PELAN RAWATAN PERIBADI · 2014. 2. 28. · Nombor telefon hospital/klinik: _____ Tarikh mula...
Transcript of PELAN RAWATAN PERIBADI · 2014. 2. 28. · Nombor telefon hospital/klinik: _____ Tarikh mula...
PELAN RAWATAN PERIBADI
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Nama pesakit: _________________________________________________
Nombor ID pesakit: _____________________________________________
Nombor telefon: ________________________________________________
Hospital: ______________________________________________________
Untuk kes kecemasan, sila maklumkan (nama) ________________________
di talian _______________________________________________________
Nombor telefon hospital/klinik: _____________________________________
Tarikh mula rawatan PEG-interferon dan ribavirin: _______________ Dos PEG-interferon anda:Dos Permulaan Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
____________________________________________________________________________
Pelarasan Dos 1 (Tarikh: ______________________________) Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
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Pelarasan Dos 2 (Tarikh: ______________________________) Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
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Dos ribavirin anda: Setiap pagi Setiap petangJururawat akan menandakan bulat pada dos ribavirin:
Dos Permulaan
Pelarasan Dos 1, Tarikh: ____________
Pelarasan Dos 2, Tarikh: ____________
-0.2 --0.3 - -0.4 - -0.5
-0.2 --0.3 - -0.4 - -0.5
-0.2 --0.3 - -0.4 - -0.5
50 mcg 80 mcg 120 mcg 150 mcg
50 mcg 80 mcg 120 mcg 150 mcg
50 mcg 80 mcg 120 mcg 150 mcg
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Nama pesakit: _________________________________________________
Nombor ID pesakit: _____________________________________________
Nombor telefon: ________________________________________________
Hospital: ______________________________________________________
Untuk kes kecemasan, sila maklumkan (nama) ________________________
di talian _______________________________________________________
Nombor telefon hospital/klinik: _____________________________________
Tarikh mula rawatan PEG-interferon dan ribavirin: _______________ Dos PEG-interferon anda:Dos Permulaan Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
____________________________________________________________________________
Pelarasan Dos 1 (Tarikh: ______________________________) Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
____________________________________________________________________________
Pelarasan Dos 2 (Tarikh: ______________________________) Jururawat akan menandakan bulat pada kekuatan dos PEG-interferon:
Isipadu suntikan PEG-interferon mingguan anda ialah: ____________mL
____________________________________________________________________________
Dos ribavirin anda: Setiap pagi Setiap petangJururawat akan menandakan bulat pada dos ribavirin:
Dos Permulaan
Pelarasan Dos 1, Tarikh: ____________
Pelarasan Dos 2, Tarikh: ____________
-0.2 --0.3 - -0.4 - -0.5
-0.2 --0.3 - -0.4 - -0.5
-0.2 --0.3 - -0.4 - -0.5
50 mcg 80 mcg 120 mcg 150 mcg
50 mcg 80 mcg 120 mcg 150 mcg
50 mcg 80 mcg 120 mcg 150 mcg
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PELAN dan REKOD Suntikan PEG-interferon September 2013 Februari 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 2 3 4 5 6 7 8 15 16 17 18 19 20 21 9 10 11 12 13 14 15 22 23 24 25 26 27 28 16 17 18 19 20 21 22 29 30 23 24 25 26 27 28
Oktober 2013 Mac 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 1 6 7 8 9 10 11 12 2 3 4 5 6 7 8 13 14 15 16 17 18 19 9 10 11 12 13 14 15 20 21 22 23 24 25 26 16 17 18 19 20 21 22 27 28 29 30 31 23 24 25 26 27 28 29 30 31
November 2013 April 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 1 2 3 4 5 3 4 5 6 7 8 9 6 7 8 9 10 11 12 10 11 12 13 14 15 16 13 14 15 16 17 18 19 17 18 19 20 21 22 23 20 21 22 23 24 25 26 24 25 26 27 28 29 30 27 28 29 30
Disember 2013 Mei 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 1 2 3 8 9 10 11 12 13 14 4 5 6 7 8 9 10 15 16 17 18 19 20 21 11 12 13 14 15 16 17 22 23 24 25 26 27 28 18 19 20 21 22 23 24 29 30 31 25 26 27 28 29 30 31
Januari 2014 Jun 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 1 2 3 4 5 6 7 5 6 7 8 9 10 11 8 9 10 11 12 13 14 12 13 14 15 16 17 18 15 16 17 18 19 20 21 19 20 21 22 23 24 25 22 23 24 25 26 27 28 26 27 28 29 30 31 29 30
Nota• Staf Klinik: bulatkan (O) pada hari suntikan • Pesakit: tandakan pangkah (X) pada tarikh suntikan
PELAN dan REKOD Suntikan PEG-interferon Julai 2014 Disember 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 1 2 3 4 5 6 6 7 8 9 10 11 12 7 8 9 10 11 12 13
13 14 15 16 17 18 19 14 15 16 17 18 19 20 20 21 22 23 24 25 26 21 22 23 24 25 26 27 27 28 29 30 31 28 29 30 31
Ogos 2014 Januari 2015
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 1 2 3 3 4 5 6 7 8 9 4 5 6 7 8 9 10
10 11 12 13 14 15 16 11 12 13 14 15 16 17 17 18 19 20 21 22 23 18 19 20 21 22 23 24 24 25 26 27 28 29 30 25 26 27 28 29 30 31 31
September 2014 Februari 2015
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14 15 16 17 18 19 20 15 16 17 18 19 20 21 21 22 23 24 25 26 27 22 23 24 25 26 27 28 28 29 30
Oktober 2014 Mac 2015
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November 2014 April 2015
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16 17 18 19 20 21 22 19 20 21 22 23 24 25 23 24 25 26 27 28 29 26 27 28 29 30 30
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PELAN dan REKOD Suntikan PEG-interferon September 2013 Februari 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 2 3 4 5 6 7 8
15 16 17 18 19 20 21 9 10 11 12 13 14 15 22 23 24 25 26 27 28 16 17 18 19 20 21 22 29 30 23 24 25 26 27 28
Oktober 2013 Mac 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 1 6 7 8 9 10 11 12 2 3 4 5 6 7 8
13 14 15 16 17 18 19 9 10 11 12 13 14 15 20 21 22 23 24 25 26 16 17 18 19 20 21 22 27 28 29 30 31 23 24 25 26 27 28 29 30 31
November 2013 April 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 1 2 3 4 5 3 4 5 6 7 8 9 6 7 8 9 10 11 12
10 11 12 13 14 15 16 13 14 15 16 17 18 19 17 18 19 20 21 22 23 20 21 22 23 24 25 26 24 25 26 27 28 29 30 27 28 29 30
Disember 2013 Mei 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 1 2 3 8 9 10 11 12 13 14 4 5 6 7 8 9 10
15 16 17 18 19 20 21 11 12 13 14 15 16 17 22 23 24 25 26 27 28 18 19 20 21 22 23 24 29 30 31 25 26 27 28 29 30 31
Januari 2014 Jun 2014
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12 13 14 15 16 17 18 15 16 17 18 19 20 21 19 20 21 22 23 24 25 22 23 24 25 26 27 28 26 27 28 29 30 31 29 30
Nota• Staf Klinik: bulatkan (O) pada hari suntikan • Pesakit: tandakan pangkah (X) pada tarikh suntikan
PELAN dan REKOD Suntikan PEG-interferon Julai 2014 Disember 2014
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 1 2 3 4 5 6 6 7 8 9 10 11 12 7 8 9 10 11 12 13 13 14 15 16 17 18 19 14 15 16 17 18 19 20 20 21 22 23 24 25 26 21 22 23 24 25 26 27 27 28 29 30 31 28 29 30 31
Ogos 2014 Januari 2015
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 1 2 3 3 4 5 6 7 8 9 4 5 6 7 8 9 10 10 11 12 13 14 15 16 11 12 13 14 15 16 17 17 18 19 20 21 22 23 18 19 20 21 22 23 24 24 25 26 27 28 29 30 25 26 27 28 29 30 31 31
September 2014 Februari 2015
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 1 2 3 4 5 6 7 7 8 9 10 11 12 13 8 9 10 11 12 13 14 14 15 16 17 18 19 20 15 16 17 18 19 20 21 21 22 23 24 25 26 27 22 23 24 25 26 27 28 28 29 30
Oktober 2014 Mac 2015
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 1 2 3 4 5 6 7 5 6 7 8 9 10 11 8 9 10 11 12 13 14 12 13 14 15 16 17 18 15 16 17 18 19 20 21 19 20 21 22 23 24 25 22 23 24 25 26 27 28 26 27 28 29 30 31 29 30 31
November 2014 April 2015
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat 1 1 2 3 4 2 3 4 5 6 7 8 5 6 7 8 9 10 11 9 10 11 12 13 14 15 12 13 14 15 16 17 18 16 17 18 19 20 21 22 19 20 21 22 23 24 25 23 24 25 26 27 28 29 26 27 28 29 30 30
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Jadual Temujanji
Lawatan# Tarikh Masa Butiran Lawatan
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Nota kepada pesakit: Sila bawa yang berikut ke klinik untuk setiap lawatan: 1) buku ini, 2) ubatan yang tidak digunakan, 3) kotak beku bersama pek-pek ais
Arahan: Rekodkan di sini mana-mana dos yang tertinggal, masalah dengan ubatan dan sebarang masalah perubatan, psikologikal atau masalah lain yang anda mungkin hadapi, sama ada anda merasakan masalah itu berkaitan ataupun tidak dengan ubatan kajian. Sila senaraikan ubatan lain yang tidak ada kaitan dengan kajian yang anda ambil, seperti ubat pencegah kehamilan, herba, vitamin dan sebagainya.
Nota
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Jadual Temujanji
Lawatan# Tarikh Masa Butiran Lawatan
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Nota kepada pesakit: Sila bawa yang berikut ke klinik untuk setiap lawatan: 1) buku ini, 2) ubatan yang tidak digunakan, 3) kotak beku bersama pek-pek ais
Arahan: Rekodkan di sini mana-mana dos yang tertinggal, masalah dengan ubatan dan sebarang masalah perubatan, psikologikal atau masalah lain yang anda mungkin hadapi, sama ada anda merasakan masalah itu berkaitan ataupun tidak dengan ubatan kajian. Sila senaraikan ubatan lain yang tidak ada kaitan dengan kajian yang anda ambil, seperti ubat pencegah kehamilan, herba, vitamin dan sebagainya.
Nota
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Nota
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Nota
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Nota
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PERGI KE KLINIK ATAUPUN BILIK KECEMASAN DENGAN SEGERA SEKIRANYA ANDA MENGALAMI:
Sesak nafas
Sakit dada
Warna air kencing pekat
Kekeliruan
Bengkak keliling buku lali atau perut
Penurunan berat badan secara mendadak
Gambaran untuk mencederakan diri sendiri atau orang lain
HUBUNGI KLINIK DENGAN SEGERA SEKIRANYA:
Anda terasa sedih sepanjang hari, hampir setiap hari
Anda hamil ataupun pasangan anda hamil
Anda terlebih ambil PEG-interferon atau ribavirin
SITUASI KECEMASAN
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Nota
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PERGI KE KLINIK ATAUPUN BILIK KECEMASAN DENGAN SEGERA SEKIRANYA ANDA MENGALAMI:
Sesak nafas
Sakit dada
Warna air kencing pekat
Kekeliruan
Bengkak keliling buku lali atau perut
Penurunan berat badan secara mendadak
Gambaran untuk mencederakan diri sendiri atau orang lain
HUBUNGI KLINIK DENGAN SEGERA SEKIRANYA:
Anda terasa sedih sepanjang hari, hampir setiap hari
Anda hamil ataupun pasangan anda hamil
Anda terlebih ambil PEG-interferon atau ribavirin
SITUASI KECEMASAN
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