Closing the Loop: A 65-year-old female client with gradual onset of symptoms of heart failure was seen in the emergency department. Results of her physical examination and diagnostic tests show evidence of abnormal pump function. The health-care team decided outpatient management was appropriate and the patient was given education to self-manage her care.
Nurse: Mrs. Smith, do you have any questions about what the doctor has told you?
Mrs. Smith: I may have some later, but not right now.
Nurse: There are some things that are very important for you to do when you are at home to take care of yourself and to help us know how you are doing. I have them written down and will review these with you, does that sound okay?
Mrs. Smith: Yes, I want to make sure I do everything I can to take care of myself.
Nurse: Okay, the amount of medication you take may need to change depending on your weight, so you will need to weigh yourself daily, and call us if any of your symptoms get worse. Any sudden weight gain of two pounds in one day or five pounds in one week will need to be reported to us. This weight gain may be caused by excess fluid in your body, so it is important that you let us know. Can you repeat back to me what you need to do at home, so I know that this is clear?
Mrs. Smith: Yes, of course. I need to weigh myself daily, and call you if any of my symptoms worsen. I did not quite get the amount of weight gain that I should be looking for?
Nurse: That’s okay, I have written it down for you, but just so it is clear, if you gain two pounds in a day or five pounds in one week you will need to call us right away. Can you repeat this back to me?
Mrs. Smith: Yes, if I gain two pounds in one day and five pounds in one week, I should call you.
Nurse: Good.