For the patient with Congestive Heart Failure, in addition to assessing Shortness of breath M1400 on OASIS C home health care forms, also include these MyHomecareBiz Best Practice assessment strategies:
Best Practice Assessment Strategies for Congestive Heart Failure (CHF)
- Monitor vital signs; auscultate breath sounds, noting crackles, wheezes. Note presence of dyspnea, tachypnea, orthopnea, paroxysmal nocturnal dyspnea, persistent cough.
- Monitor fluid I&O; note decreasing output and concentrated urine, note amount and color, as well as time of day when diuresis occurs
- Check for calf tenderness, diminished pedal pulses, swelling, local redness, or pallor of extremity, dependent edema.
- Assess for edema: measure abdominal girth, distended neck and peripheral vessels.
- Document cardiopulmonary response to activity. Note tachycardia, dysrhythmias, dyspnea, diaphoresis, pallor.
- Record weight daily.
- Recommend: changing position frequently; elevating feet when sitting. Encourage active and passive exercises. Increase activity as tolerated.
- Investigate reports of sudden extreme dyspnea and air hunger, need to sit straight up, sensation of suffocation, feelings of panic or impending doom.
(M1400) When is the patient dyspneic or noticeably Short of Breath?Identifies the level of exertion/activity that results in a patient’s dyspnea or shortness of breath.
- 0 - Patient is not short of breath
- 1 - When walking more than 20 feet, climbing stairs
- 2 - With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)
- 3 - With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation
- 4 - At rest (during day or night)
Best Practice Assessment Strategies for M1400
- If the patient uses oxygen continuously, select the response based on assessment of the patient’s shortness of breath while using oxygen.
- If the patient uses oxygen intermittently, mark the response based on the patient’s shortness of breath WITHOUT the use of oxygen.
- The response is based on the patient’s actual use of oxygen in the home, not on the physician’s oxygen order.
- The responses represent increasing severity of shortness of breath.
- For a chairfast or bedbound patient, evaluate the level of exertion required to produce shortness of breath.
- The chairfast patient can be assessed for level of dyspnea while performing ADLs or at rest. Response 0 would apply if the patient has not been short of breath during the day of assessment. Response 1 would be appropriate if demanding bed-mobility activities produce dyspnea in the bedbound patient (or physically demanding transfer activities produce dyspnea in the chairfast patient). See Responses 2, 3, and 4 for assessment examples for these patients as well as ambulatory patients
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