Download Heart Failure.indd - St. Mary Medical Center

Self-Care Handbook
Learning to Live with
Heart Failure
Write down important phone
numbers and keep them handy.
Health-care provider
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Pharmacist
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Home health-care agency
Name ___________________________________________________________________
Phone Number ___________________________________________________________
Oxygen equipment supplier
Name ___________________________________________________________________
Phone Number ___________________________________________________________
An emergency contact
Name ___________________________________________________________________
Phone Number ___________________________________________________________
If you have heart failure, this
handbook is for you.
This handbook is designed to help you and your
family understand and manage heart failure. There
are areas for you to track your medicines, diet,
weight, and exercise.
Family Members can be a wonderful source of
support. Ask them to read this handbook with you.
They will be able to help you:
keep track of medicines
cook nutritious meals
stay active without overdoing it
prevent infections
get the support you need
Heart failure cannot be cured, but by understanding
it and following simple guidelines, you can lead a
full and active life.
CONTENTS
What is heart failure ............... 2
Medicine .................................. 3
Track your medicines ........4 & 5
Weight, blood pressure, and
stress........................................ 6
Track your weight ................... 7
High sodium foods ................. 8
Low sodium foods .................. 9
Sodium intake ........................10
Other lifestyle changes .......... 11
Exercise ..................................12
Preventing swelling and
infection ..................................13
Support groups ......................14
What is heart failure?
Heart failure means that your body is not
pumping enough blood to meet your body’s
needs. Heart failure does not mean that you are
The healthy heart is strong enough to pump
blood out of the heart so it doesn’t back up into
the lungs and veins.
about to die or that your heart has stopped. It
simply means that your heart is not working as
well as it should.
The damaged heart causes slower blood flow to
Heart failure can happen in different parts of
the heart. Sometimes the heart weakens and
A traffic jam happens when you heart is not
the body. It can also cause blood to back up into
the lungs and veins.
pumping properly. Blood from the lungs or from
the rest of the body backs up, just as traffic can
back up at rush hour.
is less able to pump blood out. This is called
“systolic” failure. Or sometimes the heart
cannot relax properly to fill with blood. This
is called “diastolic” failure. Some people have
both problems.
To stop the traffic jam, the heart may enlarge its
chambers to let in more blood. It may enlarge
its muscle to beat with more force. These help
keep the heart working almost normally in the
early stages of heart failure. But these measures
cannot keep your heart working properly over
a long period of time - and can actually make
matters worse.
Heart failure also affects the kidneys’ ability to
get rid of sodium and water. The excess water
can cause your feet, ankles and legs to swell.
The terms “congestive heart failure” means that
your heart’s decreased ability to pump blood is
accompanied by excess fluid in the lungs.
Common symptoms of heart failure
• shortness of breath
• waking up due to shortness of breath
• frequent cough or wheezing
• bloating
• swollen feet, legs and ankles
• the need to urinate more often during the
night
• a sudden weight gain
• nausea or loss of appetite
• fatigue or weakness
• confusion or decreased alertness
• rapid or irregular heartbeat
• swollen neck veins
Heart failure usually doesn’t occur suddenly.
It
gradually worsens over time. Heart failure can
be caused by:
• coronary artery disease
• past heart attack
• high blood pressure
• lung disease
• heart valve disease or infection
• heart muscle disease
• heart defects present at birth
• heart damage from alcohol or drug abuse
• heart damage due to diabetes
• abnormal heart rhythms
• thyroid disorders
If your symptoms change or worsen, contact
your health care provider.
2
Medicine is a key factor in
treating heart failure.
Medicine can help make it easier for your heart to pump, strengthen your
heartbeat and remove excess fluid from your body. It can also help improve
your overall quality of life when used as directed. Your health-care provider
may prescribe one or more types of medicine, such as:
ACE inhibitors & angiotensin II receptor
blockers (ARBs)
Purpose: To open up your arteries and lower
blood pressure.
Side effects: May include a cough, dizziness, loss
of taste, swelling, skin rash and high potassium
levels.
Beta blockers
Purpose: To block the effects of chemicals that
can make your heart work too hard.
Side effects: May include shortness of breath,
slow heartbeat, fatigue and low blood pressure.
Digitalis (digoxin)
Purpose: To make your heartbeat stronger and
more regular.
Side effects: May include nausea and loss of
appetite, blurred vision, mental confusion,
irregular heartbeat and headache.
Diuretics (water pills)
Purpose: To help your body get rid of excess
fluid, making it easier for your heart to pump.
Side effects: May include leg cramps, dizziness,
skin rash and low potassium levels.
Tips for managing your medicines
Taken as prescribed, medicine can help you feel better.
Taken incorrectly, medicine can be useless or, even worse,
harmful. Follow these guidelines for taking your medicine.
Ask questions about your medicines, such as “What are they
for?” or “When should I take them?”
Check the label before you take a medicine. Be sure you
are taking the right one and have the correct dose. Always
follow the directions.
Don’t take medicine in the dark - it’s easy to make a mistake
and take the wrong one.
Tell your health-care provider if you have other prescriptions
or take any over-the-counter medicines (even aspirin or
other pain relievers), nutritional supplements or herbal
remedies. They could react with medicines he or she
prescribes.
Ask your health-care provider what you should do if you miss
a dose. Never take a larger dose the next time without his
or her permission.
Report new side effects to your health-care provider. He or
she may adjust your dose, prescribe a different medicine
or make other changes.
Always carry a list of your medicines with you. This can help
health-care professionals in an emergency.
Keep track of your medicines - keeping a written record of
Vasodilators
your medicines, including vitamins and over-the-counter
drugs, will also help you remember to take them on
schedule. The charts on the next two pages will give you a
good start.
Purpose: To open up your arteries and make it
easier for your heart to pump.
Side effects: May include headache, low blood
pressure, dizziness, nasal congestion, flushing
and irregular heartbeat.
Even if you are feeling better, take your medicine as
prescribed! Don’t stop taking a medicine without talking
to your health-care provider first. Changing the size of
doses or skipping does can be dangerous.
Aldosterone blockers
Purpose: To block the effects of a hormone that
can cause fluid buildup and high blood pressure.
Side effects: May include headache, dizziness,
enlarged breasts, irregular vaginal bleeding and
high potassium levels.
3
This handbook is not able to list all the risks, benefits, side effects, and special
precautions for each medication discussed. Patients (or guardians) should talk with
their health-care provider about risks, benefits, side effects and special precautions
for each medication prior to use. Use medications only as prescribed or directed by
your health-care provider.
Color and shape
Instructions/times to take
Now you’re ready to complete a medicine calendar or log.
Medicine Name
Purpose
Side effects
Start by “profiling” them. Complete the chart below. Doing so will help you become more familiar with your
medicines, why you take them and what the possible side effects are.
Track your medicines.
4
Medicines &
Instructions
5
Monday
Hours Taken
Sunday
Hours Taken
Hours Taken
Tuesday
Hours Taken
Wednesday
Hours Taken
Thursday
Hours Taken
Friday
Hours Taken
Saturday
Don’t be hard on your heart.
Your heart is under enough strain already. Help
make your heart’s work easier by maintaining
a healthy weight, keeping your blood pressure
under control and reducing stress.
Practice stress-reducing techniques to calm
your mind and improve your overall health. Talk
to your health-care provider about meditation,
visualization, massage, breathing techniques,
biofeedback, counseling, support groups
and stress management courses. Volunteer
activities, hobbies, taking classes, and exercising
may also help reduce stress.
Maintain a healthy weight.
Being overweight
increases your chances of having high blood
pressure, diabetes, a heart attack and other
problems. Ask your health-care provider about
the best weight for you. If you need to lose
weight, he or she can help you make a diet and
exercise plan.
My current weight is ______________.
I should maintain a weight of ______________.
Weight also plays a role in monitoring your
health. In people with heart failure, weight gain
isn’t always just a sign of eating too much. It can
also be a sign that you’re retaining fluid from
eating too much sodium or that your condition is
getting worse. Use the chart to help keep track
of your weight regularly.
Maintain a healthy blood pressure.
High blood
pressure can lead to increased risk of stroke,
heart attack and other health problems. Low
blood pressure may be a side effect of some
medicines. Ask your health-care provider what
your blood pressure should be and how you can
monitor it.
My current blood pressure is __________.
I should maintain a blood pressure of __________.
6
Are you gaining weight?
A sudden gain in weight may mean that your body is retaining fluid or that your
condition is worsening. As a result, tracking your weight is very important.
Week of:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Call your doctor if you gain ______ pounds or more in one day or ______ pounds or more in one week.
7
Stay away from sodium.
Sodium makes the body retain fluid, making the heart work even harder. Salt
is a huge source of sodium. Reducing sodium will help decrease excess fluid
in your body. (Checking your weight will help you see if you’re retaining fluid.
See page 7)
Here are some popular foods and condiments that are very high in sodium. (Generally,
foods with 140 mg or more of sodium per serving are considered high in sodium.)
Check those that you eat.
424 Croissant
Sodium content (in mg)
515 5 pretzels
616 Cheeseburger, fast food
662 Potato salad, 1/2 cup
739 Ham, 2 slices
821 Scalloped potatoes with butter, 1 cup
824 Tuna salad, 1 cup
833 1 dill pickle
850 Chicken noodle soup, 1 cup
902 Soy sauce, 1 Tbsp.
918 Cottage cheese, low-fat, 1 cup
1061 Macaroni and cheese, 1 cup
1114 Baked beans with franks, 1 cup
1203 Spaghetti with marinara sauce, 1 cup
Ask your health-care
provider what your daily
limit for sodium should be.
Note the foods you checked.
You may have to avoid these
foods and foods like them.
But, there are delicious, lowsodium foods you can eat.
I should limit sodium to
_________ mg a day.
8
Try eating a healthier diet.
Eating foods that are low in sodium will help you feel better.
Here are some foods that are relatively low in sodium. (Generally, foods with less than
140 mg of sodium per serving are considered low in sodium.)
Check those that you eat.
0Almonds, unsalted, 1 oz.
Sodium content (in mg)
<1Cooked oatmeal or pasta, unsalted, 1/2 cup
<1Apple, 1 medium
1 Romaine lettuce, 1 leaf
1 Banana, 1 medium
4 Applesauce, sweetened, 1/2 cup
6 1 tomato
20 Potato, with skin, baked
32 Broccoli, boiled or steamed, 1/2 cup
64 Baby carrots, 8 medium
74 Fresh haddock, 3 oz.
90 Fresh beef, chicken or pork, 3 oz.
103 Milk, fat-free, 1 cup
133 Bread, wheat, 1 slice
Note: The exact sodium
amount in foods can vary by
product. Be sure to read the
label carefully.
Note the foods you checked.
To eat less sodium, you
should replace high-sodium
foods with foods on this list
and foods like them. See
page 10 for some tips.
9
Lower sodium intake.
Remove the salt shaker from your table. You
The Percent Daily Value column can help you
make low-sodium choices. It shows whether a
will be less likely to use it.
serving is high or low in sodium:
20% Daily Value or more is high in sodium, while
5% or less is low.
Use herbs and other seasonings instead of salt
to flavor food. Garlic, oregano, basil, curry,
lemon juice, rosemary, or parsley are great
substitutes. Avoid salted crackers. Snack on
fresh vegetables and fruits. Eat a variety of
fresh and frozen vegetables instead of canned
vegetables. Eat fresh fish, poultry, and meat
instead of canned or processed meats.
Be sure to note the serving size listed on the
package. Although a package looks small, it may
contain more than one serving.
Nutrition Facts
Be careful with salt substitutes and spices that
taste salty. They may contain other forms of
salt that can be harmful. They may also contain
potassium, which can significantly change your
potassium level, especially if you take potassium
supplements. Ask your health-care provider
about safe substitutes.
Serving Size 1 cup (228g)
Servings Per Container 2
Amount Per Serving
Calories 250
Calories from Fat 110
Total Fat 12g
Saturated Fat 3g
Trans Fat 1.5g
Cholesterol 30mg
Sodium 470mg
Total Carbohydrate 31g
Dietary Fiber 0g
Sugars 5g
Protein 5g
Check the sodium content of foods.
It’s listed
on the label. Many frozen dinners, packaged
mixes, canned soups and condiments are high
in sodium. Many over-the-counter medicines
contain sodium too. Ask your pharmacist about
the sodium content of medicines you take.
Vitamin A
Vitamin C
Calcium
Iron
Check out nutrition labels before purchasing
food. With the exception of fresh fruits,
vegetables, and meats, most foods have a
nutrition label.
% Daily Value*
18%
15%
10%
20%
10%
0%
4%
2%
20%
4%
* Percent Daily Values are based on a 2,000 calorie diet.
Your Daily Values may be higher or lower depending on
your calorie needs:
Calories:
2,000
2,500
Total Fat
Less than
65g
80g
Sat Fat
Less than
20g
25g
Cholesterol
Less than
300mg
300mg
Sodium
Less than
2,400mg
2,400mg
Total Carbohydrate
300g
375g
Dietary Fiber
25g
30g
The amount of sodium a product contains is
listed on the label. Some products are also
labeled “sodium or salt free”, “reduced sodium”,
or “no-salt added.” Choose your foods by
comparing nutrition labels.
SOURCE: U.S. Food and Drug Administration/U.S.
Department of Health and Human Services.
10
Make other changes too!
If you smoke, quit. Smoking narrows blood
Avoid alcohol. Alcohol can slow your heart rate
vessels, making it harder to breathe. This
increases your blood pressure and heart rate,
thus increasing your risk of developing other
heart and health problems. Don’t wait - quit
now!
and worsen heart failure. It may also interact
with the medicines you take.
Reduce caffeine intake. Caffeine increases your
heart rate and could cause irregular heartbeat.
Watch your fluid intake. Drinking too many
Eat less fat and cholesterol. Diets high in fat and
liquids may force your heart to work harder.
Therefore, your health-care provider may set a
limit on the amount of fluids you can have. To
keep your mouth from getting dry, suck on some
hard candy or use a humidifier.
cholesterol can lead to more heart problems.
Eat more fruits and vegetables and talk to your
health-care provider for specific guidelines.
Ask before you drink grapefruit juice. It may
interact with some of your medicines.
11
Should I exercise?
Studies have shown that exercise has many
benefits for people with heart failure.
Involve friends or family in your activities
you’ll be more likely to stick with your exercise
program.
It can help:
• improve the flow of blood through your body
• strengthen your heart and body
• tone your muscles
• increase your energy level
• manage stress
• raise your spirits
Don’t overdo it. Exercising and staying active
are important. Keep in mind, though, that you
won’t be able to do as much as you once did.
Set realistic goals and take breaks periodically.
Stop exercising immediately and rest, no matter
Exercise does not mean you have to buy
expensive equipment or join a health club. It can
be as easy as walking regularly. Be sure to warm
up and cool down.
what you are doing, if you:
• feel tired
• have chest pain
• are very short of breath
See your health-care provider before starting
an exercise program. Your health-care provider
Call your health-care provider if these symptoms
don’t go away.
can help you develop an exercise plan based on
your level of fitness. Your program may include
a variety of aerobic activities such as walking,
swimming, cycling, or low impact aerobics.
Strength training may also be recommended.
Watch the weather. Try not to exercise outdoors
if it is too cold, hot or humid. It can interfere
with your circulation, make breathing more
difficult, or cause chest pain.
Ask questions about your exercise program.
•
•
•
•
•
•
How often should I exercise?
What kind of exercise should I do?
Are there any activities I shouldn’t do?
How long should I exercise?
Do I need special equipment or clothes?
Should I check my pulse?
12
How to prevent swelling and
infections.
Swelling of the feet, ankles and legs, known
as edema, is common in those with heart
failure. It is caused when excess fluid builds
up in one part of the body.
Sadly, heart failure can make you more likely
to get pneumonia and other illnesses. But,
there are things you can do to reduce the
risk.
In addition to consuming less salt and taking
certain medicines, there are several other
steps you can take to help reduce swelling.
Stay healthy by:
1. getting flu and pneumonia shots
(check with your health-care
provider)
2. washing your hands frequently
3. staying away from people who have
respiratory infections or who are ill
4. avoiding large crowds
Elevate your legs: Lying down or sitting with
your legs raised will help drain the fluid
away from your legs. However, this is only a
temporary measure because the fluid is just
moving from one area to another.
Be sure to get plenty of rest. To increase your
chances of staying healthy you should:
Walk on a regular basis: Walking will help
increase circulation and tone muscles. If you
are bedridden, flex your leg muscles, move
your feet in circles and wiggle your toes to
help circulation.
1. Plan at least one rest period every
day.
2. Rest between periods of heavy
activity. Alternate light and heavy
activities.
3. Avoid working long days.
4. Consider a short nap after lunch
(long naps may make it difficult to
sleep at night).
Wear special elastic stockings: These
stockings can keep fluid from collecting
in your legs. In general, they should reach
above your knees because shorter ones may
not eliminate swelling. They should be fitted
for you and adjusted as the swelling goes
down. Your health-care provider can help
decide the proper type for you.
When you rest, raise your legs to help keep
any swelling down.
13
Support groups can help, also!
Talking to family and friends can help, but there is nothing like talking to
another person who has the same problems as you. So, ask your hospital,
health-care provider or area agency on aging about support groups close to
you, and join one!
You are not alone.
Support groups give you and your family an opportunity to talk about your
condition and any problems you’re having with others who suffer from heart
failure. Sharing common problems can give you more confidence and make
everyone feel better.
Help others.
If there isn’t a support group near you, start one. It could be a wonderful
source of comfort to others with heart failure. For more information, talk to
your health-care provider or contact:
The Mended Hearts, Inc.
www.mendedhearts.org
1-888-HEART-99
(1-888-432-7899).
You can also call the American Heart Association and ask for Mended Hearts.
Other sources of help
The American Heart Association
www.americanheart.org
1-800-AHA-USA-1
(1-800-242-8721)
The National Heart, Lung, and
Blood Institute Information Center
www.nhlbi.nih.gov
1-800-575-WELL
(1-800-575-9355)
1-301-592-8573
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Discharge Preparation Checklist
Before I leave the care facility, the following tasks should be completed:
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I have been involved in decisions about what will take place after I leave the
facility.
I understand where I am going after I leave this facility and what will
happen to me once I arrive.
I have the mane and phone number of a person I should contact if a
problem arises during my transfer.
I understand what my medications are, how to obtain them and how to take
them.
I understand the potential side effects of my medications and whom I
should call if I experience them.
I understand what symptoms I need to watch out for and whom to call
should I notice them.
I understand how to keep my health problems from becoming worse.
My doctor or nurse has answered my most important questions prior to
leaving the facility.
My family or someone close to me knows that I am coming home and what
I will need once I leave the facility.
If I am going directly home, I have a scheduled follow-up appointment with
my doctor, and I have transportation to this appointment
This tool was developed by Dr. Eric Coleman, UCHSC, HCPR, with funding from the John A Hartford Foundation and the Robert Wood Johnson Foundation.
15
GO
SYMPTOMS:
♥ Breathing is easy
♥ Weight is on target
♥ Little or no swelling
WHAT TO DO:
Great Job!
♥ Keep taking your medicine
♥ Keep watching your diet and
weight
♥ Keep exercising
SYMPTOMS:
♥ Hard to breathe with
activity or at night
♥ Weight is up 3-5 pounds
♥ Swelling in ankles, legs,
or belly
♥ Chest feels heavy or
tight, but gets better with
rest
♥ Very tired
WHAT TO DO:
♥ Call your doctor or nurse
♥ Change your medicine if
directed by your doctor.
♥ Other instructions:
SYMPTOMS:
♥ Hard to breathe even at
rest
♥ Chest pain or chest feels
very heavy or tight
♥ Sweating, weakness, or
fainting
♥ _______________________
♥ _______________________
WHAT TO DO:
♥ Medical Alert - Get help NOW!
♥ Call 911 for emergency help
♥ Do not try to treat this yourself
Green - You feel well.
Caution
Yellow - You do
not feel well.
ALERT
RED - You need
medical help
NOW!
16