Cassie Williams
M E T H O D TEACHING PLAN
Client’s Initials: ____H.H._____________ Date: July 15, 2009
Diagnosis: Congestive Heart Failure (CHF)
Teaching Techniques: ___Give explanations, One-on-One discussions, Pamphlets given__
• M (Medications): I am going to go over your medications you will
be receiving while you are here in the hospital and also when and how to take them
upon discharge. If you have any questions feel free to stop me and ask and I will
further explain for you. I want to start off first by saying to always take your
medications as directed. These medications have been prescribed to help prolong
your life. Please also remember to take your meds with you to doctors’ visits and to
the hospital so that we can assure that we proved you with proper treatment. Know
what your medications are for. Always ask your PCP before taking OTC medications
or medication prescribed by a new physician. Let your doctor know if you are having
problems obtaining your medications so that we can see if you qualify for
government assistance. You are getting Digoxin 0.25 mg tab PO daily, I will
demonstrate how to take your pulse. When you take digoxin you need to check your
pulse and if it is < 60 beats/min you shouldn’t take it. This is very important. You
will need to take Lasix 20 mg PO twice a day for fluid balance. Lasix is a diuretic and
it help you get rid of extra fluid you may be accumulating in your legs, feet, hands,
or abdomen. Here at the hospital you will be receiving Lovenox 40 mg/0.4mL SubQ
daily as an injection in your abdomen to prevent (DVT) Deep Vein Thrombosis.
DVT’s are blood clots found usually in the legs. Aspirin 325 mg EC tab PO daily,
when at home do not crush tab. Coumadin 3 mg tab PO daily for you’re a-fib.
Cardizem 10 mL IV Q6h or as needed if your HR is > 140. Vasotec 1.25 mg/mL IV
Q6h or as needed for your SBP > 160. Apresoline 10 mg IV Q4h or as needed for a
SBP > 150. Potassium Chl. 40 mEq tab PO Q4h PRN x2 doses if your potassium
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levels are low. Magnesium sulf. 1g/100mL IVPB 100mL/hr x 1 dose as needed if
your magnesium levels low. Last Demerol 25 mg IV Q2h or as needed for pain.
E (Environment): Upon discharge you need to make sure
you and your family check things around the house that may be in the
way or unsafe and cause you to fall. You can sometimes get tired and
there doesn’t need to be a bunch of things around to get in the way of
your safety. Here are some things to look at upon discharge. Use carpet
with short dense pile and/or apply double-sided carpet tape to prevent
carpet slippage. Arrange furniture so it is not an obstacle in walking paths.
Make sure you can turn on lights without having to walk through dark
areas. Use sturdy step stools, preferably ones with handrails. Clean spills
immediately so there aren’t any slips. Use rubber bath mats or strips in
bathtubs and showers. Consider installing grab bars in the bath to reduce
further the risk of injury from falls. Clean spills or slippery surfaces
immediately, before walking on them especially oil or grease on cement
floors in the garage or in the drive way. Install handrails along any flight of
outdoor steps or on the patio. It’s good to have something there in case
you need to rest for a second. Also if you have pets don’t let them run
around your feet when you are walking. Animals can easily trip you right
off your feet.
T (Treatments): Some treatments and tests for CHF are
EKG, this test measures the electrical activity of your heart. It tells if you
have had a past heart attack, enlargement of the heart or are currently
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having a heart attack. It is painless and involves sticky tabs being placed on
your chest. Echocardiogram or ECHO’s use sound waves to look at your
chest. Stress test is on a treadmill. Your BP is monitored as you walk at
different levels of intensity. Heart catheterization is performed in the cath
lab. It involves a small tube being placed in the artery in your groin that can
leave dye in your arteries so when you get a x-ray you can see the blockage
in the arteries of your heart. There isn’t really a treatment for CHF. Once you
have it you just need to stick to a heart healthy diet, stop smoking, weigh
yourself daily, report changes in your symptoms immediately, stay active, no
alcohol or drugs, and be encouraged. A positive attitude can help you
overcome difficult times. Many people with heart failure can lead active
happy lives with positive changes to their lifestyles. I have included
information for you about smoking cessation, controlling high BP, and living
with heart failure. Look it over at home or when you have a chance and if
you have any questions write them down and ask your physician at your
visits with him, or let me know and I will answer all the questions that I can.
H (Health Knowledge of Disease): Your primary
diagnosis is (CHF) or Congestive Heart Failure. Heart failure means that your
heart is weak and the pumping power is reduced. A normal healthy heart can
pump blood to the body to meet even strenuous demands. The circulating
blood carries oxygen and nutrients to the tissues and removes waste
products. A weakened pump has difficulty performing this task; therefore,
fluid backs up in the lungs and other parts of the body such as the feet,
ankles, legs, hands, and abdomen. The more damages your heart muscle,
Cassie Williams
the more damaged your heart muscle is, the more sever your heart failure
will be, as will the amount, frequency, and severity of your symptoms. You
may only experience symptoms such as shortness of breath (SOB) with
strenuous exercise if your heart failure is mild. Likewise, with severe heart
failure you may be extremely short of breath and weak with minor activities.
It is important that you understand a little about the heart and how it works
in order for you to understand heart failure, tests and treatments you will
undergo and also so you can participate in your plan of care. The heart is
made up of four chambers in which blood passes through to be pumped to
the rest of the body. A misunderstanding many people have is that the blood
passes through only one half of the heart, the right side, then to the lungs to
have oxygen attached to all the blood cells. The oxygen rich blood then goes
back to the other half, the left side, which has the biggest job of squeezing
the blood out to the body parts and back to the right side of the heart. The
top chambers are weak pumps called the atria. The bottom chambers are
the strong pumps and are called ventricles. Between each chamber there are
valves. If a valve leaks, the pumping function can be reduced. We gauge the
heart’s function by the amount of blood it pumps. Normally the heart pumps
60-70% of the blood in it. When the muscle becomes weak or damaged the
percentage tends to fall depending on the severity of the heart failure. We
consider the function to be severely reduced when the percentage of blood
pumped falls below 20%. When the heart tries to make up for the lost blood
the heart swells in size and your pulse rate is faster.
Cassie Williams
O (Out/In patient Referrals): Your (PCP) primary care
physician, Dr. Allencherril, has ordered consults for your care. You have three
consultations Cardiac, Pulmonary, and Infectious Disease. Your consult for
cardiovascular is to Dr. Trillos. He will be looking at all of your cardiac
problems you are having including your CHF. Your consult for pulmonary is
Dr. Shahar. He will check out the pneumonia in your lungs, and your
Infectious Disease consult if for Dr. Fauhmbulah for the MRSA pneumonia in
your lungs. I am going to give you a packet as well with some information
about MRSA so you can have an idea of what it is, and the steps to prevent
getting it in the future. These physicians will come and see you while you are
here in the hospital and will let you know what and where we will go from
there with your plan of care.
D (Diet): Your doctor has prescribed you on a 2 gram low
sodium diet. A 2 gram low sodium diet limits high sodium foods in your diet.
No table salt is allowed at meals or during cooking while you are on this diet.
The amount of milk is also limited because of the amount of sodium it
contains. A high amount of sodium in your diet can make your blood
pressure go up and can cause other health problems. The goal of a 2 gram
low sodium diet is to prevent or lower high blood pressure. This diet can also
keep your body from holding extra fluid. Fluid excess can be a major problem
with CHF. Problems with your liver and kidneys are another reason to follow
this diet. Changing what you eat and drink may be hard at first think of these
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changes as lifestyle changes not just diet changes. You may need to make
these changes part of your daily routine. 2 grams of sodium is the same as
2,000 mg. I have attached a sample menu for you to look at and some tips
on reading food labels and help in choosing the right foods at home.
