John Smith. Patient Care Plan. Dr. Jane Doe (444) URGENT HEALTH CONCERN? PLEASE CALL TELEPHONE CARE AT: (800) FOR ROUTINE CONCERNS:

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1 Patient Care Plan John Smith LEFT HOSPITAL: 12/6/2016 URGENT HEALTH CONCERN? PLEASE CALL TELEPHONE CARE AT: (800) FOR ROUTINE CONCERNS: Dr. Jane Doe (444) BRING THIS PLAN TO ALL MEDICAL APPOINTMENTS

2 My Contacts HOME CARE SERVICES Generic Home Health Tel: (555) VETERANS CRISIS LINE The Veterans Crisis Line connects Veterans in crisis and their families and friends with qualified, caring Department of Veterans Affairs responders Veterans and their loved ones can call and Press 1, chat online at or send a text message to to receive confidential support 24 hours a day, 7 days a week, 365 days a year.

3 Congestive Heart Failure Heart failure, also called congestive heart failure (CHF), is a serious condition in which the heart does not adequately pump enough blood to the rest of the body. THINGS YOU NEED TO DO Call 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.

4 Heart Failure Warning Signs Green Zone: This is your green zone. Being in this zone means that your symptoms 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 problems you should contact your medical team at: Red Zone: This is your emergency zone. Seek help immediately! 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. 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

5 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 Limiting 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) 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.

6 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 from medicines, 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

7 My Meds What do I need to take? SODIUM BICARBONATE 325MG TAB How do I take this? 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 You have 1 refills remaining. Use this number to order a refill of this medication: 8xxxxx ROSUVASTATIN CA 20MG TAB TAKE ONE-HALF TABLET BY MOUTH AT BEDTIME FOR CHOLESTEROL POLYETHYLENE GLYCOL 3350 ORAL PWDR You have 3 refills remaining. Use this number to order a refill of this medication: 4xxxxx TAKE 1 CAPFUL = 17 GRAMS BY MOUTH TWO TIMES A DAY MIX WITH 8OZ OF WATER FOR CONSTIPATION PIMECROLIMUS 1% TOP CREAM APPLY SMALL AMOUNT TOPICALLY TWICE A DAY AS NEEDED FOR RASH ON FACE You have 5 refills remaining. Use this number to order a refill of this medication: 8xxxxx NOVO FINE 30 DISPOSABLE NEEDLE USE NEEDLE FOUR TIMES A DAY BEFORE MEALS AND AT BEDTIME

8 My Meds (continued) What do I need to take? MIRTAZAPINE 15MG TAB How do I take this? TAKE ONE TABLET BY MOUTH AT BEDTIME FOR SLEEP You have 3 refills remaining. Use this number to order a refill of this medication: 4xxxxx MELATONIN 3MG CAP/TAB TAKE ONE PILL BY MOUTH AT BEDTIME FOR SLEEP LEVOTHYROXINE NA (SYNTHROID) 0.075MG TAB LANCET,SOFTCLIX TAKE ONE TABLET BY MOUTH ONCE A DAY BEFORE A MEAL. FOR THYROID. DO NOT GIVE WITHIN 30 MINUTES OF SEVELAMER. 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 You have 3 refills remaining. Use this number to order a refill of this medication: 6xxxxx INSULIN,ASPART 100UN/ML NOVO FLEXPEN 3ML INJECT 3UNITS UNDER SKIN THREE TIMES DAILY BEFORE MEALS TAKE 15 MINUTES BEFORE MEALS FOR DIABETES

9 My Meds (continued) What do I need to take? HYDROPHILIC (EQV AQUAPHOR) TOP OINT How do I take this? You have 8 refills remaining. Use this number to order a refill of this medication: 4xxxxx APPLY SMALL AMOUNT TOPICALLY THREE TIMES A DAY FOR SKIN PROTECTION FOR DRY SKIN HYDROCHLOROTHIAZIDE 25MG TAB TAKE ONE-HALF TABLET BY MOUTH ONCE A DAY FOR FLUID RETENTION You have 1 refills remaining. Use this number to order a refill of this medication: 4xxxxx FUROSEMIDE 80 MG TAB TAKE ONE TABLET BY MOUTH TWO TIMES A DAY FOR FLUID RETENTION You have 4 refills remaining. Use this number to order a refill of this medication: 4xxxxx FERROUS GLUC 5GR (EQV MG) TAB TAKE ONE TABLET BY MOUTH ONCE A DAY WITH FOOD FOR ANEMIA You have 3 refills remaining. Use this number to order a refill of this medication: 6xxxxx EPOETIN ALFA,RECOMBINANT 2000 UNT/ML INJ You have 3 refills remaining. Use this number to order a refill of this medication: 6xxxxx INJECT 2,000 UNITS (1 ML) UNDER SKIN ON MONDAY, WEDNESDAY AND FRIDAY DOSE TO BE GIVEN IN HD CLINIC: 2,000 UNITS. NORMAL DOSE RANGE UNITS/KG. LABS: 10/27/2016 HGB 6.9 L 10/24/2016 FERRITIN 187. PHARMACY: DO NOT DISPENSE.

10 My Meds (continued) What do I need to take? DOXAZOSIN MESYLATE 4MG TAB How do I take this? TAKE ONE TABLET BY MOUTH EVERY EVENING TO HELP URINE FLOW CLOBETASOL PROPIONATE 0.05% OINT, 45GM You have 3 refills remaining. Use this number to order a refill of this medication: 4xxxxx CAMPHOR 0.5/MENTHOL 0.5% LOTION You have 8 refills remaining. Use this number to order a refill of this medication: 4xxxxx APPLY SMALL AMOUNT TOPICALLY TWICE A DAY AS NEEDED FOR SKIN CONDITION FOR ITCHING AND RASH ON HANDS APPLY SMALL AMOUNT TOPICALLY TWO TIMES A DAY FOR DRY, ITCHY SKIN FOR ITCHING ON 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 You have 1 refills remaining. Use this number to order a refill of this medication: 4xxxxx AMLODIPINE BESYLATE 10MG TAB TAKE ONE TABLET BY MOUTH ONCE A DAY FOR HIGH BLOOD PRESSURE

11 My Meds (continued) What do I need to take? AMIODARONE HCL 200MG TAB How do I take this? TAKE ONE-HALF TABLET BY MOUTH ONCE A DAY FOR HEART RHYTHM You have 3 refills remaining. Use this number to order a refill of this medication: 6xxxxx ALCOHOL PREP PAD USE 1 PAD TOPICALLY AS DIRECTED ACCU-CHEK AVIVA PLUS(GLUCOSE) TEST STRIP You have 1 refills remaining. Use this number to order a refill of this medication: 8xxxxxx USE 1 STRIP FOUR TIMES A DAY BEFORE MEALS AND AT BEDTIME FOR TESTING BLOOD SUGAR CHECK JUST PRIOR TO MEALS FOR INSULIN DOSING AND ALSO AT BEDTIME FOR RECORDING

12 This is your final medication list. Please only take these medications. TAKE THESE MEDICINES ONLY AS NEEDED My Meds (continued) What do I need to take? Why am I taking this? How do I take this? How much do I take? NEW albuterol 90 MCG/ACT Metered Dose Inhaler, 200 ACT COPD inhalation 1-2 puffs every 6 hours NEW Insulin, Aspart, Human 100 UNT/ML Injectable Solution Diabetes Subcutaneous SEE INSULIN PAGE Morning, Afternoon, Evening Glucose 4g Chewable tablet low blood sugars (less than 70) Oral 3 tablets as directed If you miss a dose, or are late on a dose, please refer to your pharmacy handout..

13 My Insulin Sliding Scale Insulin, Aspart, Human 100 UNT/ML Injectable Solution Take for Diabetes 3 times a day Follow this sliding scale table depending on blood sugar. 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 251 to 300 Take 3 units 301 to 350 Take 4 units 351 to 400 Take 5 units Above 400 Take 6 units and Call your doctor.

14 Additional Information about My Meds ALLERGIES BEANS EGGPLANT GRAPEFRUIT BERRIES MELONS MY PHARMACY VA 3801 Miranda Ave Palo Alto, CA TEL: (650) FOR PRESCRIPTION REFILLS 1) Refill by phone ) Refill online at My HealtheVet 3) Refill by mail- mail your refill slips to: VA Palo Alto Health Care System Pharmacy Service (119) 3801 Miranda Ave. Palo Alto, CA 94304

15 Medicine Dosage Change Schedule Wednesday, December 7, Take 40 MG of Prednisone 10 MG Oral Tablet LEFT HOSPITAL Thursday, December 8 Take 40 MG of Prednisone 10 MG Oral Tablet Friday, December 9 Take 30 MG of Prednisone 10 MG Oral Tablet Saturday, December 10 Take 30 MG of Prednisone 10 MG Oral Tablet Sunday, December 11 Take 20 MG of Prednisone 10 MG Oral Tablet Monday, December 12 Take 20 MG of Prednisone 10 MG Oral Tablet Tuesday, December 13 Take 10 MG of Prednisone 10 MG Oral Tablet

16 For My Health My Diet and Nutrition Instructions Because of your disease you should avoid excessive fluids in your diet. Fluids include all liquids that you drink (like water, milk, juices, tea, coffee, and soda) and anything that changes to liquid at room temperature (like ice cream, gelatin, and soup). To limit thirst try adding lemon to beverages, chewing sugar-free gum, or hard candies to keep your mouth moist. Any increases in your weight more than ½ to 1 pound in a day usually means that you have gained fluid weight. Ask your healthcare provider or a dietitian 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 drainage from the wound or dressing Inability to urinate, urinating frequently in small amounts, or painful urination Increased shortness of breath Chest Pain: CALL 911

17 My Calendar for December 2016 Sun Mon Tue Wed Thu Fri Sat LEFT HOSPITAL Dental 1:00pm 10 Dialysis- 8:30am Palo Alto Campus Palo Alto Campus PCP 10:30am San Jose Campus Cardiology 2:00pm Palo Alto, Campus

18 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 and communicate with their care team. To gain access to the upgraded features, please be sure to complete the in-person authentication at your nearest VA facility.