Download Heart Disease - Community Health and Counseling Services

COMMUNITY HEALTH AND COUNSELING SERVICES
Self Management for Heart Disease
Call Your Home Health Nurse
and/or Physician
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Weight gain of 2-3 lbs. in one day or 4-5 lbs. in
the past five days
Call 911
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Unrelieved shortness of breath
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Unrelieved chest pain
Wheezing or chest tightness at rest
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Increased coughing
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Increased swelling of legs, ankles, or feet
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Increased shortness of breath with activity
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Increase in number of pillows needed
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Any other unusual feeling that bothers you
Community Health and Counseling Services REV 09 30 2010
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Chest pain not relieved or it comes back after
taking ________ Nitro tablets
Mental changes
COMMUNITY HEALTH AND COUNSELING SERVICES
HEALTH SERVICES DEPARTMENT
MYOCARDIAL INFARCTION
WHAT IS A MYOCARDIAL INFARCTION?
A myocardial infarction or MI is more commonly known as a heart attack. The myocardium is
the heart muscle, and an infarction is an area that does not have a blood supply. During a heart
attack the blood supply to the heart muscle is cut off. The body is a wonderful creation. In
most instances, the heart muscle will "grow" new veins and arteries in the area that lost its
blood supply or otherwise learn to live without what has been lost. In order to develop new
circulation, your heart needs you to rest at first, progress to a structured exercise program,
maintain a healthy diet, and take your medications as prescribed by your doctor.
WHAT AND WHEN TO NOTIFY YOUR DOCTOR
Report immediately:
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Heart pain not relieved by your prescribed medication. (This pain may be felt as sharp,
dull, pressure, or tightness. Heart pain is most commonly in the chest and may move
into the arm(s), jaw, neck, or between the shoulder blades. Don't be confused - some
people never feel anything in their chest but do have other symptoms. When in doubt, it
is best to check it out.)
Persistent nausea, vomiting, or heartburn.
Cold skin that is moist.
Pale or gray color to skin - blue tint to lips.
Increased shortness of breath or difficulty with breathing.
Weight gains, as specified below, or increased fluid retention.
Unusual feelings or problems.
Unpleasant side effects from medications.
DAILY WEIGHTS
It is important to check your weight every day, especially in the presence of fluid retention.
You should weigh yourself:
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at the same time of the day (preferably in the morning after you urinate)
unclothed (or with the same clothing on, such as underwear)
on the same hard, flat surface.
Report a weight gain greater than 2 pounds in a 24-hour period or more than 4 pounds in a
week to your doctor immediately.
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ASSESSMENT OF EDEMA
Edema is a medical word for "fluid retention". After a heart attack, the heart may not be as
efficient a pump, which can lead to fluid retention. To check for fluid retention, push the skin
against your ankles and shins. If an impression of your finger remains, then you are retaining
fluids. Larger amounts of fluid retention are indicated by a deeper finger impression that takes
a longer period of time (minutes instead of seconds) to go away.
ACTIVITY GUIDELINES
Activity:
1.
The following is a list of activities you can do at home.
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2.
The following is a list of activities to avoid for 6 weeks.
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3.
Stairs (maximum of 2 flights at a time)
Dishes
Shower
Knitting
Crocheting
Sex (usual partner, usual environment, not after a heavy meal)
Continue the exercises you were shown in the hospital
Take a short walk twice a day. Start at the distance and speed you were walking
in the hospital. Gradually increase the distance over 4 - 6 weeks until you are
walking for a total of 20 minutes daily, as long as you have no shortness of
breath or chest discomfort.
Biking at lowest resistance for 5 minutes or less. You may gradually increase
over 4 - 6 weeks to up to 20 minutes, as long as you experience no shortness of
breath or chest discomfort.
Driving (this is a state law!)
Lifting over 30 pounds
Digging, mowing, gardening, or raking
Vacuuming
Swimming
Extreme temperature changes, e.g. hot tub, hot or cold showers, or saunas. Do
not go out on extremely hot, humid, or frigid days.
Snow shoveling
If there is any activity not listed that you are wondering about, please ask your
physician.
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SIGNS AND SYMPTOMS OF AN MI
Signs and symptoms of an MI are as follows:
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pain - usually described as crushing, stabbing, and extremely uncomfortable;
may feel like a heavy weight sitting on your chest; it may radiate into the arm(s),
jaw, neck, or between the shoulder blades.
pain that occurs with no predictability (i.e. may be during rest or during exercise)
pain that usually lasts more than 30 minutes and is not relieved by prescribed
nitroglycerin products
restlessness - feelings of anxiety are common
profound sweating
cold, moist skin
faintness and weakness
nausea and vomiting, sometimes indigestion
RISK FACTORS LEADING TO AN MI
Risk factors that can lead to an MI are:
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past history of an MI
family history of cardiac disease
gender - men are more prone
tobacco usage
high blood cholesterol
high blood pressure
excessive weight
physical inactivity
increased stress
type A personality - personality characteristics are commonly described as
competitive, demonstrating urgency in requests of others, always busy, and
lacking patience or tolerance with others.
HOW TO GET RELIEF FROM STRESSORS
There are three important steps you can take to get relief from stresses:
1.
Understand your stressors:
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What causes you stress?
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What is your reaction to each stressor?
- Is it physical? Do you feel your stomach jump or do you clench your teeth?
- Is it emotional? Do you yell or hold back your thoughts?
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2.
3.
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Devise new responses to your stressors. This step may include asking your daughter not
to visit with her children for more than an hour at a time, or it may include
concentrating on relaxation techniques.
Use stress reduction methods:
Listen to relaxing music.
Focus on a peaceful scene or place. Use all of your senses - see the place, listen to its
sounds, feel and smell the air, and taste what may be there to taste.
Consider how you perceive and think about stresses and climb out of your thoughts into
another dimension. Change the way you think.
Obtain professional help with significant stresses. You may want to consider
biofeedback (measures the muscle activity as you work with stress reduction methods to
measure your success) or hypnosis.
GENERAL INSTRUCTIONS
 DO NOT SMOKE. Let us know if you need more information on smoking
cessation.
 You need to follow a low fat/low cholesterol diet. (If diabetic, you still need to
maintain those restrictions).
 Take your medications as instructed.
CHEST DISCOMFORT
 If you have chest discomfort, stop what you are doing and sit or lie down.
 Take 1 nitroglycerin pill or spray every 5 minutes until the discomfort is gone or
until you have taken 3 pills/sprays.
 If your discomfort is not gone in 20 minutes, call your doctor or go to the nearest
emergency room.
 If the discomfort goes away but keeps returning, go to the nearest emergency room.
 Make sure you replace your nitroglycerin pills every 6 months once they have been
open.
Community Health and Counseling Services REV 09 30 2010
COMMUNITY HEALTH AND COUNSELING SERVICES
HEALTH SERVICES DEPARTMENT
ACTIONS
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NITROGLYCERIN
HOW TO TAKE NITROGLYCERIN
Sit or lie down upon the first indication of chest pain.
Relaxes blood vessels
Often, chest pain will disappear with rest. If after 5
Widens coronary arteries
Increases supply of blood and oxygen to the heart minutes, pain persists and you have:
USES
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TABLETS
Used to relieve angina (chest pain)
Used to prevent pain before strenuous exercise
Used to relieve smooth muscle pain that is not
heart related
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ADVERSE REACTIONS
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 Headache
 Dizziness
 Lowered blood pressure
 Fast heart rate
 Hot, flushed feeling
Note: These will generally only last a few minutes.
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STORAGE
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Keep in brown glass bottle.
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Refill prescription every 3 to 6 months.
Do not store other medications in the same bottle.
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Do not keep cotton in the bottle; it absorbs the
nitroglycerin.
Freshness is decreased with time, heat, air, and
moisture.
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SIGNS TO USE NITROGLYCERIN
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Jaw, neck, shoulders, arm/hand discomfort
Chest pain/pressure
Cold sweats, nausea
Shortness of breath
Anytime you are in doubt, treat discomfort
Community Health and Counseling Services REV 09 30 2010
Place 1 nitroglycerin tablet under tongue.
Wait 3 to 5 minutes.
Repeat is pain/pressure is not completely
relieved, taking 1 tablet every 3 to 5 minutes for
a total of three tables.
If not completely relieved of pain, seek help.
You can continue taking 1 tablet every 3 to 5
minutes until you get to an emergency room, or
until you can contact your doctor.
Relax 15-20 minutes after taking nitroglycerin to
prevent dizziness or faintness.
SPRAY
Do not shake the drug container. Hold it upright
with the opening of the mechanism as close as
possible to your mouth.
Press the spray mechanism with your forefinger
to release the spray onto or under your tongue,
close your mouth immediately. Do not inhale or
swallow the spray.
Follow the same directions as for tablet
administration.
HOW TO TAKE A RADIAL PULSE
WHAT IS A PULSE?
A pulse is the beat you can feel against the wall of an artery when the heart beats. The pulse is
the same as the heart rate. The normal adult pulse is 60 to 100 beats per minute. Arteries are
the vessels that carry blood from the heart to different parts of your body. It is easier to feel the
pulse in arteries that come close to the skin.
WHY DO YOU NEED TO TAKE YOUR PULSE?
Your caregiver may want you to check your pulse because of an illness, such as heart disease.
Some medicines you may be taking can change your pulse rate.
HOW TO TAKE A RADIAL PULSE:
The radial artery is found close to the inside part of your wrist near your thumb. You will need
a watch with a second hand to count your pulse. The following steps may help you take your
radial pulse.
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Bend your elbow with your arm at your side. The palm of your hand should be
facing upward.
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Using your middle (long) and index (pointer) finders, gently feel for the radial artery
inside your wrist. You will feel the radial pulse beating when you find it. Do not use
your thumb to take the pulse because it has a pulse of its own.
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Count your radial pulse for a full minute (60 seconds). Notice if your pulse has a
strong or weak beat.
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Write down your pulse rate, the date, time, and which wrist (right or left) was used
to take the pulse. Also, write down anything you notice about your pulse, such as it
being weak, strong, or missing beats.
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The radial artery is an easy artery to use when checking your heart rate during or
after exercise.
Community Health and Counseling Services REV 09 30 2010
COMMUNITY HEALTH AND COUNSELING SERVICES
HEALTH SERVICES DEPARTMENT
STEP EXERCISES (Post MI)
STEP
Step
#1
Step
#2
Step
#3
PATIENT EXERCISE
1. Exercise arms and legs twice a day
(passive ROM).
2. Flex feet every two hours. (minimum)
3. Deep breaths every two hours. (minimum)
1. Continue arm and leg exercise
twice a day.
2. Continue feet flexation every two
hours.
3. Continue deep breathing exercise
every two hours.
1. Hand on shoulders and elbow
circle 5 times. (twice a day)
2. Stand on toes 5 times. (twice a
day)
3. Ambulate in hall 25 to 50 feet
from doorway. (twice a day)
1.
2.
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PATIENT ACTIVITY
Feeds self at 45angle with arms
supported.
Bedside commode (if tolerated).
Dangle at bedside (with permission).
Complete bed bath with minimal assist.
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4.
1. Commode at bedside as tolerated.
2. Dangle at side of bed by self as tolerated.
3. Continued assistance with bed bath.
4. Out of bed to chair four times daily.
1.
1. Bath by self at bedside.
2. Bathroom privileges.
3. Out of bed to chair as desired.
1. Obtain and document vital signs before and
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3.
after all patient exercise.
2. Supervise patient with all shoulder and elbow
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4.
Step
#4
1. Arm circles in Step 3.
2. Stand on toes 10 times (twice a day)
3. Ambulate in hall 50 to 100 feet from
doorway. (twice a day)
1. Bath by self.
2. Bathroom privileges.
3. Chair as desired.
4. Walk
1.
2.
3.
4. Side bends 5 times each side. (twice a day)
4.
Step
#5
1. Side bends 10 times each side.
(twice a day)
2. Ambulate in hall 100 feet from doorway.
(twice a day)
3. Walk up and down the stairs 4 times.
(twice a day)
NURSE ACTIVITY
Actively assist patient with the arm and
leg exercises.
Instruct and supervise patient in dorsiplanter flexion and deep breathing.
Assist with bedside commode and dangle.
Perform complete bath.
Ensure arm, leg, foot and deep breathing exercises
are understood and done by patient.
Assist with bed bath.
Assist to chair.
1. Bath by self.
2. Bathroom privileges.
3. Chair as desired.
4. Up in hall by self as tolerated.
1.
2.
3.
4.
circles and toe exercises.
Ambulate with patient 25 to 50 feet from
doorway.
Document patient tolerance.
Obtain and document vital signs before and
after all patient exercise.
Supervise patient with all arm, toe and side
bend exercises.
Ambulate with patient 50 to 100 feet from
doorway.
Document patient tolerance.
Obtain and document vital signs before and
after all patient exercise.
Supervise patient with side bends and stair climbing.
Ambulate with patient 100 feet from doorway.
Document patient tolerance.
Note: As a general guideline, the nurse can plan to advance the patient daily to the next step. However, some patients may be able to advance two in one day while others
may need to stay at the same step more than one day. The progression will vary.
Community Health and Counseling Services REV 09 30 2010