HEART FAILURE EXERCISE
Student name: ___________________________ Date: ______________
How was your patient’s heart failure diagnosed?
symptoms on admission _________________________________________________________________
diagnostic tests and results:
BNP______________
Echocardiogram________________________________________________________________
MUGA scan: ___________________________________________________________________
Cardiac catheterization: __________________________________________________________
Other: ________________________________________________________________________
Possible cause(s) of your patient’s heart failure (look at history): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Does your patient have left or right sided heart failure or both (list symptoms)? __________________________________________________________________________________________________________________________________________________________________________________________
What stage Heart Failure is your patient in and why did you choose this stage? __________________________________________________________________________________________________________________________________________________________________________________________
Medications prescribed (include generic and trade names and dosage):
diuretic __________________________________________________________________________
Beta blocker ______________________________________________________________________
ACEI ____________________________________________________________________________
ARB _____________________________________________________________________________
Digitalis___________________________________________________________________________
Statin _____________________________________________________________________________
Anticoagulant/ platelet inhibitor _______________________________________________________
Referring to the CORE measures for CHF, is your patient getting the appropriate treatment? If not, what is missing and why do you think it is missing? _________________________ ______________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
What about for his/her stage of CHF? If not, what is missing? ___________________________________________
_____________________________________________________________________________________________
Evaluation of your patient’s treatment since admission (trending):
Subjective: ____________________________________________________________________________
______________________________________________________________________________________
Objective signs (VS, labs…use measurable outcomes): _________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________-
Discharge teaching started/done (be specific about what was taught and how):
activity level ___________________________________________________________________________
diet _________________________________________________________________________________
Fluid intake ___________________________________________________________________________
weight monitoring _____________________________________________________________________
what to do if symptoms worsen ____________________________________________________________
_____________________________________________________________________________________
discharge medications: _________________________________________________________________ ______________________________________________________________________________________
______________________________________________________________________________________
Follow up instructions with MD ____________________________________________________________
List any barriers to learning? _____________________________________________________________________
List any ancillary consultations you would recommend for this patient .____________________ _______________
______________________________________________________________ _______________________________
Heart Failure Guide
Types of Heart Failure
Signs/Symptoms Left- Sided Heart Failure Right-Sided Heart Failure
Edema Mild to moderate Moderate to Severe
Fluid Retention Pulmonary edema/ Pleural Effusion Ascites
Organ Enlargement Heart Liver (Jaundice may be present)
Respirations Dyspnea prominent, PND Dyspnea possible but not as prominent
JVD Mild to moderate Neck veins visibly distended
GI symptoms Mild Loss of appetite, bloating, constipation
Stages of Heart Failure
Stage A
Pts at High Risk: HTN, CAD, DM, Metobolic syndrome; pts using cardiotoxins
Treatment: Treat HTN, smoking cessation, treat lipid disorders, exercise, discourage ETOH and drug abuse, control metabolic syndrome
Meds: ACEI or ARB in appropriate pts
Stage B
Patients with Structural heart disease w/o symptoms of HF: (Hx of MI, LV remodeling including LVH and low EF), asymptomatic valve disease
Treatment: All measures under Stage A
Meds: Same as A, plus Beta- blockers in appropriate pts
Stage C
Structural heart disease with symptoms of HF and sob, fatigue, reduced exercise tolerance
Treatment: All measures under A and B, dietary salt restriction
Meds: Same as for A& B, plus diuretics for fluid retention, may include Aldosterone antagonist/ Hydralazine/ nitrates
Devices in selected patients: Pacemakers/AICDs
Stage D
Refractory HF needing special interventions: symptoms at rest despite maximum drug therapy
Treatment: All appropriate measures under A, B, and C. Decision making to choose appropriate level of care. Compassionate end of life care/hospice. Heart transplant, chronic inotropes, permanent mechanical support, experimental surgery/drugs.
CORE Measures Congestive Heart Failure
1. Evaluation of left ventricular systolic function (LVSD)
can be found:
· narrative description in the progress notes
· cardiac cath lab report
· echo report
· MUGA scan report
· gated heart scan report
2. ACEI or ARBI for left ventricular systolic dysfunction
-or contraindications documented
· ACEI/ARB allergy
· moderate/severe aortic stenosis
· chronic renal failure or renal insufficiency
3. Smoking cessation counseling
4. Discharge teaching including:
· activity level after discharge
· diet/fluid intake after discharge
· all discharge medications
· follow up instructions with MD/APN/PA
· weight monitoring
· what to do if symptoms worsen
Heart failure exercise KBurns
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