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Designed for the Unique Needs
of Homecare Providers
This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.
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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978
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Heart Failure
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Risk Reduction
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Evaluate
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| Ongoing communications among all professionals, patient and caregivers is essential to improving and maintaining stability. This is particularly true when communication involves teaching the patient about how to problem solve or create a self-care action plan that includes cardiovascular risk reduction, age appropriate health screenings and immunizations
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Continually update progress by assessing measurable outcomes. The goals and interventions for all heart failure patients are to be evaluated regularly and revised to achieve desired health outcomes.
Questions to be Considered
- Has patient's number of episodes of fluid overload improved?
- Has patient's number of episodes of fluid deficit improved?
- Has the patient’s functional capacity changed?
- What activities can you routinely do without getting short of breath?
- What activities produce symptoms?
- Have you been able to walk daily? How much?
- What social activities have you participated in during the last two weeks?
- Does the patient demonstrate increased knowledge of fluid management diet and activity?
- Does the patient demonstrate increased knowledge of their medication management?
- Has the patient had their cholesterol panel checked?
- What is their Framingham Risk score?
- Has the patient obtained vaccinations for pneumonia and influenza?
- Has the patient seen an optometrist or ophthalmologist in the past year?
- Has the patient seen a dentist in the past six months?
- Has the patient received age appropriate screenings according to the standard of care?
- If diabetic, has the patient received an evaluation of renal, endocrine and gastrointestinal function in the past year?
- Is the patient with heart failure and diabetes maintaining or improving glucose control?
- Has the patient been able to minimize the risk factors affecting heart failure stability?
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Evaluate
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