Running head: PATIENT’S PLAN: CHF 1

Patient’s Plan: CHF

Nathan Eppich

Brigham Young University- Idaho

Nursing 322 Section: 01

Sister Jamison

May 27, 2018

PATIENT’S PLAN: CHF 2

Nathan Eppich, RN.

14470 Road 170
Mesa, WA 99343

May 27, 2018

Mr. and Mrs. Ward

4533 S. 5th W.
Mesa, WA 99343

Dear Mr. Ward:

Hello, my name is Nathan Eppich; I am the nurse that has been helping care for your Congested
Heart Failure (CHF). I understand that your symptoms of CHF are continuing to worsen and you
have been looking for different avenues to help control your CHF. I understand that CHF can be
a scary diagnosis to experience. For that reason I have gathered some information for you that
can help put you on a path back to recovery. If you are persistent in following my instruction, we
can help improve the outlook on your future.

CHF is the number one leading causes of death in America and for this reason it should not be
taken lightly. On the cdc.org website there are many statistics and incidences concerning CHF.
There are nearly 5 million Americans currently living with chronic heart failure with
approximately 550,000 new cases diagnoses every year. Each year there are approximately
287,000 deaths due to CHF. Now I do not tell you this to scare you, but to show you how big of
a concern CHF truly is (CDC, 2016). I strongly encourage you to visit this website and become
familiar with CHF.

Chronic Heart Failure is the hearts inability to pump blood as well as it should. As a result, the
majority of your body doesn’t receive the proper amount of oxygen and nutrients needed to
survive. In your specific case, you have left-sided Heart Failure. This results in the left ventricle
not working properly. For this reason you are having fluid build up back into your lungs. There
are many different medical conditions that can cause CHF such as Coronary artery disease, high
blood pressure, Faulty heart valves, Cardiomyopathy, congenital heart defects, and heart
arrhythmias. Of those that were mentioned, the two main causes are Coronary artery disease and
high blood pressure. Some risk factors are high blood pressure, diabetes, tobacco use, and
obesity. (Mayo, 2018)

CHF will cause you to make drastic changes in your life. So much that it can put a toll not
only on you but also your family. For that reason you need to keep them in mind as your
going through this trial in life. I can tell you that if you don’t put a full effort into properly
taking care of this disease, it could potentially take your life. During your physical assessment
there were a few things of concern, such as shortness of breath during physical activities like
gardening and walking, respiration rate of 24, oxygen saturation of 89.3%, and a blood pressure
of 165/95. And on further examination the chest x-ray that was done shows cardiomegaly
(abnormal enlargement of the heart due to increase work load on the heart) and lower lobe
infiltration. The lower lobe infiltration is caused by fluid build up in the lungs. The medical term
PATIENT’S PLAN: CHF 3

for fluid in the lungs is called pulmonary edema. Pulmonary edema decreases the exchange of
oxygen (O2) and carbon dioxide (CO2) in the lungs as the disease progresses (Lewis, 2107).
Since there is not a proper exchange of O2 and CO2 in the lungs, your body is not getting the
proper amount of oxygen to survive. This answers your concern of becoming short of breath
during times of physical activity and will continue to worsen if action is not taken.

Ambulatory & Home Care Environment:

CHF is going to cause you to make big changes in your life. One of the biggest changes you’ll
have to make at home is a proper medication regimen. Potential for medication errors in the
home setting is much higher then in other health care settings because of the unstructured
environment. For this reason, we will educate you on your transition but it is also important for
you to keep your medication suppurated so you don’t double dose or forget to take your dose
(Ellenbecker, 2007).

Other changes that will be needed is making a plan for physical activities and limiting emotional
situations. As you know you become short of breath very quickly. For this reason it is important
that you plan rest periods after excursion to prevent exacerbation of symptoms. As for emotional
situation, those can also cause you to experience exacerbation of symptoms. It’s important to
limit those as much as possible. Another concern that I have for you is paroxysmal nocturnal
dyspnea. It manifests as attacks of shortness of breath, especially at night (Lewis, 2017). You
may wake up in a panic with a strong desire to stand or sit up but this may cause impaired gas
exchange due to fluid build up in the alveoli (air sacs) of the lungs. It is an associated risk for
those with heart failure and you may need to prop yourself up with pillows to help yourself
breather easier.

Health Promotion:

Mr. Ward your BMI is currently at a 35, which puts you in the obese category. Obesity is not
favorable for CHF and is contributing to your high blood pressure. It’s important that we get
your BMI down around 25 within the next year. I know that this goal may be daunting but with
medication, a proper diet, and exercise this goal can be achieved. The type of exercising I would
like for you to preform is called aerobic exercising. I would like for you to do it 3 times a week
for 30 min. Some examples of this type of exercising are walking, jogging, and bike riding
(ClevelandClinic, 2016). This type of exercise will improve the way your body uses oxygen and
has the most impact on your heart. It will help decrease your blood pressure, and improve your
breathing.

Treatment Options:

Based off of your BMI, and blood pressure we can see that your diet management is not suited
for an individual with CHF. Diet is one of the most important components of establishing a road
to recovery. In webmd.org it states that individuals with CHF should not be consuming more
then 2,300 mg of sodium and less then 1,500 is ideal. This is due to the fact that increase sodium
causes water retention, which in return increases blood pressure (Kaiserpermanente, 2014). I
would like to set you up on what’s called a DASH diet. This diet specifically focuses on
PATIENT’S PLAN: CHF 4

decreasing sodium; to decrease blood pressure and even provides you with specific recipes
(dashdiet, 2018). This transition will be difficult, but worth it. You will feel better and will see a
decrease in CHF symptoms if you stay true to this diet. I will provide you with more information
on this below.

The reason we are altering your diet and improving your exercise regimen is due to your high
blood pressure. Your blood pressure is currently 165/95. This is considered type 2 hypertension,
which is one of the main risk factors for CHF. For this reason I won’t to attack the CHF from
three angles. Diet, exercise, and lastly medication. I’m going to start you on an antihypertensive
and diuretic to help with the pulmonary edema. Lets make a goal for your blood pressure to drop
around 120/80 within the next 6 months (Mayo, 2018). This will decrease a lot of the symptoms
that you are experiencing and will shortly after help you start feeling better.

Managing Acute Episodes:

Early detection of worsening symptoms may prevent an acute episode. If you’re not able to catch
it early it is important that you seek medical help immediately. The Emergency Department that
you attend will have the proper equipment needed. This usually includes oxygen, nitroglycerin,
beta-blocker, and ace inhibitor (Mayo, 2018). I can’t stress enough the importance of seeking
medical help if you’re not able to manage the symptoms on your own.

A summer of your plan of care:

 Decrease BMI from 35 to 25 by preforming aerobic exercises
 Low sodium DASH diet to decrease blood pressure and strive to keep your sodium intake
at least below 2,300, keep in mind that below 1,500 is ideal.
 Start antihypertensive and diuretic medication and strive to meet your goal of 120/80 in
the next six months.
 If acute episodes can’t be treated then seek medical help.

Sincerely,

Nathan Eppich, RN.

14470 Road 170
Mesa, WA 99343
PATIENT’S PLAN: CHF 5

This is an example of what’s is going on with your heart.

(HealthJade, 2018)
 The image on the left shows a decrease in blood volume being pumped into the aorta.
This means there is a decrease in blood volume (oxygen) feeding the rest of the body!

Dash Diet URL

 http://dashdiet.org/default.asp
PATIENT’S PLAN: CHF 6

References

Centers for Disease Control and Prevention. (2016, June 16). Division for heart disease and

stroke prevention. Retrieved May 27, 2018, from

https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Cleveland Clinic. (2016, October 16). Heart failure: exercise. Retrieved May 27, 2018, from

https://my.clevelandclinic.org/health/diseases/17075-heart-failure-exercise

Dash Diet. (2018, February 26). The dash diet eating plan. Retrieved May 28, 2018, from

http://dashdiet.org/default.asp

Ellenbecker, C. H. (2007). Patient safety and quality in home health care. Retrieved May 27,

2018, from https://www.ncbi.nlm.nih.gov/books/NBK2631

Health Jade. (2018, April 08). What is congestive heart failure? Retrieved May 28, 2018, from

https://healthjade.com/congestive-heart-failure/

Kaiser Permanente. (2104, March 01). Nutrition tips for congestive heart failure. Retrieved May

28, 2018, from

https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2F

healthAndWellness%2Fconditions%2FheartDisease%2FchfNutrition.html

Lewis, S. M. (2017). Medical-surgical nursing: assessment and management of clinical

problems. St. Louis, MO: Elsevier, Inc.

Mayo Clinic. (2018, March 10). Heart attack. Retrieved May 28, 2018, from

https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-

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