Heart Failure Self Management Tool

Green Zone (All Clear)

• No shortness of breath
• No swelling
• No weight gain
• No decrease in your ability to maintain your activity level
  

Your Weight _______    Your weight in range _______ - _______

       
       Green Zone Means:

• Your symptoms are under control
• Continue taking your medications as ordered
• Follow a low salt diet
• Keep all physician appointments

Yellow Zone (Caution)
If you have any of the following signs or symptoms:

• Increased weight
• Increased cough
• Increased swelling
• Increased shortness of breath with activity
• Chest pain
• Increase in number of pillows needed or need to sit in a chair to sleep
• Anything else unusual that bothers you

Call your physician if you are going into the YELLOW zone

• Your symptoms may indicate that you need an adjustment of your medications
• Call your physician
   

      Name: ____________________________

      Phone number: _____________________

Red Zone (Medical Alert)

• Unrelieved shortness of breath; shortness of breath at rest
• Unrelieved chest pain
• Wheezing or chest tightness at rest

• Indicates that you may need to be evaluated by a physician right away 

Last Reviewed:  November, 2006