Ch f Teaching Guidelines

8/11/2019 Ch f Teaching Guidelines

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Teaching

Guidelines:Patients With Heart Failure


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Definition of

Heart FailureHeart Failure means that the heart is notpumping as effectively as it should.

When this happens, blood that should bepumped out of the heart backs up into thelungs and other parts of the body.

Also is known as CHF (congestive heartfailure)


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Causes of Heart Failure

Coronary artery disease: Less blood

reaches the heart muscle due to build up

of cholesterol and fatty deposits.

Damage to the heart muscle or valves:

resulting from disease, infection, or birth

defects


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Causes of Heart Failurecontd

High blood pressure: When BP is too high,

the heart has to pump harder to keep the

blood circulating; over time the heart

chambers get larger and weaker.

Past heart attacks: cause

damage to the heartmuscle; the remaining

healthy tissue must work

harder.


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Symptoms of CHF

Two most common symptoms:

Shortness of Breath as blood backs up

into the lungs

Edema (swelling) as blood backs up into

the legs


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Sign or Symptom Why It Happens People with HF

May Experience

Shortness of Breath

(also called dyspnea)

Blood backs up in the

pulmonary veins (the

vessels that return

blood from the lungs to

the heart) because the

heart cant keep up

with the supply. Thiscauses fluid to leak

into the lungs.

breathlessness

during activity (most

commonly), at rest, or

while sleeping, which

may come on suddenly

and wake them up

difficulty breathing

while lying flat and may

need to prop up the

upper body and head

on two pillows

wake up tired or

feeling anxious and

restless


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May Experience

Persistent Coughing or

Wheezing

Fluid builds up in the

lungs. (same as

previous slide)

Blood backs up in the

pulmonary veins (thevessels that return

blood from the lungs to

the heart) because the

heart cant keep up

with the supply.

This causes fluid to

leak into the lungs.

coughing that

produces white or pink

blood-tinged phlegm


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May Experience

Buildup of Excess

Fluid in Body Tissues

(Edema)

As blood flow slows,

coming out of the

heart, blood returning

to the heart through the

veins backs up,

causing fluid to build

up in the tissues.

The kidneys are less

able to dispose of

sodium and water, also

causing fluid retention

in the tissues.

Swelling in feet or

legs or weight gain

Shoes may feel tight.


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May Experience

Tiredness, Fatigue The heart cant pump

enough blood to meet

the needs of body

tissues.

The body diverts blood

away from less vital

organs, particularly

muscles in the limbs,

and sends it to the

heart and brain.

a tired feeling all the

time and difficulty with

everyday activities

such as shopping,

climbing stairs,

carrying groceries or

walking


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May Experience

Dizziness or Chest

Pain/Tightness

Certain medications

may cause a drop in

blood pressure.

lightheadness or

dizziness upon

standing from a sitting

position


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Carry frequently used items around the

house in a basket.

Chop or peel vegetables while sitting.

Place a basket at the bottom of the stairs

to collect items throughout the day (take

them upstairs all at once).

Develop a schedule that paces your

activities with rest periods in between.

Reducing Fatigue


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Diet: Decreasing Salt Intake

Sodium makes the

body hold on to fluid.

Thus, the heart has to

work harder to pump theadded fluid.

Decreasing the amount of salt in your diet

is one of the most important things you

can do!


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TIPS:

Take the salt shaker off

the table.

Do not add salt whencooking.

Use salt substitutes (these

usually contain potassium,

so you should check withyour doctor to see if it is

appropriate for you).


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TIPS: Avoid seasonings such as

bouillon cubes, meattenderizer, seasoned salts,

soy sauce, steak orWorcestershire sauce.

Drain and rinse cannedfoods before preparation.

Substitute low sodiumfoods.

Use frozen or fresh fruitsand vegetables.



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Foods to avoid (unless there

is a low sodium version):

Pre-seasoned mixes: tacos,

chili, rice, sauces, gravy

Snack foods: pretzels, potato

chips, olives, cheeses, pickles

Fast food (McDonalds, BurgerKing, etc.)



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Eating Out(For the patient that frequently eats out)

Order plain baked potatoor unsalted vegetablesinstead of French fries or

onion rings.Plan ahead: Select arestaurant where food ismade to order.

Many restaurants honorspecial requests for low-fator low-salt dishes.


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Limit extras before the

meal such as appetizers,

bread and butter; these

contain extra fat and salt.

Read the menu carefully.

Look for these words:

steamed, baked, roasted,garden fresh, poached,

broiled, grilled.

Eating Out (contd)(for the patient who frequently eats out)


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Read the menu and avoid Crispy, creamed, rich, buttery,

fried, in cheese sauce, stewed, potpie, with bacon or sausage

Choose healthy ethnic foods(Chinese, Mexican) by askingwhich dishes are lower in salt orfat.

Ask for salad dressings, saucesor gravies to be served on theside. This helps control how much you

use.

Eating Out (contd)(for the patient who frequently eats out)


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Medication Tips

Notify your nurse and doctor of all medications,

medication changes, herbal products or known

allergies to minimize side effects, avoid drug

interactions and avoid allergic reactions.

Take doses at the same

time each day. Use a weekly pill box to

help keep pills organized.


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Common CHF Medications

ACE inhibitors

Capoten (captopril)

Vasotec (enalapril)

Altace (ramipril) Prinovil or Zestril (lisinopril)

Accupril (quinapril)

Monopril (fosinopril) Lotensin (benazepril)

Univasc (moexipril)


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ACE inhibitors (contd)

These are a type of vasodilator; they cause

the blood vessels to expand, which lowers the

blood pressure and decreases the heartsworkload.

Side effects: cough, weakness, dizziness,

high potassium levelsCheck potassium levels regularly.


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Diuretics (water-pills)

Lasix (furosemide)

Hydrodiuril (hydrochlorothiazide)

Diuril (chlorothiazide)

Bumex (bumetanide)

Aldactone (spironolactone)

Dyrenium (triamterene)

Others


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Diuretics (water-pills) (contd):

A diuretic causes the kidney to remove more

sodium and water from the bloodstream than

usual. This lessens the fluid in the body andcauses the heart to have a decreased

workload.

It also decreases the buildup of fluid in thelungs, ankles and legs.

Take diuretics in the morning.


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When taking a diuretic you must weigh yourself daily;

your dose may be adjusted depending on the weight

you have gained or lost.

Notify your home health nurse or doctor if you gain 3

pounds in one day or 5 pounds in one week.

Make sure to urinate at least every 2 hours during the

day, and have ready access to a bathroom.


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Many diuretics cause your body to lose

potassium; if you have one of those types,

you may have to add potassium to your diet.

Foods containing potassium:

raisins, prunes, apricots, dates, bananas, cantaloupe,

oranges, greens, spinach, peas, tomatoes, mushrooms,

fresh turkey, fish or beef


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Oxygen

Nasal Cannula

Mask

Your doctor has ordered the oxygen flow rate per

minute. Do not change a setting without consulting

your doctor or nurse first.

Higher oxygen flow rates usually do not help.

Side effects: High flow rates increase the risks of

of carbon dioxide buildup in the blood especially in

patients who have lung disease (e.g., COPD).


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Vasodilators

Isordil (isosorbide dinitrate)

Apresoline (hydralazine)

These cause blood vessel walls to relax which

allows blood to flow more easily.

Side effects: dizziness or fainting when sitting orstanding quickly, headaches, heart palpitations,

nasal congestion


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Digitalis Preparations:

Lanoxin (digoxin)

Digoxin increases the force of the hearts

contraction; it also slows some types ofirregular heart beats.

Levels that are too high can cause loss of

appetite, nausea, vomiting, headaches;blurred or yellow vision.


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Beta Blockers

Coreg (carvedilol)

Lopressor (metoprolol)

Tenormin (Atenolol)

These drugs reduce the heart rate and lower

blood pressure.

Side effects: nausea or weakness; too-low

blood pressure; worsening asthma symptoms


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Blood thinners

Coumadin (warfarin)

Heparin, Lovenox

These drugs help prevent blood from clotting

and lessen the chance of getting blood clots

throughout the body.

Many drugs can interact with blood thinners.Do not take any new medications without

consulting your doctor, nurse or pharmacist.


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Blood thinners contd

Side effects include bleeding tendencies:

Watch for nosebleeds, gums bleeding, bruising

easily.Notify your home health nurse or doctor

immediately if you are bleeding easily.

You need to have your blood tested for INR

regularlyat least once per month (check withyour nurse or doctor for frequency).


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CHF HEALTH TRACK

GreenZone

COMMON SIGNS

No new or worsening of

shortness of breathNo new or worsening swelling

of your hands or feet

No weight gain exceeding

your goal weight

No chest pain or tightness

No decrease in your ability to

maintain your activity levelWHAT TO DO

Continue daily weights.

Take medication as prescribed by your doctor. DO NOT SKIPDOSES.

Follow low-salt diet.

Keep all physician appointments.

Keep up the

good work!


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CHF HEALTH TRACK

Yellow

Zone

COMMON SIGNS

Gained 3 or more pounds

Increased coughIncreased swelling in feet or legs

Increased in shortness of breath with activity

Increase in the number of pillows needed to sleep at

night

New or more frequent chest pain or tightness

New onset of dizziness or lightheadness after standing

up

WHAT TO DO

Your symptoms may mean that you need an

adjustment of your medications.

Call your home health nurse.

If you have one

or more of

these signs,

take QUICKaction!


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CHF HEALTH TRACKCOMMON SIGNS

Unrelieved shortness of breath or shortness of breath

at restUnrelieved chest pain

Wheezing or chest tightness at rest

Need to sit in chair to sleep

Weight gain or loss of more than 5 poundsConfusion

A fall related to dizziness or lightheadness

WHAT TO DO

You man need to be evaluated by a physician

right away.

Call your home health nurse or physician right

away.

Red

Zone

If you have one

or more of

these signs,

take

IMMEDIATE

action!


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Heart Failure is best managed with early

intervention.

Your home health team (nurse, therapist,

or aide) need to be notified early of anychanges in your health status.

Early intervention may prevent a

hospitalization for you or your loved one.

Remember!

This material was adapted by GMCF under contract with the Centers for Medicare & Medicaid Services (CMS), an

agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect

CMS policy. Publication No. 8SOW-GA-HH-07-26

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Ch f Teaching Guidelines