Heart Failure

What to assess every visit, the daily weight rule, the self-check tool patients use, and when to call.

Updated Sep 18, 2026

Heart failure is the most common reason our patients go back to hospital, and the readmission is almost always preceded by several days of signs somebody could have caught.

The clinical work is not complicated. The teaching is where the outcome is decided.

Every visit

Weight — same scale, same time of day, after voiding, similar clothing
Vital signs including pulse oximetry — see Vital Sign Parameters
Lungs — crackles, diminished bases, effort
Edema — location, pitting depth, and whether it is new or worse
Jugular venous distension
Orthopnea — how many pillows, and has that changed
Paroxysmal nocturnal dyspnea — waking short of breath
Activity tolerance — how far before symptoms, and how long to recover
Medication adherence, especially diuretics — count what is left
Sodium and fluid intake — ask what they actually ate yesterday, not what they should eat

The daily weight rule

This is the single highest-value thing you teach.

Call the physician for a gain of more than 2–3 lb in 24 hours, or 5 lb in a week.

For the teaching to work, the patient needs all of it:

A working scale they can get on safely
A written log, kept where the scale is
The same conditions every morning
A number written down, not remembered
To know what number means call

A patient who weighs themselves daily and writes it down has a different prognosis from one who does not. Treat setting that up as a clinical intervention, because it is one.

The self-check tool

Patients do better with a traffic-light framework they can apply without you.

Call the physician, or call 911:

Frequent dry, hacking cough
Shortness of breath at rest
Increased discomfort or swelling in the lower body
Sudden weight gain of more than 2–3 lb in 24 hours, or 5 lb in a week
New or worsening dizziness, confusion, sadness, or depression
Loss of appetite
Increased trouble sleeping, or cannot lie flat

Print the agency's CHF Self-Check Tool and the Daily Weight Log and leave them where the scale is, not in a folder.

Teaching that actually changes behaviour

Sodium — the number on the label matters less than where it comes from. Canned soup, deli meat, frozen meals, and restaurant food are where the sodium is. Work through what they actually eat.
Fluid restriction, if ordered — measure it out in the morning into one container so they can see it going down.
Medications — diuretic timing matters. A patient taking furosemide at bedtime is choosing between sleeping and taking their medication, and they will choose sleep.
Weighing — watch them do it once.
Energy conservation — sit to dress, rest between tasks, put things at waist height. An OT referral is often the highest-value call you make.

When to call

Call the physician for:

Weight gain beyond the parameters
New or worsening shortness of breath, orthopnea, or PND
New or increasing edema
Vital signs outside parameters
New confusion
Chest pain — assess immediately and consider 911

Call 911 for severe respiratory distress, chest pain with typical features, or altered mental status with hemodynamic instability.

Where the episode usually goes wrong

The patient feels better and stops the diuretic. Ask directly, without judgment; it is extremely common.
Nobody watched them use the scale. They step on it holding the counter, or weigh at a different time each day.
The teaching was delivered but not retained. Teach-back at every visit, not once at SOC.
The weight gain was recorded and nobody called. Make sure the patient knows the log is for acting on, not for showing you.