heart matters

Nutrition for patients with

heart failure
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By Nancy Peer, PhD, RN, CNE

Cardiovascular disease ranks among the

leading causes of death in the United States,
according to the U.S. Department of Health
and Human Services. As a result, objectives
developed by Healthy People 2020 look to
decrease mortality and improve quality of
life for individuals with cardiovascular dis-
ease. The focus is put on modifiable risk
factors that contribute to cardiovascular
disease, such as obesity, physical inactivity,
and poor diet.
Because heart failure can be self-limiting,
get progressively worse, and cause residual
organ damage, patient education about treat-
ment is an important nursing goal. In an
effort to identify the effects of heart failure
on quality of life and aide nurses in provid-
ing care, a creative teaching exercise was
developed in which the hosting of a dinner
party for guests experiencing different levels
of cardiovascular disease is used to outline
the nursing process. This exercise will help
you understand the important role of nutri-
tion in cardiovascular disease and its impli-
cations for quality of life.

A quick refresher
Heart failure is a combination of the body’s
compensatory mechanisms kicking in to
ensure ventricular filling and adequate
cardiac output of oxygenated blood to the
circulatory system. These compensatory
mechanisms are triggered either by sudden
or chronic changes to the heart as a result
of myocardial infarction (MI), coronary ar-
tery disease, hypertension, high cholesterol,
diabetes, infection, or kidney and respira-
tory disorders. Among the compensatory
ANILAKKUS / ISTOCK ©
vessel constriction. Also, the secretion of
antidiuretic hormone by the pituitary gland
and the hormone renin by the kidneys
stimulates the reabsorption of sodium and
water to increase blood flow.
However, these compensatory mecha-
nisms can cause peripheral edema, pulmo-
nary edema, and excess strain on the heart,
which can lead to decreased respiratory
function, poor organ perfusion, and heart

mechanisms are the release of epinephrine/ damage due to ventricular remodeling

norepinephrine (catecholamines) by the (see Key symptoms of heart failure). Although
sympathetic nervous system, which commonly seen in older patients, heart
supplements cardiac output through in- failure can now be seen in other age
creased muscle contractility and blood groups as healthcare advances allow more

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 heart matters
Key symptoms of heart failure
Shortness
Fatigue
of breath
Peripheral Limitation
edema of activities
individuals to live with acute or chronic
heart problems.
Many changes can be incorporated
into an individual’s lifestyle to slow the
progression of heart failure, as well as
maintain a higher quality of life. Among
the nutritional challenges of healthy aging
are the incorporation of healthful eating
patterns; adequate nutrient intake; and
decreasing weight gain due to lower
metabolism, physical inactivity, and poor
dietary intake. A nutritional intake of
nutrient-dense food (fruits and vegetables)
and less reliance on processed foods con-
taining high salt and fat content are corner-
stones of a heart-healthy diet.
By using the nursing process, you can
play a vital role in decreasing the exacerba-
tion of heart failure and assisting with posi-
tive lifestyle modifications that can promote
a better quality of life for your patients.
Your guests
Erika F. Volume has recently been dis-
charged from the hospital after experienc-
ing breathing complications due to excess
fluid volume. She was diagnosed with
heart failure after blood tests revealed in-
creases in B-type natriuretic peptide (BNP),
a cardiac marker specifically secreted by
heart cells used to determine cardiac
causes of dyspnea. BNP is released from
the ventricles when diastolic BP increases
to assist the kidneys with excreting sodium
as a compensatory mechanism to decrease
fluid volume. Although once very active,
she’s slowed down considerably after ex-
periencing angina secondary to chronic hy-
18 Nursing made Incredibly Easy! March/April 2017
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pertension. She’s been struggling with her
low-salt diet and fluid intake restrictions,
but sees positive differences in her daily
weight and how her clothes fit. She’s also
dealing with the management of an in-
crease in diuretic medication and her need
for potassium supplements due to the po-
tassium lost with diuretic use.
Irving G. Exchange is home after experi-
encing a bout of pneumonia that left him
physically weak and tired. Due to impaired
gas exchange, he’s using supplemental oxy-
gen, which helped him regain his ability to
perform activities of daily living. However,
a history of cigarette smoking and numerous
episodes of chronic bronchitis have caused
him to have chronic respiratory problems.
Although once physically active, he had to
move into an assistive living environment
where he can receive assistance with daily
activities. He’s now ready to resume his
social activities and has a “fancy” for his
neighbor, Doris, who doesn’t seem to let
anything cloud her positive, upbeat attitude.
Doris D. Knowledge has always prided
herself on her social activities. She’s almost
always helping someone in her senior
housing complex or planning/attending
social functions. After previous cardiac sur-
gery for complications of coronary artery
disease, she was recently diagnosed with
heart failure after experiencing shortness of
breath and a 10 lb (4.5 kg) weight increase.
Conveying to her healthcare provider that
she lacks knowledge about her medication
needs (a diuretic, a lipid-lowering drug,
and an antiarrhythmic drug) and her nutri-
tional modifications (low-saturated fat,
low-carbohydrate, and low-salt diet), she
knows that she’s at increased risk for
hospitalization or decreased socialization
should she not comply with her healthcare
provider’s recommendations.
Angela A. Intolerance has been stuck at
home with little energy or motivation to do
anything outside of her house. Although
once social, her chronic leg pain caused by
diabetic neuropathy has caused her to rely
on others for assistance with housekeeping
and grocery shopping. She’s also dealing
with diabetic complications, medication
adverse reactions, and a recent change in
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 Dinner guest nursing diagnoses
Excessive
fluid volume
Impaired
Deficient
gas
knowledge
exchange
Decreased
Activity
cardiac
intolerance
output
living accommodations, which have taken a
toll on her emotionally. Once a great cook
with a flair for hosting dinner parties, she
now exhibits decreased interest in socializa-
tion, limiting her ability to develop the
monthly senior newsletter.
David C. Output has slowed down quite a
bit over the last month. Known for his
“giant” view on life and interest in anything
that will keep him physically active, he’s
been getting most of his activity from watch-
ing sports on TV. A recent MI scare and sub-
sequent cardiac catheterization to unclog
coronary arteries has left him quite nervous
about his health. His healthcare provider has
given him some new medication to increase
his cardiac output, and he’s hopeful that he
can start resuming more activity, including
dating Angela because he misses compan-
ionship after the death of his wife.
Using a creative social format, we’ll stimu-
late conversation about heart failure, identify
dietary needs, and provide education on
nutritional choices that benefit patients with
cardiovascular disease (see Dinner guest nurs-
ing diagnoses).
Menu planning
The overall goal of our simulated dinner
party is to provide guests with a nutri-
tional/educational focus to achieve heart
failure management goals. These include
decreased symptoms of heart failure,
decreased symptoms of peripheral edema,
increased energy to tolerate exercise, under-
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Erika F.
Volume
Doris D. Irving G.
Knowledge Exchange
David C. Angela A.
Output Intolerance
standing the importance of nutrition and
medication, and decreased heart failure
complications.
Lifestyle modifications can seem daunt-
ing to those who’ve been sidelined by
acute or chronic illness. Available resources
such as cardiac rehabilitation after MI or
coronary bypass surgery aren’t commonly
accessed by older adults; yet, approximate-
ly two-thirds of deaths from cardiovascu-
lar disease occur in those ages 75 and
older, according to the American Heart
Association. Although some modifiable
factors can improve health, such as avoid-
ing alcohol and tobacco consumption, ade-
quate nutrition is essential for life. We
must consider diet modifications as both
individualized and achievable by the
patient to ensure success.
For menu planning, key nutritional
points are to keep the meal low in salt, easy
to duplicate by guests, and with a variety of
fruits and vegetables to ensure good sources
of vitamins and nutrients (see DASH diet
plan for cardiovascular disease). Keep food tex-
tures pleasing while also making it easy to
digest because guests can tire quickly with
excessive chewing. Minimize liquids and
serve food with a variety of flavor that can
be enhanced with low-potassium salt sub-
stitutes. Serve whole wheat rolls to ensure a
good source of fiber intake and serve dairy
and nuts to ensure protein intake. Nuts also
provide a good source of fatty acids essen-
tial for cardiovascular health.
March/April 2017 Nursing made Incredibly Easy! 19
 heart matters

DASH diet plan for cardiovascular disease

Low-sodium, low-fat diet

2 to 3 servings of low-fat dairy Fruits and vegetables

per day
2 to 4 servings of fruit per day Healthy grains/nuts
Less than 2 grams of sodium
3 to 5 servings of vegetables Whole wheat
per day
per day
Hearty grains
Unsaturated oils
* Important sources of
Fiber-rich protein source
* Major sources of calcium magnesium, potassium,
such as walnuts
and protein and fiber
*Major sources of energy

Considering these nutritional points, the
menu will consist of a chopped salad with
low-fat dressing, a butternut squash soup
with grated fresh cheese, and whole wheat
rolls (see The menu). For dessert, guests can
enjoy low-fat vanilla yogurt topped with
assorted cut-up fruit and crushed walnuts.
This menu will accommodate stimulation of
appetite and ease of digestion, which can be
affected by breathing difficulties, medica-
tions, and recuperation from heart failure
exacerbations. It also contains essential
nutrients, such as potassium, which can be
easily lost with diuretics or lack of nutrition.
To assist guests, keep serving dishes that
are portion controlled and lightweight to
accommodate diet and physical restrictions.
Also, don’t have a water pitcher on the
table; rather, prepour water into glasses to
monitor fluid intake. To assist digestion and
easy consumption by guests, serve chopped
salad with dressing on the side and allow a
suitable period of rest between the salad and
soup entrée to encourage socialization.
Serve the soup warm, not hot, so guests
won’t run the risk of swallowing difficulties,
and serve fruit on top of the vanilla yogurt
for dessert. Arrange to pass around a small
dish of chopped walnuts for guests to take
at will.
Evaluation of healthy outcomes
Evaluating your dinner guests, you note
that Erika was able to control her fluid in-
take and enjoyed socializing with her
friends without constant interruptions to go
to the bathroom. These key learning goals
showed her the importance of managing
fluid balance and medication effects, as well
as the importance of eating a nutrient-rich
diet to prevent heart failure complications.
Irving found that eating simple foods
with nutritional value allowed him to enjoy
eating out without experiencing any breath-
ing difficulty. This insight decreased his
anxiety about accepting social invitations
and increased his confidence in living with
heart failure.
Doris learned about Irving’s dependence
on continuous oxygen and in discussing his
health, she found that taking better care of
herself could delay the progression of heart
failure. This included paying attention to
portion control, as well as notifying her
healthcare practitioner of any weight gain
of over 3 lb (1.4 kg). Because weight is a
major patient tool to gauge fluid volume
changes due to heart failure, Doris now has
the motivation to take better care of her
health—another goal to assist with quality
of life for heart failure patients.
Angela enjoyed the ability to meet and
talk with her friends. Since she realized that
she isn’t alone in living with a chronic condi-
tion, she’s planning a column in the monthly
newsletter to educate others about cardio-
vascular disease. Angela’s insight on the
positive benefits of talking with others about
chronic illness and its impact on quality of
life led to the learning goal of sharing knowl-
edge to benefit others.
David enjoyed talking with Angela and
reminiscing about his travels with his late
wife. He and Angela are making plans to

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 The menu
Low-sodium, low-fat diet

Low-fat Italian salad dressing Fruits and vegetables

Low-fat vanilla yogurt Soup: Healthy grains/nuts

Low-fat parmesan cheese
Soft butter spread made with
olive oil
Water with lemon
Butternut squash/grated carrots/
Whole wheat rolls
low-sodium chicken broth/fresh or
powdered ginger/onion/garlic for taste Chopped walnuts
Salad:
Thinly-sliced cucumber/green pepper/
tomato/onion/salad greens

Dessert:
Fresh fruit cut-up or frozen berry
mixture thawed

start walking around the senior complex Way to clean up!

and signing up for the next senior center
outing. David’s enjoyment of companion-
ship and planning physical activity led to
his learning the value of physical activity
and socialization to both his and Angela’s
well-being.
Understanding the primary symptoms of
heart failure, such as fatigue, edema, short-
ness of breath, and activity intolerance, can
assist you with cardiovascular education.
As evidenced by our dinner guests, symp-
toms can be exacerbated by lack of dietary
modifications, lack of knowledge, and lack
of regular healthcare monitoring. Each hos-
pitalization can set the heart failure patient
up for dangerous complications with other
body systems, such as Irving’s need for
continuous oxygen, David’s decrease in
physical activity, and Angela’s decrease in
independence.
Using the nursing process, assess your
patient’s needs to help plan for health
enhancement, implement nursing interven-
tions, and evaluate his or her achievement
of healthcare goals. Educate your patient
on appropriate lifestyle modifications, spe-
cialized diet requirements, and facilitating
peer-to-peer learning. Implement interven-
tions that address physical limitations,
increase socialization, and allow for diet
modifications that are easy to duplicate.
With positive outcomes achieved, your
patient is now ready to adjust his or her life-
Because patient education is one of our
primary nursing interventions to ensure
positive health outcomes, making learning
opportunities memorable for those restricted
by chronic illness can lead to the adoption of
positive patterns and lifestyle modifications.
As in our simulated dinner party, you can
holistically address nutritional needs, social-
ization opportunities, and knowledge defi-
cits by utilizing a community approach.
Critical reflection on patient assessment, ap-
propriate planning goals, and creative nurs-
ing interventions helps reinforce the basics
of living with cardiovascular disease and in-
crease quality of life. A job well done! ■
REFERENCES
Ackley BJ, Ladwig GB. Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care. 10th ed. St. Louis,
MO: Elsevier Mosby; 2014.
American Heart Association. Statistical fact sheet, 2016
update. www.heart.org/idc/groups/heart-public/@wcm/@
sop/@smd/documents/downloadable/ucm_483962.pdf.
Billings DM, Halstead JA. Teaching in Nursing: A Guide for
Faculty. 4th ed. St. Louis, MO: Saunders-Elsevier; 2012.
Grodner M, Roth SL, Walkingshaw BC. Nutritional
Foundations and Clinical Applications: A Nursing Approach.
5th ed. St. Louis, MO: Elsevier Mosby; 2012.
HealthyPeople.gov. 2020 topics and objectives. www.
healthypeople.gov/2020/topics-objectives.
Herrman JW. Creative Teaching Strategies for the Nurse
Educator. Philadelphia, PA: F.A. Davis Company; 2008.
Lewis SL, Dirksen SR, Heitkemper MM, Bucher L. Medical-
Surgical Nursing: Assessment and Management of Clinical
Problems. 9th ed. St. Louis, MO: Elsevier Mosby; 2014.
Nancy Peer is an Assistant Professor/Clinical Faculty Member at
Central Connecticut State University in New Britain, Conn.
The author has disclosed no financial relationships related to this
article.

style to live a quality life with heart failure. DOI-10.1097/01.NME.0000511850.39129.47

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