1 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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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

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

Review The Article By Studwick Et Al. (2019) In The Readings, The Essentials Of Doctoral Education For Advanced Nursing Practice (2006), And The QSEN Competencies. Reflect On Your Own Technology Experience To Address The Following: