Policy Manual sample

MDT Home Health Care Agency, Inc. ZOE NON-INVASIVE MACHINE FOR CHF PATIENTS Policy: Provide overview of heart failure management in home care. Increase nurses knowledge and understanding of home care goals & objectives for the heart failure patient population. Goals: • Increase Patient Independence in CHF management • Transition from role of patient to self-care • No ER visits • No hospitalizations • No unscheduled home care visits ZOE is a noninvasive monitor that measures fluid status via thoracic bioimpedance. ZOE measures Zo; an objective measure of fluid status in the thoracic cavity referred to as thoracic electrical bioimpedance (TEB) or the change in resistance due to fluid changes. Ohm (Ω) is the unit of measure, Base impedance is referred to as Z-naught or Zo. Bioimpedance Greater impedance equates to a more dry or dehydrated state Less resistance represents more fluid or overhydration. Zo is a sensitive measurement, indicating fluid retention in heart failure patients as early as 12 days before symptom development or weight gain. Why is Zo Important? Intrathoracic Zo measurement, an invasive procedure, also found Zo to be an early predictor of fluid congestion among heart failure patients. Zo was found to be a better early predictor of fluid congestion than pulmonary wedge pressure. Zoe Range*: Dry To Wet 34 ohms 15 ohms * 2 ohm decrease within 24 hours dictates action. Monitoring Zo Morning is the best time for daily monitoring. Same time every morning Before breakfast, after first void Zo Saves Exacerbation Early S&S Exacerbation Late S&S Exacerbation Acute Exacerbation Decrease Appetite Fatigue Bloated feeling Fullness in ears Difficulty Sleeping Decrease Zo (<= 2 ohms in 24°) Increase: Peripheral edema, SOB with exertion, Abdominal girth, Pillow use Weight gain Develops a cough Pitting edema Increase SOB @ rest Develops S3 Develops crackles Decrease SaO2 JVD Zo less than 15 ohms This is when home care nursing intervention must occur to prevent CHF and hospitalization. Home Health Agency Nursing Care & Procedures K-234