Decompensation / focused change
F1 HF decompensation — edema and weight gain | Heart-failure-specific review identified new 3+ pitting edema to mid-calf bilaterally, increased from 1+ at the prior visit, with a 5 lb weight gain over 3 days (172 → 177 lb, above the ordered 3 lb threshold); an S3 and bibasilar crackles are noted in the parent examination, and the patient reports two-pillow orthopnea and reduced exertional tolerance — red zone. Legs elevated and the parameter-based PRN diuretic order applied; provider notified at 14:10 with the weight trend, edema change, and lung findings. Orders received to increase the daily diuretic and obtain a basic metabolic panel in 48 hours. The patient tolerated the dose and voided with reported relief. Low-sodium and daily-weight teaching reinforced with teach-back 100%. Reassessment scheduled in 48 hours; the patient was instructed to call for further weight gain or worsening dyspnea. |
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F2 Increasing dyspnea / orthopnea — exacerbation | Heart-failure-specific review found worsening exertional and nocturnal dyspnea with new three-pillow orthopnea and a 4 lb weight gain over two days; the parent examination shows bibasilar crackles, 2+ ankle edema, and an S3, with SpO2 91% on room air, down from a baseline of 95% — red zone. The patient was positioned upright and reassessed; provider notified at 09:55 with the weight trend, respiratory and cardiac findings, and oxygenation. Orders received to increase the diuretic, obtain a chest x-ray and basic metabolic panel, and reassess oxygenation. Low-sodium, fluid-restriction, and zone teaching reinforced. The patient was advised to call for further dyspnea or weight gain; same-day reassessment and lab and imaging coordination were arranged. |
F3 Acute pulmonary edema — emergency | Heart-failure-specific review during a visit found acute severe dyspnea at rest, inability to lie flat, and pink frothy sputum, with the parent examination showing diffuse crackles and an SpO2 of 84% on room air — findings consistent with acute pulmonary edema. Emergency medical services were activated according to agency protocol; the patient was positioned upright and oxygen applied per order while awaiting EMS, with serial respiratory rate, SpO2, and symptom reassessment documented. The provider was notified and family present were informed; the event, communications, and serial vital signs were documented pending transport, with follow-up to coordinate care and reassess on return home. |
F4 Over-diuresis — hypotension / orthostasis | Heart-failure-specific review found the patient reporting dizziness on standing; orthostatic assessment in the parent module showed a symptomatic drop, with mucous membranes slightly dry and a 4 lb weight loss over two days below the target — signs of over-diuresis. The patient was seated safely and fall precautions implemented; provider notified at 13:05 with the orthostatic values, the weight change, and the symptoms. Order received to hold the next diuretic dose, encourage oral intake within the ordered fluid limit, and recheck. The dizziness resolved when seated; the patient was instructed on slow position changes and to call for recurrent symptoms or falls. Reassessment and repeat orthostatics planned next visit. |
F5 Hyperkalemia risk on MRA / ACE-I | Heart-failure-specific review noted the patient is on a mineralocorticoid-receptor antagonist and an ACE inhibitor with a laboratory order due; the ordered basic metabolic panel returned a potassium above the reference range without electrocardiographic symptoms reported. Findings indicate a risk of hyperkalemia from the combined regimen. Provider notified at 11:30 with the potassium value and the current regimen; order received to hold the mineralocorticoid-receptor antagonist and recheck potassium, and to review potassium-containing salt substitutes and supplements. Dietary potassium sources and the recheck plan reviewed with the patient; teach-back accurate. Potassium recheck and reassessment scheduled per the order. |
F6 Yellow-zone weight gain caught early | Heart-failure-specific review found a 3 lb weight gain over two days (within the yellow zone but at the ordered threshold) with mild increased ankle edema and no orthopnea or dyspnea — an early yellow-zone change caught before decompensation. The PRN diuretic parameter was applied per order and the patient reassessed; provider notified at 10:15 with the weight trend and edema. Order received to continue the PRN diuretic and monitor, with instruction to call for further gain or new dyspnea. Sodium and fluid limits and the action plan reinforced; teach-back 100%. Reassessment of weight and edema planned at the next visit. |