CONGESTIVE HEART FAILURE GROUP PRESENTATION Kelly Boals Justin

CONGESTIVE HEART FAILURE GROUP PRESENTATION Kelly Boals Justin Hacker Kelly Hartwell Lynn Willis-Carr

CHF: What is it? � � � The final pathway for multiple diseases that affect the heart. Can decrease the pumping ability of the heart and usually has heart enlargement. Significant improvements and advances in understanding the syndrome and treatment over the last 10 years have been made.

Overview � Heart Failure Readmissions � About 50% of patients who present to the ER with HF symptoms have been noncompliant with medical regimens (Crowther, 2012) Diet Medications � Poor understanding (patient and family/caregiver) of Heart Failure in general and its treatments Improve communication and education � Early follow up post discharge = Fewer 30 day readmissions (Crowther, 2012)

Incidence & Demographics � � HF affects 5. 7 million people in the United States (Baas, 2010) There are 550, 000 new cases each year (Baas, 2010) HF is a major cause of morbidity, with 438, 000 hospital discharges among males and 540, 000 among females attributed to HF (Baas, 2010) HF results is 46, 980 deaths annually; 17, 694 among males (37. 7% of HF deaths) and 29, 286 among females (62. 3% of HF deaths). About 20% of patients with HF die within the first year and 80% will die within 8 years of diagnosis (Baas, 2010).

Health Promotion Model � Described by Nola Pender and focuses on health- seeking rather than disease prevention behavior (Baas, 2010). � Two sets of variables interact and determine personal commitment to action: Individual characteristics and experiences Behavior-specific thoughts and feelings �Perceived benefits of action �Perceived barriers to action �Perceived self-efficacy �Activity-related effect (Baas, 2010) � Commitment to action may be modified or broken by competing demands and preferences (Baas, 2010).

Specific Etiologies of Heart Failure Risk Factors making the Vulnerable Population � Cardiomyopathy � Specific cardiomyopathy present in diabetic patients � � � Ischemia Infection Diabetes Mellitus � Vascular changes: ↑sensitivity to spasms � Microvascular changes: focal ischemia subsequent fibrosis and necrosis Associated autonomic dysfunction

Diet � Suggested sodium intake for CHF patients: � Low sodium heart healthy daily diet = 2, 000 mg (2 grams) (FDA, 2015) � Healthy choices: � Increase fresh or frozen food � Limit Canned or boxed food, preservatives are high in sodium � Limit or remove salt from table � Use Salt alternative, herbs and seasoning � Choose unsalted snacks � Read food labels (FDA, 2015)

Challenges with Diet LOW SODIUM � � Reduction of sodium to 1, 500 -2, 000 milligrams Dinning out, trying to follow the guidelines Using low sodium substitutes are high in potassium, which can have a risk with certain medications Expense of buying fresh fruits and vegetables for low income FLUID RESTRICTIONS � � � Reduction to 1 liter of fluid per day Diuretics causing excessive thirst Reduction or no alcohol consumption may be difficult for dependent patients Understanding what is considered liquid Understanding the measuring process for fluid intake

Plan of Action KNOW WHERE YOUR DAILY INTAKE COMES FROM READ YOUR LABELS � Read serving size EX. 2/3 Cup = 1 serving � 2 servings per container � 470 mg X 2 servings = 940 mg � (FDA, 2015) �

How Live with Restrictions � � � � Read labels while shopping- consider serving sizes Resist the need to apply table salt, move it off the table Use lemon in water, this will decrease thirst Have a support person that can help you with cravings Decrease the amount of condiments, such as dressings Avoid eating out and avoid fast foods Get creative with meals and use spices that will aid with the taste Family participation

HEALTH PROMOTION ACTIVITY � Healthy cooking demonstration/class � Hospital cafeteria location at quarterly health fair � Preparing healthier version of a tasty meal � Identifying healthy alternatives to salt and saturated fat

Family participation increases success � � Family adherence to a low sodium diet (LSD) increased patient compliance (Chung et al. , 2015) The study followed heart failure patients � Objective data obtained through 24 hour urine tests measuring sodium (Chung et al. , 2015) � Family participation in the health cooking demonstration may: � Increase compliance to a LSD � Promote healthy eating � Reduce health risk of heart failure reoccurrence

Beta blockers and Sexual Considerations � � � Beta blockers can cause impotence (Roland & Kucik, 2014). Consideration for sexual dysfunction medication Prior to prescribing medication must assess for chest pain or coronary disease (Roland & Kucik, 2014). Causes vasodilation that aides with sex, but can cause extreme decrease in blood pressure with the use of nitrates (Roland & Kucik, 2014). Is the patient healthy enough to have sexual activity? Self esteem issues with having sex after the diagnosis of CHF

Healthy People 2020 � Goal � “Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events” (Healthy People 2020, 2015). � 25 Objectives listed on http: //www. healthypeople. gov/2020/topicsobjectives/topic/heart-disease-and-stroke/objectives (2015). � Improve overall cardiovascular health risk in U. S. � Meeting these objectives helps reduce the number of readmissions with CHF Managing BP and cholesterol. Knowing signs of symptoms of Heart Attack and Stroke (Healthy People 2020, 2015). �Learning to cook and eat properly.

References � � � � Baas, L. , (Rev. ed. ) (2010). Cardiac vascular nursing: review and resource manual. Silver Spring, MD: American Nurses Credentialing Center. Chung ML et al. , (2015). Adherence to a low-sodium diet in patients with heart failure is best when family members also follow the diet: a multicenter observational study. The Journal of Cardiovascular Nursing, 30(1), 44 -50 7 p. doi: 10. 1097/JCN. 000000089. Crowther, M. (2012). Heart failure readmissions: can hospital care make a difference? . Nursing made Incredibly Easy!, 1 -3. doi: 10. 1097/01. NME. 0000411092. 91068. 71 Haennel, R. G. (2012). Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants. Cardiopulmonary Physical Therapy Journal (American Physical Therapy Association, Cardiopulmonary Section), 23(3), 23 -28 6 p. Healthy People 2020. (2015). Heart Disease and Stroke. Retrieved from http: //www. healthypeople. gov/2020/topics-objectives/topic/heart-disease-and-stroke/objectives Nyberg, A. , Lindström, B. , & Wadell, K. (2013). Evidence for single-limb exercises on exercise capacity, quality of life, and dyspnea in patients with chronic obstructive pulmonary disease or chronic heart failure. Physical Therapy Reviews, 18(3), 157 -172 16 p. doi: 10. 1179/1743288 X 13 Y. 000072 U. S. Food and Drug Administration. (2015). Sodium in Your Diet: Using the Nutrition Facts Label to Reduce Your Intake. Retrieved from http: //www. fda. gov/Food/Resources. For. You/Consumers/ucm 315393. htm

References- continued � Roland, J. , & Kucik, G. (2014). Beta Blockers and Other Drugs that cause Erectile Dysfunction. Healthline. Retrieved from www. healthline. com/health-slideshow/betablockerserectiledysfunction-drug. #3