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Heart and Vascular
HEART FAILURE ZONES
Heart Failure Zones
Your name: _________________________________________________________ Date: ________________________
Step 1: Weigh yourself every day, first thing in the morning after urinating.
Wear the same amount of clothes each time you weigh yourself.
■ Use the same scale, on a hard surface—not on a rug.
■ Write down your weight on this sheet every day or use a calendar.
■
Step 2: Compare your weight today to yesterday, and over the last 7 days.
Step 3: Call your primary care provider now if you are in the yellow zone:
You gained 2 pounds since yesterday.
■ You gained 3 to 5 pounds in the last 7 days.
■ You have any one symptom in the yellow zone on the Congestive Heart Failure Zones sheet.
■ When you call the office, tell them: “I have Congestive Heart Failure and I’m in the yellow zone.”
Ask to talk with the doctor or medical assistant and tell them your symptoms.
■
If you are in the Red Zone, call 9-1-1 or go to the Emergency Department right away.
Bring this record to all your visits with your primary care provider.
Every Day
Weigh yourself every morning. Weight at discharge on home scale: _______ Goal weight: _______
■ Weigh yourself first thing in the morning after urinating, before eating or drinking, in the same clothes, and using the same scale located on hard flooring (not on a rug).
■ Check for swelling in your feet, ankles, legs, and stomach.
■ Take your medications as prescribed.
■ Remember to eat foods low in salt and get daily exercise.
Green Zone—
All Clear
Yellow Zone—
Caution
Red Zone—
Emergency
This Is Your Goal Zone
You are in good control if you have:
■ No weight gain of more than 2 pounds
■ No swelling of your feet, ankles, legs, or stomach
■ No decrease in ability to maintain your usual activity level
■
■
No shortness of breath
No chest pain
This Is Your Warning Zone
Call your primary care provider if you have any of the following symptoms:
■ Weight gain of 2 pounds or more since yesterday or weight gain of 3 to 5 pounds in the past week
■ Dizzy or unusually tired
■ Shortness of breath especially when lying down
■ Feeling like something is just not right
■ Increased coughing especially when lying down
■ Increased swelling of your feet, ankles, legs, or stomach
■ An increase in the number of pillows needed to sleep or the need to sleep in a chair
Go to the Emergency Department or call 9-1-1 If You Have any of
These Symptoms:
Struggling to breathe■ Unrelieved shortness of breath
■ Chest pain unrelieved by nitroglycerin
■ Confusion or mental changes
■
My primary care provider is: ______________________________________________________________________________________
Phone number: ____________________________________________ Cell phone: __________________________________________
Month ________________________________________________________________________________ Year ________________________________
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(Sunday’s date)
(Sunday’s date)
(Sunday’s date)
Week of:
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(Sunday’s date)
Week of:
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(Sunday’s date)
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