CHF for Clinician. AtHomeCare.com

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1 CHF for Clinician AtHomeCare.com

2 CONTACT INFORMATION FOR CLIENTS Client s Name: SOC Date: Case Manager s Name: Phone #: Physician s Name: Phone: Emergency Contact Person s Name: Phone Number: MISSION STATEMENT This Program, with a focus on patient education and disease management, seeks to improve the quality of life for clients with Congestive Heart Failure (CHF) and to decrease hospital readmission. TABLE OF CONTENTS CONTACT INFORMATION FOR CLIENTS...2 MISSION STATEMENT...2 TABLE OF CONTENTS...2 CHRONIC HEART FAILURE (CHF): TEACHING PATH...3 CHRONIC HEART FAILURE (CHF):...4 EXACERBATION PREVENTION STRATEGIES...4 SUGGESTED PARAMETERS FOR PHYSICIAN NOTIFICATION...5 URGENT TELEPHONE CALL FOR CONGESTIVE HEART FAILURE (CHF)... 6 COMPREHENSIVE MEDICATION ASSESSMENT WITH INTERVENTIONS...7 Preferred Hospital: Other Information: 2 AT Home Care Clinician

3 Client: Date: Place date and initials by education taught at numbered visit. Teaching Objectives Verbalized Understanding Emergent Care Plan // CALL Agency if: you gain 2-3 pounds overnight or over 5 days feet, ankles, or stomach swell more than usual you have dizziness, nausea, or more shortness of breath. Medication review and verification by primary MD: Flu and Pneumonia Vaccinations: Weight: Daily weight measurement, how to weigh, when to weigh, safety when weighing, tips for weighing Dyspnea: Presence of shortness of breath, dyspnea at rest/with activity, shortness of breath at rest. Orthopnea: Presence of orthopnea, causes orthopnea, use of pillows, oxygen, and safety in the home. Fatigue: Presence of increased fatigue, monitor routine activities, managing fatigue Ascites: Signs and symptoms of ascites, how to manage ascites Edema: reporting presence of increased edema, definition causes of edema, prevention, salt and edema, managing edema Angina: Definition of angina, causes, signs and symptoms, triggers, nitroglycerin, smoking and angina Activity: Activity pacing, exercise, sexual activity

4 Teaching Objectives Verbalized Understanding Nutrition: Salt intake, reading food labels, foods high and low in salt, fluid intake and restrictions; review patient s favorite food labels Lipids: Definition and sources of cholesterol, causes of elevated cholesterol, HDL/ LDL and triglicerides, types of fats, cholesterol testing, reducing cholesterol, food choices Medication Management: Medication compliance, how to manage medications, effects/side effects, refills, OTC medications, importance of taking medications Digoxin- Monitor use of Digoxin, checking pulse, Digoxin toxicity, how to take pulse, importance of taking pulse Diuretics- Compliance with diuretics, managing side effects, potassium replacement, hydration CHRONIC HEART FAILURE (CHF): EXACERBATION PREVENTION STRATEGIES Teach Patient: To monitor & record weight To notify Agency if weight gain of 3 or more pounds in a 7 day time period To take medications as prescribed To monitor sodium intake and maintain at 2 grams per day avoid alcohol About importance of pneumonia vaccine and annual flu vaccine To eat a balanced diet To get adequate sleep To increase activity/exercise Have Patient Describe what swelling occurred prior to seeking medical attention Signs and Symptoms of Heart Failure Exacerbation: Swelling of lower extremities, weight gain of 3/more pounds, abdominal swelling, dyspnea, orthopnea, increased cough, extreme fatigue Most patients are routinely managed with the following 4 types of medications: 1. Angiotensin-Converting Enzyme (ACE) inhibitors Alleviate HF symptoms, improve clinical status, reduce risk of death and rehospitalization and should be prescribed to all patients with systolic HF unless contraindicated Monitor for symptomatic hypotension, worsening renal function, potassium retention, cough, angioedema 4 AT Home Care Clinician

5 2. Beta adrenergic blockers Alleviate HF symptoms, improve clinical status, reduce risk of death and rehospitalization and should be prescribed to all patients with stable systolic HF unless contraindicated or intolerant; used in addition to ACE inhibitors Monitor for symptomatic hypotension, fatigue, bradycardia, fluid retention & worsening HF; symptomatic hypotension may resolve with separating beta blocker and ACE inhibitor administration times 3. Diuretics Most patients will require diuretics to control fluid retention; loop diuretics preferred for most patients Consult with MD regarding allowing the patient to make dosage changes if weight increases or decreases beyond the desired range as appropriate Monitor for electrolyte imbalance, renal function, and symptomatic hypotension 4. Digoxin Improves HF symptoms, quality of life, and exercise tolerance; reduce combined risk of death and hospitalization; used in conjunction with diuretics, ACE inhibitors, and beta adrenergic blockers; low doses are used to treat HF (0.125 mg daily or every other day) Monitor pulse rate and for signs of digoxin toxicity Laboratory Monitoring: Serum electrolytes and renal function are routinely monitored in patients with HF. Hypokalemia is of concern with diuretic therapy and may increase risk of digoxin toxicity. Hyperkalemia is of concern with ACE inhibitors and aldosterone antagonists. Decreased renal function will require diuretic and digoxin dosing. Suggested Parameters for Physician Notification Clinician Education for Congestive Heart Failure (CHF) History Any marked change in symptoms including: Unrelieved shortness of breath or new shortness of breath at rest Unrelieved chest pain Wheezing or chest tightness at rest Inability to sleep without sitting up Inability to stand without sever dizziness or light-headedness New or worsening confusion (as reported by caregiver) Any fall(s) Physical Assessment (or telemonitoring data) Any marked change in objective findings, for example: Apical heart rate >100 or <50 Systolic blood pressure <90 or >160; or postural drop >20 mmhg Respiratory rate >24 Oxygen saturation <90% Temperature >101F Weight gain of 5 lbs in one week or 2-3 lbs overnight New signs of pulmonary congestion or wheezing Markedly increased edema New vascular or pressure ulcer Evidence of an injurious fall Lab Values Any marked change in lab values, or new finding, such as: An increase in BUN above 40 An increase in Creatinine above 2.0 Sodium <128 or >150 Potassium <3.4 or >5.0 Glucose <60 or >300 Hematocrit <25 White blood cell count <12,000 INR >6.0

6 Urgent Telephone Call for Congestive Heart Failure (CHF) Patient s Name: DOB: Date: Physician s Name: MR#: Stopped Meds: Started Meds: Complaint with CHF medications/ treatment regime (diet, daily weights)? YES NO 1. What symptoms precipitated the call? Unrelieved shortness of breath Unrelieved chest pain Any falls Wheezing or chest tightness at rest Inability to sleep without siting up Dizziness or lightheadedness severe when standing New or worsening confusion (as reported by caregiver) Weight gain 2 lbs in a day; 3-5 in a week 2. Change in symptoms: Overall, how are your symptoms compared to 2 days ago? Better About the same Worse (describe 3. Current Treatments: Medication changes (for CHF) No Changes Changes 4. Interventions: (check all that apply) Initiated Skilled Nurse visit within 24 hours Contact primary physician re: (Refer to Physicians Notification Parameters) Phone: Fax: Lab monitoring (check all that apply) Electrolytes and renal function (BUN and Creatinine) Blood Sugar INR Others (specify) Clinician Notes/ Interventions (specify): Clinician Signature 6 AT Home Care Clinician

7 Comprehensive Medication Assessment with Interventions Access patient for the following: Vision (ability to read labels) May need to make ophthalmologist appointment for vision test/ new glasses, may need to purchase a magnifying glass or someone to read labels Comprehension (ability to understand medication purposes) May need information written out or someone to assist Literacy deficits (ability to read labels) May need a pill board with each pill taped to a board and how often to take each pill (this may be used if there are no children in the home) or someone to read the labels Manual dexterity (can patient open the bottle?) May need an OT referral, non-childproof bottles or someone to manipulate the bottles for the patient. Patient s ability to purchase medications (Cost and travel to/from pharmacy) May need a MSW referral Family Caregiver/ Champion (someone to assist patient to be compliant with diet, medications, and daily weights) Champion Name: Availability of Champion: Reconcile medications at each visit and check for compliance and any side effects.

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