By Lisa Bruno Gateway Community College April 1, 2011 Instructors Ellen Cummings, RN, MSN, CNE Beth Walker, RN, MSN, CNE

GOALS 1. Patient/Family will describe signs and symptoms of Heart Failure. 2. Patient/Family will demonstrate use of prescribed medications, dietary guidelines, self care tools and will identify when doctor needs to be contacted. 3. Patient/Family will demonstrate tools for safely managing CHF.

OBJECTIVES 1. Determine patient’s ability and willingness to learn. 2. Modify teaching to patient’s level of understanding and comprehension. 3. Teach patient what CHF is and how to manage it safely. 4. Encourage patient to share feelings about diagnosis using Therapeutic Communication.

Types of Heart Left sided Heart Failure results in the left side of heart not pumping enough blood to the body. Right sided Heart Failure results in the right side of the heart not pumping blood to the body.

Encourage patient to consider using a pill box to keep medications organized.

CHF Medications… ACE Inhibitors Beta Blockers Vasodilatation-they allow the vessels to expand. The goal is to lower blood pressure and decrease workload on the heart. Can cause a cough and dizziness and potassium needs to be checked Examples: Vasotec, Captopril, and lisinopril Beta blockers work at lowering heart rate and blood pressure. Nausea, low Blood pressure, can complicate Asthma issues. Examples: metoprolol and atenolol.

More CHF medications….. Diuretics Digoxin Patient may know these as water pills. Helps kidneys remove fluid and Na and decreases the workload on the heart. Will help with the edema in ankles and legs. Watch for potassium loss. Encourage patient to eat potassium rich foods like bananas, oranges, greens. Ex-Lasix, HCTZ Increases the force of the blood via contraction at the left ventricle. Can also help with some Irregular heat beats=arrhythmias. If patient is taking too much patient may have nausea and vomiting, headaches and blurred vision

More Medications continued… Blood Thinners Oxygen Coumadin and Heparin. These drugs will help prevent blood clots from forming. Levels need to be monitored. Watch for bleeding, bruising, have patient have blood testing of INR. Let doctor know about bleeding. The doctor may order patient to have a prescription for in home Oxygen Therapy in order to decrease the workload on the heart. Vasodilators such as hydralazine which cause the blood vessels to relax.

Patients will need to learn about what Salt does to the body. We need to teach our patient that avoiding it is very important.

Look for “Low Salt” on labels. Avoid pre-seasoned mixes, decrease visits to fast food restaurants

Maintain ongoing communication with your doctor…….. See your doctor regularly Follow up on your doctor’s orders for lab work a. Basic Metabolic Panel…including Cholesterol levels. Some tests will require you to fast the night before so plan to schedule blood draw early in the morning when possible. It is important to monitor Potassium levels b. BNP

Remember… Take meds as prescribed Get flu Vaccination Get Pneumococcal Vaccination Take frequent rest breaks. Don‘t over exert yourself. Stop activity if you have shortness of breath or feel dizzy. Follow the low sodium diet and Fluid guidelines. Weigh self daily and keep a journal and bring to doctor visits. Call the doctor if you gain 3-5 lbs over 2-3 days. Don’t Smoke. If you do its time to consider quitting.

References American Heart Association website. Cardiovascular care made incredibly visual!. (2007). Philadelphia: Lippincott Williams & Wilkins. Hill, Catherine A., (2009). Acute Heart Failure: Too Sick for Discharge Teaching ? Critical Care Nursing Quarterly, Volume 32-Issue 2-p Lewis, H.D. (2007). Medical-Surgical Nursing Assessment and management of Clinical problems. St Louis: Mosby Elsevier. Varcarolis, Elizabeth. (2006). Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. St Louis: Saunders Elsevier.