Congestive Heart Failure (CHF) - KEPRO 10.10 packet.pdf · 1 October 2010 sc, mlg Congestive Heart...

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October 2010 sc, mlg

Congestive Heart Failure (CHF)

Presented by: APS HealthcareSouthwestern PA Health Care Quality Unit(APS HCQU)

© 2012 APS Healthcare, Inc. © 2012 APS Healthcare, Inc. © 2012 APS Healthcare, Inc. 2

Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy, or federal, state, and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

Certificates for training hours will only be awarded to those attending the training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

Disclaimer

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• Recognize risk factors for CHF

• Identify symptoms of CHF

• List methods of support for individuals with CHF

Objectives


• A decrease in the heart’s pumping ability

• Inability of heart to meet the needs of the body

• Progressive

Congestive Heart Failure Is…

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• Affects 1.2‐2% of the U.S. population

• 75% of individuals are over 65

• 3.5 million hospitalizations per year

Facts About CHF

© 2012 APS Healthcare, Inc. © 2012 APS Healthcare, Inc. © 2012 APS Healthcare, Inc.

Normal Blood Flow

FROM BODY

FROM BODY

TO LUNGS

TO BODY

FROM LUNGS

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• Injury / damage to heart

• Increased strain on heart

• Structural problems

Risk Factors for CHF


CHF and I/DD

• Down Syndrome

• Fragile X Syndrome

• Williams Syndrome

• Prader‐Willi Syndrome

• Smith‐Magenis Syndrome

• Velo‐cardial Facial Syndrome

• Cornelia de Lange Syndrome

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• Medical history

• Physical exam

• Diagnostic tests

Diagnosis of CHF


• Shortness of breath

• With activity

• At rest

• Orthopnea

• Paroxysmal nocturnal dyspnea

• Fatigue / activity intolerance

• Dizziness / fainting spells

Symptoms of CHF

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• Swelling

• Pronounced neck veins

• Weight gain

• Cough

Symptoms of CHF


• Rapid heart rate

• Depression

• Anemia

• Lack of appetite

Symptoms of CHF

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• There is no cure

• Slow progression

• Minimize symptoms

• Improve quality of life

• Save lives

Is There a Cure for CHF?


• Treat underlying cause

• Improve symptoms and quality of life

• Slow progression

• Prolong life

Treatment Goals

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• Medications

• Lifestyle Changes

• Surgery

Treatment Modes


• Diuretics

• Digoxin

• ACE inhibitors

• Beta Blockers

• Other Medications

Medication Therapy

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• Purpose• Increase urine production

• Decrease blood volume

• Side Effects• Low potassium

• Thirst

• Increased urination

• Examples: • Lasix, Bumex, Demadex, Zaroxolyn, Aldactone, Hydrochlorthiazide(HCTZ)

Diuretics


• Purpose• Increases pumping action of heart

• Slows heart rate

• Side effects• Slow pulse

• Digoxin toxicity

Digoxin (Lanoxin)

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• Purpose• Dilation of blood vessels

• Side effects• Persistent cough

• Dizziness

• Weakness

• Examples• Capoten, Vasotec, Zestril, Accupril, Monopril

ACE Inhibitors


• Purpose• Decrease workload of the heart

• Side effects• Decreased heart rate

• Decreased blood pressure

• Fatigue

• Insomnia

• Examples• Tenormin, Lopressor, Coreg, Betapace, Inderal, Carvedilol

BETA Blockers

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• Angiotensin II Receptor Blockers (ARB’s)

• Vasodilators

• Iron Supplements

• Potassium Supplements

• Coenzyme Q‐10

Other Medications


• Cold and cough remedies

• May increase blood pressure

• May increase workload of heart

• Anti‐inflammatory medications

• May cause fluid retention

Over the Counter Interactions

CAUTION !

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•Weight loss

• Exercise program

• Stop smoking

• Reduce stress

• Avoid alcohol

• Dietary changes

Lifestyle Changes


• Increase potassium

• Fluid restrictions

• Low fat diet

• Low sodium diet

Dietary Changes

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• Active partners in care

• Avoid re‐hospitalization

• Education

• Follow‐up care

Heart Failure Clinics


• Valve replacement

• Bi‐ventricular pacemaker

• Left ventricular assistive device (LVAD)

• Transplant

• Artificial heart

• Implantable sensors

Surgical Interventions

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Supporting an Individual with CHF

• Monitor symptoms

• Ensure medications are taken

• Encourage moderate exercise

• Encourage rest

• Elevate lower extremities

• Read food labels

• Avoid temperature extremities

• Encourage appropriate clothing

• Avoid colds, flu, and pneumonia

• Listen and be positive


BY FOLLOWING THE PLAN OF CARE WITH YOUR SUPPORT,

INDIVIDUALS WITH CHF CAN LIVE A HAPPY AND FULL LIFE

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• Heart Disease

• Heart: Congenital Abnormalities

• Heart Healthy Nutrition

• Stress Management

• Weight Management

Suggested Trainings


• Mayo Clinic Staff (2009, December 23). Heart failure. Retrieved October 19, 2010 fromhttp://www.mayoclinic.com/health/heart‐failure/DS00061

• Heart Failure Society of America (n.d.). Quick facts and questions about heart failure. Retrieved October 19, 2010 from http://www.hfsa.org/heart_failure_facts.asp

• American Heart Association (2009, March 20). Medications commonly used to treat heart failure. Retrieved October 19, 2010 from http://www.americanheart.org/presenter.jhtml?identifier=118

• American Heart Association (2009, April 10). Treating and livingwith heart failure. Retrieved October 19, 2010 fromhttp://www.americanheart.org/presenter.jhtml?identifier=1579

References

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To register for future trainings,

or

for more information on this or any other physical or behavioral health topic, please visit our website at

www.hcqu.apshealthcare.com


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Please take a few moments to complete the evaluation form found in the back of your packets.

Thank You!

Evaluation


There will be a test review after all tests have been completed and turned in to the Instructor.

Test Review

TOTAL FAT INTAKE PER DAY SHOULD BE NO MORE THAN 30% OF TOTAL CALORIES SATURATED FATS Solid at room temperature Raise blood cholesterol Main source is animal foods

Beef Lamb Veal Pork Poultry fat Butter Cream Whole milk cheeses Whole milk dairy products

Some plant sources Coconut oil Palm oil Cocoa butter

Recommended amounts 7-10 % total calories If heart disease then <7 % total calories

CHOLESTEROL Solid at room temperature Raise blood cholesterol Found in all animal fats Recommended amounts

No more than 300 mg per day If heart disease then <200 mg per day

HYDROGENATED FATS Fats that are changed from un-

saturated into saturated form Create trans fatty acids Raise blood cholesterol Common in margarine/

shortening/cooking oils Foods high in trans fatty acids

French fries Doughnuts Cookies Crackers Commercially fried food Commercially baked food

Use only if <2 gm saturated fat/tbsp.

POLYUNSATURATED FATS Liquid at room temperature May help lower blood cholesterol

when used instead of saturated fat Main source is plant oils

Safflower oil Sesame seed oil Sunflower seed oil Corn oil Soybean oil

MONOUNSATURATED FATS Liquid at room temperature May help lower blood cholesterol

when used instead of saturated fat Main source is plant oils

Canola oil Olive oil Peanut oil

10.10/ssc

CONGESTIVE HEART FAILURE


TIPS FOR LOWERING SODIUM INTAKE

Eliminate salt during cooking

Remove salt shaker from the table and the stov-etop

Use spices and herbs to enhance the taste of food

Read labels: Look for words such as salt, sodi-um, Na, NaCl, or brine and select foods with 140 mg or less of sodium/serving, eat only small amounts of food with 150-350 mg of sodium/serving and avoid foods with more than 350 mg sodium/serving

Select unsalted snack products: nuts, pretzels, etc.

Eliminate lunch meats from menu

Eliminate pre-prepared (convenience) foods from menu

Eat more fresh fruits and vegetables

Use frozen rather than canned vegetables

Drain and rinse canned foods before preparing them

Use unsalted broths and bouillon

When eating out look for “heart healthy” items on the menu

When eating out ask the waitress/waiter to have food prepared without additional salt

10.10/ssc

FOODS HIGH IN SODIUM

Athletic drinks Baked goods Bouillon cubes Canned meats and fish Canned soup and dry soup mixes Canned vegetables Condiments: Catsup, Chili sauce, BBQ

sauce, Mustard, Mayonnaise, Steak sauce, Worcestershire sauce, Soy sauce

Convenience foods Cottage cheese Deli meats Dips Fast food Frozen dinners/entrees/skillet dinners Hot dogs/sausage/bacon Instant cooked cereals Instant puddings Meat tenderizer Peanut butter Pickles/Olives Pizza Prepared mixes Salad dressings Salted nuts Seasoned salts Smoked/cured ham Snack foods

FOODS LOW IN SODIUM

Eggs Fresh fruits Fresh/dried herbs Fresh meats Fresh vegetables Frozen fruits Frozen vegetables Jell-O Liquid smoke Loaf bread Oils Tabasco sauce Water packed tuna and salmon (drain

& rinse) Many products come in low sodium

form-read labels

10.10/ssc


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The following suggestions are for individuals trying to achieve a low-sodium diet. The current dietary guidelines for Americans recommend a daily sodium intake under 2,300 mg per day. The definition of a low-sodium food is one containing 140 mg or less per reference amount (and per 50 g if reference amount is small). Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

1. Choose low-sodium foods. The total sodium per serving is listed on the nutrition label on foods. Processed and/or convenience foods are typically high in sodium and make up the biggest part of our sodium intake. Read nutrition labels since sodium amounts can vary greatly amongst food products.

2. Avoid adding salt to foods. Flavor foods with herbs and spices. Toppings can greatly increase the sodium content of an otherwise low-sodium

food. Types of food Low-sodium Foods

( ≤ 140 mg per serving) Moderately High Sodium Foods (141-300 mg sodium per serving)

High Sodium Foods ( > 300 mg sodium per serving)

Breads, cereals, and other grains

• Barley, bulgur, corn grits, couscous

• Cream of wheat or rice

• Oatmeal

• Puffed rice or wheat

• Shredded wheat

• Pasta

• Rice, brown or white

• Trail mix bars

• Instant, flavored cream of wheat

• Instant, flavored oatmeal

• Most ready-to-eat cereals

• Cereal bars, granola bars

• Breads, rolls, buns

• Instant corn grits

• Bisquick

• Flavored rice mixes, frozen or boxed

• Pasta mixes with flavor packets

• Bagels, biscuits, cornbread, crescent rolls

• Breadcrumbs, stuffing

• Muffins, pancakes, waffles

• Flour tortillas

Meat, Poultry, Fish, Dry Beans, Eggs and Nuts

• Bass, bluefish, catfish, cod, flounder, haddock, halibut, herring, mackerel, orange roughy, perch, rockfish, salmon, sea bass, snapper,

• Clams, scallops

• Chicken, turkey, pork, and venison

• Beef

• Blue crab, shrimp

• Peanut butter

• Canned nuts

• Alaska King crab, lobster, mussels

• Anchovies, sardines

• Canned fish, meat, or dry beans

• Battered or breaded meats

• Bacon, sausage, spareribs, and hot dogs

• Lunch meats, kielbasa, polish sausage


Types of food Low-sodium Foods ( ≤ 140 mg per serving)

Moderately High Sodium Foods (141-300 mg sodium per serving)


• Dry beans, boiled or canned with no added salt

• Eggs

• Unsalted nuts and seeds

• Beef jerky, pork skins

• Baked beans

Milk and milk products

• Milk

• Yogurt

• Low-sodium cheeses

• Brie, cheddar, Colby, gouda, limburger, monterey, mozzarella, muenster, provolone, and ricotta

• Cream cheese

• Buttermilk, malted milk, nonfat dry milk

• American cheese, bleu cheese, feta, pimento,

• Cheez Whiz, Easy Cheese, Velveeta

• Cottage cheese

Fruits • Most types of fresh, frozen, and canned fruits

• •

Vegetables • Most fresh and frozen vegetables

• Canned vegetables with no added salt

• • Breaded vegetables

• Canned vegetables

• Pickled vegetables

• Vegetables with cream or cheese sauces

Candy, Desserts, Pastries, and Sweets

• Gum drops, jelly beans, marshmallows

• Brownie from mix

• Frozen juice bars, fudge bars, gelatin

• Frozen yogurt, ice cream, sherbet, sorbet

• Most cakes from mix

• Some snack cakes, processed cookies

• Toaster pastry’s

• Doughnuts

• Some croissants, éclairs

• Snack pies, instant pudding

• Some processed cookies

Snack foods • Air-popped popcorn

• Salt-free pretzels or crackers

• Tortilla chips

• Potato chips

• Snack crackers

• Microwave popcorn, cheese popcorn

• Cheese balls/puffs, corn chips, pork skins

• Pretzels


Types of food Low-sodium Foods ( ≤ 140 mg per serving)

Moderately High Sodium Foods (141-300 mg sodium per serving)


Fats • Sodium-free or low-sodium salad dressings, vinegar and oil

• Unsalted butter

• Vegetable oils

• Sour cream, whipping cream

• Some regular salad dressings • Salad dressings, some regular and reduced-fat

• Butter, margarine, mayonnaise

Sauces and Condiments

• Tomato sauce made from fresh tomatoes or use canned tomato sauce with no added salt

• • Barbeque sauce, marinades, soy sauce, steak sauce, teriyaki sauce, gravy

• Mustard, ketchup, salsa

• Alfredo, hollandaise, and tomato sauce

Other • Low-sodium soup • • Baking soda

• Antacids, seltzer-containing drugs

• Canned soups and homemade soups if made with bouillon cube or high-sodium stock

• Fast foods

• Frozen dinners, frozen pizza, frozen meatless burgers

• Olives, pickles

• Macaroni & cheese, lasagna

FDA Definitions of nutrient claims U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition A Food Labeling Guide September 1994 (Editorial revisions June 1999 and October 2004)

Pennington, J., Bowes and Church’s Food Values of Portions Commonly Used, 18th ed., Lippincott, Philadelphia, ©2005. 10.10/sc

CONTENTS

Information You Should Know What is Congestive Heart Fail-

ure? What are the Risk Factors? Is Treatment Available? Improving Quality of Life with

CHF

FOR MORE INFORMATION OR TRAINING ON CONGESTIVE HEART FAILURE (CHF) OR OTH-ER PHYSICAL OR BEHAVIORAL HEALTH TOP-ICS, CONTACT APS HEALTHCARE AT

www.hcqu.apshealthcare.com CONGESTIVE HEART FAILURE

WEBSITES:

www.hfsa.org www.americanheart.org

www.guidant.com

Southwestern PA HCQU

Southwestern PA Health Care Quality Unit

(APS HCQU) Phone: 1-888-321-5861

Fax: 724-864-3750 Website:

www.hcqu.apshealthcare.com

10.10/sc,bap

Information You Should Know

CHF stands for Congestive Heart

Failure CHF affects approximately 5 mil-

lion people CHF is the #1 cause of hospitalization

for people over 65 years Less than 50% of people diagnosed

with CHF are living after 5 years Less than 25% of people diagnosed

with CHF are living after 10 years

What is Congestive Heart Failure?

CHF is a condition the develops gradually over many years. It is not a heart attack. With congestive heart failure, the heart’s pumping ability is reduced and it is not able to pump enough blood to the body tissues to meet their needs. This also results in a backup of blood into the lungs and other parts of the body. The major symptoms of congestive heart failure are shortness of breath with activity or at rest, difficulty breathing when lying flat, easy fatigue, activity intolerance, swelling of the legs and feet, weight gain, and cough.

What Are the Risk Factors?

Hypertension Coronary Artery Disease Diabetes Aging Smoking Obesity Physical Inactivity High Cholesterol Severe Lung Disease Heart Valve Disease Congenital Heart Disease Kidney Disease

Is Treatment Available?

There is currently no cure for CHF, but with early diagnosis and treatment, its progression can be slowed and symptoms minimized. Treatment includes drug therapy with Diuretics, Digoxin, ACE Inhibitors, and Beta Blockers. Treatment also includes lifestyle changes, such as smoking cessation, decreasing stress, weight loss, dietary changes (low fat, low sodium), and possible fluid restrictions.

Improving Quality of Life with CHF

Notify your physician if you develop

any of the following symptoms: Increasing shortness of breath Weight gain of 2 lbs. or more in

2 days (weigh yourself daily) Dry, hacking cough Extreme muscle fatigue Increased swelling of lower

extremities or abdomen Major decrease in urine output Blackout spells or dizziness Nausea, vomiting, or diarrhea Palpitations or increased heart

rate Take your medications as ordered Check with your physician regarding a

moderate exercise program Rest between activities or when you

become fatigued or short of breath Sit with feet elevated several times

during the day Avoid temperature extremes Dress warmly in cold weather Avoid constricting clothing Avoid colds, flu Get flu vaccine and pneumonia vaccine Avoid crowds during cold and flu

season

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