Table of Contents. Welcome Letter Information on Heart Failure Information on EMMI Weight Monitoring Log Sodium Monitoring Log Discharge Instructions

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3 Table of Contents Welcome Letter Information on Heart Failure Information on EMMI Weight Monitoring Log Sodium Monitoring Log Discharge Instructions

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5 Dear Patients, Munroe would like to extend a warm welcome to you and your family. We thank you for choosing Munroe Regional Medical Center for your medical and heart failure care. Our philosophy of care is patient-focused with a total commitment of providing high quality and safe healthcare that governs everything we do as an organization. No two patients are the same and we are dedicated to providing you individualized care. Our give is to provide optimal comfort and health that will assist you in improving your quality of life. You will find the enclosed Heart Failure educational packet very informative. If you have any questions regarding heart failure and heart failure care please feel free to contact me at the phone number listed below. Thank you for trusting Munroe and giving us the opportunity to serve you. Sincerely, Cecilia Bato, MSN, ARNP Heart Failure Coordinator at Munroe Regional Medical Center ext SW 1 st Ave, Ocala, FL

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7 What to Expect During Your Stay and How to Participate in Your Care When You Have Been Diagnosed With Heart Failure Here at Munroe we use a team approach to your care. Remember, you are an important member of the healthcare team. Please ask questions, express concerns and give us your input regarding your care. What is Heart Failure? If you have heart failure, you are not alone. Five million Americans have heart failure. Heart failure develops over time as the heart s pumping action grows weaker. Your heart cannot pump blood through your body as well as it should. Heart failure doesn t mean your heart has stopped or is about to stop working. The most common cause of heart failure is a heart attack. Other major causes are coronary artery disease, high blood pressure, and diabetes. Heart failure is also known as congestive heart failure. Common Symptoms of Heart Failure: Shortness of breath Swollen or tender belly with loss of appetite and/or nausea Frequent coughing Fast heart rate or heavy heart beat Tired and weak Swollen ankles and/or legs Difficulty sleeping due to breathing problems Weight gain Confusion & impaired memory What to Expect As we explain your surroundings to you and what to expect with the care you will receive, please ask questions if something isn t clear. Vital Signs We will check your vital signs and your oxygen level on a routine basis. Vital signs are body temperature, pulse rate, respiration rate (rate of breathing), and blood pressure. Telemetry You will be placed on cardiac telemetry so that we can monitor your heart rhythm while you are here. Cardiac telemetry measures your heart rhythm and rate and transmits the information to a monitor. We have a specialized team who watches your telemetry monitor 24 hours a day. Lab Work You will have your blood drawn on a regular basis as ordered by your physician. Please ask if you have any questions about the blood work ordered by your doctor. Sometimes lab work is due at specific times for accurate measurement, so we apologize if we wake you.

8 Testing Your nurse or doctor will explain ordered procedures to you. You may have some tests done to evaluate how well your heart is functioning, such as: Echocardiogram EKG Nuclear Stress Test Cardiac Catheterization Please let your doctor, nurse or other member of your healthcare team know if you have any questions or concerns. Your Medications Your doctor and nurse will ask you all the medications you are taking, including over the counter medications such as vitamins and dietary supplements. We will discuss medication changes with you. If you have questions about your medications, please do not hesitate to ask. Daily Weights Weight gain can be a sign that your body is holding onto extra fluid and your heart failure is worsening. Daily weights are another tool to help manage your Heart Failure. We will weigh you on admission and daily at the same time. We will teach you how to manage your weight at home. It will be important for you to follow this practice after you are discharged. Recommended Low Sodium (2000 mg/day) Diet Please do not allow any food to be brought in to you from outside the facility as it may contain too much salt. We will help you follow a low sodium (salt) diet while you are here. We will teach you about your salt intake and why it is so important. Think about your usual diet at home and how you can modify it to lower your salt intake. Remember water follows salt, so the more salty food you eat the more your risk of getting fluid overloaded. It can also make you more thirsty which can make you drink too much fluid that your body cannot get rid of. Fluids Too much fluid in your body can make it more difficult for your heart to work. We will want to measure all liquids that you drink. We will also measure your urinary output as well. Helping us track your fluid Intake and Output, while you are here, will help you manage it yourself after you go home from the hospital. Remember to ask any questions you may have. IV Fluids You may receive intravenous fluids (IV) and medications. They too will be measured carefully. If you are on IV medications, we will change it into a tablet form as soon as possible. Educational Tools Educational programs will be provided to you to help you manage your Heart Failure after you go home. We can also enroll you in an on-line computer educational program, which you will be able to access from your home.

9 Discharge Planning A nurse will review your progress and work with you to develop a plan for discharge. Discuss with your nurse all concerns you may have about going home from Munroe. At Discharge You will be given information about your discharged medications, vital signs, and how to monitor and record your daily weight. The discharge instructions also include activity, fluid intake and dietary restrictions designed to help prevent fluid retention. A reminder to schedule your follow-up appointment(s) with your physician(s) is included on your discharge instructions. Watch your symptoms closely and call your physicians if your symptoms change or get worse. Tips to Fight Against Heart Failure Take your medications Eat a low-salt, heart-healthy diet Get regular exercise Quit smoking Limit or avoid alcohol Weigh yourself each day Manage stress Keep a daily log of your weight and symptoms Notify your physician about any worsening signs and symptoms such as fluid weight gain, more shortness of breath, or any unusual increase or drop in your heart rate and blood pressure. Remember, PREVENTION is the key to staying out the hospital. More information is available at The Web site and educational materials of the Fight Against Heart Failure program are not meant to provide medical advice. Also, the information provided through this program is not a substitute for professional healthcare. Talk with your doctor or other clinician to learn more about your own diagnosis, treatment, or condition.

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11 Emmi Solutions Name:. Date to view by: Date of Birth: address*. Please print clearly * address is for Emmi Solutions to use to send a program reminder and instructions to patient after discharge. Patient privacy is assured. Check all programs you would like to view and give to your nurse to enroll. HEART FAILURE DAILY WEIGHT HEART FAILURE NEXT APPOINTMENT WITH DOCTOR HEART FAILURE SODIUM HEART FAILURE WHAT IT IS HEART FAILURE WHAT IT IS (FRIENDS AND FAMILY) HEART FAILURE: ALCOHOL AND SMOKING HEART FAILURE: REST, EXERCISE AND BP HEART FAILURE: WATER PILLS AND FLUIDS If you have questions about this program please ask your nurse. Nurse initials Time Secretary initials Date Time

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13 Daily Weight Log Weigh yourself daily in the morning when you first wake up, after you have gone to the bathroom and before you eat. Bring this to your next doctor s visit. Sunday Monday Tuesday Wednesday Thursday 02/05/ /06/ /07/ /08/ /09/ Friday Saturday 02/10/12 02/11/12 Notify your doctor if you have a 2-3 pound weight gain overnight or 5 pounds in a week

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15 Daily Weight Log Weigh yourself daily in the morning when you first wake up, after you have gone to the bathroom and before you eat. Bring this to your next doctor s visit. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Notify your doctor if you have a 2-3 pound weight gain overnight or 5 pounds in a week

16 Daily Weight Log Weigh yourself daily in the morning when you first wake up, after you have gone to the bathroom and before you eat. Bring this to your next doctor s visit. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Notify your doctor if you have a 2-3 pound weight gain overnight or 5 pounds in a week

17 Daily Sodium and Fluid Intake Log Name: Mr. John Doe 2/5/12 Maximum Daily Sodium: 2000 mg (2 gm) diet Maximum Daily Fluid: 2000 ml/day Previous Weight: Today s Morning Weight: Difference in Weight: Food & Fluid Consumed Serving Amount Sodium Fluid Comment Breakfast Crisp Rice Cereal 1 cup 206 mg Fried Egg 1 large 163 mg White bread 1 slice 153 mg Butter 1 tbsp. 127 mg Coffee 1 cup or 8 oz 240 ml Water 1 cup or 8 oz 240 ml Breakfast Total 649 mg 480 ml Lunch Chicken (white meat roast) 3 oz. 66 mg Fresh baked potato 1 8 mg Butter 1 tbsp 127 mg Apple 1 0 mg Orange Juice 1 cup or 8 oz 240 ml Water 1 cup or 8 oz 240 ml Lunch Total 201 mg 480 ml Total for Breakfast and Lunch 850 mg 960 ml Dinner Cheese pizza (5 oz) 1 slice 456 mg Macaroni cooked ½ cup 1 mg Orange Juice 1 cup or 8 oz 240 ml Water 1 cup or 8 oz 240 ml Ice Cream 1 cup or 8 oz 260 mg 240 ml You have 1150 mg of sodium and 1040 ml of fluid for the rest of the evening Total 717 mg 720 ml Grand Total 1567 mg 1680 ml 1oz = 30ml; 1 cup = 8oz =240ml; 4 cups = 32oz = 1 quart; 6 cups = 48oz =1 1/2 pts = 1440ml; 8 cups = 64oz = 2 qts = 1920ml

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19 Daily Sodium and Fluid Intake Log Name: Maximum Daily Sodium: 2000 mg (2 gm) diet Maximum Daily Fluid: 2000 ml/day Previous Weight: Today s Morning Weight: Difference in Weight: Food & Fluid Consumed Serving Amount Sodium Fluid Comment Breakfast Lunch Breakfast Total Dinner Lunch Total Total for Breakfast and Lunch Total Grand Total 1oz = 30ml; 1 cup = 8oz =240ml; 4 cups = 32oz = 1 quart; 6 cups = 48oz =1 1/2 pts = 1440ml; 8 cups = 64oz = 2 qts = 1920ml

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27 Activity Heart Failure (HF) Discharge Instructions Up as tolerated or as instructed by your physician and/or nurse. Treatment Instructions Weigh yourself daily and record (use your daily worksheet/monthly calendar). Weigh first thing (one time) in the morning, after urination and before breakfast). Dietary recommendation: 2000 milligram (2 gram) low sodium diet per day. Follow your recommended fluid restrictions per day. Know your heart failure (and all) medications and why you are taking them. (Make sure you know what medications to take when you get home). Report or Call Your Health Care Provider If you have a 2-3 pound weight gain overnight or 5 pound weight gain in a week. If you have increasing shortness of breath, swelling, difficulty lying down in bed, coughing, wheezing, etc. (Please do not wait too long to call your doctor the risk of getting readmitted for CHF or same condition is high). If you have chest pain or symptoms become very severe call 911. Follow Up Appointments Make sure you make all your appointments as instructed. If you have any problems or questions regarding above call Cecilia Bato, ARNP HF Coordinator at (352) ext. 8457

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