A Logbook for You A logbook for patients with heart failure and their families Use this logbook to help you: learn more about your disease take better control of your heart failure keep track of your health when you are in hospital, at home, or at clinic appointments know when to call your health care provider We put a heart beside helpful and important information. This logbook belongs to: Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2014 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Denise Jurkiewicz RN Created: 05/2008 Form: D-5533 (06/2014)
Your doctor has told you that you have heart failure. What is heart failure? Heart failure happens when your heart doesn t pump enough blood to meet the needs of your body. It doesn t mean that your heart is about to stop working. Heart failure is a chronic (long-term) disease, just like many other diseases. Carefully managing your health and making some lifestyle changes can help you live longer and feel better. What's happening to my heart? Your heart becomes larger because your heart muscle loses elasticity (ability to return to its normals shape and size). This makes it harder for your heart to pump blood out to your body. 2
What's happening to my body? With heart failure, you may have these symptoms: Coughing, shortness of breath Extra fluid in and around lungs Pumping of heart grows weaker Swelling in stomach area Tiredness Swelling in ankels and legs How can this logbook help? This logbook can help you manage your health in these ways: 1. Use this logbook to keep track of your heart failure symptoms. Keeping track of your symptoms can help you take better control of your heart failure. 2. Learn about lifestyle changes you can make that will improve your symptoms. Making these changes can help you manage your disease and help you feel better. 3. Learn where to find more information about your disease (websites and books). 3
4. Learn when it s important to call your health care provider. Letting your health care provider know when your symptoms change or get worse will help them keep track of your health. For example, call your health care provider if you gain 2 to 3 pounds over 3 days. How do I use this logbook to keep track of my heart failure symptoms? You may first use this logbook in the hospital with the help of the nurses. You can then take it home to help you keep track of your heart failure symptoms. If your symptoms get worse, the log will help you know when to call your health care provider. Before you use the logbook, a health care provider will let you know your: target weight (your weight without extra fluid) fluid restriction (1.5 litres a day) sodium or salt restriction (2 grams of salt or less a day) Write this information in your charts. Write down your weight and symptoms each morning on the 1 st chart. Write down the amount of fluid and salt you have during the day. Write the total amounts in the 2 nd chart before you go to bed. Follow these steps to fill out the log: 1. Use new charts each month. Write the name of the month on the charts and use the numbers at the side for the day. 2. Weigh yourself at the same time every day. The best time to weigh yourself is after you wake up in the morning and after you urinate. Write down your weight in the 2 nd column of the 1 st chart. Compare your weight to the previous day s weight and your target weight. Call your health care provider if you gained 2 to 3 pounds over 3 days. 4
3. Think about your breathing. Do you have more shortness of breath when you do regular activities? Are you waking up at night because you feel short of breath? In the 1 st chart under shortness of breath, write: a down arrow if your shortness of breath is the same or better an up arrow if your shortness of breath is worse, increasing or new Call your health care provider if your shortness of breath is new or getting worse. 4. Are you coughing? Is it getting worse and waking you up at night? Do you have a new cough? In the 1 st chart under cough, write: a down arrow if your cough is the same or better an up arrow if your cough is worse, increasing or new Call your health care provider if your cough is new or getting worse. 5. How high does your head need to be for you to sleep? Do you need more pillows? Are you sleeping in a chair? In the 1 st chart under Head position when sleeping, write: a down arrow if your head is in the same position as the night before or lower an up arrow if you had to raise your head higher to sleep, or if this is a new problem Call your health care provider if this is a new problem or it s getting worse. 6. Look at your legs, ankles, hand, fingers, and belly. Are they more swollen? Are they less swollen? Are they the same? In the 1 st chart under Ankle, leg, belly, hand or finger swelling, put: a down arrow (and write the body part) if the swelling is the same or better an up arrow (and write the body part) if the swelling is worse or if this is a new problem Call your health care provider if this is a new problem or it s getting worse. 5
7. Write down how many millilitres you drink during the day. At the end of the day, compare this amount with your fluid restriction. If it s the same, write an equal ( = ) sign. If the amount isn t the same, record it in the 2 nd chart under Fluid restriction. Write the amount you were over or under with a plus ( + ) or minus ( - ) sign. 8. Write down how much salt you have during the day. At the end of the day, compare this amount with your sodium or salt restriction. If you ate any high salt foods, write it down in the 2 nd chart under Salt restriction. If you were over your fluids or ate some salty foods, your weight may increase over the next day or 2. 9. Write down any changes in your water medicines in the last column on the 2 nd chart. For example, if you called your health care provider and they increased your dose of Lasix, please write this under Changes to my water medicines. 6
Chart 1: Keeping track of your heart health Month: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Target Weight: Weight Shortness of breath Signs and symptoms of your heart health (use a or ) Cough Head position when sleeping Ankle, leg, belly, hand or finger swelling 7
Chart 2: Keeping track of your fluids, salt and medicines Month: Fluid Restriction: Salt restriction ; Changes to my water medicines Day (use =, + or - ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 8
What kind of lifestyle changes will improve my symptoms? Take all the medicines your doctor prescribed you. Talk with your doctor first before stopping any medicines. If you are having uncomfortable side effects from a medicine, your doctor can recommend another one that s better for you. Don t take any over-the-counter medicines, herbal supplements such as ginseng, or painkillers such as Motrin (Ibuprofen), without asking your health care provider first. If you are feeling better, it could be because of your medicines. So, don t stop taking them. Make sure you have enough refills of your prescriptions so your medicines don t run out. Ask your doctor to renew your medicines before they run out. Ask your pharmacist to put your medicines in blister packs. This can make it easier for you to keep track of them. Follow a low sodium (salt) diet. A low salt diet should include only 2 grams of sodium a day or less. If you need advice on how to follow this diet, ask to see the dietitian before you go home from hospital. The dietician can also help you include a low sodium diet with another diet you may already be on. Read the Nutrition Facts on packages of food when you go grocery shopping to find out how much sodium there is in a serving. Products with a serving size of sodium less than 5% are good choices. 9
It takes about 2 to 3 months for your body to get used to the taste of no salt. Try to lose weight if you are overweight. Your heart has to work harder and you feel more tired when you are overweight. For every pound you lose, you can reduce your blood pressure and lower the amount of work your heart has to do. Talk to a dietitian about your B.M.I. (body mass index) and what a healthier weight would be for you. Then get advice on how to adjust your diet to reach this goal. Ask your nurse or doctor about exercise. Talk to them about how much exercise you should do and when you can start. There are also many heart rehabilitation clinics that have exercise programs that are right for you. Their information can help you begin your own exercise program. Follow your fluid restriction. Make sure you follow your instructions for the exact amount you can drink each day. If you are not sure, ask your doctor or nurse. Be careful if you are taking water tablets. Don t drink extra fluids to replace the water lost (when you urinate) while using these medicines. Only drink the amount you were told each day. Try to quit smoking. There are many aids and smoking cessation (quit smoking) classes to help you stop. Ask your health care provider what would be best to help you. Avoid alcohol. 10
One lifestyle change I promise to make: I will start this goal: Date What I will do to help me make this change: Were can I find more information about heart failure and what will help? Websites: www.heartfailurematters.org www.abouthf.org www.uhnpatienteducation.ca search heart failure Books: Success with Heart Failure by Marc Silver M.D. The No-Salt Lowest Sodium Cookbook by Donald A. Gazzaniga 100 Questions and Answers about Congestive Heart Failure by Campion Quinn 11
When do I need to call my health care provider? Call your health care provider if you: do fewer activities because you are tired and/or short of breath more often gain 2 to 3 pounds over 3 days have increased or new swelling in your feet, legs, hands or belly have a new cough or your cough is getting worse feel dizzy or light headed Call 911 if you have chest pain that does not get better after 3 sprays of nitroglycerin and you have severe shortness of breath that does not go away with rest. Important phone numbers: Family Doctor Cardiologist Other number Remember to always ask your health care provider to explain any information that you don't understand. 12
Questions I have for my health care team: My questions: Answers: 13