House Calls runs every other Saturday. Today’s column is written by Trish Walker, a registered nurse with Sutter Coast Home Care. It is the second in a series about congestive heart failure.
We know that educating patients helps them to follow the treatment plan for heart failure (HF). This knowledge also helps to decrease hospitalizations and ER visits.
The goal of this article is to teach you how to recognize the changing signs and symptoms of HF, evaluate these changes, and take action. These steps are key in preventing hospitalization.
Approximately 25 percent of HF patients discharged from the hospital are readmitted in 30 days, 37 percent in the first six months, and 44 percent in the first year. Roughly 46 percent of readmissions could be prevented if the patient participated in self-care, which would decrease costs by 39-56 percent. This is a huge sum of money.
Self-care management starts with you, the patient, taking control of your disease. Poor self-care leads to a decrease in the quality of your life, multiple hospital admissions and increased cost, and may result in death.
What would alert you to a change in your HF? The most common symptom is shortness of breath, which can appear in a number of ways. You may have a change in your tolerance for exercise; or are unable to lay flat when you sleep, needing to increase the number of pillows you use. Do you need to sleep in a sitting position, like in a chair or recliner? Are you waking up suddenly at night feeling shortness of breath and anxious, like you are suffocating?
There are other signs of worsening HF. Have you developed a cough, or is your cough worsening? Are you more fatigued, even in just your legs? Your legs may feel really heavy, or you might be unable to perform your usual activities. Have you noticed any changes in your sleep patterns?
Patients should ask themselves these questions too. Is my appetite poor? Am I hungry, but fill up quickly when I eat? Is my belly bloated, or do I have nausea? Do I have shortness of breath with eating? If you answer “yes” to any of these questions, you may have worsening HF.
Some patients experience chest pain or pressure. Others may complain of dizziness, lightheadedness, or even sweating. Family members may notice a change in the patient’s mental status, such as, confusion or extreme sleepiness.
A large number of patients will have swelling. It can be in their legs and/or arms. Men may have swelling of their scrotum. Others may have abdominal swelling, which you may only notice because your clothes feel tighter.
There are a number of ways patients can participate in self-care:
• Monitor your weight daily.
• Check for swelling.
• Observe for a cough, or shortness of breath.
• Check your blood pressure and heart rate daily.
• Watch for any changes in your sleep and eating patterns.
• Take your medication, and follow your diet, as prescribed.
• Keep a daily log of your weight and symptoms.
Here is a simple tool that can assist patients to evaluate their HF symptoms. This tool divides symptoms into three colored “zones,” just like on a stoplight, “Green, “Yellow,” and “Red.”
Green Zone: You do not have shortness of breath, swelling, weight gain or chest pain, and are able to maintain your normal activity level. This indicates that all is clear and under control.
Yellow Zone: A weight gain of 3 or more pounds in two days, increased cough, increased swelling, shortness of breath with activity, or you need to sleep with more pillows — these can indicate that some adjustments might be needed in your medications. It is important to contact your doctor promptly in order to prevent getting hospitalized. Remember, patients can quickly progress to the “red zone” if they don’t seek treatment at this time.
Red Zone: If you have any of these signs or symptoms, including unrelieved shortness of breath or breathing difficulty at rest, unrelieved chest pain, wheezing or chest tightness, you need to sleep sitting up, a weight gain of more than 5 pounds in two days, or confusion, you must seek prompt medical attention or you may die. Call your doctor or 911.
The key to stopping the progression of HF is recognizing the “zone” you are in. Signs and symptoms can come on quickly, so do not ignore the warning signs your body is giving you. Learn all you can about HF. Your survival with this disease is in your hands.
The third article in this series will address the treatment of HF. It will discuss medications, diet, exercise, and self-care, which are all critical in preventing hospitalization.