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.
- 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
NOTE: This nursing care plan is recently updated with new content and a change in formatting. Nursing assessment and nursing interventions are listed in bold and followed by their specific rationale in the following line. Still, when writing nursing care plans, follow the format here.
Diminished physical activity, insufficient cardiac reserve to meet oxygen demands, and prolonged inactivity caused by symptoms of heart failure lead to physical deconditioning and worsen the patient’s symptoms and exercise tolerance. Worsening HF further compromises the patient’s cardiac function, therefore, intensifying activity intolerance. As a result, the patient may feel fatigued and have difficulty performing activities of daily living.
- Activity Intolerance
(Current taxonomy changed Activity Intolerance label to Decreased Activity Tolerance)
May be related to
Common etiological factors for this nursing diagnosis:
- Imbalance between oxygen supply/demand
- Generalized weakness
- Prolonged bed rest
May be evidenced by
The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Weakness, fatigue
- Changes in vital signs, presence of dysrhythmias
- Pallor, diaphoresis
Desired goals and outcomes
Common goals and expected outcomes:
- Participate in desired activities; meet own self-care needs.
- Achieve measurable increase in activity tolerance, evidenced by reduced fatigue and weakness and by vital signs within acceptable limits during activity.
Nursing Assessment and Rationales
Below is the nursing assessment for this heart failure nursing care plan.
1. Check vital signs before and immediately after activity, especially if the patient receives vasodilators, diuretics, or beta-blockers.
Orthostatic hypotension can occur with activity because of medication effect (vasodilation), fluid shifts (diuresis), or compromised cardiac pumping function.
2. Document cardiopulmonary response to activity. Note tachycardia, dysrhythmias, dyspnea, diaphoresis, pallor.
Compromised myocardium and inability to increase stroke volume during activity may cause an immediate increase in heart rate and oxygen demands, thereby aggravating weakness and fatigue.
3. Assess for other causes of fatigue (treatments, pain, medications).
Medications such as beta-blockers, tranquilizers, and sedatives can cause fatigue as a side effect. Pain and stressful procedures can also diminish the patient’s energy can cause fatigue.
4. Identify factors that could affect the desired level of activity and motivation.
Age, pain, breathing problems, impaired visual acuity, hearing problems, functional decline, etc., are all factors that could hinder interventions from improving activity tolerance. Other factors unrelated to heart failure could affect the client’s participation in interventions to improve activity tolerance (Chew et al., 2019). Fatigue affects both the client’s actual and perceived ability to participate in activities.
Nursing Interventions and Rationales
These are the nursing interventions for this heart failure nursing care plan.
1. Monitor and evaluate the patient’s response to activities.
Vital signs and oxygen saturation levels should be monitored before, during, and immediately after activity to determine whether they are within the desired range. Heart rate should return to baseline within 3 minutes following the activity. Moderate continuous training is efficient, safe, and well-tolerated by HF patients, and it is recommended by the Heart Failure Association Guidelines (Cattadori et al., 2018). If the patient can tolerate activity, use the data obtained to develop goals to increase the intensity and duration of the activity gradually.
2. Consider the use of the 6-minute walk test (6MWT) to determine the patient’s physical ability.
6MWT is an exercise test that entails measuring the distance walked over a span of 6 minutes (Enright, 2003). It helps gauge the patient’s cardiopulmonary response. More information about the 6MWT can be found here.
3. Evaluate accelerating activity intolerance.
May denote increasing cardiac decompensation rather than overactivity. Three factors that affect the risk of exercise include age, heart disease presence, and exercise intensity (Piña et al., 2003). Sudden cardiac death during exercise is rare in apparently healthy individuals. Individuals with cardiac disease seem to be at a greater risk for sudden cardiac arrest during vigorous exercise (such as jogging) than are healthy individuals (Fletcher et al., 2001).
4. Assist with self-care activities as necessary. Encourage independence within prescribed limits.
Assisting with ADLs ensure that the patient’s need is met while reducing cardiac workload. As much as possible and as tolerated by the patient, involve them in promoting a sense of control and reducing helplessness.
5. Slow the pace of care and provide adequate rest before and after periods of exertion (e.g., bathing, eating, exercise).
Allow the patient extra time to carry out physical tasks, especially on geriatric clients. Older patients are more vulnerable to falls and injuries due to decreased muscle strength, reduced balance, etc.
6. Organize nursing care activities to allow rest periods.
Intersperse activity periods with rest periods by developing a schedule that promotes pacing and prioritizes activities to meet the patient’s personal care needs without undue myocardial stress and excessive oxygen demand (Cattadori et al., 2018; Piña et al., 2003). Grouping nursing care allows adequate time for the patient to recharge.
7. Implement a graded cardiac rehabilitation program.
Strengthens and improves cardiac function under stress if cardiac dysfunction is not irreversible. Gradual increase in activity avoids excessive myocardial workload and oxygen consumption. Cardiac rehabilitation offers an effective model of care for older patients with heart failure (Austin et al., 2005). The potential benefit of increasing exercise performance by increasing training load from moderate to higher doses of exercise should be weighed against the lack of an improvement in cardiac vagal modulation and the possible increase in the risk of adverse events (Volterrani & Iellamo, 2016).
8. Adjust the client’s daily activities and reduce the intensity of the level. Discontinue activities that cause undesired physiological and psychological changes.
It prevents straining and overexertion, which may aggravate symptoms. Stop all activity if severe shortness of breath, pain, or dizziness develops. Additionally, instruct the patient or significant other to recognize the signs of overexertion. One way to ensure the patient is not overexerting during physical ability is if they can talk during the routine; if they cannot do so, decrease the intensity of activity.
9. Encourage patient to have adequate bed rest and sleep; provide a calm and quiet environment.
It relaxes the body and promotes comfort. Temporary bed rest should also be implemented during an acute exacerbation of heart failure symptoms.
10. Initiate interventions and safeguards to promote safety and prevent risk for injury during activity. Interventions include:
- Assist the patient during ambulation, if necessary.
- Ascertain the patient’s ability to stand and move about and degree of assistance needed or use of movement aids or equipment.
- Instruct or demonstrate physical activities that may be unfamiliar with the patient.
- Start with warm-up activity and end with cool-down activities.
- Avoid performing physical activities outside extreme temperatures or during humid weather.
- Wait 2 hours after eating a meal before performing a physical activity.
11. Encourage the client to maintain a positive attitude; provide evidence of daily or weekly progress.
It helps enhance the patient’s sense of well-being and raises the patient’s motivation and morale. Motivation is necessary for patients with HF who are attempting to become more physically active but may not be sufficient to initiate physical activity. In addition to a high level of motivation to be physically active, patients with HF must have a high degree of self-efficacy (Klompstra et al., 2018). Provide a positive atmosphere during the exercise regimen to help minimize patient frustration.
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References and Sources
Recommended references and sources for heart failure nursing care plan:
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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.