Heart Failure Discharge Instructions
ADVERTISEMENT
1
2HEART FAILURE – CONGESTIVE HEART FAILURE
DISCHARGE INSTRUCTIONS: GUIDELINES TO FOLLOW AT HOME
Page 1 of 2
SPECIAL INSTRUCTIONS:
CHF Teaching Packet given and discussed
CHF Discharge video viewed
Sudden Cardiac Arrest (SCA) DVD viewed
SCA Teaching Packet given and discussed
Labs:
ProBNP _____ Potassium _____
BUN _____
Creatinine _____
Ejection Fraction (EF) __________%
Date: ________________________
MEDICATIONS:
You have received instructions on the medications your physician has prescribed at discharge. A list of these
medications has been provided to you.
Keep a list of all current medications and the dates when you received the Flu and Pneumococcal (Pneumonia)
Vaccines.
Flu Vaccination Date: ____________________________________
Pneumococcal (Pneumonia) Vaccination Date: ____________________________________
ACTIVITY:
You can do normal everyday activities as your body allows.
Take rest breaks if you feel tired. Do not over exert.
Stop activity if you have pain, shortness of breath or feel dizzy.
Limitations: ______________________________________________________________________________________
SMOKING – TOBACCO USE:
If you smoke, you are strongly encouraged to stop. If you have recently quit smoking, congratulations! For further
information to stop smoking or to remain smoke‐free, call MGH Respiratory Therapy at 740.383.8711 or the Ohio
Tobacco Quit Line at 800‐QUIT‐NOW (800.784.8669).
DIET:
Follow a low sodium (salt) diet. Your doctor recommends: _________________________________________________
Your doctor may also recommend a fluid limit to about _________ cups/day.
Choose foods and drinks with low or no salt. Remove salt shaker from the table.
Free Heart Healthy Eating Class – Call 740.383.8484 to schedule.
WEIGHT MONITORING:
Weigh yourself every day at the same time and write it down.
Take your weight log to doctor visits.
Call your doctor if you gain 3‐5 pounds over 2‐3 days
Weight today __________
EQUIPMENT/SUPPLIES:
Not Applicable
Home Oxygen _____ liters/min __________________company
Hand Held Nebulizer (HHN)
Scale
TREATMENTS: Not Applicable
REPORT TO YOUR DOCTOR OR SEEK MEDICAL
HEART ATTACK WARNING SIGNS
ASSISTANCE:
Chest discomfort
Shortness of breath or have more difficulty
Discomfort or pain in one or both arms, back, neck, jaw or
breathing
stomach
Swelling of your feet, ankles, hands or abdomen
Shortness of breath
Feeling tired with normal activity or experiencing
Breaking out in cold sweat, nausea, or light‐headedness
dizziness or fainting
Trouble sleeping or waking up feeling short of
Call 9‐1‐1
If you are having heart attack warning signs:
breath or coughing
Chest pain or pressure
Don’t wait more than a few minutes – 5 minutes at most – to call
Weight gain of 3‐5 pounds over 2‐3 days
9‐1‐1.
Inability to take medications or follow treatment
plan
CHF DISCHARGE INSTRUCTIONS
PATIENT LABEL
FORM # 536 CHF
FORMULATED: 10/01/04
REVIEWED: 5/06,8/06
REVISED: 8/06,3/08,10/08
WHITE: CHART
YELLOW PATIENT
December 9, 2008
PINK: PHYSICIAN
H:\ClinicalPathways\CHF\HeartFailureCHFDischIns
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical