Heart Failure Clinical Pathway

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1 Patient & Family Guide 2016 Heart Failure Clinical Pathway

2 Heart Failure Clinical Pathway Your hospital stay will follow a written care plan called a Clinical Pathway. The pathway is a guide for all members of your healthcare team as well as for you and your family. The pathway will give you an idea of what to expect while you are in the hospital. The pathway was developed as a guide for your stay. You may be discharged sooner than the number of days on the pathway or stay longer. The pathway will cover: Tests Treatments Teaching and planning needed before discharge Additional information about heart failure is available in the patient guide called Living with Heart Failure and the free Patient Education Channel 75 on your bedside TV (if available). There will be a registered nurse called a Navigator who will assist you through the pathway. If you have any questions, please ask. We are here to help you. 1

3 Process Admission Day to Day 2 Assessment We will: Check your temperature, blood pressure, pulse, and oxygen regularly. Listen to your chest and assess for shortness of breath and/ or chest discomfort. Check your ankles, legs, and body for signs of swelling. Measure the fluids you take in and put out, and weigh you each morning. You will be asked about your medical history and if you need support to stop smoking. You may be assessed by other members of the healthcare team including nurse practitioners, a physiotherapist, an occupational therapist, a respiratory therapist, and a social worker. Tests Medication Treatments Nutrition We will do blood tests. You will have a chest X-ray and an electrocardiogram (ECG). You may have an echocardiogram (ultrasound of the heart). You will be given medication by mouth or intravenously (by IV) as ordered by the doctor or nurse practitioner. You may need to have oxygen. We may monitor your heart. You may be on fluid and salt restrictions as ordered by your healthcare providers. 2

4 Process Admission Day to Day 2 Activity Education Discharge Planning Your activity level will depend on what you are able to do and what your medical team has ordered for you. Tell your nurse about any symptoms associated with your activities such as chest pain, angina, shortness of breath, or weakness. You may be on bedrest and use the commode when you need the bathroom, or you may get up to use the regular bathroom if you are stable. Your medical team will tell you what restrictions you have. If you are stable, you will sit up in a chair for 20 minutes, 3 times a day. This can be increased as tolerated at your medical team s discretion. You may be on blood thinner injections to prevent clots. It will be important for you to pump your ankles and/or do ankle and foot exercises to prevent clots. If you are at a high risk to fall, it is important to have your call bell nearby. Ring for help when needed to get out of bed. Staff will explain what they are doing for you. They will stress the need for monitoring your fluid and salt intake, and taking daily weights, now and when you go home. The Living with Heart Failure booklet will be provided along with pamphlets about Sodium Restricted Diet and High Sodium Foods To Avoid. You will be encouraged to learn about heart failure on the free Patient Education Channel 75 on your bedside TV (if available). We may give you a Falls Risk pamphlet. Staff may begin to talk about your discharge plan with you and your family. 3

5 Process Days 3-5 Assessment We will continue to: Check your temperature, blood pressure, pulse, and oxygen level regularly. Listen to your chest and assess your breathing effort and/or chest discomfort. Check for a decrease in body swelling. You will be weighed each morning before breakfast. If you are able, we will ask you to keep track of the fluids you drink for fluid restriction. We will also ask you to record your daily weight and signs and symptoms in the weight log attached to this guide. This will be good practice for when you go home. You may be assessed by other members of the healthcare team: nurse practitioners, a physiotherapist, an occupational therapist, a respiratory therapist, or a social worker. If you are a new diabetic or poorly controlled, we may have the Diabetes Case Coordinator assess you and refer you for outpatient follow-up. The dietitian may visit you if you need help with diet changes. Tests Medication Treatments Nutrition We may do more tests. Daily blood tests may be done to adjust your medications. You will be given medication as ordered by the doctor or nurse practitioner according to your weight, blood pressure, heart rate, and lab values. As you get better, you will switch from IV medications to pills. You may still have oxygen but need it less often or not at all. We may still need to monitor your heart. You will continue on a low salt diet and your fluids will continue to be restricted. 4

6 Process Days 3-5 Activity Education Discharge Planning You will be encouraged to increase your activity level including sitting up in a chair for meals, and walking in your room and in the hall. This will depend on what you could do comfortably before you came to hospital. If you feel short of breath or weak, or if you have chest pain/ pressure or symptoms of angina, stop and rest, and notify nursing staff. If you are not moving around well you may continue to have daily injections of blood thinners to prevent clots. If you are at high risk to fall, always remember to ring for help when getting out of bed. Read the information in the Living with Heart Failure booklet and pamphlets on Sodium Restricted Diet and High Sodium Foods To Avoid. Watch the information on heart failure on the free Patient Education Channel 75 on your bedside TV (if available). We will help you learn how to keep track of your fluids and daily weights and to monitor for signs and symptoms of worsening heart failure. We will help you learn about your medications. Be involved: ask questions to help you understand what heart failure is, and your treatment plan. If you need more help to go home safely, we will talk about community supports and services with you and set up consults as needed. 5

7 Process Days 6 & 7 Assessment Tests Medication Treatments Nutrition Activity Education We will continue to check your temperature, blood pressure, pulse, oxygen level, daily weight, amount of swelling, and breathing effort/level of comfort. If able, you will continue to document your fluid intake and weight as this is good practice for when you go home. We will continue to check for any changes in your condition. Arrangements will be made for future tests or follow-up for after your discharge. You will receive medications as ordered by your doctor or nurse practitioner. A list of medications and/or a prescription will be given to you before discharge. You will get a schedule of when to take your medications when you go home. You may no longer need oxygen or need to have your heart monitored. You will continue on a low-salt diet, and if ordered your fluids will continue to be restricted. You will continue to progress in your activity level as you are able. You will continue to self-monitor and report any symptoms associated with activity. Staff will reinforce information about healthy diet, fluid and salt restriction, self-monitoring (daily weights and signs and symptoms of fluid retention), when to report symptoms or see a doctor, activity level and rest. Make sure you understand your heart failure and how to manage your symptoms when you go home. Ask questions if you do not understand the information we have provided and reviewed with you. 6

8 Process Days 6 & 7 Discharge Planning Discharge planning for home, home with services, or alternate living arrangements continues. Make sure you have made arrangements to have a scale for daily weight-taking at home. If needed, we will arrange for prescriptions for equipment needed for mobilizing and bathroom safety at home (canes, walkers, raised toilet seats, etc). Process Discharge Day/Awaiting Discharge: Days 7-8 Assessment Tests Medication We will take your daily weight before breakfast. We will check your vital signs once a day and as needed. You will need blood work done on your discharge day. You will have your prescriptions and a medication schedule for when to take your medications at home. Treatments Nutrition Activity Education Discharge Planning You will continue on your low-salt diet and fluid restrictions as ordered. You will know how to measure and monitor your fluid intake when you go home. You will continue to progress in your activity level as you are able. Staff will continue to reinforce the importance of daily weights and self-monitoring of signs and symptoms of worsening heart failure, when to report symptoms to your doctor, medications, activity and rest. Remember to take the patient pamphlets with you to review again when you go home. If needed, a follow-up appointment with the Heart Function Clinic will be arranged for shortly after your discharge date. You should make an appointment to see your family doctor within one week of discharge. 7

9 Weight Log Date Symptoms of Heart Failure Weight 8

10 Weight Log Date Symptoms of Heart Failure Weight 9

11 Weight Log Date Symptoms of Heart Failure Weight 10

12 Looking for more health information? This pamphlet and all our active patient pamphlets are searchable here: Contact your local public library for books, videos, magazines, and other resources. For more information go to Nova Scotia Health Authority promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! Nova Scotia Health Authority Prepared by: Cardiac Services Designed by: Nova Scotia Health Authority, Central Zone Patient Education Team Printed by: Dalhousie University Print Centre The information in this brochure is for informational and educational purposes only. The information is not intended to be and does not constitute healthcare or medical advice. If you have any questions, please ask your healthcare provider. WG Updated March 2016 The information in this pamphlet is to be updated every 3 years or as needed.

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