This nursing care plan guide contains 18 NANDA nursing diagnosis 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 metabolic needs of the body 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 absence of disease, cannot tolerate a sudden expansion in blood volume. Heart failure is a progressive and chronic condition that is managed by significant lifestyle changes and adjunct medical therapy to improve quality of life. Heart failure is caused by a variety of 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 specialist no longer uses this term. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure.
Nursing care plan goals for patients with heart failure includes 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 diagnosis for patients with Heart Failure:
- Decreased Cardiac Output
- Activity Intolerance
- Excess Fluid Volume
- Risk for Impaired Gas Exchange
- Risk for Impaired Skin Integrity
- Deficient Knowledge
- Acute Pain
- Ineffective Tissue Perfusion
- Ineffective Breathing Pattern
- Ineffective Airway Clearance
- Impaired Gas Exchange
- Risk for Decreased Cardiac Output
- Other Nursing Care Plans
Anxiety is profoundly frequent among patients with heart failure with nearly 30 percent of patients have clinically significant anxiety symptoms. Anxiety may make it more challenging for patients with heart failure to follow recommendations for diet, exercise, and medication use.
May be related to
- Breathlessness from inadequate oxygenation
- Patient will identify strategies to reduce anxiety.
- Patient will demonstrate improved concentration.
- Patient will manage anxiety and coping patterns.
|Assess the patient’s level of anxiety. Hildegard E. Peplau described 4 levels of anxiety: mild, moderate, severe and panic.||The patient with mild anxiety will have minimal or no physiological symptoms of anxiety. Vital signs will be within normal ranges. The patient will appear calm but may report feelings of nervousness such as “butterflies in the stomach.” |
The patient with moderate anxiety may appear energized, with more animated facial expressions and tone of voice. Vital signs may be normal or slightly elevated. The patient may report feeling tense.
With severe anxiety, the patient will have symptoms of increased autonomic nervous system activity, such as elevated vital signs, diaphoresis, urinary urgency and frequency, dry mouth, and muscle tension. At this stage, the patient may experience palpitations and chest pain. The patient may be agitated and irritable and report feeling overloaded or overwhelmed by new stimuli.
In the panic level of anxiety, the autonomic nervous system increases to the level of sympathetic neurotransmitter release. The patient becomes pale and hypotensive and experiences poor muscle coordination. The patient reports feeling completely out of control and may display extremes of behavior from combativeness to withdrawal.
|Assess physical reactions to anxiety.||Anxiety also plays a role in somatoform disorders, which are characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause.|
|Validate observations by asking patient, “Are you feeling anxious now?”||Anxiety is a highly individualized, normal physical, and psychological response to internal or external life events.|
|Recognize awareness of the patient’s anxiety.||Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.|
|Interact with patient in a peaceful manner.||This approach may help decrease anxiety so that patient’s cardiac work is also decreased.|
|Familiarize patient with the environment and new experiences or people as needed.||Awareness of the environment promotes comfort and may decrease anxiety experienced by the patient. Anxiety may intensify to a panic level if patient feels threatened and unable to control environmental stimuli. A decrease in anxiety will also mean that patient’s cardiac work is also decreased.|
|Administer oxygen during the acute stage.||Oxygen therapy diminishes the work of breathing and to increase comfort.|
|When patient displays anxiety, promote physical comfort and psychological support.||A family member’s presence may provide reassurance; pet visitation or animal-assisted therapy can also be helpful.|
|Converse using a simple language and brief statements.||When experiencing moderate to severe anxiety, patients may be unable to understand anything more than simple, clear, and brief instruction.|
|When patient is comfortable, teach ways to control anxiety and avoid anxiety-provoking situations.||Anxiety may intensify to a panic state with excessive conversation, noise, and equipment around the patient. Increasing anxiety may become frightening to the patient and others.|
|Assist in identifying factors that contribute to anxiety.||Talking about anxiety-producing situations and anxious feelings can help the patient perceive the situation realistically and recognize factors leading to anxious feelings.|
|Help patient determine precipitants of anxiety that may indicate interventions.||Obtaining insight allows the patient to reevaluate the threat or identify new ways to deal with it.|
|Screen fo depression, which often accompanies or results from anxiety.||Symptoms of depression and anxiety are present in about one-third of patients with heart failure. Studies found evidence confirming “markedly higher” rates of depression and anxiety disorders among patients with heart failure, compared to the general population.|
|Allow patient to talk about anxious feelings and examine anxiety-provoking situations if they are identifiable.||Talking about anxiety-producing situations and anxious feelings can help the patient perceive the situation realistically and recognize factors leading to anxious feelings.|
|Assist the patient in developing new anxiety-reducing skills (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements).||Discovering new coping methods provides the patient with a variety of ways to manage anxiety.|
|Avoid unnecessary reassurance; this may increase undue worry.||Reassurance is not helpful for the anxious individual.|
|Intervene when possible to eliminate sources of anxiety.||Anxiety is a normal response to actual or perceived danger; if the threat is eliminated, the response will stop.|
|Explain all activities, procedures, and issues that involve the patient; use non-medical terms and calm, slow speech. Do this in advance of procedures when possible, and validate patient’s understanding.||With preadmission patient education, patients experience less anxiety and emotional distress and have increased coping skills because they know what to expect. Uncertainty and lack of predictability contribute to anxiety.|
|Educate patient and family about the symptoms of anxiety.||If patient and family can identify anxious responses, they can intervene earlier than otherwise.|
|Teach patient to visualize or fantasize about the absence of anxiety or pain, successful experience of the situation, resolution of conflict, or outcome of procedure.||Use of guided imagery has been useful for reducing anxiety.|
References and Sources
Recommended references and sources for heart failure nursing care plan:
- Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
- Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
- 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. [Link]
- 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. [Link]
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Cardiac Care Plans
Nursing care plans about the different diseases of the cardiovascular system:
- 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 | 16+ Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 7 Care Plans
Originally published on July 14, 2013.