Molly’s self management plan

Support at home

This will depend on the individual.

Medications

Molly should be encouraged to take her prescribed medications and also discuss with her any problems such as difficulty making it to the toilet, dizziness or feeling more tired or fatigued than normal. It is the fine-tuning or balance of taking these different drugs that gets the best possible function of the heart. A small adjustment can sometimes make all the difference. Molly may require many different medication considerations in order to reduce her symptoms (NYHA) and keep her symptoms stable. Often symptomatic control is the principal aspect of medications in heart failure management. (Palliation of symptoms) Molly should be advised not to take other non prescribed medications as these can be harmful.

Fluid intake

Fluid restriction to within 2 litres in 24 hours (which includes all foods plus liquids) is part of a self management plan in heart failure. Patients would rather monitor fluid intake to within 2 litres than add in more water pills which make them run to the toilet. As there is no point adding in more diuretics if they then override this by drinking too much liquid which will make fluid overload worse. This explanation will explain rationale to Molly however, she may feel thirsty more often due to her diabetes. So ice cubes and a sugar free sweet at times may be used to keep mouth moist and reduce thirst.

Diet

Molly should be encouraged to eat a healthy diet to maintain her activities and help with her fatigue symptoms. However salt intake should be discussed in a practical way.

Try to keep salt intake less then 2 grams per day.
Avoid foods high in salt such as cheese, bacon, sausages, processed foods, salted snacks.
Check the packaging of food to work out the salt content

Often sensible advice is to either:
Avoid adding salt to food when cooking.
Avoid adding salt to food at the table.
Avoid using salt substitutes such as Lo-salt as this can interfere with your medications.
Effervescent or fizzy medicines can have a high salt content and should be considered when checking prescriptions

Activity

Physical activity advice should always be tailored to suit the individual. Molly should be advised that any activity even just walking around at home is good for her, as long as she does it regularly. She could start with several short sessions (e.g. 5 minutes) of light-paced activity each day, and gradually aim to reduce the frequency, and increase the duration of each session as her endurance improves. She should be advised not too push through any symptoms, but to gradually slow down, come to a stop and let them settle – then restart the activity slowly when she feels able. Molly should be encouraged to pace herself alternating work and rest by doing things in small stages, and should avoid overdoing it on a good day, as she may feel tired the next.

Vaccinations

It is advisable that Molly has the annual flu immunisation and the pneumonia immunisation (only needed once) to give her protection against infection. She should also be advised to check for green / yellow spit which might indicate a chest infection. Prompt treatment with antibiotics is very important as any infection makes the heart work harder and gives the heart extra work.

Leg monitoring

For some people living with heart failure, they find it difficult to weigh themselves daily : see Razas self management. If like Molly this is difficult due to eye problems/frailty etc then they should be advised to check for signs of extra fluid : extra fluid in the tissues causes swollen feet and ankles. It can also gather in the abdomen (stomach) and legs. Early reporting of sudden fluid or weight gain is vital and Molly should be encouraged to report any changes to your symptoms such as increased puffiness in ankles or abdomen, increase in weight or increase in breathlessness to the nurse or doctor.

Incontinence

As we can see, Molly is embarrassed to discuss this aspect of her self management. This is a very important subject specifically with the elderly as reducing or stopping medications due to incontinence is a common factor for heart failure symptoms worsening. Discussing this with the GP may lead to a diuretic reduction if symptoms are stable but this should reflect a holistic approach to her ongoing care with Molly as a partner.

Incontinence aids should also be discussed and arranged and a community nurse involved if patients struggle to go out to collect these. This should form part of anticipatory care planning.