This nursing care plan guide contains 18 nursing diagnoses and some priority aspects of clinical care for patients with heart failure. Learn about the nursing interventions and assessment cues for heart failure, including the goals, defining characteristics, and related factors for each nursing diagnosis.
What is Heart Failure?
Heart failure (HF) or Congestive Heart Failure (CHF) is a physiologic state in which the heart cannot pump enough blood to meet the body’s metabolic needs following any structural or functional impairment of ventricular filling or ejection of blood.
Heart failure results from changes in the systolic or diastolic function of the left ventricle. The heart fails when, because of intrinsic disease or structural, it cannot handle a normal blood volume or, in the absence of disease, cannot tolerate a sudden expansion in blood volume. Heart failure is a progressive and chronic condition managed by significant lifestyle changes and adjunct medical therapy to improve quality of life. Heart failure is caused by various cardiovascular conditions such as chronic hypertension, coronary artery disease, and valvular disease.
Heart failure is not a disease itself. Instead, the term refers to a clinical syndrome characterized by manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever the cause, pump failure results in hypoperfusion of tissues, followed by pulmonary and systemic venous congestion.
Heart failure can affect the heart’s left side, right side, or both sides. Though, it usually affects the left side first. The signs and symptoms of heart failure are defined based on which ventricle is affected—left-sided heart failure causes a different set of manifestations than right-sided heart failure.
Left-Sided Heart Failure
- Dyspnea on exertion
- Pulmonary congestion, pulmonary crackles
- Cough that is initially dry and nonproductive
- Frothy sputum that is sometimes blood-tinged
- Inadequate tissue perfusion
- Weak, thready pulse
- Oliguria, nocturia
Right-Sided Heart Failure
- Congestion of the viscera and peripheral tissues
- Edema of the lower extremities
- Enlargement of the liver (hepatomegaly)
- Anorexia, nausea
- Weight gain (fluid retention)
Because heart failure causes vascular congestion, it is often called congestive heart failure, although most cardiac specialists no longer use it. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure.
Nursing Care Plans
Nursing care plan goals for patients with heart failure include support to improve heart pump function by various nursing interventions, prevention and identification of complications, and providing a teaching plan for lifestyle modifications. Nursing interventions include promoting activity and reducing fatigue to relieve the symptoms of fluid overload.
Here are 18 nursing care plans (NCP) and nursing diagnoses for patients with Heart Failure:
- Decreased Cardiac Output UPDATED
- Activity Intolerance UPDATED
- Excess Fluid Volume
- Risk for Impaired Skin Integrity
- Deficient Knowledge
- Acute Pain
- Ineffective Tissue Perfusion
- Ineffective Breathing Pattern
- Ineffective Airway Clearance
- Risk for Impaired Gas Exchange
- Impaired Gas Exchange
- Risk for Decreased Cardiac Tissue Perfusion
- Other Nursing Care Plans
Risk for Decreased Cardiac Tissue Perfusion
Alteration of tissue perfusion is related to dilation, constriction, and occlusion of the heart’s blood vessels.
The following are the common risk factors:
- Pulmonary congestion
- Presence of edema
Below are the common expected outcomes for heart failure nursing care plan:
- Maintained adequate tissue perfusion as evidenced by blood pressure, pulse rate and rhythm, respiratory rate, and capillary refill within normal limits.
- Demonstrate improvement in mental status.
Nursing Assessment and Rationales
The following are the nursing assessment for this heart failure nursing care plan.
1. Assess changes in mental status such as anxiety, memory loss, confusion, depression, restlessness, lethargy, stupor, and coma.
This may signal reduced cerebral perfusion and decreased oxygen level.
2. Monitor blood pressure every 15 minutes or more frequently if unstable. Watch out for any reduction greater than 20 mm Hg over the patient’s baseline or related changes such as dizziness and changes in mental status.
A major side effect of the medical management of heart failure is hypotension which can also result from the disease.
3. Monitor heart rate. Monitor for any changes such as tachycardia, arrhythmia.
Indicate decompensation and reduced function of the heart.
4. Assess the extremities for color, temperature, capillary refill, pulse presence, and amplitude.
Signs of peripheral vasoconstriction due to sympathetic nervous system compensation include pallor, coolness, delayed capillary refill time (more than 2 seconds), and decreased pulse amplitude. The presence of edema in the extremities may be observed due to fluid overload.
Nursing Interventions and Rationales
Here are the nursing interventions for this heart failure nursing care plan.
1. Administer inotropic, vasodilators as ordered. Watch out for adverse effects that include hypotension, arrhythmia.
- 1.1. Dopamine, dobutamine, milrinone
These inotropic drugs enhances the strength of contractions and are kept in case for use in Acute decompensated heart failure (ADHF) related to low-cardiac output and cardiogenic shock until the patient is stabilized. They may be utilized in a long period during advanced-stage HF as a bridge to transplantation or for palliation of symptoms. Use may be associated with increased mortality and ventricular dysrhythmias. Transfer to the coronary care unit may be required for closed monitoring during the administration of these inotropic medications.
- 1.2. Nitroglycerin, nitroprusside, nesiritide
These vasodilators are given in Acute decompensated heart failure (ADHF) to reduce cardiac workload by decreasing ventricular filling pressures and systemic vascular resistance. These medications are not recommended for patients with systemic blood pressure less than 90 mm Hg, low-output HF, and cardiogenic shock.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 6 Care Plans
References and Sources
Recommended journals, books, and other interesting materials to help you learn more about heart failure nursing care plans and nursing diagnosis:
- Albert, N. M. (2012). Fluid management strategies in heart failure. Critical care nurse, 32(2), 20-32.
- Albert, N., Trochelman, K., Li, J., & Lin, S. (2010). Signs and symptoms of heart failure: are you asking the right questions?. American Journal of Critical Care, 19(5), 443-452.
- Alkhawam, H., Abo-Salem, E., Zaiem, F., Ampadu, J., Rahman, A., Sulaiman, S., … & Vittorio, T. J. (2019). Effect of digitalis level on readmission and mortality rate among heart failure reduced ejection fraction patients. Heart & Lung, 48(1), 22-27.
- Allen, J. K., & Dennison, C. R. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review. Journal of Cardiovascular Nursing, 25(3), 207-220.
- Amin, A., Garcia Reeves, A. B., Li, X., Dhamane, A., Luo, X., Di Fusco, M., … & Keshishian, A. (2019). Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure. PloS one, 14(3), e0213614.
- Austin, J., Williams, R., Ross, L., Moseley, L., & Hutchison, S. (2005). Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. European Journal of Heart Failure, 7(3), 411-417.
- Barrese, V., & Taglialatela, M. (2013). New advances in beta-blocker therapy in heart failure. Frontiers in physiology, 4, 323.
- Bikdeli, B., Strait, K. M., Dharmarajan, K., Li, S. X., Mody, P., Partovian, C., … & Krumholz, H. M. (2015). Intravenous fluids in acute decompensated heart failure. JACC: Heart Failure, 3(2), 127-133.
- Bocchi, E. A. (2001). Cardiomyoplasty for treatment of heart failure. European journal of heart failure, 3(4), 403-406.
- Bolger, A. P., Coats, A. J., & Gatzoulis, M. A. (2003). Congenital heart disease: the original heart failure syndrome. European Heart Journal, 24(10), 970-976.
- Brater, D. C. (2000). Pharmacology of diuretics. The American journal of the medical sciences, 319(1), 38-50.
- Brennan, E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688.
- Brunner, L. S. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (Vol. 1). Lippincott Williams & Wilkins.
- Butler, J., Young, J. B., Abraham, W. T., Bourge, R. C., Adams, K. F., Clare, R., … & ESCAPE Investigators. (2006). Beta-blocker use and outcomes among hospitalized heart failure patients. Journal of the American College of Cardiology, 47(12), 2462-2469.
- Cattadori, G., Segurini, C., Picozzi, A., Padeletti, L., & Anzà, C. (2018). Exercise and heart failure: an update. ESC heart failure, 5(2), 222-232.
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- Conti, C. R. (2011). Intravenous morphine and chest pain. Clinical cardiology, 34(8), 464.
- Cowie, M. R., & Mendez, G. F. (2002). BNP and congestive heart failure. Progress in cardiovascular diseases, 44(4), 293-321.
- De Bruyne, L. K. M. (2003). Mechanisms and management of diuretic resistance in congestive heart failure. Postgraduate medical journal, 79(931), 268-271.
- De Jong, M. J., Chung, M. L., Wu, J. R., Riegel, B., Rayens, M. K., & Moser, D. K. (2011). Linkages between anxiety and outcomes in heart failure. Heart & Lung, 40(5), 393-404.
- Drazner, M. H., Rame, J. E., & Dries, D. L. (2003). Third heart sound and elevated jugular venous pressure as markers of the subsequent development of heart failure in patients with asymptomatic left ventricular dysfunction. The American journal of medicine, 114(6), 431-437.
- Elkayam, U., Akhter, M. W., Tummala, P., Khan, S., & Singh, H. (2002). Nesiritide: a new drug for the treatment of decompensated heart failure. Journal of cardiovascular pharmacology and therapeutics, 7(3), 181-194.
- Ellison, D. H., & Felker, G. M. (2017). Diuretic treatment in heart failure. New England Journal of Medicine, 377(20), 1964-1975.
- Enright, P. L. (2003). The six-minute walk test. Respiratory care, 48(8), 783-785.
- Faris, R. F., Flather, M., Purcell, H., Poole‐Wilson, P. A., & Coats, A. J. (2012). Diuretics for heart failure. Cochrane Database of Systematic Reviews, (2).
- Felker, G. M., Ellison, D. H., Mullens, W., Cox, Z. L., & Testani, J. M. (2020). Diuretic therapy for patients with heart failure: JACC state-of-the-art review. Journal of the American College of Cardiology, 75(10), 1178-1195.
- Fletcher, G. F., Balady, G. J., Amsterdam, E. A., Chaitman, B., Eckel, R., Fleg, J., … & Bazzarre, T. (2001). Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation, 104(14), 1694-1740.
- Friederich, J. A., & Butterworth, J. F. (1995). Sodium nitroprusside: twenty years and counting. Anesthesia & Analgesia, 81(1), 152-162.
- Gao, X., Peng, L., Adhikari, C. M., Lin, J., & Zuo, Z. (2007). Spironolactone reduced arrhythmia and maintained magnesium homeostasis in patients with congestive heart failure. Journal of cardiac failure, 13(3), 170-177.
- Giordano, F. J. (2005). Oxygen, oxidative stress, hypoxia, and heart failure. The Journal of clinical investigation, 115(3), 500-508.
- Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W., & Young, J. B. (2000). Team management of patients with heart failure: a statement for healthcare professionals from the Cardiovascular Nursing Council of the American Heart Association. Circulation, 102(19), 2443-2456.
- Gulanick, M., & Myers, J. L. (2021). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Mosby.
- Haque, W. A., Boehmer, J., Clemson, B. S., Leuenberger, U. A., Silber, D. H., & Sinoway, L. I. (1996). Hemodynamic effects of supplemental oxygen administration in congestive heart failure. Journal of the American College of Cardiology, 27(2), 353-357.
- Herman, L. L., & Tivakaran, V. S. (2017). Hydralazine.
- Hinkle, J. L., & KH, C. (2017). Brunner & Suddarth’s textbook of medical‑surgical nursing. Vol. 1.
- Holme, M. R., & Sharman, T. (2020). Sodium nitroprusside.
- Jaarsma, T., Strömberg, A., De Geest, S., Fridlund, B., Heikkila, J., Mårtensson, J., … & Thompson, D. R. (2006). Heart failure management programmes in Europe. European Journal of Cardiovascular Nursing, 5(3), 197-205.
- Jacobs, M. (1984). Mechanism of action of hydralazine on vascular smooth muscle. Biochemical pharmacology, 33(18), 2915-2919.
- Joynt, K. E., Whellan, D. J., & O’connor, C. M. (2004). Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. Journal of cardiac failure, 10(3), 258-271.
- Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., … & Rich, M. W. (2015). Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure, 8(3), 655-687.
- Kemp, C. D., & Conte, J. V. (2012). The pathophysiology of heart failure. Cardiovascular Pathology, 21(5), 365-371.
- Kim, W., & Kim, E. J. (2018). Heart failure as a risk factor for stroke. Journal of stroke, 20(1), 33.
- Klompstra, L., Jaarsma, T., & Strömberg, A. (2018). Self-efficacy mediates the relationship between motivation and physical activity in patients with heart failure. The Journal of cardiovascular nursing, 33(3), 211.
- Krämer, B. K., Schweda, F., & Riegger, G. A. (1999). Diuretic treatment and diuretic resistance in heart failure. The American journal of medicine, 106(1), 90-96.
- Leier, C. V., & Chatterjee, K. (2007). The physical examination in heart failure—Part I. Congestive Heart Failure, 13(1), 41-47.
- Levy, P., Compton, S., Welch, R., Delgado, G., Jennett, A., Penugonda, N., … & Zalenski, R. (2007). Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Annals of emergency medicine, 50(2), 144-152.
- Lewis, P. A., Ward, D. A., & Courtney, M. D. (2009). The intra-aortic balloon pump in heart failure management: implications for nursing practice. Australian critical care, 22(3), 125-131.
- Maisel, W. H., & Stevenson, L. W. (2003). Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. The American journal of cardiology, 91(6), 2-8.
- Masip, J., Gayà, M., Páez, J., Betbesé, A., Vecilla, F., Manresa, R., & Ruíz, P. (2012). Pulse oximetry in the diagnosis of acute heart failure. Revista Española de Cardiología (English Edition), 65(10), 879-884.
- Milo-Cotter, O., Cotter, G., Kaluski, E., Rund, M. M., Felker, G. M., Adams, K. F., … & Weatherley, B. D. (2009). Rapid Clinical Assessment of Patients with Acute Heart Failure: First Blood Pressure and Oxygen Saturation–Is That All We Need?. Cardiology, 114(1), 75-82.
- Mullens, W., Abrahams, Z., Francis, G. S., Skouri, H. N., Starling, R. C., Young, J. B., … & Tang, W. W. (2008). Sodium nitroprusside for advanced low-output heart failure. Journal of the American College of Cardiology, 52(3), 200-207.
- Nicholson, C. (2007). Heart failure: A clinical nursing handbook (Vol. 31). John Wiley & Sons.
- Nyolczas, N., Dekany, M., Muk, B., & Szabo, B. (2017). Combination of hydralazine and isosorbide-dinitrate in the treatment of patients with heart failure with reduced ejection fraction. Heart Failure: From Research to Clinical Practice, 31-45.
- Oh, S. W., & Han, S. Y. (2015). Loop diuretics in clinical practice. Electrolytes & Blood Pressure, 13(1), 17-21.
- Pereira, J. D. M. V., Cavalcanti, A. C. D., Lopes, M. V. D. O., Silva, V. G. D., Souza, R. O. D., & Gonçalves, L. C. (2015). Accuracy in inference of nursing diagnoses in heart failure patients. Revista brasileira de enfermagem, 68, 690-696.
- Picano, E., Gargani, L., & Gheorghiade, M. (2010). Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart failure reviews, 15(1), 63-72.
- Piña, I. L., Apstein, C. S., Balady, G. J., Belardinelli, R., Chaitman, B. R., Duscha, B. D., … & Sullivan, M. J. (2003). Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation, 107(8), 1210-1225.
- Platz, E., Merz, A. A., Jhund, P. S., Vazir, A., Campbell, R., & McMurray, J. J. (2017). Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. European journal of heart failure, 19(9), 1154-1163.
- Qamer, S. Z., Malik, A., Bayoumi, E., Lam, P. H., Singh, S., Packer, M., … & Ahmed, A. (2019). Digoxin use and outcomes in patients with heart failure with reduced ejection fraction. The American journal of medicine, 132(11), 1311-1319.
- Redeker, N. S., Adams, L., Berkowitz, R., Blank, L., Freudenberger, R., Gilbert, M., … & Rapoport, D. (2012). Nocturia, sleep and daytime function in stable heart failure. Journal of Cardiac Failure, 18(7), 569-575.
- Reid, M. B., & Cottrell, D. (2005). Nursing care of patients receiving: Intra-aortic balloon counterpulsation. Critical care nurse, 25(5), 40-49.
- Rogers, C., & Bush, N. (2015). Heart failure: Pathophysiology, diagnosis, medical treatment guidelines, and nursing management. The Nursing Clinics of North America, 50(4), 787-799.
- Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American college of Cardiology, 48(8), 1527-1537.
- Scott, L. D., Setter-Kline, K., & Britton, A. S. (2004). The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Applied Nursing Research, 17(4), 248-256.
- Serber, S. L., Rinsky, B., Kumar, R., Macey, P. M., Fonarow, G. C., & Harper, R. M. (2014). Cerebral blood flow velocity and vasomotor reactivity during autonomic challenges in heart failure. Nursing research, 63(3), 194.
- Sica, D. A., Carter, B., Cushman, W., & Hamm, L. (2011). Thiazide and loop diuretics. The journal of clinical hypertension, 13(9), 639-643.
- Volterrani, M., & Iellamo, F. (2016). Cardiac Rehabilitation in patients with heart failure: New perspectives in exercise training. Cardiac failure review, 2(1), 63.
- Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Colvin, M. M., … & Westlake, C. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology, 70(6), 776-803.
- Zhao, X., Zhang, D. Q., Song, R., & Zhang, G. (2020). Nesiritide in patients with acute myocardial infarction and heart failure: a meta-analysis. Journal of International Medical Research, 48(1), 0300060519897194.
- Ziaeian, B., Fonarow, G. C., & Heidenreich, P. A. (2017). Clinical effectiveness of hydralazine–isosorbide dinitrate in African-American patients with heart failure. JACC: Heart Failure, 5(9), 632-639.
Originally published on July 14, 2013.
22 thoughts on “18 Heart Failure Nursing Care Plans”
GOOD NDx keep it up`yeah jah bless
Very good work.
You’ve always made my work easier
Thank you! :)
Thank you are really helping me
Am a student nurse and this is really helping me a lot
Thanks alot,had a problem with this but now I feel I can do better
A really benefit websites
This notes are lit and helping alot thanks and keep updating especially pharmacology am astudent nurse
A very nice explanation keep it up!
Thanks much. This is a great jobe well done. Be blessed
Thank you Caleb, check out our other nursing care plans and nursing diagnoses!
I wish you would add some patient education information, sometimes it seems like it may be common knowledge, but I’d like to see specifically focused education topics! Please and thank you!
You can check the deficient knowledge nursing diagnosis for this care plan.
This is great!! I am a student nurse, currently working on my unit for Chronic health conditions. This has really helped me a lot.
this site has been very helpful for me in my studies, very grateful.
Thanks so much, I’m a student nurse currently working on my care study and it has really been helpful.
Please,can I also have a detailed pathophysiology of peripartum cardiomyopathy as well as its nursing care plans. Thanks a lot once again.
This is such a comprehensive nursing care plan for heart failure. I appreciate the author. Kudos to you!
Wow!! These are great!! I wish this site had been around when I was in school!!
Even now as an NP. These are a wonderful resource to review processes.. don’t know who came up with this site but kudos to you!!!
So much hands on information. Where can we get it as PDF info