Heart Failure Monitoring Worksheet - Tufts University

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Month   o f   _ ________________  
 
Heart   F ailure   M onitoring   W orksheet  
 
 
 
Respiratory  
Furosemide   D ose  
Day  
Appetite  
Comments  
Rate/Minute  
AM                               P M  
1   t ab  
½   t ab  
e.g.,   “ Breathing   b etter   t oday”   o r   “ Gave   e xtra  
Sample  
32  
Excellent       X   G ood     Fair       Poor  
(or   1 2.5   m g)  
(or   6 .25   m g)  
furosemide   ½   t ablet”  
1  
 
 
 
Excellent       Good     Fair       Poor  
 
2  
 
 
 
 
Excellent       Good     Fair       Poor  
3  
 
 
 
Excellent       Good     Fair       Poor  
 
4  
 
 
 
Excellent       Good     Fair       Poor  
 
5  
 
 
 
 
Excellent       Good     Fair       Poor  
6  
 
 
 
Excellent       Good     Fair       Poor  
 
7  
 
 
 
 
Excellent       Good     Fair       Poor  
8  
 
 
 
 
Excellent       Good     Fair       Poor  
9  
 
 
 
Excellent       Good     Fair       Poor  
 
10  
 
 
 
 
Excellent       Good     Fair       Poor  
11  
 
 
 
Excellent       Good     Fair       Poor  
 
12  
 
 
 
 
Excellent       Good     Fair       Poor  
13  
 
 
 
 
Excellent       Good     Fair       Poor  
14  
 
 
 
Excellent       Good     Fair       Poor  
 
15  
 
 
 
 
Excellent       Good     Fair       Poor  
16  
 
 
 
 
Excellent       Good     Fair       Poor  
17  
 
 
 
Excellent       Good     Fair       Poor  
 
18  
 
 
 
 
Excellent       Good     Fair       Poor  
19  
 
 
 
Excellent       Good     Fair       Poor  
 
20  
 
 
 
 
Excellent       Good     Fair       Poor  
21  
 
 
 
 
Excellent       Good     Fair       Poor  
 
22  
 
 
 
Excellent       Good     Fair       Poor  
23  
 
 
 
 
Excellent       Good     Fair       Poor  
24  
 
 
 
 
Excellent       Good     Fair       Poor  
25  
 
 
 
Excellent       Good     Fair       Poor  
 
26  
 
 
 
 
Excellent       Good     Fair       Poor  
27  
 
 
 
Excellent       Good     Fair       Poor  
 
28  
 
 
 
 
Excellent       Good     Fair       Poor  
29  
 
 
 
 
Excellent       Good     Fair       Poor  
30  
 
 
 
Excellent       Good     Fair       Poor  
 
31  
 
 
 
Excellent       Good     Fair       Poor  
 
 
Respiration   R ate:     C ount   t he   n umber   o f   b reaths   f or   3 0   s econds   a nd   m ultiply   t imes   2   t o   g et   t he   r espiratory   r ate   p er   m inute.   I n   d ogs,   o btain  
the   r espiratory   r ate   w hen   t hey   a re   a t   r est   a nd   n ot   p anting.   I n   c ats   g et   t he   r espiratory   r ate   a t   r est   w hen   t hey   a re   n ot   p urring.   I n   a nimals   w ith  
well   c ontrolled   h eart   f ailure   t he   b reathing   r ate   i s   o ften   l ess   t han   3 5-­‐40   b reaths   p er   m inute.   W hen   t he   b reathing   r ate   i s   c limbing,   o r   w hen  
there   i s   m ore   e ffort   t o   t he   c hest   w all   o r   b elly   m uscles   d uring   b reathing,   t hen   f luid   i s   l ikely   a ccumulating   i n   t he   l ungs   a nd   m ore   f urosemide  
may   b e   i ndicated.   P lease   b ring   t his   s heet   w ith   y ou   t o   y our   n ext   v eterinary   e xam.  
 
 
 

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