Transcript Patient Discharge Teaching : Heart Failure

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
 Beta blockers work at
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
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
 Increases the force of the
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
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
 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.
Oxygen
 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. www.heart.org
• 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 106-111.
 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.