LONG TERM

CARE CASE
STUDY: CHF BY: ALIVIA ONEY

WITH
HYPONATREMIA
 RESIDENT OVERVIEW
Resident PMH: MEDICATIONS: PERTINENT LABS: OTHER
Information: • Multiple fractures • Lasix for CHF • Na IMPORTANT
• 92 YO male from MVA • tolvaptan tablet
• 7/12- 123 mmol/L INFORMATION:
• 72 in, 158.8 lbs., • dysphagia • 7/20- 124 mmol/L
1x/week- • Resident is given
• obstructive and • 7/25- 130 mmol/L
21.6 BMI (normal hyponatremia Gatorade for low
reflux uropathy • Glucose- 114 ^
WT) • metoprolol and levels
• hematuria • K- 4.6 (WNL)
• skilled d/t recent lisinopril for HTN • Current diet
• Volume depletion • BUN/Cr- 16/0.81
laminectomy, • docusate sodium (WNL) order- heart
acute CHF • Hypocalcemia
tablet- • Hgb/Hct- 11.8/34.1 healthy
episode • Acute RF (low)
constipation • Fluid restriction-
• CHF dx within • Retention of urine
• famotidine- 1200 mL
time since last • Afib • The increased Na
stomach upset • Very healthy for
admission in 2018, • HTN lab came a couple
currently has • CHF days after advanced age
hyponatremia tolvaptan
administration
 What is Congestive
Heart Failure?
◦Left-sided
◦Left ventricle weakens, CO to body is decreased
◦Backflow into the pulmonary vein- high pressure
causes pulmonary congestion/edema
◦Right-sided
◦Right ventricle weakens, CO to lungs diminished
◦Backup of blood in the vena cava and body
circulation causes edema in legs, liver, and
abdominal organs.
◦Systolic vs. diastolic
◦Pumping vs. filling issues- both result in
decreased CO and a backflow of blood
◦Compensatory mechanisms: low CO = low BP =
activation of RAAS to preserve blood pressure
and volume
◦this can cause the hyponatremia
 EPIDEMIOLOGY- prevalence:
• Lower in Europe than US and Canada
• ~6.2 million adults in the US, 1.8% population

ETIOLOGY:
• Conditions that weaken the heart
• CAD, inflammation, HTN, cardiomyopathy, MI, irregular heartbeat, DM
EPIDEMIOLOGY,
ETIOLOGY, S/S, CLINICAL MANIFESTATIONS: dependent on the type of CHF (left sided
vs. right sided)
AND TYPICAL • Shortness of breath, esp. when laying down, fatigue, confusion, cough,
TREATMENT weakness
• Abdominal pain, N/V, ascites and edema of lower limbs, WT gain, distended
neck veins, hyponatremia

TYPICAL MEDICAL CARE:

• Medications- diuretics, vasodilators and ACE inhibitors, beta-blockers to
slow HR
• Healthy habits (smoking, exercise/WT maint., alcohol)
• Nutrition therapy- low sodium and fluid restriction - see future slides.
• Heart transplant
 DIAGNOSIS AND COMORBIDITIES:
Diagnosis: Tests: echocardiogram (ejection fraction- % of blood pumped out w/ each beat)
- 40% or less, reduced EF; 50% or more, preserved EF
CT/MRI- imaging of heart

Labs: Brain natriuretic peptide (BNP), raised during HF; other tests to determine kidney and
liver function

Comorbidities: Kidney/liver damage, lack of perfusion and excess build up of fluid in organs

Pulmonary issues, fluid buildup around the lungs

Malnutrition, lack of appetite from ascites and lack of perfusion compromises absorption

Other heart conditions, irregular heartbeat, leaky valves, cardiac arrest

NUTRITIONAL IMPLICATIONS: EVIDENCE-
BASED NUTRITION INTERVENTIONS

Fluid restriction: Less

Low sodium: <2 g/d than 2 L/d
Less salt = less fluid retention, More fluid increases blood
less edema and dilution of serum volume and makes it harder for
sodium levels the heart to pump
*1200 mL
PATIENT CLINICAL
COURSE AND CURRENT
RECOMMENDATIONS:
◦ Current diet order, heart healthy diet – NAS with low fat
emphasis
◦ Fluid restriction of 1200 mL
◦ Recommended switching to a regular diet
◦ Advanced age (92 YO)
◦ low serum sodium levels w/ discontinued sodium
tablets at hospital due to CHF episode
◦ Increase the dietary sodium without giving excessive
salt tablets which would cause fluid retention
◦ Give Gatorade as supplement to increase electrolyte
consumption
◦ HTN medications and Tolvaptan for CHF
REFERENCES:
1. Types of congestive heart failure: Left vs. Right side. (2015, June 9). UPMC HealthBeat.
https://share.upmc.com/2015/06/difference-between-left-side-right-side-heart-failure/
2. Rodriguez, M., Hernandez, M., Cheungpasitporn, W., Kashani, K. B., Riaz, I., Rangaswami, J., Herzog, E., Guglin, M., & Krittanawong, C.
(2019). Hyponatremia in heart failure: Pathogenesis and management. Current Cardiology Reviews, 15(4), 252–261.
https://doi.org/10.2174/1573403X15666190306111812
3. Roger, V. L. (2021). Epidemiology of heart failure. Circulation Research, 128(10), 1421–1434.
https://doi.org/10.1161/CIRCRESAHA.121.318172
4. Heart failure—What is heart failure? | nhlbi, nih. (n.d.). Retrieved July 26, 2022, from https://www.nhlbi.nih.gov/health/heart-failure
5. Heart failure—Symptoms | nhlbi, nih. (n.d.). Retrieved July 26, 2022, from https://www.nhlbi.nih.gov/health/heart-failure/symptoms
6. Heart failure—Treatment | nhlbi, nih. (n.d.). Retrieved July 26, 2022, from https://www.nhlbi.nih.gov/health/heart-failure/treatment
7. Heart failure—Diagnosis | nhlbi, nih. (n.d.). Retrieved July 26, 2022, from https://www.nhlbi.nih.gov/health/heart-failure/diagnosis
8. Congestive heart failure diet: How to reduce salt and fluid intake. (2018, June 26). Healthline.
https://www.healthline.com/health/congestive-heart-failure-diet