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CHF Patient Education
- 1. What is CHF? Nutrition Medications CHF Zone Review Question and Answer Session
- 3. Congestive Heart Failure (CHF) happens when blood backs up, or congests, into the liver, abdomen or lungs. This typically happens when the heart muscle is damaged, weakened, stiffened and/or enlarged. One may also notice swelling of their legs or ankles or possibly even the whole body if left untreated.
- 4. Coronary Artery Disease High Blood Pressure Faulty heart valves Damaged heart muscle History of heart attack Congenital heart defects Smoking Poor diet Lack of exercise
- 5. For anyone still smoking, NCH offers smoking cessation information and assistance. Please let one of us or your nurse know if you are interested in assistance to quit. Florida Quit Line 1-800-U-Can-Now Staffed 24/7
- 6. Fatigue Shortness of Breath Swelling Sudden Weight Gain Cough Palpitations
- 7. Stop Smoking Reduce sodium intake ◦ No prepackaged frozen meals or canned products Preventative medical care Take your medications as directed Maintain a healthy weight Monitor your weight daily Report any significant changes to your doctor immediately ◦ Weight gain >5 pounds in a week ◦ Weight loss > 8 pounds in a week
- 8. Prior to starting any activity or exercise program please consult with your doctor. Exercise regularly following your doctors guidelines. Ask your doctor about a Cardiac Rehabilitation Program.
- 9. Moderate physical activity can actually help the heart grow stronger. Plan activities with two to three 20-30 minute rest periods every day. Short walks are a good way to begin your exercise program. Try to avoid activities in extreme hot or cold temperatures. Look for activities you enjoy doing such as bicycling, fishing, gardening, or swimming.
- 10. If you experience any of the following symptoms during your activity, stop and rest. ◦ Shortness of Breath ◦ Cough ◦ Chest discomfort ◦ Pain ◦ Dizziness ◦ Fast heart beat ◦ Extreme weakness If after rest the symptoms do not go away, call your doctor or go to the emergency room.
- 11. Do not exercisebeyond your outlined recommendations. Remember, that more is not always better and something is better than nothing!!
- 12. Helping to livehealthier
- 13. Fluid restrictions are sometimes used by doctors to help prevent an overload of fluid in the body. If you become fluid overloaded you may experience shortness of breath, increased swelling and/or weight gain.
- 14. Eat allowed fruits and vegetables ice cold between meals. Chew on ice cubes (but remember they count as part of your fluid balance!). Use small cups/glasses for beverages. Freeze allowed beverages in ice cube trays. Drink in sips instead of gulps. NO straws. Measure your daily fluid allotment and store it in a container in the refrigerator.
- 15. Remember that 2 cups of retained fluid is equal to about 1lb of fluid weight gain. Keep your home well humidified. Try lemon wedges, sour hard candies, or chewing gum to stimulate saliva and moisten a dry mouth. Rinse your mouth with non-alcohol mouthwash. Again, do not use a straw.
- 16. Changing your diet is not easy. It may take several weeks before your adjust to the new tastes and flavors of your meals. Most people with CHF should follow a low sodium diet. Following a low sodium diet will help keep water from building up in your body and may help prevent you from having to take some medications.
- 17. A low sodium diet is considered 2300 mg of sodium per day, but your doctor may recommend 2000 mg of sodium per day due to your CHF. How much is 2000 mg of sodium? ◦ ¼ teaspoon = 600 mg of sodium ◦ ½ teaspoon = 1200 mg of sodium ◦ ¾ teaspoon = 1800 mg of sodium ◦ 1 teaspoon = 2400 mg of sodium
- 18. Page 15 in your packet gives you a list of sodium content in some common foods. Pages18-19 give you some helpful hints on spices and dining out. Pages 20-21 give you a starting reference list of foods allowed or to avoid.
- 19. No single meal should have more than 600 mg of sodium. Stop adding salt to food. Take the salt shaker off the table. Do not add salt when cooking. Pick foods naturally lower in salt such as fresh fruits, vegetables, meat, chicken and fish, dried beans, rice, canned products labeled as “No Salt Added”
- 20. Avoid prepackaged frozen meals, canned foods, and pickled foods whenever possible. If you use a canned food, get the “No salt added” products instead of the „Low Sodium” Use dry beans rather than canned beans. Salt is often used in the canning process to ensure long shelf life. Avoid commercial spice mixtures (the first ingredient is often salt).
- 21. Garlic. It is beneficial to your heart and immune system as well as tasty and full of flavor. Herbs and spices will add flavor and are loaded with health boosting nutrients. Crush herbs in your hand before adding to food to release added flavor. Peppers add spice and flavor to meals. Remove the pepper seeds for a milder taste. Mozzarella or Swiss cheese are the lowest in sodium.
- 22. Reading labels is the best way to find out how much sodium something has in it. It may seem challenging at first, but many people find it fun after they become accustomed to it. Lets learn about a food label and what information they can give us. Please refer to your booklet on page 17-18 for detailed information.
- 23. Nutrition Facts Serving Size1 cup (228g) 1. Start here with Serving Size Servings per Container 2 2. Check Calories Amount per Serving Calories 250 Calories from Fat 110 % Daily Value* Total Fat 12g 18% 3. Limit these Nutrients Saturated Fat 3g 15% Trans Fat 3g Cholesterol 30mg 10% Sodium 470 mg 20% Total Carbohydrates 31g 10% Dietary Fiber 0g 0% Sugars 5g Protein 5g Vitamin A 4% 4. Get enough of these Nutrients Vitamin C 2% Calcium 20% Iron 4% 5. Footnote *Percent Daily Values are based on a 2000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Calories 2,000 2,500 6. Quick guide to % Daily Values Total Fat Less than 65g 80g Sat Fat Less than 20g 26g a. 5% or less is LOW Cholesterol Less than 300mg 300 mg b. 20% or more is HIGH Sodium Less than 2400 mg 2400mg Total Carbohydrates 300g 375g Dietary Fiber 25g 30g
- 24. Always take asinstructed by your physician
- 25. Beta blockers Digoxin Diuretics Angiotensin-converting enzyme (ACE inhibitors) Angiotensin II (A-II) receptor blockers
- 26. Beta Blockers slow the heart rate, lower blood pressure and lessen the risk of some abnormal heart rhythms Examples: Propanolol, Metoprolol, Coreg, Atenolol, Sotalol
- 27. Frequently prescribed medications to treat HTN and a primary CHF medication Can be taken at any time of day, with or without food Taking with food slows absorption and minimizes side effects Often prescribed with other medications
- 28. Side Effects: ◦ Low heart rate Take your pulse everyday and get medication parameters from your doctor ◦ Dizziness/Hypotension Be careful when standing up from a seated position ◦ Fatigue/Lethargy ◦ Sudden weight gain ◦ Impotence ◦ Vomiting/Diarrhea
- 29. Digoxin increases the strength of heart contractions and tends to slow your heart beat Examples: Lanoxin
- 30. Can be taken with or without food but high fiber diets may decrease absorption Take at least two hours before or after high fiber or antacids Consult with your MD before taking any herbal or over the counter medications Take your pulse everyday and get parameters from your MD
- 31. Side Effects: ◦ Fatigue ◦ Slowed Heart Beat ◦ Headache ◦ Vomiting/Diarrhea ◦ Toxicity Blurred vision, light flashes, or yellow-green visual halos around objects REPORT TO MD IMMEDIATELY
- 32. Diuretics prevent fluid from collecting in your body and decrease fluid in your lungs, making breathing easier Examples: Lasix, Bumex, Hydrochlorothiazide
- 33. Take in the morning If taking twice per day, then take in the morning and afternoon May need potassium or magnesium supplements Use sunblock to prevent photosensitivity Follow a low sodium diet Have your BP and kidney function checked regularly by your MD
- 34. Side Effects: ◦ Electrolyte imbalance ◦ Orthostatic Hypotension ◦ Dehydration Dark, concentrated, smelly urine Extreme thirst ◦ Toxicity Ringing in the ears Abdominal pain Fever REPORT THESE IMMEDIATELY
- 35. ACE inhibitors lower blood pressure, improve blood flow and decrease your hearts workload Examples: Captopril, Enalapril, Lisinopril, Ramipril
- 36. Take on an empty stomach, one hour before meals Do not use salt substitutes Choose foods low in salt and potassium NSAIDS may cause body to retain salt and water and decrease the effectiveness of your ACE
- 37. Side Effects: ◦ Nausea/Vomiting/Diarrhea ◦ Dizziness/Hypotension ◦ Skin Rash ◦ Cough Most common If persists or severe, contact MD ◦ Toxicity High Potassium Swelling in face, neck or tongue (ANGIOEDEMA) REPORT TO MD IMMEDIATELY
- 38. Reduces high blood pressure, making it easier for the heart to pump blood, improving heart failure. These drugs provide the same benefits of the ACE Inhibitors without the potential side effect of persistent cough Examples: Avapro, Diovan, Micardis, Cozaar
- 39. Take on a full or empty stomach Take at least two hours before or after an antacid It may take a few weeks to feel full benefit of medication Have kidney function and blood pressure monitored by your MD
- 40. Side Effects: ◦ Hypotension/Dizziness ◦ Headache ◦ Nausea/Vomiting/Diarrhea ◦ Elevated Potassium Level ◦ Confusion
- 42. These are quick glance reviews to give you an idea of how well controlled your CHF is today. Everyday goals ◦ Weigh yourself every morning before breakfast. ◦ Take your medication as prescribed. ◦ Check for swelling in your feet, ankles, legs and stomach. ◦ Eat a low salt diet. ◦ Balance activities and rest periods.
- 43. Congratulations! Your symptoms are under control. No shortness of breath. No weight gain more than 2 pounds. No swelling in your feet, ankles, legs or stomach. No chest pain. No decrease in your ability to maintain a normal activity level.
- 44. Call your doctor‟s office if: ◦ Short of breath. ◦ Swelling in your feet, ankles, legs and stomach. ◦ Feeling tired, no energy. ◦ New or increasing cough. ◦ Dizziness. ◦ Chest pain. ◦ Feeling uneasy. ◦ It becomes harder to breath lying down or you must sleep in a chair. ◦ Weight gain of 3 pounds in a day or 5 pounds in a week.
- 45. Go to the emergency room or call 911 if you have any of these symptoms: !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Struggling to breath or unrelieved shortness of breath while sitting still. Weight gain or loss of 5 pounds in 2 days. Unrelieved chest pain. Confusion.
Editor's Notes
- #4 What does this mean? It means that your heart can’t pump enough blood to meet your bodies needs. It is not unusual to have swelling when the blood starts to congest.
- #5 One rash factor can cause CHF. The more you have the higher the risk becomes. It is very important to stop smoking if you are a smoker. We can assist you with a smoking cessation class and information. Please let one of us or your nurse know you are interested. We would be glad to help.
- #7 Symptoms can be chronic or acute. This means they can be ongoing or start suddenly.
- #8 Lifestyle changes are the best way to improve your quality of life. Activity, low sodium diet, managing your stress, and weight loss are the keys to helping manage your disease/
- #26 Introduce yourself and let the group know you will be discussing CHF medications.
- #27 Lower the heart rate and blood pressureCan limit or even reverse some damage done to the heartLower risk for abnormal heart rhythmsIncrease heart functionMay help you live longer
- #30 Increase the strength of your heart contractionsSlows the heart rate
- #33 Water pillsHelp you breath easier by stopping fluid buildupCan affect your electrolytes so you want to keep them monitored
- #36 Aces claim to help you live longer and feel betterAces widen your blood vessels to lower your blood pressureThey decrease how hard your hear has to work.
- #39 Alternate for PPI who cant take ACES
- #43 Look at your handout please.