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COMMUNITY HEALTH AND COUNSELING SERVICES Self Management for Heart Disease Call Your Home Health Nurse and/or Physician Weight gain of 2-3 lbs. in one day or 4-5 lbs. in the past five days Call 911 Unrelieved shortness of breath Unrelieved chest pain Wheezing or chest tightness at rest Increased coughing Increased swelling of legs, ankles, or feet Increased shortness of breath with activity Increase in number of pillows needed Any other unusual feeling that bothers you Community Health and Counseling Services REV 09 30 2010 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: 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: 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. Community Health and Counseling Services REV 09 30 2010 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. 2. The following is a list of activities to avoid for 6 weeks. 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. Community Health and Counseling Services REV 09 30 2010 SIGNS AND SYMPTOMS OF AN MI Signs and symptoms of an MI are as follows: 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: 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: What causes you stress? 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? Community Health and Counseling Services REV 09 30 2010 2. 3. 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 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 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 ADVERSE REACTIONS Headache Dizziness Lowered blood pressure Fast heart rate Hot, flushed feeling Note: These will generally only last a few minutes. STORAGE Keep in brown glass bottle. Refill prescription every 3 to 6 months. Do not store other medications in the same bottle. Do not keep cotton in the bottle; it absorbs the nitroglycerin. Freshness is decreased with time, heat, air, and moisture. SIGNS TO USE NITROGLYCERIN 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. Bend your elbow with your arm at your side. The palm of your hand should be facing upward. 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. Count your radial pulse for a full minute (60 seconds). Notice if your pulse has a strong or weak beat. 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. 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. 3. 4. PATIENT ACTIVITY Feeds self at 45angle with arms supported. Bedside commode (if tolerated). Dangle at bedside (with permission). Complete bed bath with minimal assist. 1. 2. 3. 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 2. 3. after all patient exercise. 2. Supervise patient with all shoulder and elbow 3. 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