Hi, welcome back to our cardiovascular nursing essentials series. Today we're going to go over triage and communication. My name is Jenny Kennedy, VP of Care Transformation with MedAxiom. These are my disclosures. So today we're going to go through some really important communication techniques associated with triage. So as you know, there's always assignments. I've got some reading here for you, but I also wanted to point out this really helpful tool. It's a clinical app. It's the ACC guideline. I recommend that you download this. This has a lot of important information with the guidelines that you can keep right at your fingertips and have with you to reference them quickly. So let's get started. So since we're focusing on the ambulatory side, you know, sometimes there's this misconception that it's easier to do that from a nursing perspective. And I'm actually, as you probably have found out or are learning, it's really challenging and it takes a lot of your knowledge and background to be able to talk to somebody on the phone or understand in a message what's going on with them and determine priority-wise what needs to happen. And so we want to make sure that we're really tuning into our patients and the conversations that we're having. And this is going to be a skill set that you develop over time. It's just like anything. You're learning it. When you start new, you'll develop it and you'll be able to anticipate things better as you get that experience. But I want to go over some things about, you know, triage and how your responsibility plays into it. So generally nurses and sometimes our medical assistants are that frontline communication with the patient. And you've got to make that decision of, is this something that needs action now? Is it something that can wait? And this is where, like I said, all that critical thinking really comes into play. It's very important that we stay within our scope of nursing. So if you don't have protocols, if you don't have those protocols or order sets, things of that nature, you cannot give, you know, orders, you got to stay within your scope of nursing. So even if you know what you need to do, make sure you're staying within that realm. I want to make sure that you start anticipating what questions to ask. You know, the worst thing you want to do is go back and forth, back and forth, which can delay care communication. So what you want to do is be prepared. When you start hearing cues from your patient, you want to start thinking about those questions that you need to ask and anticipate what you're going to need to communicate to your physician. You want to put on your hat of, if I'm the provider and I'm going to make decisions, what are those things that you would need to know so that you can get as much information as possible before communicating with your provider? And also, we want to make sure, you know, you're staying within that scope, and a lot of places may use protocols and policies. So check with your leadership. If you don't have those in place, maybe that's an opportunity to dive into. Those do really help teams to be more effective and efficient to respond to those patients in a timely manner. And then training your team so that everybody knows the source of the protocols, is educated on what to do. So there's clear expectations of an escalation process within your organization. Documentation is really important. You guys deal with so many patients on a daily basis. You've got to have very clear documentation, because that's how you're also communicating with your providers and know where to follow up with your patients. And then also, just be mindful who you're speaking with. If it's not the patient, make sure you're following HIPAA. Make sure it's somebody that you're allowed to communicate with. Cannot state that enough, especially through messaging and security issues there. So make sure that you're complying with HIPAA at all times. So when do we triage? You're going to get bombarded with phone calls, messages, text, any number of communication from patients asking things or needing things. So you've really got to make that decision. Is this a urgent or a non-urgent issue? Of course, to your patients and family, everything's urgent, right? But you know you have to prioritize. So the non-urgent issues are going to be things that are routine. Is it generally related to patient management? Maybe reflect your plan of care, things like education, some routine med changes. Do they need a pre-op clearance for something that's going to be scheduled down the road? So thinking about what they're really the meat of their problem or their concern is is going to help you identify. Now the triage or urgent issues that we want to address quickly are those that are really symptom-based, maybe time-sensitive. So maybe it is related to a surgery that's coming up, it's already scheduled, and there's a time crunch. And obviously any kind of clinical condition that is impairing a person's ability to breathe or their concern. So you really have to kind of clue into what they're telling you so that you know how to respond. And from there, you're going to take that information and you're going to assess it. So you've got to use your clinical thinking skills. And remember, we always go with our ABCs, right? So never forget, if you're feeling overwhelmed, never forget your airway, breathing, and circulation. That's top of mind. That will help you reset. Now once you've gotten information and kind of made an assessment, some of those things, you may just be giving a patient advice. Some of it, you may be sending a message to your provider. As we mentioned, sometimes you have a protocol to work off. That's the best way to go if you can agree on protocols that are implemented within your practice. Sometimes there's just recommendations for a patient they can do at home. Sometimes they do need to be seen based on what they're telling you. Is this that I need to get them in today or tomorrow? Or is it, well, maybe we can get them in three days or a week. And then of course, there are those urgent scenarios that require a patient to call 911 or have somebody take them to the ED. All that sounds very easy. It's not. We know it's not. It's hard to decipher. Patients aren't always clear in their communication. It's hard to read. You can't always see the patient in front of you unless you are virtually. But there's lots of challenges. So what I want you to think about is taking away these top considerations. I want you to kind of keep these in terms of these are the things that I want to know on all of my patients. So number one is why, why are they calling you? Okay. What is, what is that? That's going to, you know, I need my, I need my refill or I'm having chest pain. If they're having complaining of something symptom wise or clinically, what are those symptoms? Tell them to explain them. And you want to ask about pain, the, the duration of the pain, how long has it been going on? You want to talk about, so is anything helping it? Is anything making it worse? Have they taken anything new medication wise, or did they take anything and did that relieve it or did that make it worse? Where are they at currently? You want to assess their breathing status. That's very important. Obviously, are we talking about, they can't breathe, they can't catch their breath or, you know, something, something else that could be an emergency you know, a lot of times our patients may just feel this general fatigue more so than usual. So we're talking, okay, you're lethargic, but is this more than your baseline? Is it's things like, I just, I'm so exhausted. I can't get out of bed or I can't get going in my day. What's the difference from their baseline? Also assessing, do they feel like their heart's racing, pounding, anything irregular there? And do they have any swelling in their feet? Of course, you're not going to ask all of these questions. It's going to be very dependent on the triggers that they're telling you. So these are just very good things to kind of keep in mind and, and ask the questions based on what they're, they're telling you. The two most frequent reasons patients will call their cardiologists for, for clinical advice is chest pain and shortness of breath. So I'd like to take some time and walk through these two most common scenarios with you and help give you some guidance. These are only recommendations. So it's very important that you're talking within your organization to your leadership and your physicians about your process for your location or your office, so that you're all on the same page. For chest pain though, that is one of the most common reasons that people will seek medical care. And just because they call with chest pain does not mean that they need to go to the emergency room. That should not be our reflex. We've got to ask some questions. Some of them do need to go, but some of them do not. There's multitude of reasons. So let's talk about that a little bit. So acute chest pain is defined as acute chest pain is referred to any kind of symptoms that are new or different from previous pain. So that could be in terms of pattern intensity or duration. So this is a different new it's occurring right now. So that's acute. Critical is referred to chest pain that is chronic and it's consistent. So it doesn't change really. It's kind of there may have similar patterns of frequency, intensity, things of that nature. And even though we use the term chest pain, patients may not describe it the same. So you don't always get that. It's this elephant on my chest pressure could be squeezing, could be burning, could be a heaviness, could be beyond just the chest. It could be in their arms, their neck, their jawline, sometimes even in their upper abdomen. So you've really got to listen to what the descriptors are, because those are going to give you clues into what next steps you need to take. Also want to remind you, different subgroups of patients may present differently. So females don't always present with that typical chest pain. They're more likely to come with complaints of nausea or vomiting, maybe some palpitations. And then diabetics may not always have a strong feeling of pain. It might be more kind of diaphoresis and shortness of breath. So make sure you're aware of those kind of considerations. Now causes of chest pain do not indicate it's not always associated with myocardial injury. Of course, that's what we're trying to get to is, is, is this important enough that we're concerned that it's actually injury to the heart, but there are a lot of other reasons patients get chest pain. So you can see the list here, gastrointestinal is actually one of the top reasons patients will get chest pain. So when we're looking at myocardial injury, obviously that's that chronic angina could be unstable angina, or it could be an actual MI. We're looking at pericardial disease. So these are things that are associated like endocarditis, pericarditis, or tamponade. So of course, if it's one of those pericarditis, they would have potential, you know, sinus tac or, or fever with, with their symptoms, pulmonary things might be pneumonia, pneumothorax, pulmonary embolism, also obviously very urgent or need attention. It could also be things like a pulmonary hypertension. When we look at GI issues, it can be things like GERD, peptic ulcer disease, cholecystitis even can mimic and put pressure that causes it to feel like chest pain. So lots of reasons there, and it can often be confused with heart conditions or, or M we want to work them out for an MI musculoskeletal. A lot of injuries can cause that pain that is concerning. So think you want to ask questions about if they had any kind of injury, car accidents, things like that, that could have caused any pain in their, their chest costochondritis is frequently associated with non-cardiac chest pain as well. And then psychosocial. So I'm sure you've heard of, of people have presented with chest pain and it can be related to a panic attack or anxiety. So we have to be able to assess what's really going on with that patient beyond just their heart. There are several factors that you can assess to help you prioritize and see if this is associated more with our cardiac myocardial injury. And these are kind of the nature of their symptoms. Okay. So we know we just talked about what chest pain looks like in a, an MI patient. So we want to remember those, have they had a history of, of CAD or is this new a strong history is going to increase their likelihood that it is cardiac related. What's their age. So if they're over 50, generally they are at higher risk. And what's their sex males typically tend to be at a higher risk as well. And then what are those traditional other risk factors that are present? So those are those things like obesity, smoking, hypertension hyperlipidemia, all of those things that we know put our patients at a higher risk. So some of the questions you want to ask is really, again, going to give you an indication of, is it something to be concerned about immediately? So you want to know where that pain is. We talked about the locations that chest pain usually presents us. We want to know, does it radiate? So is it starting at the chest? It goes up the jaw or is it starting at the jaw? It goes down the arm. Does it, does it move from one area to another talking about that quality? So as we mentioned, it could be pressure, could be burning, squeezing. What are, what are they feeling? Talking about when it started and how long it has been occurring can tell you a little bit too. So is it intermittent or is it been, it started at 3am and it's now 11am and it hasn't stopped at all. What's their pain scale? So obviously getting that number zero to 10 pain, is it a 10 out of 10 or are we talking two, three? What helps it? What makes it worse? So maybe it's worse with movement, deep breathing, maybe sitting up helps or laying down, you know, just really trying to figure out what helps or makes it worse. Have they tried anything for it? Did it get better with Advil? Maybe that's related to a musculoskeletal issue. Did they take nitro and it got better? That should be a big flag that that's probably cardiac related. And then what other symptoms are they having that you would anticipate with cardiology concerns? So are they short of breath, extremely fatigued? Are they weak? Are they sweating, diaphoresis, any kind of nausea, vomiting, anything like that? So you collected all this information and realizing that not all patients present the same, you've got to make this extremely important decision. And that can be, that can be hard. I would say that anytime you're, you're not certain you want to discuss it with your provider. Okay. And anytime your patient's just feeling maybe they're telling you their symptoms and you're just not really feeling that there's this sense of it's, it's urgent. I would say, don't discredit your gut and don't discredit if the patient's telling you they just feel this really strange impending feeling of doom. You don't want that obviously, but sometimes patients feel that way and they may not present typically and it ends up being an issue. So don't ever discount the patient's perception of how they're feeling as well. So how do you respond to all this? Obviously if they're telling you they can't breathe, you're hearing that they are unable to catch their breath. They can barely get out a sentence to you. If someone's calling and they're telling you, my mom, my dad is unconscious. I can't wake them up. Obviously those are emergency situations and 911 needs to be called. Anybody that's high risk and has had chest pain for greater than five minutes that's not relieved with nitroglycerin, you would want to consider that. Anything that's really crushing, severe, heavy pressure. These are reasons you would want to direct your patient to the ED, not them driving, but calling 911 or having somebody take them. We do not ever want to tell them to drive themselves to the ED. But as we said, not every patient needs to go to the emergency room. So how do you determine if they're not quite ready to be seen in the emergency room, which is our hope? Is there an opportunity to get them into your clinic the same day or with their provider or consult with another provider that's anybody with maybe that chest pain greater than five minutes, but maybe they haven't had any history of CAD. Maybe their chest pain has been intermittent, but it's kind of increasing in frequency or severity. Maybe they're a little dizzy, lightheaded, or they just sound kind of weak. These are those patients that are important, not necessarily need to be seen right now, but you can get them seen the same day and really lay eyes on them and assess them. And then those that can be scheduled in the next day, two or three would be those that maybe have intermittent chest pain more than three days. Anything that a patient may call and just say, I'm not real sure, I'm not really having any changes, but I feel like I want to be seen. Maybe something's going on and it's just not a huge concern, but we want to get them in. So there are options. Again, I just want to call out that you need to discuss this with your providers and your leadership on what your practice is going to do. These are some guidelines that you can work from, but talk with your leadership, talk with your teams and get a plan together so that you can have a strategy to help your patients and not just rely on the emergency room. You've got to remember your high-risk population and that's really anybody that is 50 years or old plus hypertension, diabetes, hyperlipidemia, smoking, obesity. So keep that in mind as you're triaging your chest pain patients. Okay. The second most common or another common issue that your patients are going to call is shortness of breath. And it's just as complex, right? I think from a cardiology standpoint, obviously we immediately want to start assessing for heart failure and there's a multitude of things that it could be. So the number one thing you want to do is, is this severe enough that they need 911? So that's going to be, again, just like in chest pain, is it somebody that is not able to talk to you? Is it somebody that is only able to catch their breath while they're sitting and resting? Is it sudden with an onset of chest pain? If that is the case, then those are your call 911, have somebody take them to the ED patients? If not, we do want to triage and go down around and see, are these our heart failure patients? Do they need some sort of intervention that's non-emergent that can help get them some relief? And oftentimes the answer is yes. These are those patients that have a history of heart failure, maybe have some difficulty breathing. This is gonna be, you know, not at rest. These are gonna be those, well, I got up this morning and I brushed my teeth, started getting dressed, but I got tired and I had to rest for a bit. So increased difficulty in completing their activities, but able to still do some of that. Are they telling you they've got orthopnea or PND? Obviously they're not gonna say that, but they're gonna say things like, well, I just don't feel right. Last night I couldn't sleep. I ended up moving to the recliner and that was the only way I could doze off. Or I woke up and I couldn't catch my breath. Those are big flags to you that this is probably fluid overload. So we wanna ask them some important questions. How long they've been feeling short of breath, when it started, what they were doing. May not know, they may not have a reason or understanding, but it's important that we ask. Getting their history. Do they have heart problems? Do they have lung problems? Cause it could be a pulmonary issue, right? They could have asthma or COPD. So we wanna ask them, do they have an inhaler? Have they used it? Things of that nature. Does their shortness of breath get worse with activity? So we talked about that. Are they able to get up and move around or is that limiting them from completing their activities of daily living? What makes it better? So the example of propping up in the recliner, that's a very common thing, or going from one pillows to three pillows to get comfortable to sleep. Are they having any other associated symptoms such as chest pain, palpitations, chest pressure, things like that? We wanna assess their swelling. Do they have swelling, not just in their feet and their ankles, but what about their abdomen? What about their fingers? Look at those extremities or ask them to look at those extremities and see if it's different. And we talked about the sleeping and then those are just really easy indicators to listen for that will be very informative for you. Next is heart failure zones. And many of you may have seen this and this is just an example of one but they're all very similar. And I really encourage if you don't use this that you have one or talk to your team about putting one in place. And this is really intended to help educate your patients and engage them in their daily management so that we're being more proactive instead of reactive because it allows them to check in with themselves every day. And so when you have these triage patients on the phone and you've determined it's heart failure take the time to educate them if you can because we wanna make sure that they're really checking in every day that they're weighing themselves every morning. So that's not just whenever they can but it needs to be consistent. So they get up in the morning, go to the restroom get on the scale with the same amount of clothes at the same time every day. And we want them to compare it, write it down and compare it to the day before. Obviously that's where we're looking for weight changes. We want them to watch their diet, their salt intake are they on a fluid prescription? Some are, some aren't but we want them to be mindful of that if they are check for that swelling and we want them to still be active but balance that with rest as well as take their medications as prescribed. So that's kind of their responsibility to do that every single day. And then they check in and see which zone they're in. So green is great. That's their goal, right? That's really their symptoms are under control. There's no weight gain, no additional shortness of breath no chest discomfort or pain, no swelling and no weight gain of three pounds overnight or five pounds in a week. Does not mean they're perfectly healthy but this is really their baseline, okay? So compare it to their baseline. If someone's in that caution or yellow zone this is when we want to trigger maybe an appointment or an intervention. So that's when they have gained that three pounds overnight or five pounds in a week. They may have some GI issues like nausea, vomiting, diarrhea they may feel more shortness of breath than usual. They may have extra swelling. Again, look beyond just the feet check abdomen and their fingers. So these are all things that are signs that they're gaining fluid but not necessarily that it's an emergency situation. And this is where you can communicate with your provider and intervene. Potentially it's increasing their diuretics for three days and following up with them after that. I do say it's really helpful to write your phone number and their doctor or provider's name on the zones because they have so many different doctors. Typically they can get confused. And if there's somebody there helping them it just makes it easy. So I do like to call that out. And then our red zone is emergent zone, right? So that's when they cannot catch their breath. Maybe they're having that crushing chest pain that they're having a racing heart palpitations. Maybe they've got altered mental status. Obviously those are emergent. Those are not something you can intervene. So those do go to the emergency room. So we've assessed those two kind of most common clinical scenarios and now you need to communicate back. And I just want to take a moment on how we communicate with our providers and our patients and family members. Cause that's really important that we're all communicating. And so I want to make you familiar with the SBAR format when you're communicating with your providers. So SBAR is the Situation Background Assessment and Recommendation. And the key things I want you to remember is you need to be clear and concise. When you're talking to a provider especially if it's in a clinic day or catching them between the hospital patients they've got a lot going on as well as you but you need to give them the most concise explanation of what's going on. Cause you're only going to have their attention for so long it's short period of time. So you want to tell them what the problem is concisely. You want to give them a brief background and what information is pertinent to that scenario, okay? You want to give them your own assessment use your assessment skills. You know what needs to be communicated. So make sure that they have that. And then any action that you're requesting, okay? And that way you can be effective in your communication not have to go back and forth with the provider. Sometimes it's on the phone, sometimes it's messaging just making sure that you're decreasing those questions and the gap in time of communicating back to that patient. And this is where it is important when you're talking to your patients and anticipating those questions. So if you know you have a doctor and you've communicated with him and he's told you before he wants to know X, Y, and Z you know in advance while you've got that patient on that you need to confirm those before you follow up with that physician or provider. Once you have those interventions or orders you going to relay them back to your patient or a family. And we use the teach back method and I'm sure you're familiar with this but I want to make sure that you understand because it's very important especially when we're engaging our patients we want to make sure that they know what they're doing. So it's using simple terminology to explain to the patient what you want them to do. Then you're going to ask them that patient or their family member to explain it back to you in their own words. And you're going to say, okay, did I explain it correctly? And you're going to understand that through how they teach it back to you. And that's your opportunity to see, did they understand or do I need to re-explain it? And the reason we do this is it's proven to be effective in improving our communication and that relates to improved health outcomes. It can get very, very confusing very quickly for these patients, especially for changing their meds. Say, oh, I want you to increase your Lasix for three days. They could easily hear two or change it permanently. And so we've got to make sure that we're explaining it in the right way. And the best way to do that is for them to return that information to you. And so the elements are making sure that you're using that plain language, right? They're not healthcare providers. Even if they are, you should just be speaking to them like a layman using very simple language, having them repeat it, turn it back to you in their own words. Make sure that you are being caring, not blowing them off because their patients do feel that when you're stressed. And I know it's not intentional. We want to make sure that they understand that they have your attention. If you have questions, use open-ended questions so that they can provide that information to you. Teach back if you're in person. You know, in the context of this, oftentimes we're on the phone, but if they are in person, you want to make sure that you're connecting with that patient through eye contact. Try not to ask those yes or no questions. Again, we want open-ended so they can give you real information. And just make sure if they're pushing back at all that they understand that you're trying to make sure that you're explaining it in the proper way. Repeat it as much as needed, okay? Sometimes it can be frustrating, of course, but please do take that time to repeat it and then document that in your EMR. All right, so next we are going to put it all together. We're going to demonstrate a scenario and hopefully it will be helpful to you in your practice. Hi, is this Ms. Davis? Yes, this is she. Hi, Ms. Davis. My name's Jenny. I'm one of the nurses from the clinical cardiology group. I'm going to be doing your virtual visit today. Can you just verify your name and birthdate for me? Yes, it is Ann Davis and my birthday is March 27th, 1976. Okay, thank you, Ms. Davis. I appreciate it. I understand you're a patient of Dr. Cobb and you called in this morning so we set up this appointment because you're having some concerns about your breathing. Can you tell me what's going on? Yes, I'm worried because every time I get up to do anything it gets harder to breathe. I have to keep taking breaks to catch my breath. I thought I was just tired so I'd lay down to rest but I had to keep adding pillows and I couldn't get comfortable. Oh, okay. I'm sorry to hear that. So I just want to ask you a few more questions as I'm going through your chart here. So I don't see that you're using any kind of your chest muscles. Do you feel like it's harder to breathe? Like, are you using your abdomen or your tummy more to breathe? I do feel like that. It takes me a few minutes after I sit down but I can catch my breath once I sit down. But when I do any type of activity, I just get worn out. Okay, so it does get better when you sit down. Okay, that's good to know. So you're able to do some things but you just have to take a lot of breaks. Can you tell me when it started and did you notice anything that made it get worse? Well, last night I was really tired. I did spend the day with my family yesterday and we had a cookout and I probably overdid it. I woke up in the middle of the night and I started having some trouble breathing and I actually had to get up and go in the recliner in the living room and I did fall back to sleep. Okay, so you usually are able to sleep in the bed but you had to sit up in the recliner to get able to be comfortable. Okay, and did you, can you tell me what you ate at your cookout yesterday with your family? Well, I did try to make some good choices but I had some barbecue chicken and a lot of watermelon. Oh, okay, that does sound good. Ms. Davis, have you checked your weight today? And I wanted to ask you too about your, to see if you have any swelling. Can you look at your fingers, look at your tummy and your feet and your ankles? Can you tell me if there's any more swelling and what your weight was this morning if you took it? Yes, I didn't weigh myself, but I'm looking at my fingers and it looks like my wedding ring is really tight and they're pretty swollen. Okay, do you have a scale? Are you able to check your weight? I can check my weight, but I'm coughing a little too and I get a little dizzy when I stand up. Okay, when you are coughing, does it feel tight? Does it, do you have any chest pain or tightness or heaviness? I don't have any chest pain or tightness. It's more just some coughing. Okay, now do you have any way to check your blood pressure or your heart rate? No, I don't have any way to check my blood pressure. I don't have a machine. Okay, so I'm looking in your chart and I do see that you have a history of atrial fibrillation and heart failure and that's what you're seeing Dr. Cobb for. So I'm gonna go through and ask you about your medications and just have a few more questions. So with your medications, do you have a list or your bottles with you? Cause I'm gonna read them. I wanna make sure we've got the right doses for you. So I've got Eliquis that you're taking five milligrams of that twice a day. Yes, I'm taking that twice a day. Okay, Coreg 50 milligrams twice a day. Yes, I have that one as well. Okay, Lasix 60 milligrams, that's just once a day. Yeah, I did run low on that one and I sent it to get filled yesterday. Okay, okay, let me just confirm the rest of your meds and we're gonna circle back to that one. And then I've got Jardian's 10 milligrams once a day. Yes, I have that one as well. Okay, perfect. So have you been taking all of those except the Lasix? Did you have those this morning? Yeah, I have everything else and I took them this morning and I just sent my husband to the pharmacy so I can take my Lasix soon. Okay, great, perfect. I'm glad you sent him. So I can see your color looks good. See, you're not using too many accessory muscles meaning your chest or your breathing. So I do wanna talk to the doctor and see what we can do for you. So at this time, Ms. Davis, I'm gonna conclude the call and I will talk with Dr. Cobb and then I'm gonna call you on your cell phone with some further instructions, okay? That sounds good, thank you. Thank you, I will give you a call back within the hour. Talk to you soon. Bye-bye. Bye-bye. Hi, Ms. Davis, this is Jenny calling you back from Dr. Cobb's office. Do you have time to talk? Yes. Great, so was your husband able to get back with your prescription? Yes, he was. Perfect, so what I want you to do, we're gonna have you take an extra Lasix pill today. That's your water pill. So normally you take one 60 milligram tablet. You're gonna take two of those today, okay? Also, I want to know, do you have a scale? Yes, I do have one. I do hate those things, but I do have one. Okay, yes, ma'am, I understand. I do need you to start using it. And I want you to weigh yourself every morning. So every morning when you get up, I need you to go to the bathroom just like you would normally do. And then with the same amount of clothes every day, I want you to get on your scale and check your weight. And you've got to keep a log. So when you write down your weight for the morning, I want you to look at the day before. So if you've gained three or more pounds overnight, I want you to give us a call back because that could be a sign that you're gaining fluid, okay? So can you start doing that tomorrow for me? Okay, I can start that tomorrow. How long do I do that? Yes, that's gonna be every day. You need to keep doing that. So I wanna make sure that you see any signs of fluid gain before you start feeling them. So I want you to keep doing that. But if tomorrow you wake up and you check your weight and it's okay, but you still feel short of breath, give me a call back in the morning. And if anytime you catch yourself being unable to breathe or catch your breath, or you get severe chest pain, I need you to tell your husband to take you to the emergency room or call 911, okay? Just to be safe. Okay. Now, I know we've gone over a lot of instructions today. Can you tell me what you're gonna do today and moving forward? Yes, I'm gonna take an extra water pill as soon as my husband gets home. And I'll call you back if I'm still short of breath tomorrow. I'll get on that scale and weigh myself daily and call if I have any more swelling or I look like I'm gaining the fluid. And if I have an emergency and can't breathe, or if I just developed some chest pain or get worse, I should go on to the emergency room. Yes, that's correct. Now, Ms. Davis, you should have a copy of what we call the heart failure zones. It looks like a traffic light. It's green, yellow, and red. Do you have that? Yes, I do. Perfect. So I want you to put that on your bathroom mirror, okay? That's gonna help you remember to check in with yourself every single day, okay? Remember, check your weight, take your medications, check for swelling. All of those things that we've talked about today. And I want you to make sure your husband knows what those are too. Also, you are scheduled for an appointment in two weeks. So on July 28th at 9 a.m., I want us to keep that appointment, okay? But if you notice any signs of fluid buildup or you're not feeling better tomorrow, give us a call back, okay? And then I also want to make sure you understand what you're looking for. So tell me what we talked about today in terms of what are those signs you're looking for for fluid buildup? So I'm looking for any swelling that I might have in my feet, my legs, belly, or fingers, if I'm gaining my weight, and if I'm feeling really overtired and having some difficult breathing. That's right. Yes, that's absolutely right. So you give us a call if you have any questions or you see any changes with your fluid, and we will see you at your appointment on July 28th at nine o'clock in the morning. Okay, dear. My husband just got here with my medications. I'm gonna go ahead and take them and I'll call you back if I have some problems. Thank you. Thank you. Bye-bye. Bye-bye. And that concludes this module. I hope you found it helpful. If you have any questions, please feel free to email academy at medaxium.com. Thank you.

cardiovascular nursing

triage

communication techniques

ACC guideline app

ambulatory triage

nursing protocols

SBAR format

teach-back method