Inotropic Home Therapy Patient Assessment Guide

Vital Signs (per physician parameters)

Blood Pressure (including orthostatic)

Lung Sounds (report rales & changes)

Heart Sounds

Weight gain (per physician parameters)

Edema (+ 1-4; pitting; non-pitting)

Dyspnea at rest (scale 1 – 5)

Dyspnea with activity (scale 1 – 5)

Chest pain (pain scale)

o Location

o Intensity

o Duration

o Radiation

General pain (pain scale)

o Location

o Intensity

o Duration

o Radiation

Nocturnal dyspnea

o Use of extra pillows

o Needs to sleep in recliner

Diet recall for past 24 hours

o Consider dietitian consult if available

Review patient symptom journal

Review medications:

o Any changes since last visit?

Any trouble obtaining or taking medications?

Any questions about your oral medications?

Importance of oral medication compliance

Any interruptions in infusion?

Verify following inotrope therapy

o Return demonstrate

o Take inventory

o Obtain teach back

Central line assessment

o site (red, swelling, drainage,

o temp)

o PICC line

Mid-arm circumference

External catheter length

o Catheter flow (any occlusion

alarms)?

o No routine flushing of catheter

Any ED visits or hospital admissions?

Changes

Next physician appointment date

What to report and to whom

HOME VISIT and TELEPHONE VISIT

Additional areas of assessment to facilitate understanding of any changes in critical parameters

This document is to be used by the home care nurse as an assessment guide to assure all aspects of

patient therapy and care are addressed during a home health visit or telephone assessment. The nurse

should document against all of the following each home care visit and each telephone assessment with

the patient / caregiver. The following are the parameters set for:

Patient name: ______________________________________________ DOB:___________________

Acceptable Parameters per Dr. _________________________________________________________

(Report variances in parameters to both pharmacy and physician)

Weight Gain of: _________ pounds in ______ hours

B/P Outside of Range: _______ - ________ systolic; _______ - _______ diastolic;

Pulse: < ______ or > _______

Temperature: Report temperature > ______ F

IV Access drainage, redness, swelling, occlusion, or pain.