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Heart Failure: Action Plan

  • Green zone

    I'm feeling okay.

    • I don’t have new or worse shortness of breath.
    • I don't have new weight gain.
    • I don't have new or worse swelling in my belly, legs, ankles, or feet.
    • I can do my usual activities.
    • I don’t have chest pain.

    My Action Plan:

    1. Take my daily medicines on schedule.
    2. Weigh myself every morning and write it down.
    3. Follow my low-sodium diet.
    4. Follow fluid restrictions if my doctor advises it.
    5. Be as active as I can.
    6. Go to all my follow-up visits.

  • Yellow zone

    My symptoms are worse.

    • I feel more short of breath at rest.
    • I wake up feeling short of breath.
    • I can’t be active because I feel too short of breath.
    • I have new or worse swelling in my belly, legs, ankles, or feet.
    • I have weight gain of 2 to 3 pounds in 1 day OR 5 pounds in 1 week.
    • I have a dry, hacking cough.
    • I need to sit upright to sleep.
    • I feel more tired.
    • I have less appetite.

    My Action Plan:

    1. Call my doctor for instructions.
    2. Change the dose of medicines (such as diuretics) if instructed.
    3. Make sure to limit sodium from food and drinks.
    4. Limit fluids as advised.
    5. Keep tracking my weight each day.
    6. Use oxygen if prescribed.

  • Red zone

    I need medical help now.

    • I am severely short of breath at rest.
    • I have chest pain.
    • I am confused or extremely sleepy.
    • I passed out (fainted).
    • My lips or fingers are turning blue or gray.
    • I have sudden weight gain of 3 pounds or more in 1 day.

    My Action Plan:

    1. Call 911or go to the nearest emergency room.
    2. Tell them I have heart failure and am having severe symptoms.
    3. Sit upright.
    4. Use oxygen if prescribed.
    5. Do not drive myself to the hospital.

  • Use the space below to write other instructions or information from your doctor, such as chronic conditions, recent surgeries, implanted devices, medicine names and doses, emergency contacts, or warning signs specific to you. Contact your doctor if you have any symptoms that aren’t listed above.

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