A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection fraction) about early warning signs of decompensation that should prompt a call to the provider. Which findings should the nurse instruct the client to report immediately? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
New or worsening dyspnea at rest, orthopnea, or paroxysmal nocturnal dyspnea suggests pulmonary congestion and requires prompt evaluation (Choice 3). A rapid weight gain of 2 to 3 lb in one day or 5 lb in one week indicates fluid retention and should also be reported promptly (Choice 5). Prescribed acetaminophen without new symptoms is not an early heart-failure warning sign (Choice 1). An asymptomatic resting heart rate of 50 to 60 may be expected with a beta-blocker (Choice 2). A stable blood pressure of 118/72 without dizziness is not concerning (Choice 4), and mild fatigue that resolves with rest without limiting usual activity is not decompensation by itself (Choice 6).
CHF Early Decompensation — Self-Monitoring 1. Daily morning weight after voiding, before breakfast — same scale, same clothing 2. Dyspnea triad: at rest, orthopnea (need extra pillows), PND (waking up gasping) 3. Edema: ankles, abdomen new or worsening 4. Activity intolerance: less tolerance than baseline 5. Cough: dry, persistent, especially at night
Memory Tip — "FACES of CHF" Fatigue (new), Activity limitation, Chest congestion / Cough, Edema, Shortness of breath.
Action Threshold Weight gain 2 lb/day OR 5 lb/week → call provider same day. Resting dyspnea or PND → call same day; if severe, call 911.
Caution Avoid NSAIDs (fluid retention) and high-sodium foods (>2 g/day target). Take diuretic in morning; do not skip even if asymptomatic.
Scenario72 y.o., chronic HFrEF (EF 30%). Stable on carvedilol, lisinopril, furosemide, spironolactone. Clinic teaching today on home monitoring and when to call.
Discharge Tools- Bathroom scale, daily weight log- Home BP cuff- Sodium tracker (target < 2 g/day)- Pillbox with morning diuretic dose- Action plan card (green/yellow/red zones)
Yellow Zone (call same day)- Weight ↑ 2-3 lb/day OR 5 lb/week- New or worse dyspnea, orthopnea, PND- New ankle/abdominal swelling- New persistent cough
Red Zone (call 911)- Severe SOB, cannot speak in full sentences- Chest pain- Confusion- Pink frothy sputum
Daily weight monitoring — The single most sensitive early indicator of fluid retention in HF. Weigh at the same time each morning after voiding, before breakfast, in similar clothing, on the same scale. A gain of 2-3 lb in 24 hours or 5 lb in a week signals decompensation and requires provider contact.
Orthopnea and paroxysmal nocturnal dyspnea (PND) — Orthopnea = dyspnea when lying flat, relieved by sitting up; client typically uses extra pillows. PND = sudden waking 1-3 hours into sleep with severe dyspnea, lasts 15-30 min after sitting up. Both reflect left-sided HF pulmonary congestion and require same-day evaluation.
HF self-management action plan — Three-zone tool: green (stable, continue plan), yellow (early decompensation, call provider same day), red (severe symptoms, call 911). Clients who use a written action plan have fewer hospitalizations and improved outcomes.