X.

DISCHARGE PLAN

MEDICINES  Take maintenance medication as follows:

 Carvedilol 12.5 mg PO once a day
7 am
 Calcium carbonate 600 mg PO thrice a
day between meals
 Sodium Bicarbonate 325 mg tab PO
thrice a day
7 am 12 pm 7 pm
 Vitamin D 50 mcg PO Once a day
7 am
 Encourage strict compliance to treatment
regimens and take medication as directed.
 Avoid taking over-the counter drugs.
 Report if adverse reactions occur.
EXERCISE  Provide an environment that is conducive to
safety and wellness.
 Do not lift heavy weights using the affected
arm.
 Perform rubber ball compression on the affected
arm.
 Engage in physical exercises as tolerated.
 Resume activities of daily living as soon as
possible.
 Do not drive unless the doctor has said it is safe
to do so
TREATMENT  Clean the incision site with soap and water or
betadine.
 Follow infection protocols during wound
dressing.
 Keep the incision clean and dry.
HEALTH EDUCATION  Encourage strict compliance to treatment
regimens and take medication as directed.
 Seek prompt consultation if complications
occur.
 Get plenty of rest and sleep.
 Quit drinking alcohol.

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 OUTPATIENT  Call the doctor if you manifest the following
signs and symptoms
 Chest Pain
 Shortness of breath
 Easy bruising
 Bone, joint, and muscle pain
 Cyanosis
 Irregular heartbeat
 Muscle weakness
 Changes in mental status
 Swelling of legs and feet
 High blood pressure
DIET  Eat a healthy balanced diet. It should be rich in
fruits and vegetables.
 Restrict foods that are high in sodium,
potassium, and phosphate, such as canned
goods, processed meats, and bananas.
 Use herbs instead of salt when cooking.
 Avoid foods that are high in cholesterol and
sugar.
 Limit fluid intake.
SPIRITUAL SUPPORT/SEXUALITY  Encourage the patient to express concerns and
anxieties to her significant others.
 Provide assistance and reinforcement to allay
the patient's fears.
 Consider joining a support group.
 Sexual activities can be continued as long as the
affected arm is handled with care.

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XI. UPDATES
In the Philippines, kidney failure is seen as one of the most burdensome conditions as it is
the second-largest expense of the national health insurance agency, the Philippine Health Insurance
Corporation (Philhealth, 2018), and is often a source of out-of-pocket health expenditure among
households. By the end of 2016, there were 36 247 patients on dialysis in the country (Philippine
Renal Disease Registry, 2016), an increase of 15% from the previous year. The number of patients
who have KF but are not receiving any form of dialysis remains unknown.

While a kidney transplant is considered the best option for KF patients, donor's kidneys are
not readily available, and the cost of post-surgery monitoring and immunosuppression therapy is
limiting for most. Patients who are ineligible or on the waiting list for transplant have to resort to
dialysis. The choice depends on both patient and system-level factors such as age, comorbidities,
availability, affordability, and even personal preferences.(Chanouzas D, Ng KP, Fallouh B,
Baharani J., 2011). Most patients in the Philippines are on center-based HD (94%), while 4% are
on continuous ambulatory peritoneal dialysis. Only 2% of KF patients can get kidney transplants.
PhilHealth currently supports funding for all three modalities but at different levels of coverage.
(Bayani et al., 2020)

As of June 2020, there are over 20 pending bills in the 18th Congress of the Philippines
seeking to expand the coverage of HD from 90 to 156 sessions (assuming three sessions per week,
per year) and establish a dialysis center in each government hospital. Given PhilHealth's limited
budget, it is unclear whether expanding the coverage of HD to 156 sessions would be affordable
and sustainable.

Medical studies are also continuously undertaken to slow down the progress of chronic
kidney disease. Last April 30, 2021, the U.S. Food and Drug Administration approved Farxiga
(dapagliflozin) oral tablets to reduce the risk of kidney function decline, kidney failure,
cardiovascular death, and hospitalization for hrort failure in adults with chornic kidney disease
who are at risk for disease progression.

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XII. BIBLIOGRAPHY
American Kidney Fund. 2021. Kidney Failure (ESRD) Causes, Symptoms, & Treatments.
https://www.kidneyfund.org/kidney-disease/kidney-failure/#
Azura Vascular Care. (2017). The 4 Types of Dialysis Access.
https://www.azuravascularcare.com/infodialysisaccess/types-of-dialysis-access/
Benjamin O, Lappin SL. End-Stage Renal Disease. [Updated 2021 Sep 16]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-
Chanouzas D, Ng KP, Fallouh B, Baharani J. (2011) What influences patient choice of treatment
modality at the pre-dialysis stage? Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfr452.
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a
review. Jama. 2019;322(13):1294–1304. doi: 10.1001/jama.2019.14745
Elshahat S, Cockwell P, Maxwell AP, Griffin M, O’Brien T, O’Neill C (2020). The impact of
chronic kidney disease on developed countries from a health economics perspective: A systematic
scoping review. PLoS ONE 15(3): e0230512. doi:10.1371/journal.pone.0230512
Food and Drug Administration (2021). FDA approves treatment for chronic kidney disease.
https:www.fda.gov/news-events/press-announcements/fda-approves-treatment-chronic-kidney-
disease
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. (2016) Global
Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS ONE
11(7): e0158765. doi:10.1371/journal.pone.0158765
John Hopkins Medicine. (2021). End Stage Renal Disease.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/end-stage-renal-failure
Laminate Medical. (2016). Which type of AV Fistula is best for patients?. Laminate Medical
Technologies. http://www.laminatemedical.com/2016/06/22/type-av-fistula-best-dialysis-
patients/
Medline Plus. (2020). End Stage Renal Disease. https://medlineplus.gov/ency/article/000500.htm
Philippine Health Insurance Corporation. (2019). Stats and Charts
2018. https://www.philhealth.gov.ph/about_us/statsncharts/snc2018.pdf.
Philippine Renal Disease Registry. (2016). Report for 2016, Version 1. Quezon: Renal Disease
Control Program (REDCOP);
Vaidya SR, Aeddula NR. Chronic Renal Failure. [Updated 2021 Jul 16]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-

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 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF NURSING
PERCENTAGE ACTUAL GRADE
PARAMETER
(%)
Introduction and Objectives
Personal Data 5

Nursing History of Past and Present Health Illness 5

PEARSON Assessment 15

Diagnostic Procedures
a. Ideal 5
b. Actual

Anatomy and Physiology 5

Pathophysiology
a. Algorithm 15
b. Explanation

Management
a. Medical and Surgical (Ideal and Actual) 5
b. Nursing Care Plan (NCP) 25
c. Promotive and Preventive Management 5
Drug Study 5

Discharge Plan 5

Updates 5

Organization/Documentation 2.5

Bibliography 2.5

TOTAL: 100

REMARKS:
______________________________________________________________________________
______________________________________________________________________________
______________

SIGNATURE OF THE CLINICAL INSTRUCTOR:

__________________________________________

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