A 67-year-old man with a five-year history of heart failure with reduced ejection fraction presented to the ER approximately 7 days ago with worsening shortness of breath, and new onset orthopnea. He was hospitalized for two days, with medications adjusted, and states at that time his symptoms were significantly improved. The nurse practitioner now sees him in follow up. The patient states today that, “For the past day, I feel just like I did the day I was admitted to the hospital. I might even feel worse.”  The patient reports a 5 lb weight gain since arriving home from the hospital. He denies dietary indiscretion with high sodium foods and states he is taking all medications prescribed at hospital discharge as advised   On physical exam, he is sitting upright, slightly labored breathing,  BP=165/92, his resting heart rate=110 with S3 heart sound present, respiratory rate 26, neck veins to 8 cm, and bilateral crackles through the lung fields. The most appropriate next step in his care is to:

A. Perform medication reconciliation.
B. Obtain a detailed 48-hour dietary and fluid intake history.
C. Advise on the need for evaluation and treatment in the emergency department.
D. Ensure he has a cardiology follow-up within the next week.

---
YouTube: https://www.youtube.com/watch?v=bFdd4tB96hQ

Visit fhea.com to learn more!