ACE and hydrops fetalis: These initial changes included: removing assessment items recommended for symptoms of HF not specific to dyspnea (e.g. vomiting/diarrhea, feelings of dizziness or lightheaded, feelings of confusion, and feelings of syncope); removing medications recommended for symptoms of HF not seen as specific for managing dyspnea (e.g. angiotensin-converting enzyme inhibitor, beta-blockers, digoxin, etc.); and removing the self-care recommendation to have an annual influenza vaccine.