heart failure: inpatient education discharge …heart failure discharge instructions i understand...

FD.250.H351.PHC (R.Nov-15) (this page)

The information in this document is intended solely for the person to whom it was given by the health care team.

FD.780.H4321.PHC (R.Nov-15) (this collection of documents)

Heart Failure Discharge Instructions

I understand that I should follow these instructions because I have been treated for Heart Failure.

Follow-up:• I need to make an appointment to see my Health Care Provider (i.e. doctor or nurse)

within 2 weeks of leaving hospital.

• If I have a Specialist doctor, I need to make an appointment for within 6 weeks of leaving hospital.

Report to your Primary Care Provider if you experience any of the following:• You gain more than 2kg (4 lbs) in 2 days or 2.5kg (5 lbs) in a week

• You feel more short of breath than usual

• You feel more chest pain or new onset of heart palpitations (racing beats)

• You find it harder to breathe when sleeping or lying down

• You have a cough with frothy sputum

Daily Weights:I will weigh myself daily if possible, preferably in the morning. I will record weights on a heart failure record or calendar. This will help to track weight gains or losses which can mean a change in fluid. Too much fluid in the body can lead to swelling and more shortness of breath.

Diet:It is important to follow a low salt (sodium) diet which means not adding salt from the salt shaker, reading food labels, and keeping my sodium intake to less than 2000 mg per day.

I will limit my fluid or liquid intake if instructed by my health care provider. I have been told to limit my fluid intake to: _____________ litres per day.

• Both of these steps help to reduce swelling and shortness of breath.

5 lbs

SALT

1 cup = 8oz = 250ml4 cups = 1000ml (1 litre)

For more copies, go online at http://vch.eduhealth.caor email [email protected] and quote Catalogue No. FD.780.H43

© Vancouver Coastal Health, September 2016


www.vch.ca

Activity:• It is important to be active each day, balancing rest with periods of

exercise or activity.

• I will discuss increasing my activity level with my Health Care Provider.

• Activity or exercise does not have to be hard; walking is an excellent way to improveyour health.

Medications: • I may be asked to take medicines like ACE Inhibitors and beta blockers. These may help

me live a longer and healthier life.

• I will bring my prescription and all my medicines to the pharmacy to be relabeled as needed.

• I will take my medicines as prescribed even if I am feeling better. Heart failure medicinesusually need to be taken life long. I should not stop taking any medicines before talking tomy Health Care Provider.

• I can discuss any side effects with my Health Care Provider. Some sideeffects can be prevented or lessened with minor changes to my medicines.

• I should have a yearly flu vaccine and a pneumonia vaccine every 5-10years. Both flu and pneumonia can cause lung infections which canworsen my heart failure.

Common Medications for Heart Failure:ACE Inhibitors: these are medicines such as ramipril, enalapril, lisinopril, or perindopril. They help the heart to pump better and prevent your heart from getting weaker.

ARB’s: these are medicines such as candesartan, losartan, or valsartan. They work much like the ACE inhibitors and are used when there is an allergy to an ACE Inhibitor.

Beta Blockers: these are medicines such as carvedilol, metoprolol or bisoprolol. They reduce how hard your heart has to work and helps the heart to pump better. They also help to prevent and treat irregular heart beats.

Diuretics: these are medicines which are often called water pills, one type is furosemide. They work to improve symptoms by getting rid of extra fluid. Spironolactone is a special diuretic that also blocks some of the side effects of heart failure and helps to keep potassium levels steady when you are taking other diuretics.

Resources for People with H

eart Failure A Guide For PatientsH

eart and Stroke Foundation of BC and YukonT

he H

eart and S

troke Fou

ndation

(HS

F) of B

C an

d Yukon

provides in

formation

regarding h

eart disease education

an

d advocacy. H

SF branches offer inform

ation and various care m

anagement strategies.

1212 West B

roadway

Vancouver, B

C V

6H 3V

2T

el: 604-736-4404 Toll-F

ree: 1-888-473-4636Fax: 604-736-8732http://w

ww

.heartandstroke.ca/

BC Heart Failure N

etwork

BC

’s Heart Failure N

etwork gen

erates and shares

accurate, current, an

d relevant in

formation

for health care providers an

d patients in

BC

. We’re called

“BC

’s Heart Failure N

etwork” because w

e work for

the people of BC

who are livin

g with heart failure

to improve their health an

d well-bein

g regardless of geography or cultural backgroun

d.

ww

w.bcheartfailure.ca

Comm

on Medications

for Heart Failure

ACE InhibitorsT

hese are drugs such as ramipril,

enalapril, captopril, an

d lisinopril. T

hey help im

prove your heart’s pumping action

an

d prevent your disease from

getting

worse. A

ngioten

sin recep

tor block

ers (A

RB

s) have a similar function. E

xamples

are candesartan

or losartan.

Beta BlockersT

hese are drugs such as carvedilol, bisoprolol and m

etoprolol. They reduce

how hard your heart has to w

ork and prevent your disease from

getting worse.

They also help to prevent and treat

irregular heartbeat.

DiureticsT

hese are drugs such as furosemide.

They w

ork to improve sym

ptoms by

removing extra fluid.

Aldosterone AntagonistsD

rugs such as spironolactone block some

effects of heart failure and keep potassium

levels steady when you are on a diuretic.

DigoxinU

sually called digoxin or lanoxin, it w

orks to help relieve symptom

s or to control an irregular heartbeat.

Anti-coagulantsD

rugs such as aspirin and warfarin are

used to prevent heart attack and/or stroke.

Local Comm

unity Health Services/

Rehabilitation SupportT

here are a num

ber of other health professionals w

ho m

ay assist you. When

ever possible, develop a consisten

t relation

ship with each:

•C

omm

unity H

ealth Nurses

• H

ealthy heart programs

•N

utritionists

•Support groups

•P

harmacists

•C

ardiac rehabilitation•

Cardiologist/G

eriatriciancen

tres/Other in

ternist

•P

alliative Care T

eams

•C

ardiac Nurse Specialists

Canadian Heart Failure N

etwork

Wan

t to learn about heart failure an

d how to m

anage

your disease? Visit the patien

t inform

ation section

for heart failure in

formation

, diet and exercise.

http://ww

w.chfn

.ca

QuitNow

Help w

ith quitting sm

oking.

Help lin

e: 1-877-455-2233w

ww

.quitnow

.ca

University of Victoria – Centre of Aging

Ch

ronic D

isease Self-M

anagem

ent P

rogram:

Peer-led patien

t education program

offered in com

mun

ities throughout B

C.

http://ww

w.coag.uvic.ca/cdsm

p/

HealthLink BC

Nursing Services: T

he 24-hour tele-health service puts you in

touch with a registered n

urse any tim

e, day or n

ight, just by calling on

e of the followin

g n

umbers:

•C

all anyw

here in B

ritish Colum

bia: 8-1-1•

Deaf an

d hearing-im

paired toll-free, province

wide call: 7-1-1

http://ww

w.healthlin

kbc.ca

For more copies, go online at http://vch.eduhealth.ca

or email phem

@vch.ca and quote Catalogue No. FB.780.R47

© Vancouver Coastal Health, Septem

ber 2016

The information in this docum

ent is intended solely for the person to w

hom it w

as given by the health care team.

ww

w.vch.ca

Patient Reminders

Heart Failure

Steps to Help Reduce Sym

ptoms

When to Call or Visit Your Doctor

Heart Failure (H

F) is a con

dition w

hich usually happen

s over a period of time.

With H

F, the heart muscle is w

eakened

and does n

ot pump w

ell.

This can

result in poor blood circulation

to tissues an

d organs of the body. A

lso, blood can

“back up” causing sym

ptoms

such as:

•Shortn

ess of breath

•Sw

elling of han

ds and low

er legs

•Sen

sation of bloatin

g

•Irregular heart beat

•W

aking at n

ight with sudden

shortness

of breath

•T

rouble breathing w

hen lyin

g flat

1.Weigh yourself daily before

breakfast.

Your goal weight is:

2.Lim

it fluid intake to

6 to 8 cups (or 1.5-2.0 litres)per day if in

structed byyour doctor

3.Avoid high salt foods

4.Don

’t add extra saltto your food

5.Take your m

edications

as prescribed

6.Try to get a little

exercise each day

7.Avoid alcohol

and sm

oking

8.Speak to your doctorabout an

nual vaccin

ations.

If you gain 5 lbs (2.5 kg)

in a w

eek or 4 lbs (2kg) in

2 days

If you are thinkin

g of changin

g an

y of your medication

s (in

cluding n

on-prescription

)

If you notice an

y of the followin

g:

•C

hest pain

•Sudden

dizziness or heart palpitation

s

•In

creased fatigue

•T

rouble breathing w

henlyin

g flat

•In

creased shortness

of breath

•D

ifficulty breathing

at night

•In

creased signs of sw

elling such as

swollen

ankles, bloatin

g, or clothing

feels tight

SALT

N

o smoking!

No alcohol!

5 lbs

Limiting Your Fluid IntakeIf you have a health condition that causes you to collect fluid in your hands, feet, legs, stomach, lungs, or heart, you may need to drink less fluid. Extra fluid causes your heart to work harder and may cause trouble with your breathing. Only follow a fluid restriction if instructed by your doctor.

LIMIT FLUID TO: ________ CUPS/DAY = ________ LITRE/DAY

1 cup = 8 oz = 250 ml and 4 cups = 1 litre (1000 ml)

Glasses: ___________________ ml/oz Mugs: ___________________ ml/oz

Bowls: ___________________ ml/oz Other: ___________________ ml/oz

WHAT COUNTS AS FLUID?All drinks and foods that are liquid at room temperature count as fluid.

Water & Ice Cubes Milk Soups Soft Drinks

Coffee & Tea Juices Popsicles Alcohol

Gelatin Desserts (eg. Jell-O®) Ice Cream & Sherbet

Liquid Nutritional Supplements (eg. Boost®)

Milkshakes & Smoothies

BOOST

For more copies, go online at http://vch.eduhealth.caor email [email protected] and quote Catalogue No. FD.786.M65



www.vch.ca

TIPS FOR TRACKING YOUR FLUID INTAKE

• When you are away from home, use a water bottle to monitor your fluid intake.• Write down the amount you drink each day until limiting your fluid becomes a habit.• Try to drink the same amount each day.• Try filling a large container with the same amount of fluid as your daily

limit. Every time you have some fluid, remove the same amount from thecontainer. When the container is empty, you have reached your limit offluid for the day.

• Measure how much fluid your mugs and glasses hold - it may be more than you think.

TIPS FOR REDUCING YOUR FLUID INTAKE

• Use smaller cups and glasses to help limit the amount of fluid.• Sip your fluids slowly throughout the day.• Limit foods that make you thirsty, such as salty or sweet foods.• Reduce or avoid alcohol; it dehydrates your body and makes you thirsty.• Take pills with soft food, such as applesauce, instead of fluid.• If you have diabetes, keep your blood sugar levels in a good range.

TIPS FOR DEALING WITH THIRST OR DRY MOUTH

• Try ice cubes/ice chips - 1 cup (250 mL) equals ¾ cup (185 mL) of fluid.• Freeze a favourite beverage in an ice cube tray for flavoured ice cubes.• Snack on fresh vegetables between meals.• Snack on frozen grapes or berries.• Chew sugarless gum or suck on a sugarless candy.• Moisten your mouth with a lime/lemon wedge.• Brush your teeth often.• Rinse your mouth with cold water or non-alcohol based mouthwash

without swallowing.• Ask your pharmacist about gels or sprays that can add moisture to your mouth.

Remember to weigh yourself daily: If you gain 2 kg (4 lb) in 2 days or 2.5 kg (5 lb) in 1 week, please call your doctor or health care provider.

For more tips and resources for limiting fluid, call HealthLink BC (dial 811) to speak to a health care professional. You can also refer to www.healthlinkbc.ca

Heart Failure Record

Check Your Weight Every Day• Checkingyourweighteverydayletsyouknowifyourbodyisretainingfluid.• Extrafluidthatbuildsupinyourbodymakesyourheartworkharder.• Whenyoureportweightgainearlytoyourhealthcareprovider,theycanhelpyouprevent

yourheartfailurefromgettingworse.

Weigh yourself the same way each day:• Preferablybeforebreakfastoratthesametimeeveryday• Afteremptyingyourbladder(going‘pee’)• Wearingthesameamountofclothing• Usingthesamescale,keptinthesameplace(onahardsurfaceisbest)

Record your weightonthispageandbringittoyourdoctororclinicappointment(oryoumayuseyourownmethodsuchasacalendar,anotebook,oracomputer).Thispagecanalsobeusedtorecordyourdailyfluidintake,activity,andsymptoms.

Remember:LimitFluidTo:________Cups/Day=_______L/Day

1cup=8oz=250ml 4cups=1000ml(1litre)Measurehowmuchfluidyourglasses,mugsandbowlshold.

Date Daily Weight(Before breakfast) Daily Fluid Intake Activity/Exercise

(in time or distance)Symptoms/Medication Changes

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Important: If you gain 2 kg (4 lb) in 2 days or 2.5 kg (5 lb) in 1 week, please call your doctor or health care provider.

For more copies, go online at http://vch.eduhealth.caor email [email protected] and quote Catalogue No. BA.100.W44



www.vch.ca



Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday



Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday



Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

If you gain 2 kg (4 lb) in 2 days or 2.5 kg (5 lb) in 1 week, please call your doctor or health care provider.

Thefollowingsignsandsymptomsmaymeanworseningheartfailureorfluidretention:Shortness of breath, weight gain or loss, fatigue, shortness of breath while lying down at night, ankle swelling, or abdominal swelling or bloating.

Low Salt (Sodium) Diet

A diet high in salt (sodium) causes your body to hold on to (or retain) fluid. This fluid build-up makes your heart work harder. The fluid build-up can cause swelling in your feet, legs or belly. Fluid can also build up in your lungs, making it hard for you to breathe. Most of the salt in your diet comes from the processed food that you eat.

You should aim for less than 2000 mg of Sodium per day.

Most fresh vegetables and fruit, whole grains, rice, fresh meats, poultry, fish, eggs, milk and yogurt are naturally low in sodium.

Steps you can take to lower the salt in your diet:1. Buy fresh or frozen foods more often.

2. Remove salt from the table and instead use herbs, spices, seasonings, andother flavourings that do not have added salt. Try one of the seasoningblends which do not contain salt such as Mrs. Dash.

3. Read the Nutrition Facts panel on packaged foods and choose foods lower in sodium.

4. When buying canned foods, choose ones with no added salt. Foods labeled with‘No Added Salt’ may contain sodium naturally, but no ingredients containing saltare added to the product.

5. Limit fast foods and “convenience” foods (such as seasoned pasta or rice mixes), cannedfoods (such as stews and soups) and salty snack foods.

6. Avoid processed meats (such as wieners, turkey roll, corned beef); cured meats (such asbacon, ham, sausages); and processed cheese. Limit other cheeses.

7. Limit dining out since restaurant and fast food meals are higher in salt than home cookedlow salt meals. When you do eat out; ask restaurants to limit the salt and MSG that theyuse and order dressing and sauces on the side. You can also ask for nutrition information(if available) to see how much salt is in the food.

8. Limit seasonings and sauces that are high in sodium such as ketchup, relish, bouilloncubes, broth, soy sauce, barbecue sauce, fish sauce, black bean sauce etc.

For more copies, go online at http://vch.eduhealth.caor email [email protected] and quote Catalogue No. BB.227.L69



www.vch.ca

Nutrition FactsPer ½ cup (125 mL)

Amount % Daily Value

Calories 70

Fat 0.5 g 1 %

Saturated Fat 0 g 0 % + Trans Fat 0 g

Cholesterol 0 mg

Sodium 250 mg 10 %

Carbohydrates 13 g 4 %

Fibre 2 g 8 % Sugars 6 g

Protein 2 g

Vitamin A 1 % Vitamin C 2 %

Calcium 0 % Iron 4 %

How to Read a Food Label for SODIUM Reading food labels is the only way to be sure of the sodium content of foods.

The sodium content must be listed on the package, check the Nutrition Facts panel.

Food manufacturers change ingredients all the time; make it a habit to read the label.

Follow these 2 easy steps to read the label:

Step 1: Check the Serving Size Always compare the serving size on the package to the amount that you eat. The label lists the amount of sodium per serving of food (not the package or container).

Step 2: Check the SodiumKeep track of the total amount you eat each day. 200 mg sodium or less/serving or 8% Daily Value (DV) or less/serving.

Tips:• Try to keep the sodium content of each meal

below 650mg.• Watch out for ingredients which are High in

Sodium such as: Baking soda Disodium phosphate Brine Garlic salt, onion salt or celery salt Kosher salt Sea salt Seasoning salt Monosodium glutamate (MSG) Any other ingredient with the word “sodium”,

such as: sodium citrate or sodium nitrate. Do Not use products such as “No Salt”.

They contain too much potassium.

Remember your sodium target is less than 2000 mg/day!

Unprocessed (Choose these!) Processed (Avoid these!)Cucumber: 7 slices = 2 mg sodium Dill pickle: 1 medium = 569 mg sodiumChicken Breast: 3 oz = 74 mg sodium Chicken Pie: 1 serving frozen = 889 mg sodiumTomato: 1 small = 14 mg sodium Tomato Soup: 1 cup = 960 mg sodiumPork Tenderloin: 3 oz = 58 mg sodium Ham: 3 oz = 1095 mg sodiumSwiss cheese: 1 oz = 54 mg sodium Processed cheese slices: 1 oz = 474 mg sodium

Look what happens to the sodium content of foods when they are processed

These are just examples, always read the Nutrition Facts panel on the food label.

Why People with Heart Failure Should Keep ‘Active’

What does it mean to be ‘active’?Activity and exercise - People often use these two terms to mean the same thing. All physical activities and exercise do involve increasing the heart rate and strengthening muscles.

There is, however, a small difference in their meanings. Physical activity is when you are using energy to move your body to get from place to place. Exercise is a type of physical activity. The difference is - exercise is planned. We exercise to improve or maintain fitness or health.

Why activity is important Keeping active is one of the best ways to keep healthy. Any amount of activity is better than none at all.

Keeping active helps you:

Sleep better Feel less tired Feel less breathless Feel more confident and

in control

Studies show that daily activity is good for you. It can help you to live better and longer.

Getting started • Always check with your health care

provider first before starting an activityto make sure you find an activity thatmatches your personal needs and ability.

• Start off slowly and pace yourself.

Is the activity level right for me? • Get to know your body.

It is important that youfeel comfortable doingthe activity.

• As long as you can talkwithout being too shortof breath the level ofactivity is okay.

Balance activity and rest• Be active at a time when you feel rested,

such as first thing in themorning or after a nap.

• Spread your activitiesthroughout your day.

• If you are tired after anactivity or the next day,then you have tried to dotoo much.

• It may take your body a while to finda balance between activity and rest, sodon’t give up.

Activities most people with heart failure can do Walking Light housework Gardening Light vacuuming Stretching Laundry Grocery shopping

For more copies, go online at http://vch.eduhealth.caor email [email protected] and quote Catalogue No. FD.780.W54



www.vch.ca

When to stop an activityStop the activity if you:

• Cannot carry on a conversation, sing, orwhistle without being short of breath.

• Feel weak, tired, or dizzy.• Feel sick to your stomach (nauseated).• Feel your heart is pounding or racing.• Feel your heart beating irregularly and

this is new for you.• Have pain in your chest, neck, jaw, arm,

or shoulder.Stop and rest. Sit in a comfortable chair. Do not go to bed for a nap.

Activity most people with heart failure should not doActivities that involve working above your

head such as painting or washing walls, washing windows, vacuuming curtains.

Lifting or pushing heavy objects.

Straining or holding your breath to do an activity.

Sit ups or push ups.

Climbing a lot of stairs.

Heavy housework or yard work.

Going into a sauna or hot tub.

Learn more about how important activity isReview the ‘Actionset’ called ‘Heart Failure: Activity and Exercise’ on the HealthLink BC web site:

www.healthlinkbc.ca/kb/content/actionset/aa87369.html

Check the BC Heart Failure Network web site.

What if you don’t feel confident doing activities and exercises on your own?There are many community-based programs designed specifically for people with heart disease. To find a program in your community:• Talk to your health care provider

• Call HealthLink BC at 8-1-1

• Go to the HealthLink BC websitewww.healthlinkbc.ca• Click on the ‘Find’ button.• Type in ‘cardiac rehabilitation’ in the

‘What?’ box.• Type in your location in the

‘Where?’ box.• Click the ‘Go’ button.• Choose a program.

• Contact the Physical Activity Line (PAL)• 1-877-725-1149• www.physicalactivityline.com• [email protected]

Tips about activity Stick with it, so it

becomes a habit. Include a variety of

different activitiesso you do not getbored doing thesame thing all thetime.

Wear loose, comfortable clothingand supportive shoes.

Count the fluids you drink duringthe activity as part of your dailyfluid amount.

heart failure: inpatient education discharge …heart failure discharge instructions i understand...

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