18 Heart Failure Nursing Care Plans


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.

Clinical Manifestations

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
  • Tachycardia
  • Oliguria, nocturia
  • Fatigue

Right-Sided Heart Failure

  • Congestion of the viscera and peripheral tissues
  • Edema of the lower extremities
  • Enlargement of the liver (hepatomegaly)
  • Ascites
  • Anorexia, nausea
  • Weakness
  • 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 Plans

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:

  1. Decreased Cardiac Output
  2. Activity Intolerance
  3. Excess Fluid Volume
  4. Risk for Impaired Gas Exchange
  5. Risk for Impaired Skin Integrity
  6. Deficient Knowledge
  7. Acute Pain
  8. Ineffective Tissue Perfusion
  9. Hyperthermia
  10. Ineffective Breathing Pattern
  11. Ineffective Airway Clearance
  12. Impaired Gas Exchange
  13. Fatigue
  14. Risk for Decreased Cardiac Output
  15. Fear
  16. Anxiety
  17. Powerlessness
  18. Other Nursing Care Plans


Patients who are suffering from heart failure may have continuing perception of powerlessness because they are incapable of changing their inevitable outcomes. Powerlessness may be displayed at any time during the patient’s illness and may be observed in the hospital, ambulatory care, rehabilitation, or home environment.

Nursing Diagnosis

  • Powerlessness

May be related to

  • chronic illness and hospitalizations

Desired Outcomes

  • Patient will express sense of personal control.
  • Patient displays increased ability to manage self.
  • Patient will recognize means to control over personal situation.
Nursing InterventionsRationale
Nursing Assessment
Assess for factors contributing to a sense of powerlessness.Identifying the related factors with powerlessness can benefit in recognizing potential causes and building a collaborative plan of care.
Assess for feelings of apathy, hopelessness, and depression.These moods may be an element of powerlessness.
Evaluate the patient’s decision-making competence.Powerlessness is the feeling that one has lost the implicit power to control their own interests.
Know situations/interactions that may add to the patient’s sense of powerlessness.It is necessary for healthcare providers to recognize the patient’s right to refuse certain procedures. Some routines are done on patients without their consent fostering a sense of powerlessness.
Appraise the impact of powerlessness on the patient’s physical condition (e.g., appearance, oral intake, hygiene, sleep habits).Individuals may seem as though they are powerless to establish basic aspects of life and self-care activities.
Assess the role of illness plays in the patient’s sense of powerlessness.The dilemma about events, duration, and course of illness, prognosis, and dependence on others for guidance and treatments can contribute to powerlessness.
Evaluate the results of the information given on the patient’s feelings and behavior.A patient facing powerlessness may overlook information. Too much information may overwhelm the patient and add to feelings of powerlessness. A patient simply experiencing a knowledge deficit may be mobilized to act in his or her own best interest after information is presented and options are explored. The act of providing information about heart failure may strengthen a patient’s sense of independence.
Therapeutic Interventions
Listen actively to patient often.This approach creates a supportive environment and sends a message of caring.
Encourage patient to identify strengths.This will aid patient to recognize inner strengths.
Provide patient with decision-making opportunities with increasing frequency and significance.This approach enhances patient’s independence.
Help the patient in reexamining negative perceptions of the situation.The patient may have his or her own perceptions that are unrealistic for the situation.
Provide encouragement and praise while identifying patient’s progress.This approach creates a supportive environment and sends a message of caring.
Assist patient to differentiate between factors that can be controlled and those that cannot.The patient may have his or her own perceptions that are unrealistic for the situation.
Avoid using coercive power when approaching the patient.This approach may increase the patient’s feelings of powerlessness and result in decreased self-esteem.
Eliminate the unpredictability of events by allowing adequate preparation for tests or procedures.Information in advance of a procedure can provide the patient with a sense of control.
Support in planning and creating a timetable to manage increased responsibility in the future.Use of realistic short-term goals for resuming aspects of self-care foster confidence in one’s abilities.

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 Nursing5(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 Research17(4), 248-256. [Link]

See Also

You may also like the following posts and care plans:

Cardiac Care Plans

Nursing care plans about the different diseases of the cardiovascular system:

Originally published on July 14, 2013. 


  1. 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!

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