What the nurse needs to know
one of the most important effects of lowered cardiac output in heart failure is a reduction in renal blood flow and glomerular filtration rate, which leads to sodium and water retention.
With decreased renal blood flow, there is a progressive increase in renin secretion by the kidneys along with parallel increases in circulating levels of angiotensin II. increased angiotensin II contributes to vasoconstriction and stimulates aldosterone production by the adrenal cortex.
Aldosterone increases tubular reabsorption of sodium with an accompanying increase in water retention. angiotensin II also increases the level of antidiuretic hormone, which also contributes to vasoconstriction and inhibits water excretion.
What the patient need s to know
- diet sodium/salt
- heart failure causes the body to hold on to sodium, which causes extra fluid to build up in the body. extra fluid makes the heart work harder
- check with your healthcare provider to find out what your daily intake of sodium limit should be – typically 1500-2000 mg a day. a teaspoon of salt contains about 2300 mg of sodium
- ways to reduce salt/sodium intake
- take the salt shaker off the table. remember salt is salt whether sea or kosher it is still salt
- choose fresh foods when possible-avoid processed or smoke – cured foods
- don’t add salt when cooking – try different herbs and spices to season food, for example: garlic POWDER, black pepper, basil, chives, parsley, paprika, dill, sage, curry, chili powder, thyme, lemon juice, vinegar, Mrs. Dash® Salt-Free Seasoning Blends
- look for low sodium versions of food you like
- examples of low-sodium foods:
- beans, peas, rice, lentils, or whole wheat pasta (dried and fresh, cooked without salt)
- fruits (fresh, frozen, or canned in juice – avoid heavy syrup)
- fresh meats, poultry, and fish
- vegetables (fresh and plain frozen)
- read food labels for sodium/salt content – food items in a bottle, a can or a box contain preservatives which are high in salt
- avoid high sodium/salt seasonings such as barbecue sauce, soy sauce (even “lite” soy sauce), dry salad mixes, garlic salt, taco seasoning, onion salt, ketchup, seasoned salt, pickle relish
- examples of high sodium foods:
- lunch meats
- chipped beef
- hot dogs
- canned meats/fish/beans
- canned vegetables/soups
- jarred/canned tomato sauce
- check with your healthcare provider before using salt substitutes; do not use them if you have kidney disease since they contain potassium
- extra weight makes the heart work harder
- limit fat intake and ask your healthcare provider about ways to control your weight
- ways to reduce fat intake
- use the food pyramid as a guide for portion sizes (www.mypyramid.gov)
- choose lean meats, poultry, and fish and cut visible fat and skin off
- avoid fried foods
- check food labels for fat content
- total cholesterol
- people who have a total cholesterol level of 240 mg/dl or more have twice the risk of coronary heart disease as those whose cholesterol level is at 200 mg/dl
- after a heart attack recommended cholesterol is 170 mg/dl or less
- HDL vs LDL Cholesterol
- HDL (high density lipoprotein) is the good cholesterol
- HDL levels of 60 mg/dl or higher give some protection against heart disease
- LDL (low density lipoprotein) is the bad cholesterol
- an optimal level of LDL is less than 100 mg/dl. higher levels are considered a risk factor
What the nurse needs to know
weight gain may be an early sign that fluid is accumulating in the patient’s vascular system or tissues. a person can retain 8 to 15 pounds of fluid before swelling, shortness of breath, or other symptoms occur. two pounds is equivalent of one liter of fluid.
- ask the patient if they have a scale at home.
- make sure the patient has an accurate “dry weight” – their weight on the day of discharge.
what the patient needs to know
- a rapid weight gain without a change in the amount you usually eat may be a sign that your body is holding onto fluid and your treatment plan may need to be changed.
- having a scale at home is vital to the successof your treatment plan.
- write down your starting weight (weight at discharge from the hospital) on the calendar.
- hang the calendar in the same room where you keep your scale.
- weigh yourself first thing in the morning everyday at the same time, on the same scale, wearing the same amount of clothing, and after urinating.
- record your weight each day on the calendar.
- take this calendar with you every time you go to see your healthcare provider.
- call your healthcare provider if you gain 2 pounds in one day or 5 pounds in a week.