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Cassie Williams


Client’s Initials: ____H.H._____________ Date: July 15, 2009

Diagnosis: Congestive Heart Failure (CHF)
Teaching Techniques: ___Give explanations, One-on-One discussions, Pamphlets given__

• M (Medications): I am going to go over your medications you will

be receiving while you are here in the hospital and also when and how to take them

upon discharge. If you have any questions feel free to stop me and ask and I will

further explain for you. I want to start off first by saying to always take your

medications as directed. These medications have been prescribed to help prolong

your life. Please also remember to take your meds with you to doctors’ visits and to

the hospital so that we can assure that we proved you with proper treatment. Know

what your medications are for. Always ask your PCP before taking OTC medications

or medication prescribed by a new physician. Let your doctor know if you are having

problems obtaining your medications so that we can see if you qualify for

government assistance. You are getting Digoxin 0.25 mg tab PO daily, I will

demonstrate how to take your pulse. When you take digoxin you need to check your

pulse and if it is < 60 beats/min you shouldn’t take it. This is very important. You

will need to take Lasix 20 mg PO twice a day for fluid balance. Lasix is a diuretic and

it help you get rid of extra fluid you may be accumulating in your legs, feet, hands,

or abdomen. Here at the hospital you will be receiving Lovenox 40 mg/0.4mL SubQ

daily as an injection in your abdomen to prevent (DVT) Deep Vein Thrombosis.

DVT’s are blood clots found usually in the legs. Aspirin 325 mg EC tab PO daily,

when at home do not crush tab. Coumadin 3 mg tab PO daily for you’re a-fib.

Cardizem 10 mL IV Q6h or as needed if your HR is > 140. Vasotec 1.25 mg/mL IV

Q6h or as needed for your SBP > 160. Apresoline 10 mg IV Q4h or as needed for a

SBP > 150. Potassium Chl. 40 mEq tab PO Q4h PRN x2 doses if your potassium
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levels are low. Magnesium sulf. 1g/100mL IVPB 100mL/hr x 1 dose as needed if

your magnesium levels low. Last Demerol 25 mg IV Q2h or as needed for pain.

E (Environment): Upon discharge you need to make sure

you and your family check things around the house that may be in the

way or unsafe and cause you to fall. You can sometimes get tired and

there doesn’t need to be a bunch of things around to get in the way of

your safety. Here are some things to look at upon discharge. Use carpet

with short dense pile and/or apply double-sided carpet tape to prevent

carpet slippage. Arrange furniture so it is not an obstacle in walking paths.

Make sure you can turn on lights without having to walk through dark

areas. Use sturdy step stools, preferably ones with handrails. Clean spills

immediately so there aren’t any slips. Use rubber bath mats or strips in

bathtubs and showers. Consider installing grab bars in the bath to reduce

further the risk of injury from falls. Clean spills or slippery surfaces

immediately, before walking on them especially oil or grease on cement

floors in the garage or in the drive way. Install handrails along any flight of

outdoor steps or on the patio. It’s good to have something there in case

you need to rest for a second. Also if you have pets don’t let them run

around your feet when you are walking. Animals can easily trip you right

off your feet.

T (Treatments): Some treatments and tests for CHF are

EKG, this test measures the electrical activity of your heart. It tells if you

have had a past heart attack, enlargement of the heart or are currently
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having a heart attack. It is painless and involves sticky tabs being placed on

your chest. Echocardiogram or ECHO’s use sound waves to look at your

chest. Stress test is on a treadmill. Your BP is monitored as you walk at

different levels of intensity. Heart catheterization is performed in the cath

lab. It involves a small tube being placed in the artery in your groin that can

leave dye in your arteries so when you get a x-ray you can see the blockage

in the arteries of your heart. There isn’t really a treatment for CHF. Once you

have it you just need to stick to a heart healthy diet, stop smoking, weigh

yourself daily, report changes in your symptoms immediately, stay active, no

alcohol or drugs, and be encouraged. A positive attitude can help you

overcome difficult times. Many people with heart failure can lead active

happy lives with positive changes to their lifestyles. I have included

information for you about smoking cessation, controlling high BP, and living

with heart failure. Look it over at home or when you have a chance and if

you have any questions write them down and ask your physician at your

visits with him, or let me know and I will answer all the questions that I can.

H (Health Knowledge of Disease): Your primary

diagnosis is (CHF) or Congestive Heart Failure. Heart failure means that your

heart is weak and the pumping power is reduced. A normal healthy heart can

pump blood to the body to meet even strenuous demands. The circulating

blood carries oxygen and nutrients to the tissues and removes waste

products. A weakened pump has difficulty performing this task; therefore,

fluid backs up in the lungs and other parts of the body such as the feet,

ankles, legs, hands, and abdomen. The more damages your heart muscle,
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the more damaged your heart muscle is, the more sever your heart failure

will be, as will the amount, frequency, and severity of your symptoms. You

may only experience symptoms such as shortness of breath (SOB) with

strenuous exercise if your heart failure is mild. Likewise, with severe heart

failure you may be extremely short of breath and weak with minor activities.

It is important that you understand a little about the heart and how it works

in order for you to understand heart failure, tests and treatments you will

undergo and also so you can participate in your plan of care. The heart is

made up of four chambers in which blood passes through to be pumped to

the rest of the body. A misunderstanding many people have is that the blood

passes through only one half of the heart, the right side, then to the lungs to

have oxygen attached to all the blood cells. The oxygen rich blood then goes

back to the other half, the left side, which has the biggest job of squeezing

the blood out to the body parts and back to the right side of the heart. The

top chambers are weak pumps called the atria. The bottom chambers are

the strong pumps and are called ventricles. Between each chamber there are

valves. If a valve leaks, the pumping function can be reduced. We gauge the

heart’s function by the amount of blood it pumps. Normally the heart pumps

60-70% of the blood in it. When the muscle becomes weak or damaged the

percentage tends to fall depending on the severity of the heart failure. We

consider the function to be severely reduced when the percentage of blood

pumped falls below 20%. When the heart tries to make up for the lost blood

the heart swells in size and your pulse rate is faster.

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O (Out/In patient Referrals): Your (PCP) primary care

physician, Dr. Allencherril, has ordered consults for your care. You have three

consultations Cardiac, Pulmonary, and Infectious Disease. Your consult for

cardiovascular is to Dr. Trillos. He will be looking at all of your cardiac

problems you are having including your CHF. Your consult for pulmonary is

Dr. Shahar. He will check out the pneumonia in your lungs, and your

Infectious Disease consult if for Dr. Fauhmbulah for the MRSA pneumonia in

your lungs. I am going to give you a packet as well with some information

about MRSA so you can have an idea of what it is, and the steps to prevent

getting it in the future. These physicians will come and see you while you are

here in the hospital and will let you know what and where we will go from

there with your plan of care.

D (Diet): Your doctor has prescribed you on a 2 gram low

sodium diet. A 2 gram low sodium diet limits high sodium foods in your diet.

No table salt is allowed at meals or during cooking while you are on this diet.

The amount of milk is also limited because of the amount of sodium it

contains. A high amount of sodium in your diet can make your blood

pressure go up and can cause other health problems. The goal of a 2 gram

low sodium diet is to prevent or lower high blood pressure. This diet can also

keep your body from holding extra fluid. Fluid excess can be a major problem

with CHF. Problems with your liver and kidneys are another reason to follow

this diet. Changing what you eat and drink may be hard at first think of these
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changes as lifestyle changes not just diet changes. You may need to make

these changes part of your daily routine. 2 grams of sodium is the same as

2,000 mg. I have attached a sample menu for you to look at and some tips

on reading food labels and help in choosing the right foods at home.