Teaching Guidelines: Patients With Heart Failure

1
TeachingGuidelinesPatients With Heart Failure
2
Definition ofHeart Failure

• Heart Failure means that the heart is not pumping
  as effectively as it should.
• When this happens, blood that should be pumped
  out of the heart backs up into the lungs and
  other parts of the body.
• Also is known as CHF (congestive heart failure)

3
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

4
Causes of Heart Failure contd

• 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 heart
  muscle the remaining healthy tissue must work
  harder.

5
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

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
Reducing Fatigue

• 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.

12
Diet Decreasing Salt Intake

• Sodium makes the body hold on to fluid.
• Thus, the heart has to work harder to pump the
  added fluid.

• Decreasing the amount of salt in your diet is one
  of the most important things you can do!

13
Diet Decreasing Salt Intake

• TIPS
• Take the salt shaker off the table.
• Do not add salt when cooking.
• Use salt substitutes (these usually contain
  potassium, so you should check with your doctor
  to see if it is appropriate for you).

14
Diet Decreasing Salt Intake

• TIPS
• Avoid seasonings such as bouillon cubes, meat
  tenderizer, seasoned salts, soy sauce, steak or
  Worcestershire sauce.
• Drain and rinse canned foods before preparation.
• Substitute low sodium foods.
• Use frozen or fresh fruits and vegetables.

15
Diet Decreasing Salt Intake

• 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, Burger King, etc.)

16
Eating Out (For the patient that frequently eats
out)

• Order plain baked potato or unsalted vegetables
  instead of French fries or onion rings.
• Plan ahead Select a restaurant where food is
  made to order.
• Many restaurants honor special requests for
  low-fat or low-salt dishes.

17
Eating Out (contd)(for the patient who
frequently eats out)

• 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.

18
Eating Out (contd)(for the patient who
frequently eats out)

• Read the menu and avoid
• Crispy, creamed, rich, buttery, fried, in cheese
  sauce, stewed, pot pie, with bacon or sausage
• Choose healthy ethnic foods (Chinese, Mexican) by
  asking which dishes are lower in salt or fat.
• Ask for salad dressings, sauces or gravies to be
  served on the side.
• This helps control how much you use.

19
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.

20
Common CHF Medications

• ACE inhibitors
• Capoten (captopril)
• Vasotec (enalapril)
• Altace (ramipril)
• Prinovil or Zestril (lisinopril)
• Accupril (quinapril)
• Monopril (fosinopril)
• Lotensin (benazepril)
• Univasc (moexipril)

21
Common CHF Medications

• ACE inhibitors (contd)
• These are a type of vasodilator they cause the
  blood vessels to expand, which lowers the blood
  pressure and decreases the hearts workload.
• Side effects cough, weakness, dizziness, high
  potassium levels
• Check potassium levels regularly.

22
Common CHF Medications

• Diuretics (water-pills)
• Lasix (furosemide)
• Hydrodiuril (hydrochlorothiazide)
• Diuril (chlorothiazide)
• Bumex (bumetanide)
• Aldactone (spironolactone)
• Dyrenium (triamterene)
• Others

23
Common CHF Medications

• 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 and causes the
  heart to have a decreased workload.
• It also decreases the buildup of fluid in the
  lungs, ankles and legs.
• Take diuretics in the morning.

24
Common CHF Medications

• Diuretics (water-pills) (contd)
• 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.

25
Common CHF Medications

• Diuretics (water-pills) (contd)
• 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

26
Common CHF Medications

• 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).

27
Common CHF Medications

• 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
  or standing quickly, headaches, heart
  palpitations, nasal congestion

28
Common CHF Medications

• Digitalis Preparations
• Lanoxin (digoxin)
• Digoxin increases the force of the hearts
  contraction it also slows some types of
  irregular heart beats.
• Levels that are too high can cause loss of
  appetite, nausea, vomiting, headaches blurred
  or yellow vision.

29
Common CHF Medications

• 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

30
Common CHF Medications

• 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.

31
Common CHF Medications

• 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
  regularly at least once per month (check with
  your nurse or doctor for frequency).

32
 
 
  CHF HEALTH TRACK
 

• COMMON SIGNS
• No new or worsening of shortness of breath
• No 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 level

 
Keep up the good work!

• WHAT TO DO
• Continue daily weights.
• Take medication as prescribed by your doctor. DO
  NOT SKIP DOSES.
• Follow low-salt diet.
• Keep all physician appointments.

 
33
 
  CHF HEALTH TRACK
 

• COMMON SIGNS
• Gained 3 or more pounds
• Increased cough
• Increased 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

 
If you have one or more of these signs, take
QUICK action!

• WHAT TO DO
• Your symptoms may mean that you need an
  adjustment of your medications.
• Call your home health nurse.

 
34
 
 
  CHF HEALTH TRACK
 
 

• COMMON SIGNS
• Unrelieved shortness of breath or shortness of
  breath at rest
• Unrelieved chest pain
• Wheezing or chest tightness at rest
• Need to sit in chair to sleep
• Weight gain or loss of more than 5 pounds
• Confusion
• A fall related to dizziness or lightheadness

If you have one or more of these signs, take
IMMEDIATE action!

• WHAT TO DO
• You man need to be evaluated by a physician right
  away.
• Call your home health nurse or physician right
  away.

 
35
Remember!

• Heart Failure is best managed with early
  intervention.
• Your home health team (nurse, therapist, or aide)
  need to be notified early of any changes in your
  health status.
• Early intervention may prevent a hospitalization
  for you or your loved one.

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