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New guidelines for the evaluation and management of chronic heart failure from the American College of Cardiology and the American Heart Association reflect a new emphasis on prevention, says Pat Manion, RN, MS, CCRN, CEN, trauma coordinator at Genesys Regional Medical Center in Grand Blanc, MI. She says you should include the following points in your discharge teaching:
• Emphasize the importance of patients weighing themselves at the same time every day. "A weight gain of 3-5 pounds in one week should trigger a phone call to their doctor," says Manion.
• Explain that postural hypotension related to the angiotensin-converting enzyme (ACE) inhibitors and beta-blockers may occur. Inform patients about the possibility of weakness or dizziness when moving from a lying to a sitting, or a sitting to a standing position, Manion says. "Instruct them to change positions slowly, and sit for a few moments before standing when getting out of bed," she says.
• Instruct patients to follow a moderate sodium restriction (2 g-3 g), and read labels to determine sodium content.
• Encourage yearly immunization with pneumococcal and flu shots.
• Encourage patients to discuss an exercise program with their physicians. "A consistent, structured exercise program can improve exercise tolerance," says Manion.
Warn patients not to take a nonsteroidal anti-inflammatory agent, as these drugs can worsen sodium retention and vasoconstriction and can hinder the efficacy and enhance the toxicity of diuretics and ACE inhibitors.