Dear Mr.

Ward,

Enclosed within this letter you will find important information pertaining to your recent

medical diagnosis of Congestive Cardiac Failure. Although changes will be required of you and

your family members our goal is to aid you to be able to continue to live a comfortable and

enjoyable life. Sacrifices will be required, but these sacrifices will provide an elevated quality of

life.

The healthcare team wants you to understand the causes of congestive cardiac failure.

Heart failure is often caused by smoking because smoking causes vasoconstriction or in other

words cause blood vessels to get smaller. The constricted vessels makes it harder for blood to

move throughout the body which decreases the supply of oxygen to vital muscles and organs.

Another contributing factor to this disease is obesity. Excess body fat requires your heart to work

harder to supply blood and oxygen to the body. This is only made worse by adding high

cholesterol. High levels of LDL cholesterol and low levels of HDL cholesterol can lead to fat

buildup in the blood vessels called atherosclerosis. The more fatty buildup that develops, the less

blood can pass through blood vessels to vital organs including the heart. All of these factors

cause the heart to work harder to compensate. The heart compensates by making bigger heart

muscle, but these changes can be deadly (Lewis, Dirksen, Heitkemper, Bucher, Harding, 2017).

In your chest x-ray it showed an enlarged heart which is a strong indicator of muscle remodeling.

This diagnosis can seem frightening, but you are not alone. This disease affects millions

of people worldwide. It is estimated that over 23 million individuals suffer from Heart disease

worldwide, 5.8 million of which live in America (Roger, 2013). Heart disease is also the most

common reason for hospital admission in adults over the age of 65 (Roger, 2013). You are not

alone and it is important for you to find ways to cope with your diagnosis. Include your family
and loved ones in your plan of care. They can be a great comfort and support. As your healthcare

team, we encourage you to seek ways to improve your quality of life.

Identifying and eliminating risk factors is key to avoiding increased heart disease

complications. Some of those risk factors include: age, male gender, smoking, poor diet,

elevated blood pressure, high blood cholesterol levels and physical inactivity (Mayo Clinic).

Although some risk factors like age and gender cannot be altered you do have control over other

risk factors. Lets discuss some ways to decrease these risk factors. First, if you smoke create a

plan to stop. As was explained above smoking causes vasoconstriction which decreases blood

flow. Second, I noted in your charting that you are overweight. This puts increased stress on the

heart which can introduce new problems. Plan ways to exercise and eat healthier meals (we will

discuss more on this later). I commend you for your efforts to exercise because it is a very

important step towards disease management. This can be beneficial to lowering your cholesterol

levels, hypertension and body weight reduction. Now that risk factors have been identified it is

important to analyze how these conditions will affect your life and the lives of your close friends

and family.

It is vital that you create a home that is safe and promotes a healthy lifestyle. Identify

house hold items or exercises that cause your body stress and look for ways to reduce these

stressors. For example, if you have stairs in your home take a break after going up or down them.

Set walking goals, but dont push yourself to hard. Avoid extreme hot or cold weather as these

can aggravate heart symptoms (Lewis et al., 2017). Encourage your friends and family not to

smoke in or around the house. When you shop only buy healthy foods low in sodium, low in fat,

and increase fruits and vegetables. If you begin to experience symptoms of dizziness ensure that

places you sit or lay by are cleared of furniture with sharp edges or glass to decrease the chance
of hurting yourself. Always rise slowly from sitting or lying positions to decrease your fall risk.

Your family can be a great support group. Ask them to help safety proof your house or to go

shopping with you. Make meals times more enjoyable by cooking and eating together. Family

can be a very beneficial support group for emotional and spiritual needs.

Another great support group is us, your healthcare team. Our aim is to help you achieve

optimal health through goal setting and following a care plan. Your support is crucial to the

success of these goals and we invite you to share in the planning of these goals. Below we have

outlined four goals we would like to begin working on. If you have any concerns about these

goals please let us know.

These goals are to be implemented immediately if possible. They are designed to promote

health, and reduce the risk of future heart failure complications. These goals are:

1. Eating and maintaining a well-balanced diet. This includes reducing your daily

sodium intake to less than 2 grams per day the average American consumes 7 to 15

grams per day (Lewis et al., 2017). Consume more fruits and vegetables and decrease

consumption of fatty foods.

a. Ways to achieve this:

i. Speak with a registered dietician for guidance on foods you should and

should not be consuming.

ii. Examine food labels for fat, and sodium content.

iii. Find other ways to season food without using sodium such as lemon.

iv. Look for recipes that follow your diet restrictions on

www.supertracker.usda.gov. This website has excellent resources

including food planning, nutritional facts, recipe ideas and even

 provides a day by day food tracker that can tell you how much of each

nutrient you are consuming.

2. Exercise Regularly. Lets set a goal to exercise for 15 minutes a day, 5 times a week.

Ways to achieve this:

i. Assess your physical abilities and set your goal based on your self-

observations. For example, maybe walking around the blocks causes

you severe chest pain, but you feel comfortable walking half way

around the block.

ii. Find an exercise partner. This will provide both moral support and

safety support if sudden chest pain or difficulty breathing were to

occur.

iii. Remember to take scheduled breaks after physical exertion. This will

enable your body time to keep up with the physical demand (Lewis et

al., 2017).

iv. Choose activities you enjoy to motivate physical activity.

3. Preform personal health assessments regularly. This will allow you to detect early

onset of declining health.

a. Ways to achieve this:

i. The health assessment should include :

1. Daily weighing. If you gain more than 3 pounds in two days or

3 to 5 pounds in a week call your doctor.

2. Look for changes in your ability to breath.

 3. Assess the extremities for any swelling tingling or numbness

(Lewis et al., 2017).

ii. Remind yourself to preform your daily assessment by :

1. Setting an alarm for yourself using your cellphone.

2. Preform the assessment the same time each day.

3. Ask family members to observe for any sudden health changes.

4. Follow medication schedules and precautions. This goal is to help avoid drug

interactions between food and other drugs. These medications are used to decrease

risk factors associated with heart failure and need to be taken per doctors instruction.

a. Ways to achieve this.

i. Use a medication tray that is labeled with the days of the week. Fill the

medication trays with daily prescribed medications. This can ensure

the consumptions of the correct medications.

ii. Take daily medications at the same time each day. Write down when

you take needed drugs to ensure overdose does not occur.

iii. Verify that drugs dont interact with other medications or foods. If you

have questions speak with your Doctor.

These goals will help control heart failure, but in the event of an acute episode more

treatment may be required. In case of an acute episode practice deep breathing and apply oxygen

if ordered, call your health care provider, and place yourself in a relaxing environment. You may

be given certain medications such as a diuretic for fluid retention and swelling, a beta blocker to

decrease heart rate or ACE inhibitor to dilate blood vessels for increased blood flow. Other
heart tests such as echocardiogram to produce a visual display of the heart or an ECG to assess

heart conduction (Mayo Clinic).

Mr. Ward we hope that this letter has been beneficial to you. As your Healthcare team we

congratulate you on your efforts to better your personal health. We encourage you to contact us

if you have any questions or concerns. It is a pleasure serving you. Thank you for letting us take

care of you!

Sincerely,
Western Regional Cardiac Team
Jacob Ewell SRN
 References

Lewis, S., Dirksen, S. R., Heitkemper, M., Bucher, L., Harding, M. M., Jeff. (2017). Medical-

Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume,

10th Edition. [Pageburstl]. Retrieved

from https://pageburstls.elsevier.com/#/books/9780323328524/

Mayo Clinic. (n.d.). Heart failure Risk factors. Retrieved from

http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/risk-factors/con-

20029801

Roger, V. L. (2013). Epidemiology of Heart Failure. Circulation Research, 113(6), 646

659.http://doi.org/10.1161/CIRCRESAHA.113.300268

SuperTracker: My Foods. My Fitness. My Health. (n.d.). Retrieved from

https://www.supertracker.usda.gov/foodtracker.aspx