The Fluid management algorithm will help to guide your intervention.
Advise patients to:
- Consult their doctor or nurse if their weight increases or decreases by more than 2kg within a 48 hour period
- Report more gradual weight gain if associated with increasing dyspnoea or oedema
- Self-adjust diuretic doses according to any changes in body weight by providing a flexible diuretic action plan for those patients who could make changes safely
It is important that a recommended fluid restriction is individualised for each patient according to the severity of heart failure, renal function, other dietary behaviours and current physical assessment. In general, 1.5 to 2 litres a day is appropriate for most patients and an intake of greater than 2 litres a day should usually be avoided. [#national-heart-foundation-of-australia-and-the-cardiac-society-of-2011]
Educate patients to:
- Manage thirst by using small glasses, sucking ice and spacing fluids over the entire day
- Understand that fluid includes all liquids, as well as solid foods that turns into a fluid at room temperature or in the mouth (e.g., soup, jelly, custard, yoghurt, ice-cream, watermelon, grapes, oranges)
- Familiarise themselves with how much their usual cup, mug or glass holds and to keep a record of fluid intake until they become accustomed to how much they are allowed
- Understand that fluid restrictions may need to be liberalised in warmer weather to account for increased losses through sweat. Increase fluids gently to replace fluid lost from sweat or in extreme heat, ensuring that daily weight is monitored
- Avoid drinking less than their recommended fluid intake to avoid dehydration
Excessive intake of dietary sodium contributes to fluid overload and is a major cause of preventable hospitalisation.3 Reducing intake of dietary sodium intake may result in beneficial haemodynamic and clinical effects, particularly when combined with a diuretic regimen. Expert guidelines suggest a sodium-restriction of 2-3g/day for patients with HF, especially for individuals who are symptomatic and/or taking diuretics. [#national-heart-foundation-of-australia-and-the-cardiac-society-of-2011]
Referral to the Dietitian to optimise sodium restriction is recommended if available.
Educate patients to:
- Understand the relationship between sodium intake and symptom management in HF. Restricting salt intake can help with controlling fluid overload
- Determine current dietary sodium intake and identify options to measure and adhere to recommended daily intake
- Recognise foods low in sodium such as fresh fruit and vegetables, whole grains, lean meats, unsalted beans and nuts, fresh herbs and unprocessed foods
- Recognise foods high in sodium such as processed meats, cheeses, sauces, frozen dinners and packaged mixes, canned soup and canned vegetables
- Gradually reduce salt intake so their palate has a chance to adjust to the change and food does not seem tasteless
- Read food labels and identify lower salt alternatives
- Avoid adding salt to cooking and regular meals – avoid putting salt on the table to avoid any temptation
See patient education section for factors to consider regarding adult learning and health literacy. Also, explore barriers to adherence discussed in the Supporting behaviour change section.