TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines
PATIENT EDUCATION FORM
Name Francisco, Krisianne Mae L. Area
Inclusive
Year Level BSN III B RLE Group 3B dates of
Rotation
Name of
Tom Age 60yrs old Gender Male
Patient
Date February 13,
Diagnosis COVID – 19
Admitted 2021
MAIN CONCEPT / TOPIC: Discharge Patient Education
Details of Patient Education Content:
1. Advised to stay at home as much as possible.
2. Encouraged the patient and relatives to minimize social gathering and keep social
distancing in public places.
3. Instructed the patient and relatives to wear facemask and face shield when going outside
from home.
4. Advised the relatives to keep food proper handling and cook foods properly.
5. Advised proper and regular fluid intake. Because good hydration is crucial for optimal
health and it may help the patient to increase defense mechanism against the virus.
6. Advised healthy diets such as eat fruits and vegetables. Because eating a healthy diet is
very important during the COVID-19 pandemic. These are important for supporting
immune systems.
7. Instructed the proper medication and supplemental vitamin intake as prescribed by the
doctor.
8. Encouraged and demonstrated proper hand hygiene such as washing hands with soap and
the use of alcohol – based sanitizer for appropriate infection control procedure.
9. Encouraged to keep environment clean and sanitized.
Patient’s Signature / Significant Other’s Signature
Date Signed
Date Submitted