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Disease Management: Congestive Heart FailureMaintain treatment goals:NutritionMeet with dietitian for low-sodium consult; recommend <1500-2000 mg sodium per day (per physician recommendation) and try to keep meals equal in sodiumExerciseReview home exercises guidelines with patient; exercise within cardiac rehab recommendations (see listed references for more detailed exercise guidelines)LabsMake sure labs are current and review with patient: lipids, glucose, and metabolic panelHelp arrange f/u if needed; make sure labs are current if medication/health status changesBlood PressureMonitor each visit at rest and assess for appropriate exercise responseMedicationsCheck for diuretic, B-blocker, and ARB/ACE inhibitor prescription; provide education on compliance and medications; refer to pharmacist for medication management consult as necessaryAlcohol and tobacco useAssess for use; refer for cessation assistance if neededSleepAssess for sleep apnea/C-PAP complianceWeightMake sure patient checks weight and records daily; report to MD if increases 3 pounds in 1 day or 5 pounds in 1 weekSigns/symptomsProvide education on CHF signs/symptoms and when to call MD/seek medical attentionAppointmentMake sure patient is scheduled to f/u with PCP or cardiologist within 1-2 weeks of newly diagnosed CHFAdvanced care planningProvide resources for completing healthcare directive; make sure code status is up to dateHome careAssess need for possible home care if you suspect patient would benefit from assistance; provide resourcesFluid restrictionsAssess whether specific fluid restriction has been advised by MD; instruct patient to “drink to thirst”PsychosocialEvaluate for depression and social support; provide referral if neededAnnual assessment of complications: (Should verify that patient is having these done yearly)Targeted annual history and physical examCardiovascular and cerebrovascular complication assessmentRenal assessmentSpecial considerationsTreatment and referral for complications: (Contact physician if problems arise that need attention) Cardiovascular and cerebrovascular diseaseNephropathyPeripheral vascular diseaseWeight gain, congestion, increased dyspneaLower extremity edema, wounds, weeping, cellulitisTreatment goals not met:Consider referral to specialist (cardiology, nephrology)Assess patient adherence (biggest problems are understanding and adherence)Re-evaluate for depressionRe-address specific treatment goals that are not being metReferencesAmerican Association of Cardiovascular and Pulmonary Rehabilitation (2004). Guidelines for cardiac rehabilitation and secondary prevention programs (4th ed.). Champaign, IL: Human Kinetics.American College of Sports Medicine (2010). ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (6th ed.). Baltimore, MD: American College of Sports Medicine.American Heart Association (2012). Heart failure. Retrieved from Clinic (2012). Heart failure - care & treatment. Retrieved from SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). American College of Cardiology Web Site. Available at: Clinic (2012). Heart failure - lifestyle & home remedies. Retrieved from ................
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