERROUS GLUC 5GR (EQV 300-325MG) TAB TAKE ONE TABLET BY MOUTH ONCE A DAY WITH FOOD FOR ANEMIA


EPOETIN ALFA,RECOMBINANT 2000 UNT/ML INJ INJECT 2,000 UNITS (1 ML) UNDER SKIN ON MONDAY, WEDNESDAY AND FRIDAY DOSE TOBE GIVEN IN HD CLINIC: 2,000 UNITS. NORMAL DOSE RANGE 10-50 UNITS/KG. LABS:10/27/2016 HGB 6.9 L 10/24/2016 FERRITIN 187 . PHARMACY: DO NOTDISPENSE.



My Meds (continued)


DOXAZOSIN MESYLATE 4MG TAB TAKE ONE TABLET BY MOUTH EVERY EVENING TO HELP URINE FLOW


CLOBETASOL PROPIONATE 0.05% OINT, 45GM APPLY SMALL AMOUNT TOPICALLY TWICE A DAY AS NEEDED FOR SKIN CONDITION FORITCHING AND RASH ON HANDS


CAMPHOR 0.5/MENTHOL 0.5% LOTION APPLY SMALL AMOUNT TOPICALLY TWO TIMES A DAY FOR DRY, ITCHY SKIN FOR ITCHINGON BODY


ASPIRIN 81MG EC TAB TAKE ONE TABLET BY MOUTH ONCE A DAY FOR HEART


ASCORBIC ACID 500MG TAB TAKE ONE TABLET BY MOUTH ONCE A DAY FOR SUPPLEMENT


AMLODIPINE BESYLATE 10MG TAB TAKE ONE TABLET BY MOUTH ONCE A DAY FOR HIGH BLOOD PRESSURE



My Meds (continued)


AMIODARONE HCL 200MG TAB TAKE ONE-HALF TABLET BY MOUTH ONCE A DAY FOR HEART RHYTHM


ALCOHOL PREP PAD USE 1 PAD TOPICALLY AS DIRECTED


ACCU-CHEK AVIVA PLUS(GLUCOSE) TEST STRIP USE 1 STRIP FOUR TIMES A DAY BEFORE MEALS AND AT BEDTIME FOR TESTING BLOODSUGAR CHECK JUST PRIOR TO MEALS FOR INSULIN DOSING AND ALSO AT BEDTIME FORRECORDING

You have 1 refills remaining. Use this number to order a refill of this medication: 8xxxxxx


This is your final medication list. Please only take these medications.

TAKE THESE MEDICINES ONLY AS NEEDEDWhat do I need to take? Why am I taking this? How do I take this? How much do I take?

NEWalbuterol 90 MCG/ACT Metered DoseInhaler, 200 ACT

COPD inhalation 1-2 puffsevery 6 hours

NEWInsulin, Aspart, Human 100 UNT/MLInjectable Solution

Diabetes Subcutaneous SEE INSULIN PAGEMorning, Afternoon, Evening

Glucose 4g Chewable tablet low blood sugars (less than70)

Oral 3 tabletsas directed

If you miss a dose, or are late on a dose, please refer to your pharmacy handout..

JOHN SMITH

My Meds (continued)

My Insulin Sliding ScaleInsulin, Aspart, Human 100 UNT/ML Injectable Solution

Take for Diabetes 3 times a day

Follow this sliding scaletable depending on bloodsugar.

IF MY BLOOD SUGAR IS:

Below 70 glucose tablet or orange juice

60 to 200 Do not take any insulin

201 to 250 Take 2 units




Above 400 Take 6 units and Call your doctor.

JOHN SMITH

Additional Information about My Meds

ALLERGIES

BEANSEGGPLANTGRAPEFRUITBERRIESMELONS

MY PHARMACY

VA3801 Miranda AvePalo Alto, CA 94304TEL: (650) 493-5000

FOR PRESCRIPTION REFILLS

1) Refill by phone- 1-800-311-25112) Refill online at My HealtheVet www.myhealth.va.gov3) Refill by mail- mail your refill slips to: VA Palo Alto Health Care System Pharmacy Service (119) 3801 Miranda Ave. Palo Alto, CA 94304


Medicine Dosage Change ScheduleWednesday, December 7,

LEFT HOSPITAL

Take 40 MG of Prednisone 10 MG Oral Tablet

Thursday, December 8 Take 40 MG of Prednisone 10 MG Oral Tablet

Friday, December 9 Take 30 MG of Prednisone 10 MG Oral Tablet





JOHN SMITH

Saturday, December 10

Sunday, December 11

Monday, December 12

Tuesday, December 13

For My Health

My Diet and Nutrition Instructions

Because of your disease you should avoid excessive fluids in your diet. Fluids include all liquids thatyou drink (like water, milk, juices, tea, coffee, and soda) and anything that changes to liquid at roomtemperature (like ice cream, gelatin, and soup). To limit thirst try adding lemon to beverages, chewingsugar-free gum, or hard candies to keep your mouth moist. Any increases in your weight more than ½to 1 pound in a day usually means that you have gained fluid weight. Ask your healthcare provider or adietitian for more information about limiting fluid.

My Activity Instructions

Do not smoke. Do not lift anything.

Warning Signs

Infection: signs and symptoms include: temperature greater than 101F, chills, and/or night sweats,redness, swelling, or increased pain around the wound edges, incision, pus or bad smelling drainagefrom the wound or dressingInability to urinate, urinating frequently in small amounts, or painful urinationIncreased shortness of breathChest Pain: CALL 911


My Calendar for December 2016Sun Mon Tue Wed Thu Fri Sat

1 2 3

4 5 6 7 8 9Dental 1:00pmPalo Alto Campus

10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31


17 LEFT HOSPITAL 18

Dialysis- 8:30amPalo Alto Campus

PCP 10:30amSan Jose Campus

Cardiology 2:00pmPalo Alto, Campus

My HealtheVet

VA’s online personal health record. Veterans can find lab results,immunization records, health care team notes, current medical issues,as well as order prescription refills, see upcoming appointments andcommunicate with their care team.

To gain access to the upgraded features, please be sure to complete thein-person authentication at your nearest VA facility.

www.myhealth.va.gov


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