OBJECTIVES
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CHF in Long Term Care Review of CHF
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Onset
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symptoms
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diagnosis
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Treatment
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Risk factors for CHF
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Introduce CHF scoring tool
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Introduce CHF assessment form
CHF in LTC
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Goals for LTC residents with CHF: Improve quality of life
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Prevention of exacerbations
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Prevention of hospital readmissions Prolongation of life
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Provision of palliative care
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CHF
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Congestive Heart Failure
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Approximately 5.8 million Americans are afflicted with CHF
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Over 670,000 new cases of heart failure are diagnosed each year
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Number of deaths have more than doubled since 1979, averaging 250,000 annually
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WHAT BRINGS ON CHF?
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Hypertension
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Prior MI
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History of heart murmurs
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Enlarged heart
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Diabetes
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Family history of enlarged heart Congenital heart defects
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Age over 65
What brings on CHF? (Chronic diseases)
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Chronic diseases Diabetes
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Severe anemia
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Hyperthyroidism
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Hypothyroidism
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Emphysema
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Lupus
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Hemochromatosis (excess of Iron absorbed in GI tract)
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Amyloidosis (proteins abnormally deposited in organs and tissues)
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What brings on CHF? (Acute causes)
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Acute causes
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Viruses that attack heart muscle
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Severe infections
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Allergic reactions
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Blood clots in the lungs
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Use of certain medications
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Any illness that affects the whole body
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CHRONIC VS ACUTE SYMPTOMS
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Chronic
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SOB during exertion or lying flat
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Fatigue and weakness
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Swelling in legs, ankles, and feet
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Rapid or irregular heart beat
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Reduced ability to exercise
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Persistent cough or wheezing with white frothy sputum Ascites
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Lack of appetite and nausea
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Difficulty concentrating or decreased alertness
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Acute
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Sudden start of symptoms and quick increase in severity Sudden fluid buildup
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Palpatations
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Sudden, severe SOB
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Coughing up of pink, foamy mucus
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Chest pain
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Nocturia
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Dizzy spells
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Sudden weight gain from fluid retention
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DIAGNOSIS
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Weight loss >10 lbs in 5 days in response to treatment supports a CHF diagnosis.
DIAGNOSIS
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Minor Criteria
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Bilateral ankle edema
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Nocturnal cough
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Dyspnea on ordinary exertion Hepatomegaly
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Pleural effusion
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Tachycardia (HR>120 bpm
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TREATMENT
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Diuretics
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Digitalis
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Vasodilators
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Blood pressure control
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Oxygen

RISK FACTORS
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Hx of CHF
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Has ICD device
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Depression
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Sleep apnea
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Anemia of chronic illness
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Obesity
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Hypertension
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Hx of cardiac resynchronization therapy
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Congenital heart defects
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Hx of heart murmurs Thyroid disease
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Hx of MI
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Diabetes
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Valvular heart disease
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Dyslipidemia
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Renal insufficiency
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Excess alcohol consumption Chronic heart arrythmias
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COPD
CHF SCORING TOOL
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Should be completed on admission to facility
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Circle all risk factors present
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*if patient has HX of CHF, proceed to scoring
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**if patient has 2 or more risk factors, proceed to scoring
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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
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Scoring
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Circle yes for each sign/symptom and give 1 point
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If score is 0-2, patient is LOW risk for CHF exacerbation
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If score is 3 or above, patient is HIGH risk for CHF exacerbation
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Place copy of scoring tool in RT mailbox and a copy in patient medical chart
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If patient is LOW or HIGH risk, RT will then assess patient with assessment form
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PEL RE-HOSPITALIZATION INTERVIEW PROGRAM FOR CHP
PEL CHF INITIAL ASSESSMENT
HIGH RISK PATIENTS
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Urine Output Q 24 hours; vital signs Q4-8 hours
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RT assessment and follow up bi-weekly
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Daily weight monitoring
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Dietary consultation: 2000mg sodium diet, 2000cc fluid limit
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Medication Treatment Plan per Physician
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Heart Failure education compliance
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Encourage self management
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Promote compliance
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Evaluate risk factors
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Assess for early signs of de-compensation
LOW RISK PATIENTS
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RT assessment and follow up with patient weekly
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Weights 3 times/week (M, W, F or Tu, Tr, Sun)
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Pulse ox Q day
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Q day assessment of swelling/edema and breath sounds Daily vitals
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Heart Failure education
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Dietary consultation (restricted sodium intake)
QUESTIONS
Bibliography
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- 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.