Taking Control of Your Heart Failure (Patient Self-Care Book)

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Self-care Management tool/ patient education booklet to be used in conjunction with a comprehensive HF management plan. Specifically created with low literacy and low health literacy patients in mind. Used with extensive teaching by nurse educator. Pls credit author and HCA Mainland Medical Center if you use or adapt this booklet.

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Taking Control of Your Heart Failure (Patient Self-Care Book)

  1. 1. Dawn Martinez, RNHeart Failure Program Coordinator
  2. 2. 2
  3. 3. Table of Contents• What Is Congestive Heart Failure? 5• What Does Congestive Heart Failure Mean? 6• What Causes Heart Failure? 7• Managing Your Heart Failure At Home 8• Blood Pressure And Heart Failure 9• How To Weigh Yourself Every Day 10• Why Should I Weigh Every Day? 11• Fluid Control 12• Items That Count As Fluids, and Fluid Control Tips 13• Why Is A Low Sodium Diet Important? 14• Low Sodium Diet Tips 15• Common High Sodium Foods & Spices 16• Common Low Sodium Foods & Spices 173
  4. 4. Table of Contents• Tips for Dining Out 18• More Diet Tips 19• Heart Failure Medicines 20• Types of Heart Failure Medication 21• Medication Tips 22• Activity Guidelines 23• How Much Is Too Much Activity? 24• Why Stop Smoking and Drinking? 25• Stress Management 26• How Can My Family Help Me? 27• When To Call My Doctor 28• When To Call 911 29• Questions For Your Healthcare Team 30• Resources 31• More Information 324
  5. 5. What Is Congestive Heart Failure?• Your heart has become too weak or too stiff to pump outenough blood to meet your body’s needs.• It is not the same as a heart attack. Not all people withheart failure have had heart attacks. Heart attacks are dueto blockages in the blood vessels that feed the heart.• It does not mean your heart is “stopping.” You can livewith heart failure for a long time, but it is a serious diseasethat can affect your quality of life and how long you live.5
  6. 6. What does Congestive Heart FailureMean?• When your heart doesn’t pumpenough blood out to your body,fluid begins to build up in yourblood vessels, especially the bloodvessels to the lungs. This fluid leaksinto the lungs, belly, and feet &legs. It causes you to feel short ofbreath, weak, and to have swellingin the legs, feet, and belly.• Congestive Heart Failure, CHF,Heart Failure, and HF are all namesfor the same condition.6
  7. 7. What Causes Heart Failure?• There are many conditions which may lead to heartfailure. High Blood Pressure, High Pressure in theLungs, Irregular Heart Beat, Coronary Artery Disease(blockages in the heart’s blood vessels), and HeartValve Problems are very common causes.• Smoking, Alcohol Abuse, Cocaine or other street druguse, some types of Heart Infections, and Diabetes canalso lead to heart failure. Sometimes we cannot figureout why a person has gotten heart failure.7
  8. 8. Managing Your Heart Failure At HomeThere are several important ways that youcan help control your heart failuresymptoms. These are things you can doin addition to taking all of yourmedications and following all of yourdoctor’s instructions!Two of the most important ways you canhelp take care of yourself are:Weigh yourself every day, andwrite it down.Eat a low sodium (salt) diet.Other things you can do to control yourheart failure are: check your bloodpressure, get enough exercise and rest,and stop drinking alcohol and smoking.8
  9. 9. Blood Pressure And Heart FailureMany HF patients have highblood pressure too. Highblood pressure makes yourweak heart work evenharder, and you may feelmuch worse as a result. Youmay have more problemsand more symptoms.It is important to take anymedications your doctorprescribes for your bloodpressure. Following a lowsalt diet will also lower yourblood pressure.9
  10. 10. How To Weigh Yourself Every DayDoing “Daily Weights” is a bit more than just stepping on thescale each day. It is important that you follow these tips tomake your weight as accurate as possible:Weigh in the morning, after using the bathroom butbefore breakfast.Use the same scale every day. Make sure it is on a hardfloor, not a rug or carpet.Wear the same amount of clothing every time youweigh.Record your weight in your Heart Failure Log each day.If you are just getting home from the hospital, weighon your scale right away and record it. Your weight willprobably be different than the hospital scale weight.10
  11. 11. Why Should I Weigh Every Day?Your condition may change veryquickly when you have CHF.One of the earliest signs of achange in your heart failure isweight gain. If you are weighingyourself each day, the scale willshow the extra fluid you arecarrying before you even beginhaving symptoms. This is animportant step in keeping youout of the hospital by catchingchanges very early.11
  12. 12. Fluid ControlYour doctor may instruct you to drink only a certain amount of fluidseach day, so that the fluids don’t build up in your body and makeyour heart failure symptoms worse. Usually, the instructions willtell you to drink only a certain amount in liters or ML or CC. The MLand CC are the same thing, and a liter is 1000 ML.121 quart = 4 cups = 32 ounces = 960 ML = approximately 1 Liter1 pint = 2 cups = 16 ounces = 480 ML1 cup = 8 ounces = 240 ML1 ounce = 30 ML
  13. 13. Items That Count As Fluids, & FluidControl Tips• All drinks: water, tea, milk, coffee, beer, wine, liquor, soda,punch, and juices, etc.• Ice cubes, Ice cream, popsicles, sherbet, sorbet• Jello, gelatin salads• Cream and liquid non-dairy creamer• Soup, stock, broth~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~Lemon wedges, sour hard candies, and gum help moisten yourmouth.Mouthwash to refresh a dry mouth.Measure out your allowed fluid for the day, and stick to it.Use small cups and glasses—makes you feel as if you are havingmore fluid if you have to refill your glass.Eat allowed fruits ice cold between meals to refresh dry mouth.13
  14. 14. Why Is A Low Sodium Diet Important?• Sodium is an important chemical that ourbodies need to function properly, butwhen there is too much sodium, orsalt, in the body our kidneys hold on toextra fluid to dilute the salt or thin it out.Heart failure weakens the heart and itcannot handle this extra fluid, so youbegin to have symptoms of fluidoverload, like swelling and shortness ofbreath.• A low sodium diet is about 2000mg (or 2grams) daily. This is about one teaspoonof salt! Your body actually needs onlyabout 1/8 teaspoon to function each day.14
  15. 15. Low Sodium Diet Tips• It may be very difficult tochange your eating habits, sodon’t be discouraged if youmake mistakes. Each day, takesmall steps toward the ideallow salt, low fat diet and youwill reach your goal.• The easiest salt tip: GET RID OFTHE SALT SHAKER!• Low salt and low fat do NOTequal no flavor!15
  16. 16. Common High Sodium Foods & Spices• Packaged mixes: gravies, sauces, taco seasoning, marinades, mac-n-cheese, dinnerkits (Hamburger Helper), instant potato mixes, etc.• Season Salt, Garlic Salt, Lite Salt, any seasonings with “salt” in the name.• MSG, monosodium glutamate, Accent, meat tenderizer.• Soy Sauce (even the “lite” kind), Worcestershire, Teriyaki Sauce, etc.• Ketchup, Jarred Salsa, BBQ Sauce, Cocktail Sauce, Salad Dressings, Steak Sauce,Hot Sauce.• Most spice mixes such as Cajun Seasoning, Poultry Seasoning, Steak Seasoning,etc.• Pickles, Relishes, Chutneys, Jarred Horseradish Sauce, Antipasti, Dips.• Canned Soups, Gravies, Broths, Tomato Sauces, Tomato Paste.• Canned and Jarred Vegetables, Canned Beans, Sauerkraut, etc.• Lunch or Deli Meats, Canned Meats/Fish, Yellow Cheeses, Velveeta or AmericanCheese, Hot dogs, Sausages, Bacon, Bacon Bits, Imitation Seafood (Krab)• Most Frozen or Prepared Bread Products or Kits such as Instant Cereals/Grits,Frozen Waffles, Corn Bread Mix, Dressing Mix, etc.• Salty snacks: Chips, Nuts, Pretzels, Saltines, etc.16
  17. 17. Common Low Sodium Foods & Spices• Mrs. Dash Seasonings and Marinades• Pure Dried Spices such as Basil, Oregano, Italian Seasoning, Onion or GarlicPowder, Black Pepper• Fresh Herbs and Garlic• Flavored Vinegars, Citrus Juices• Unsalted or “No Salt Added” Canned Soups, Broths, and Vegetables• Dried Beans, Grains, and Pastas• All Fresh or Frozen Vegetables and Fruits• All Fresh/Frozen Meats, Poultry, Seafood, Eggs and Egg Substitutes• White and Cream Cheeses, Ricotta, Cottage Cheese• Frozen Dinners with less than 600MG of Sodium each• Milk, Yogurt, Frozen Yogurt• Most Breads, Muffins, Rolls, etc.• Low Sodium Vegetable Juices, Tomato Sauces, etc.• Fresh, Refrigerated Salsa (From the Produce Section).17
  18. 18. Tips For Dining Out• Ask Questions! Your Waiter or Cook CanExplain How Most Of The Dishes ArePrepared and Make Recommendations ForLow Salt and Low Fat Dishes.• Avoid Dishes with Gravies, Sauces, SoySauce, or MSG. Order Plain Foods such asPlain Baked Potato, Rice, Etc. Do Not OrderSmoked or Cured Foods.• Oil & Vinegar Dressing for Salads. AvoidMarinated Salads, Croutons, CreamyDressings, Bacon Bits, Yellow Cheese, Olives,Pickles, and Antipasti.• Get Grilled, Broiled, or Baked Entrees.18
  19. 19. More Diet Tips• Watch your portion sizes. Most packaged meals contain more than oneserving.• Read the Nutrition Labels. Look for Sodium Free (less than 5mg perserving), Very Low Sodium (35mg or less per serving), or Low Sodium(140mg or less per serving), High Fiber (5gm or more per serving), LowCholesterol (20mg or less per serving), Cholesterol Free (less than 2mg perserving), Low Fat (3gm or less per serving), and Fat Free (less than ½ gmper serving).• Try to keep sodium, fat, and cholesterol less than 5% of the Daily Value perserving. Daily Value is based on 2000 calorie diet usually, sometimes 2500calories.19
  20. 20. Heart Failure Medicines20Heart Failure medicines help your weak heart to workbetter and help relieve your symptoms. Sometimes youwill also take medicines to control other health conditionswhich may make your heart failure worse. Depending onyour particular needs, you may take very differentmedications from other heart failure patients.
  21. 21. Types of Heart Failure Medication• ACE Inhibitors or ARBs: Work in the kidney system to lower the bloodpressure so the heart doesn’t have to work as hard.• Beta Blockers: Slow the heart rate while letting the heart pump better bystopping some of the harmful chemicals that are produced during heartfailure episodes. They also lower blood pressure. Sometimes you may feelworse when starting or changing the dose of beta blockers, but this effectis temporary.• Digoxin: Helps the heart beat stronger. This helps your heart pump moreblood out to the rest of the body.• Isordil dinitrate and hydralazine decrease how hard the heart has to pumpby lowering the blood pressure.• Diuretics, or “water pills,” get rid of excess fluid in your body. This will helpget rid of some of the swelling in your body and may help you breathemore easily. The heart doesn’t have to work as hard to pump blood to thebody when the extra fluid is removed. Some diuretics cause you to losepotassium, so your doctor may prescribe a potassium supplement for you.21
  22. 22. Medication Tips• Take all your medication exactly as directed. Take them at the same timesevery day. Using a pill organizer or writing times on the bottle lid may helpyou.• Always keep the medicines in the original bottle (except for the ones inthe pill organizer) and question your pharmacist if the pills change shapeor color when you refill them.• Do not run out of any medications. Make sure you have enough to last thewhole trip if you are travelling. If you do run out of your medicine, callyour doctor right away.• Keep an up-to-date list of your medications with you at all times. Take yourmedicine bottles to all your doctor’s appointments, including any vitamins,herbs, or other supplements you take. Tell the doctor about any homeremedies or over-the-counter medicines you take too.• Don’t change the dose of medicine you are taking or skip any doses unlessyour doctor has instructed you to do so. If you miss a dose, don’t take itwith the next dose!22
  23. 23. Activity Guidelines• Group your activities with plannedrest periods between them. A 30minute rest period is usually enough.Don’t overdo it!• Avoid activities in extremetemperatures.• Do not perform heavy lifting.• Don’t start exercising unless yourdoctor has said it is OK. Ask about acardiac rehab program to help youincrease your activity slowly.23
  24. 24. How Much Is Too Much Activity?• If you are tired, stop and rest.• IMMEDIATELY STOP THE ACTIVITY IF:– You have increased shortness of breath– Chest pressure or pain– Dizziness or feel faint– Palpitations or a racing heart– Unusual, severe weakness or tiredness– If the symptoms do not go away call your doctor or go tothe emergency room!24
  25. 25. 25Smoking causes the body’s blood vessels to tighten up. Your weak heart thenhas to work much harder to pump blood out to the body. Smoking causesdamage to the lungs, which may make it harder for you to tolerate thesymptoms of heart failure.Drinking alcohol can lead to a weak heart muscle and worsen your HFsymptoms even more. The extra fluid you drink with alcohol may make yourswelling and shortness of breath worse. Alcohol damages the liver. The liverhelps your body use the medications you must take. If your liver is damaged,your heart failure medicines may not work as well.If you are having trouble stopping smoking, drinking, or using street drugs, talkto your doctor or nurse. There are many ways your healthcare team can helpyou quit!
  26. 26. Stress Management• It is important to control stress in your daily life. Stresscauses chemical changes in your body which put a strain onyour weakened heart.• Many people use meditation, yoga, mindfulness activities,journaling, or guided imagery to relieve stress. Ask yournurse about these techniques or others that may help.• If you feel overwhelmed by the stressors in your life,speaking with a counselor may also help.• Sometimes people with serious chronic diseases like HFbecome depressed due to all the changes and issuesassociated with their diseases. If this occurs, your doctormay recommend medications or other types of treatmentto help you deal effectively with these stressful issues.26
  27. 27. How Can My Family Help Me?• Heart Failure is a complicated disease which can be difficult tomanage alone. The many medications, diet and fluid restrictions,and all the other “rules” for taking care of yourself can becomeconfusing, especially when you are very tired or your brain is feeling“fuzzy” from the HF.• Your family can assist in many ways: by helping you organize yourmedications, going to doctor visits with you, and helping you shopfor HF healthy foods. They can also watch for signs and symptomsthat you may not be aware of, so that early treatment can keep youout of the hospital!• Your family can help you when you are feeling overwhelmed orupset as well. Most HF patients go through periods where they areangry or sad or feel lost because of all the life changes their heartfailure has caused. Talking to a trusted friend or family member, oranother CHF patient can help with this stress.27
  28. 28. WHEN TO CALL MY DOCTOR• Weight gain of 2-3 pounds in 1 day or 5 poundsin less than a week.• Worsening shortness of breath or when at rest.• New or worsening swelling of feet, legs, belly, orhands.• Feeling full, hungry but unable to eat much,bloated or tight.• New or worsening cough (wet or dry).• Needing more pillows than usual to sleep orunable to breathe well when lying down, unableto sleep due to restlessness.• Feel dizzy or lightheaded but have not passedout and do not have new or worsening irregularheartbeat.28
  29. 29. WHEN TO CALL 911• ANY CHEST PAIN OR PRESSURETHAT DOESN’T GET BETTER AFTERFIFTEEN MINUTES OF REST ORAFTER TAKING PRESCRIBED DOSESOF NITROGYLCERIN• SEVERE SHORTNESS OF BREATH,COUGHING UP FOAMY PINKISH ORWHITE SPUTUM• FAST OR VERY IRREGULAR HEARTBEAT THAT MAKES YOU FEEL WEAKOR DIZZY• A FAINTING SPELL• SEVERE CONFUSION ANDDIFFICULTY THINKING29
  30. 30. Questions For Your Healthcare Team1. ____________________________________Answer: _____________________________2. ____________________________________Answer: _____________________________3. ____________________________________Answer: _____________________________4. ____________________________________Answer: _____________________________30
  31. 31. ResourcesMy Heart Failure Doctor: ___________________Phone: (___)___-____Pharmacy: ______________________________Phone: (___)___-____My Primary Doctor: _______________________Phone: (___)___-____Mainland Center Hospital: (409)938-5000Mainland Heart Failure Nurse: (409) 938-515931
  32. 32. More Information• American Heart Association:www.americanheart.org• Freedom from Smoking:www.ffsonline.org• Heart Failure Society ofAmerica:www.hfsa.org32
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