TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING

PATIENT EDUCATION FORM

Name Area
Inclusive
Year Level RLE Group dates of
Rotation
Name of
Age Gender
Patient
Date
Diagnosis
Admitted

MAIN CONCEPT / TOPIC: Pneumonia

- Breathing warm, moist (wet) air helps loosen the sticky mucus that may be choking
your child. Other things that may help include: Placing a warm, wet washcloth loosely
near your child's nose and mouth.
- To soothe the throat and relieve the cough with a safe remedy, give a warm water,
ginger, honey and also lemon can help relieve the cough.

Patient’s Signature / Significant Other’s

Signature
Date Signed
Date Submitted
Form No.: TSU-COS-SF-09 Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1