Rush‐Copley Medical Center Congestive Heart Failure Self‐Management Teaching Guide and Patient Handbook
OUR PROMISE TO YOU Working together with your physicians, nurses, dietitians and social workers, we promise to include you in all the decisions that affect your health. By partnering with you, we look forward to helping you achieve the following goals: • • •
Keep you well informed so you can take the right steps to improve your health. Listen to and address all your questions and concerns regarding your Congestive Heart Failure. Provide you with the lifestyle and self‐management skills to reduce or prevent long term complications associated with congestive heart failure.
This booklet is a starting point for your lifelong education regarding heart failure and will provide you with some of the basic education you will need. Your caregivers will review this booklet with you and your family during your hospital stay. Following your stay you will receive a follow‐up phone call from one of our staff within 72 hours. The intention of this call is to help support you as you transition into your home environment. We have broken this packet into three stages so that you have the opportunity for reflection and ample time to ask questions. • • •
Stage 1: Overview of congestive heart failure Stage 2: Symptoms and diagnosis of congestive heart failure Stage 3: Management of congestive heart failure
Thank you for allowing us to partner with you in your health care. Sincerely, Your Rush‐Copley Team
HEART FAILURE EDUCATION CHECKLIST
I have received heart failure education.
I have a clear explanation of my diagnosis of heart failure.
I have reviewed my medicines and know when and how to take them.
I understand the importance of and how to weigh myself.
I understand the importance of and how to check for swelling.
I understand when it is necessary to call my healthcare provider.
I understand my instructions on a heart healthy diet and sodium restrictions.
I know what exercises I can do.
Green Zone: All Clear Your Goal Weight: • No shortness of breath • No swelling • No weight gain • No chest pain • No decrease in your ability to maintain your activity level
Yellow Zone: Caution If you have any of the following signs and symptoms: • Weight gain of 2 or more pounds • Increased cough • Increased swelling • Increase in shortness of breath with activity • Increase in the number of pillows needed to sleep at night Call your home health nurse if you are going into the YELLOW zone
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Red Zone: Medical Alert Unrelieved shortness of breath: shortness of breath at rest Need to sit in chair to sleep Weight gain or loss of more than 5 pounds Waking up in the night gasping for air
Call your physician immediately if you are going into the RED zone
Green Zone Means: • Your symptoms are under control • Continue taking your medications as ordered • Continue daily weights • Follow low-salt diet • Keep all physician appointments
Yellow Zone Means: • Your symptoms may indicate that you need an adjustment of your medications Call your physician or home health nurse. Name:___________________________ Number:_________________________ Instructions: ______________________ _________________________________
Red Zone Means: This indicates that you need to be evaluated by a physician right away
Call your physician right away Physician:_________________________ Number:___________________________
Stage 1 Overview of Congestive Heart Failure
Heart Failure Facts: Heart failure is sometimes called congestive heart failure or CHF. It affects 5 million Americans, with 500,000 new cases diagnosed each year. While the term heart failure sounds frightening, it is important to remember the following points: • • • •
Your heart is not about to stop! Your symptoms may improve with suitable treatment. Most people with this condition live active and comfortable lives. Heart failure is a very common condition, so you are not alone in fighting this problem.
What are the Functions of the heart? The heart is a muscular pump that provides blood to all the other organs in the body including the brain, kidneys and muscles. The heart has two major functions:
Cardiac Filling (diastole)
Cardiac Emptying (systole)
What happens to the heart with Heart Failure? When the heart muscle is weakened due to infection of the heart muscle, blockages in the heart arteries, lung disease, heart valve problems, high blood pressure, or diabetes, it becomes less forceful in pumping the blood throughout the body. When this occurs there is less blood moving out of the heart. Just like a balloon that is stretched over and over again, the heart eventually loses its ability to return to its normal shape. Over time, the heart walls become thickened and enlarged. Eventually, the heart struggles to return to a normal size and the weakened heart pumps less blood with each beat.
What can cause Heart Failure? Heart failure usually occurs because something makes the heart weak or stiff. Your doctor will help determine what has caused your heart failure, which will influence the treatment or therapy he or she prescribes. Common causes of Heart Failure include: •
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A weakened heart muscle caused by a heart attack (Myocardial Infarction). This happens when one of the vessels supplying blood to the heart becomes completely blocked, and the portion of the heart muscle dies. The damaged part of the heart loses its ability to pump. After some time the heart gets tired or strained and eventually pumps less blood to the body. Long‐term high blood pressure (Hypertension) that has not been controlled. Blood pressure is the force pushing blood through the vessels of the body. When your blood pressure is high, your heart has to work harder to deliver the blood. Because of this extra hard work load, high blood pressure causes the heart muscle to thicken. The extra strain eventually makes the heart weak causing the hearts filling function to be compromised. A weakened heart muscle from valvular heart disease. Heart valves make sure the blood flows in the correct direction through the heart. If valves stop working properly, as result of narrowing or leakage, extra strain will be put on the heart muscle, which eventually will weaken the pump function of the heart. Age may impact heart failure. As the heart gets older the filling function becomes less efficient. The heart muscle stiffens with the normal aging process. Hardening of the arteries (atherosclerosis) is the end process of Coronary artery disease. Atherosclerosis leads to narrowing of the blood vessels that supply oxygenated blood to the heart muscle. As the vessels become narrower the heart muscle will not get enough oxygen‐rich blood. This part of the heart will become too weak to pump the blood effectively. The strain on the heart may lead to the weakening of the heart. Cardiomyopathies are a group of diseases that damage the heart muscle and lead to heart failure. A few types of cardiomyopathies are dilated and hypertrophic. As many as 20% to 30% of people have no obvious cause of their heart failure. In these cases, the cause of the heart failure is said to be unknown or idiopathic. A viral infection of the heart or alcohol‐related damage to the heart muscle may explain some of these cases. In addition, thyroid abnormalities and the use of cocaine can be a cause for idiopathic heart failure.
Stage 2 Symptoms and Diagnosis of Congestive Heart Failure
How does Heart Failure affect my body? The two main problems associated with heart failure are: •
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Fluid retention o As blood backs up in the heart it is forced into other areas of the body such as the lungs, arms, legs, and abdomen. Irregular heart rhythm o People with heart failure are more likely to have rhythm disturbances. As the heart becomes weak and overloaded irregular heart rhythms may occur more frequently.
What are common symptoms of Heart Failure? Many of the symptoms associated with heart failure are associated with the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms occur because not enough oxygen‐rich blood gets to the body. The most common symptoms of heart failure are: • • • • • • • • • • • • • • •
Fatigue Shortness of breath Asthma‐like wheezing Dry, hacking couch, often occurring a few hours after laying down, but stops once you sit upright Difficulty sleeping Pink‐tinged froth in the mouth and pale, clammy skin (these suggest fluid in the lungs) Fluid build‐up, first in the feet, next in the ankles and legs, and finally in the lower abdomen Weight gain Chest pain Stomach pain or lack of appetite Swelling of the neck veins Fast or irregular heart beat Restlessness, confusion, or loss of memory Swollen ankles Dizziness
How is Heart Failure diagnosed? The diagnosis of heart failure is based on the information the doctor gets from asking you questions and from what he or she finds when they examine you. Then your doctor will order several tests to confirm the diagnosis and determine the cause of your heart failure. Tests included in the diagnosis of heart failure include: •
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Blood tests: basic tests will be done to make sure your kidneys are functioning appropriately and to see if you’ve had a heart attack. A blood test may also be done occasionally to determine the progression of your heart failure. Your electrolytes and thyroid function will likely be checked as well. Chest x‐ray: This important test allows the physician to see the size of your heart and whether there is any lung congestion. ECG: This recording of the pattern of your heart provides important information about the rhythm of your heart. The ECG can also indicate previous heart attacks. Echocardiogram: This is an ultra sound of your heart, which allows your doctor to look at how your heart pumps and fills. Echocardiograms evaluate your heart’s pumping and filling capacity. The echocardiogram is also the best way to look at the heart valves. Stress test: This treadmill or stationary bike test is designed to assess your ability to exercise. It will also check for coronary artery disease. Heart catheterization: During this test a long, thin tube, called a catheter, is placed in a vein in your wrist or groin. Pressure measurements are made inside the right‐side chambers of your heart. Then the amount of blood your heart is pumping is evaluated.
Stage 3 Management of Congestive Heart Failure Resources: Daily Weight Diary Medication Chart Fluid Log
How can I manage my Heart Failure? Although there is no real cure for heart failure, there are several things you can do to help keep your CHF under control. Treatment of heart failure is directed at: • • •
Reducing your symptoms and maintaining that improvement Preventing the heart function from getting worse Help you live longer
To achieve these goals, effective therapy needs a good partnership between you, your family and friends, and the heart failure team. The following five management tools will help you maintain an active lifestyle in a comfortable manner. Lifestyle changes are key to your treatment! 9 9 9 9 9
Weigh yourself daily Take your medications exactly as your doctor has prescribed them Follow your diet closely Contact your doctor if any problems occur and keep all of your follow up visits as directed Reduce fluid intake as directed by your doctor
1. Weigh yourself daily It is important that you recognize early signs of fluid retention. The most common features of fluid retention are: • •
Sudden weight gain Shortness of breath
Weighing yourself daily will help you better manage your heart failure. Since heart failure can cause your body to hold onto fluids and salt, you may notice yourself gaining weight. Weigh yourself everyday at the same time of the day and on the same scale. Make sure your scale is on a hard surface – not on a rug. The best time to weigh yourself is in the morning after you wake up and empty your bladder. Subtle changes in your weight may be a sign that your heart failure is getting worse. Record your weight on a daily tracking diary, bring your weight diary with you when you visit your doctor. If you notice a gain of 2 to 3 pounds overnight or more than 1 pound each day for 3 days in a row, call you doctor.
Daily Weight Chart Date: Example: 1/1/12
Weight: 150 pounds
Physician Called: No
2. Take your medications exactly as your doctor has prescribed them Many different types of medicines are used to treat heart failure. Each type does a different job. Your doctor and nurses will tell you about your medications including their names and what they do. Taking your medications regularly is very important. Some helpful hints to taking your medications as ordered are: • • • • • • •
Avoid missing doses Never take two doses at once (A slotted pill box may help you remember when to take your medications). Do not take over‐the‐counter medications without your doctor’s knowledge, including vitamins and herbs. Some medications such as Aleve and Advil may make your heart failure worse; seek advice from your physician prior to taking them. Bring your medication schedule with you when you visit your doctor. Make an easy to follow schedule Take your medications when you do other daily activities such as having breakfast‐ make sure you know whether to take your medication with food, on an empty stomach, or at a specific time.
Some of the potential medications your physician may prescribe are: •
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ACE inhibitor; ACE stands for angiotensin converting enzyme. ACE inhibitors are medicines that expand blood vessels and allow blood to flow easier. They help the heart pump better. They slow the disease process, so that patients may live longer and spend less time in the hospital. ARB’s; ARB stands for angiotensin receptor blocker. ARB’s are similar to ACE inhibitors. These medicines expand your blood vessels to help the blood flow your body easier. They also ease the work of your heart. Beta‐blockers; These help the heart pump better and slow down the disease process. They also help prevent heart attack. Diuretics; These are commonly called “Water Pills” they remove excess water that cause swelling and difficulty breathing. Diuretics will increase the need to urinate. It is important these are taken at the same time daily to avoid complications of heart failure. Try to schedule activities around your diuretic schedule. Digitalis; Increases contractility of the heart in patients with a weakened heart muscle. They are also used in some cases to help control rhythm abnormalities.
Medication Log Instructions:
Medication:
Dose:
Example: Metoprolol
25mg
Take 2 times daily
Why I take the Medication: Blood pressure
2. Follow your diet closely Your doctor will probably recommend a low‐salt (low‐sodium) diet. Salt makes the body hold onto water and may add to your fluid build up. The more sodium and fluid you consume the more fluid you will retain. When your body holds fluid, this is called edema. This can worsen your condition and make it more difficult for your heart to work. Most doctors recommend limiting your sodium to 2,000 milligrams, or 2 grams, per day. Ask your doctor what is right for you.
How will you know how many milligrams you are getting? Food labels will tell you how much sodium is in the food you eat. These labels are found on all food products you eat except fresh fruits and vegetables. The labels also tell about serving size, fat, cholesterol, carbohydrates, sugar, protein, and calories per serving. 1. Read the serving size 2. Remember each serving contains the amount listed. Eating 3 servings would increase your sodium by three times the amount. 3. Read the amount of Sodium in each serving
Tips for limiting sodium: • • • • •
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If there are 250 milligrams of sodium or more in a serving of any food, that’s a lot. Avoid it unless you can work it into your daily allowance. Avoid adding salt. Table salt has the most sodium of any food. One teaspoon of salt has 2,360 milligrams of sodium. That is more than you should get in a whole day! Do not add salt to your food while cooking or at the table. Try using fresh or dried herbs or spices to season your food. Do not use salt substitute unless your doctor says you may. Avoid snack foods with visible salt on them such as salted crackers, pretzels, potato chips, and salted nuts. Check ingredient lists. Avoid products that contain the following words: salt, sodium, sodium chloride, monosodium glutamate (MSG), brine, broth, corned pickled, or smoked. These foods are generally high in sodium. Always think fresh and eat fresh. Jarred, canned, or boxed foods generally are much higher in sodium than fresh foods. Choose fresh fruits, fresh vegetables, whole grains, and low‐fat or fat free milk. Avoid deli items such as bacon, luncheon meats, corned beef, anchovies, and mayonnaise based salads. Avoid sauces such as gravy, ketchup, barbecue sauce, and soy sauce. Limit beverages such as tomato juice, soda‐pop, and vegetable juice. Limit canned foods and condiments such as canned soups, canned beans, salad dressings, pickles and olives.
Eating a low‐sodium diet may be a change for you. You will get used to eating in a lower sodium way. It may take a few weeks, so keep working hard at changing your eating habits. When you eat out: • • • •
Ask for your food to be prepared without salt. Stay away from butter, cheese, and sauces. Stay away from fried foods. Choose oil and vinegar salad dressing.
For additional information about your diet please ask your doctor or caregiver for a referral to see a dietitian.
3. Contact your doctor if any problems occur and keep all of your follow up visits as directed It is important that you monitor your heart failure symptoms every day and take action when you notice any changes or deterioration. Some helpful tips to remember: •
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Record your weight daily o Keep your weight book next to your scale. When you wake up each morning, after going to the bathroom, weigh yourself. Log your weight in your weight diary. If you notice a gain of 2 or more pounds contact your doctor. Check your ankles for swelling o As you put your socks on in the morning check your ankles. Press your legs with your thumb – if it leaves an imprint there may be fluid. Contact your doctor if you notice increased swelling. Measure your breathing o Do you have to stop to catch your breath during your daily activities such as getting dressed or climbing the stairs? This could be a sign of fluid buildup. If you notice a change in your daily activities due to shortness of breath contact your doctor.
Your doctor will set up frequent follow up appointments. It is important that you keep all of your appointments as scheduled.
4. Reduce fluid intake as directed by your doctor Your doctor probably will have you limit how much you drink. This is called a “fluid restriction”. Ask your doctor the amount of fluid you can consume to keep your heart failure manageable. Any items that are a liquid at room temperature will count toward your daily consumption. This includes: • • • • • • • • • •
Alcoholic drinks Coffee Flavored water Liquid medicine Tea Water Fruited gelatin Ice cream Popsicle Soup
To help you better understand fluid amounts: Item Creamer Ice Cream Italian ice Jello Popsicle Soda Ice
Amount 1 small container ½ Cup ½ Cup ½ Cup 2 Thin bars 1 Can ½ Cup
Fluid Content 15 ml or ½ oz 90 ml or 3oz 100 ml 3 1/3 oz 120 ml 4 oz 60 ml 2 oz 360 ml 12 oz 120 ml 4 oz
Keeping a log of your fluid intake is helpful for some people in order to track the amount of fluid consumed in a day. Alcoholic beverages should be avoided as they may alter the affects of medications, reduce the strength of the heart contraction, and may make heart rhythms more irregular.
Fluid Log Time Example: 7 am
Fluid Type water
Amount 8 oz
What else can I do to avoid hospitalization and improve my heart failure symptoms? Activity: Your doctor will regulate your activity depending on your condition. Treat activities like bathing, shaving, eating, and dressing as physical activities, spacing them over time. Perform tasks at a slow moderate pace and rest after each one. Resting after each task does not necessarily mean sleeping. You can rest by sitting quietly in a chair for 20 to 30 minutes. Later, as the medications begin to work and you begin to feel better, you will be encouraged to increase your activity. Exercise: Regular exercise, such as walking or swimming, help to keep the heart strong, lower anxiety, and control weight and blood pressure. The kinds of exercises you may do and the level at which you may exercise depend on the severity of your heart failure. Check with your healthcare provider for advice. Exercising may help lower your blood pressure, help control your weight, decrease your stress and tension, and boost your energy level. Types of exercise include: using a stationary bicycle or treadmill, walking in your neighborhood or mall, mowing the lawn or working in the garden. Stop Smoking: Smoking causes more than 230,000 deaths from heart disease each year in the United States. Cigarette smoke contains many chemicals that affect your body. Smoking makes your heart work harder. Smoking increases your heart rate and blood pressure, and decreases blood flow to your arteries. Quitting smoking is your best option! Within 20 minutes of your last cigarette, your heart rate and blood pressure can drop to a normal level. Within 24 hours of your last cigarette your chance of heart attack starts to decrease. It’s never too late to quit smoking! Ask your doctor about the best strategy to help you stop smoking. Stop Illicit Drug Use: Illicit drug use is known to increase damage to the heart muscle, which leads to worsening symptoms of heart failure. Cocaine use is very toxic to the heart. 1 out of 3 people who use cocaine are likely to have a heart attack. Long term use of cocaine and other illicit drugs reduce the heart ability to pump blood effectively. Talk to you your doctor about the best strategy to stop illicit drug use. Educate yourself: Stay informed about the newest advances in the treatment of heart failure by talking with your doctor, nurse, or other healthcare professional. The American Heart Association is a tremendous resource of educational information. You can call it tool‐free at (800)242‐8721 or visit it’s website at www.heartprofilers.com. At this site you will find a program called “Living with Heart Failure”. You can also visit the Heart Failure Society of America at www.abouthf.org.
