An everyday guide to. living with heart failure: Personal record
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1 An everyday guide to living with heart failure: Personal record
2 Contact details How to use this record Your details Name of birth Phone Hospital details Hospital consultant GP details GP Phone Address Out of hours GP service This personal record comes together with An everyday guide to living with heart failure. It is designed to help you keep all the important notes about your heart failure symptoms, medication and treatment, in one place. It will help both you and your different health professionals to keep track of your progress more easily. Bring this record, together with any echocardiogram or ECG reports you may have, to all your appointments at the hospital and the GP surgery, and to your heart failure clinic. The information recorded here should remain confidential to you and all your health professionals. Medication 2 Progress 6 Blood results 12 Daily weight chart 16 Daily fluid record 20 List of abbreviations/ medical terms 24 Patient s hospital number Heart failure nurse If this record is found, please return it to the GP surgery Note to health professionals: This record documents the patient s health status with regard to their heart failure and is not a substitute for the patient s medical notes. Heart failure nurse s phone number An everyday guide to living with heart failure: Personal record has been adapted from the Patient Held Record developed by Other contacts Tracey Dare BHF Heart Failure Specialist Nurse Dorset County Hospital NHS Foundation Trust. To order further copies, please visit bhf.org.uk/publications orderline@bhf.org.uk or call and quote G275A. 2 British Heart Foundation Personal record 1
3 Medication We discuss how to manage your medications and their possible side effects on pages of An everyday guide to living with heart failure. Name of medication What it's for Strength Morning Lunchtime Evening Bedtime Other times Comment 2 British Heart Foundation Personal record 3
4 Medication Name of medication What it's for Strength Morning Lunchtime Evening Bedtime Other times Comment 4 British Heart Foundation Personal record 5
5 Progress This is a record of your progress that should be filled out each time you visit your nurse or doctor. For more information about heart failure and symptoms, please see pages 5-17 of An everyday guide to living with heart failure. HR heart rate, BP blood pressure, ECG heart tracing, ET exercise tolerance, PND paroxysmal nocturnal dyspnoea (waking up suddenly short of breath/panicky), Pillows number of pillows you sleep on at night, Oedema swelling, NYHA New York Heart Association score (1,2,3,4), JVP Jugular venous pressure For more information on these terms, see page 24 of this booklet. HR BP sitting BP standing ECG ET PND Pillows Cough Oedema Fatigue NYHA JVP Weight 6 British Heart Foundation Personal record 7
6 Progress HR BP sitting BP standing ECG ET PND Pillows Cough Oedema Fatigue NYHA JVP Weight 8 British Heart Foundation Personal record 9
7 Progress Ask your doctor or nurse to record anything you should change. Comments/problem Action Signed 10 British Heart Foundation Personal record 11
8 Blood results One of the most common types of blood test you will have is a U&E, or kidney function check, comprising sodium, potassium, urea and creatinine levels. People with heart failure often have slightly out of range results (the normal values are listed in brackets). Do not be alarmed if your results are out of range as this might be normal for you. We discuss tests on page 5 of An everyday guide to living with heart failure. Sodium ( ) Potassium ( ) Urea (3-6.5) Creatinine (50-120) Comments 12 British Heart Foundation Personal record 13
9 Blood results Sodium ( ) Potassium ( ) Urea (3-6.5) Creatinine (50-120) Comments 14 British Heart Foundation Personal record 15
10 Daily weight chart Please see page 47 of An everyday guide to living with heart failure for guidance on how to weigh yourself properly. Remember, if you gain 1-2 pounds (about 1 kilo) or more in 2-3 days, you may be retaining fluid. Call your doctor, nurse or GP for advice. Weight Comments Weight Comments 16 British Heart Foundation Personal record 17
11 Daily weight chart Weight Comments Weight Comments 18 British Heart Foundation Personal record 19
12 Daily fluid record For information about managing your fluid balance and how to record your daily fluids, please read pages of An everyday guide to living with heart failure. Day/date Fluid in drinks Fluid in food Total fluid for the day Day/date Fluid in drinks Fluid in food Total fluid for the day Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Sunday Sunday 20 British Heart Foundation Personal record 21
13 Daily fluid record Day/date Fluid in drinks Fluid in food Total fluid for the day Day/date Fluid in drinks Fluid in food Total fluid for the day Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Sunday Sunday 22 British Heart Foundation Personal record 23
14 List of abbreviations/medical terms Your health professionals may use some of these terms when making notes about your progress. Term Explanation Term Explanation BP Blood pressure HR Heart rate CABG Coronary artery bypass graft JVP Jugular venous pressure (measurement of fluid overload) DCM Dilated cardiomyopathy LV Left ventricle this is the main pumping chamber of the hear ECG Electrocardiogram a heart tracing MI Myocardial infarction = heart attack ECHO Echocardiogram an ultrasound scan of the heart NYHA New York Heart Association score, used for measuring degree of heart failure symptoms ET Fatigue Exercise tolerance 1 Good. No limitations. Can manage more than 1 mile. Takes regular exercise 2 Fair. Can manage up to ½ mile on the flat. Walking up inclines causes SOB 3 Moderate. Limited to 100 yards at best. Washing and dressing causes SOB 4 Poor. SOB at rest 0 None 1 After moderate physical effort, eg, walking down the corridor or showering 2 After mild exertion, eg, washing and dressing 3 After minimal exertion, eg, standing from the chair, pottering around the room 4 At rest Oedema 1 No symptoms 2 Symptoms on moderate exertion 3 Symptoms on mild exertion 4 Symptoms at rest Swelling / water retention in the tissues. Can occur in the feet, ankles, lower limbs and abdomen 1 None 2 Mild (resolves after rest) 3 Moderate (eg, mid calf / below knee) 4 Above knee 5 Thigh / sacral / abdomen PND Paroxysmal nocturnal dyspnoea sudden wakening in the night due to SOB SOB Shortness of breath 24 British Heart Foundation Personal record 25
15 We are the nation s heart charity, dedicated to saving lives through pioneering research, patient care, campaigning for change and by providing vital information. But we urgently need your help. We rely on your donations of time and money to continue our life-saving work. Because together we can beat heart disease. British Heart Foundation 2012, registered charity in England and Wales (225971) and in Scotland (SC039426) G275A/0112 bhf.org.uk Heart Helpline bhf.org.uk Information & support on anything heart-related Phone lines open 9am to 5pm Monday to Friday Similar cost to 01 or 02 numbers British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW T F
LIVING WITH HEART FAILURE
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