Assessment of patients who present with signs and symptoms suggestive of new onset heart failure or
exacerbation of chronic heart failure requires a comprehensive approach as outlined on these cards. Use
your “cash” card to insure appropriate assessment of all patients.

- Coronary artery disease
- Excessive dietary sodium intake
antidysrhythmics (Vaughn Williams Class I) SIgNS OF HEART FAILURE:
- Tachycardia
- Third heart sound (S3)
- Increased jugular venous pressure
- Positive hepatojugular reflux
- Bilateral crackles
- Peripheral edema not due to venous insufficiency
- Laterally displaced apical impulse
- Weight gain
- Abdominal distention (Note: These signs are generally associated with congestion; not all
patients with acute heart failure are congested).
- Dyspnea on exertion
- Dyspnea at rest
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue
- Decreased exercise tolerance
- Unexplained cough, especially at night
- Acute confusion or delirium
- Abdominal or gastrointestinal symptoms (e.g. nausea, bloating, abdominal pain, anorexia)
- Decreased food intake
- Decline in functional status
- Complete blood count
- Urinalysis
- Serum electrolytes including calcium and magnesium
- Blood urea nitrogen
- Serum creatinine
- B-type natriuretic peptide
- Fasting lipid panel
- Fasting blood glucose - Liver function tests - Drug levels of relevant medications (e.g., digoxin) - Thyroid panel - 1-lead electrocardiogram - Chest radiograph - Two-dimensional echocardiography - Radionuclide imaging (consider) - Cardiopulmonary exercise testing (consider) - Cardiac catheterization (consider) - Myocardial biopsy for suspected myocarditis (consider) ASSESSmENT QUESTIONS:
• What symptoms prompted you to seek medical care? When did they begin?
• Did your symptoms begin suddenly or gradually worsen over time?
• What makes the symptoms better/worse?
• Do the symptoms occur continuously or only with certain activities?
• Do symptoms improve with rest?
• Do you have any pain now? Did you recently have pain? Rate on a 0-10 scale.
• Has your heartbeat felt any different than usual? E.g., “race,” “flutter,” or “skip?”
• Have you felt short of breath? Do you wake up short of breath at night?
• Can you speak as much as you like before getting short of breath?
• What makes your breathing easier?
• Do you cough? Is it worse than usual?
• Do you cough throughout the day or mostly in the morning?
• Do you cough up any secretions?
• Do you use oxygen at home?
• Have symptoms kept you from sleeping?
• Do you sleep in bed or in a chair?
• Are you able to lie flat in bed?
• How many pillows do you use to sleep? Is this more or less than usual? • Have you recently slept more or less than usual? Do you feel rested?• Ask spouse/significant other if patient snores or intermittently stops breathing during sleep.
• Have you recently eaten more salty foods or drank more water than usual?
• How often do you eat out?
• How often do you weigh yourself?
• Have you gained or lost weight recently?
• Have you experienced any swelling? Is swelling present all day or only evenings?
• How far up your legs do you have edema?
• Have you felt bloated or had edema?
• Are your clothes, belt, rings, and shoes tighter than 1 week or 1 month ago?
• Have you had nausea or abdominal pain?
• Have you taken all prescribed meds?
• Did you run out of any medications?
• Have you had diarrhea/vomiting that may have affected absorption of medications?
• Have you taken extra diuretic meds?
• Have you changed the dose of any med?
• Did any physician/NP recently prescribe different medications for you or change the dose
• Do you take any over-the-counter medications or herbal supplements? Activity
• How far can you walk?
• Can you dress, bathe, prepare food, climb stairs without stopping to rest?
• What activities could you do recently but not now because of worsened symptoms?
• Have you decreased your activity level?
• Do you have difficulty remembering information or feelings of confusion?
• Have you had other health problems that may make your heart failure worse?
2006 American Association of Heart Failure Nurses


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