CHF PROGRAM

OBJECTIVES

  • CHF in Long Term Care Review of CHF
    • Onset
    • symptoms
    • diagnosis
    • Treatment
  • Risk factors for CHF
  • Introduce CHF scoring tool
  • Introduce CHF assessment form

CHF in LTC

  • Goals for LTC residents with CHF: Improve quality of life
    • Prevention of exacerbations
    • Prevention of hospital readmissions Prolongation of life
    • Provision of palliative care

CHF

  • Congestive Heart Failure
    • Approximately 5.8 million Americans are afflicted with CHF
    • Over 670,000 new cases of heart failure are diagnosed each year
    • Number of deaths have more than doubled since 1979, averaging 250,000 annually

WHAT BRINGS ON CHF?

  • Hypertension
  • Prior MI
  • History of heart murmurs
  • Enlarged heart
  • Diabetes
  • Family history of enlarged heart Congenital heart defects
  • Age over 65

What brings on CHF? (Chronic diseases)

  • Chronic diseases Diabetes
    • Severe anemia
    • Hyperthyroidism
    • Hypothyroidism
    • Emphysema
    • Lupus
    • Hemochromatosis (excess of Iron absorbed in GI tract)
    • Amyloidosis (proteins abnormally deposited in organs and tissues)

What brings on CHF? (Acute causes)

  • Acute causes
    • Viruses that attack heart muscle
    • Severe infections
    • Allergic reactions
    • Blood clots in the lungs
    • Use of certain medications
    • Any illness that affects the whole body

CHRONIC VS ACUTE SYMPTOMS

  • Chronic
    • SOB during exertion or lying flat
    • Fatigue and weakness
    • Swelling in legs, ankles, and feet
    • Rapid or irregular heart beat
    • Reduced ability to exercise
    • Persistent cough or wheezing with white frothy sputum Ascites
    • Lack of appetite and nausea
    • Difficulty concentrating or decreased alertness
  • Acute
    • Sudden start of symptoms and quick increase in severity Sudden fluid buildup
    • Palpatations
    • Sudden, severe SOB
    • Coughing up of pink, foamy mucus
    • Chest pain
    • Nocturia
    • Dizzy spells
    • Sudden weight gain from fluid retention

DIAGNOSIS

  • Weight loss >10 lbs in 5 days in response to treatment supports a CHF diagnosis.

DIAGNOSIS

  • Minor Criteria
    • Bilateral ankle edema
    • Nocturnal cough
    • Dyspnea on ordinary exertion Hepatomegaly
    • Pleural effusion
    • Tachycardia (HR>120 bpm

TREATMENT

  • Diuretics
  • Digitalis
  • Vasodilators
  • Blood pressure control
  • Oxygen

RISK FACTORS

  • Hx of CHF
  • Has ICD device
  • Depression
  • Sleep apnea
  • Anemia of chronic illness
  • Obesity
  • Hypertension
  • Hx of cardiac resynchronization therapy
  • Congenital heart defects
  • Hx of heart murmurs Thyroid disease
  • Hx of MI
  • Diabetes
  • Valvular heart disease
  • Dyslipidemia
  • Renal insufficiency
  • Excess alcohol consumption Chronic heart arrythmias
  • COPD

CHF SCORING TOOL

  • Should be completed on admission to facility
  • Circle all risk factors present
    • *if patient has HX of CHF, proceed to scoring
    • **if patient has 2 or more risk factors, proceed to scoring
Acute Scoring
*if patient exhibits ANY of the signs/symptoms under acute scoring, stop
immediately and notify MD
*circle yes for each sign/symptom and give 3 points
  • Scoring
    • Circle yes for each sign/symptom and give 1 point
    • If score is 0-2, patient is LOW risk for CHF exacerbation
    • If score is 3 or above, patient is HIGH risk for CHF exacerbation
    • Place copy of scoring tool in RT mailbox and a copy in patient medical chart
    • If patient is LOW or HIGH risk, RT will then assess patient with assessment form

PEL RE-HOSPITALIZATION INTERVIEW PROGRAM FOR CHP

PEL CHF INITIAL ASSESSMENT

HIGH RISK PATIENTS

  • Urine Output Q 24 hours; vital signs Q4-8 hours
  • RT assessment and follow up bi-weekly
  • Daily weight monitoring
  • Dietary consultation: 2000mg sodium diet, 2000cc fluid limit
  • Medication Treatment Plan per Physician
  • Heart Failure education compliance
  1. Encourage self management
  2. Promote compliance
  3. Evaluate risk factors
  4. Assess for early signs of de-compensation

LOW RISK PATIENTS

  • RT assessment and follow up with patient weekly
  • Weights 3 times/week (M, W, F or Tu, Tr, Sun)
  • Pulse ox Q day
  • Q day assessment of swelling/edema and breath sounds Daily vitals
  • Heart Failure education
  • Dietary consultation (restricted sodium intake)

QUESTIONS

Bibliography

    • AMDA. (2010). Heart failure in the long-term care setting.
    • Department of Health and Human Services. (2010). Heart failure fact sheet. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_heart_failure.pdf
    • Framingham Criteria for Congestive Heart Failure. (2005). Retrieved from www.medicalcriteria.com/criteria/framing ham.htm.
    • HeartPoint. (1997). Congestive heart failure. Retrieved from www.heartpoint.com/congestiveheartfail uretellme.html
    • Medical Associates Clinical Practice Guidelines for Heart Failure. (2009). Retrieved from http://www.mahealthcare.com/practice_guidelines/Congestive%20Heart%20Failure .pdf. Guideline 27, 1-5.