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18 Heart Failure Nursing Care Plans

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By Matt Vera BSN, R.N.
Heart Failure Nursing Care Plans and Nursing Diagnosis
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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.

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 specialists no longer use it. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure.

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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:

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

3. Excess Fluid Volume

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Excess Fluid Volume

Compensatory mechanisms cause salt and water retention as cardiac output falls in heart failure, increasing blood volume. When blood flow through the renal artery is decreased, the baroreceptor reflex is stimulated, and renin is released into the bloodstream. Renin interacts with angiotensinogen to produce angiotensin I. When angiotensin I contact ACE, it is converted to angiotensin II, a potent vasoconstrictor. Angiotensin II increases arterial vasoconstriction, promotes the release of norepinephrine from sympathetic nerve endings, and stimulates the adrenal medulla to secrete aldosterone, enhancing sodium and water absorption. Stimulation of the renin-angiotensin system causes plasma volume to expand and preload to increase. The increase in fluid volume puts the failing ventricles under additional stress.

Nursing Diagnosis

Common related factors for this nursing diagnosis:

  • Reduced glomerular filtration rate (decreased cardiac output)/increased antidiuretic hormone (ADH) production, and sodium/water retention.
  • Changes in glomerular filtration rate
  • Use of diuretics
  • Fluid intake or sodium intake

May be evidenced by

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Orthopnea, S3 heart sound
  • Oliguria, edema, JVD, positive hepatojugular reflux
  • Weight gain
  • Hypertension
  • Respiratory distress, abnormal breath sounds

Patient goals and outcomes

Common goals and expected outcomes:

  • Demonstrate stabilized fluid volume with balanced intake and output, breath sounds clear/clearing, vital signs within acceptable range, stable weight, and absence of edema.
  • Verbalize understanding of individual dietary/fluid restrictions.

Nursing Assessment and Rationales

The following are the nursing assessment for this heart failure nursing care plan.

1. Monitor urine output, noting amount and color, as well as the time of day when diuresis occurs.
Urine output may be scanty and concentrated (especially during the day) because of reduced renal perfusion. Recumbency favors diuresis; therefore, urine output may be increased at night and/or during bed rest.

2. Monitor and calculate 24-hour intake and output (I&O) balance.
Diuretic therapy may result in a sudden increase in fluid loss (circulating hypovolemia), even though edema or ascites remains.

3. Maintain chair or bed rest in semi-Fowler’s position during an acute phase.
Recumbency increases glomerular filtration and decreases the production of ADH, thereby enhancing diuresis.

4. Establish a fluid intake schedule if fluids are medically restricted, incorporating beverage preferences when possible. Give frequent mouth care. Ice chips can be part of the fluid allotment.
Involving patients in the therapeutic regimen may enhance a sense of control and cooperation with restrictions.

5. Weigh daily. Frequently monitor blood urea nitrogen, creatinine, and serum potassium, sodium, chloride, and magnesium levels.
Document changes edema in response to therapy. A gain of 5 lb represents approximately 2 L of fluid. Conversely, diuretics can result in excessive fluid shifts and weight loss.

6. Assess for distended neck and peripheral vessels. Inspect dependent body areas for edema (check for pitting); note the presence of generalized body edema (anasarca).
Excessive fluid retention may be manifested by venous engorgement and edema formation. Peripheral edema begins in feet and ankles (or dependent areas) and ascends as failure worsens. Pitting edema is generally obvious only after retention of at least 10 lb of fluid. Increased vascular congestion (associated with RHF) eventually results in systemic tissue edema.

7. Auscultate breath sounds, noting decreased and/or adventitious sounds (crackles, wheezes). Note presence of increased dyspnea, tachypnea, orthopnea, paroxysmal nocturnal dyspnea, persistent cough.
Excess fluid volume often leads to pulmonary congestion. Symptoms of pulmonary edema may reflect acute left-sided HF. RHF’s respiratory symptoms (dyspnea, cough, orthopnea) may have slower onset but are more difficult to reverse.

8. Investigate reports of sudden extreme dyspnea and air hunger, need to sit straight up, a sensation of suffocation, feelings of panic, or impending doom.
May indicate the development of complications (pulmonary edema and/or embolus) and differs from orthopnea paroxysmal nocturnal dyspnea in that it develops much more rapidly and requires immediate intervention.

9. Monitor BP and central venous pressure (CVP)
Hypertension and elevated CVP suggest fluid volume excess and may reflect developing pulmonary congestion, HF.

10. Assess bowel sounds. Note complaints of anorexia, nausea, abdominal distension, constipation.
Visceral congestion (occurring in progressive HF) can alter intestinal function.

11. Obtain patient history to ascertain the probable cause of the fluid disturbance.
May include increased fluids or sodium intake or compromised regulatory mechanisms.

12. Monitor  for distended neck veins and ascites
Indicates fluid overload.

13. Evaluate urine output in response to diuretic therapy.
The focus is on monitoring the response to the diuretics rather than the actual amount voided.

14. Assess the need for an indwelling urinary catheter.
Treatment focuses on diuresis of excess fluid.

15. Auscultate breath sounds q 2hr and pm for the presence of crackles and monitors for frothy sputum production
When increased pulmonary capillary hydrostatic pressure exceeds oncotic pressure, fluid moves within the alveolar septum and is evidenced by the auscultation of crackles. Frothy, pink-tinged sputum is an indicator that the client is developing pulmonary edema.

16. Assess for the presence of peripheral edema. Do not elevate legs if the client is dyspneic.
Decreased systemic blood pressure to stimulation of aldosterone, which causes increased renal tubular reabsorption of sodium Low-sodium diet helps prevent increased sodium retention, which decreases water retention. Fluid restriction may be used to decrease fluid intake, hence decreasing fluid volume excess.

17. Measure abdominal girth, as indicated.
In progressive RHF, fluid may shift into the peritoneal space, causing increasing abdominal girth (ascites).

18. Palpate abdomen. Note reports of right upper quadrant pain and tenderness.
Advancing HF leads to venous congestion, resulting in abdominal distension, liver engorgement (hepatomegaly), and pain. This can alter liver function and prolong drug metabolism.

19. Encourage verbalization of feelings regarding limitations.
Expression of feelings may decrease anxiety, which is an energy drain that can contribute to feelings of fatigue.

Nursing Interventions and Rationales

Here are the nursing interventions for this heart failure nursing care plan.

1. Weigh the patient daily and compare to the previous measurement.
Bodyweight is a sensitive indicator of fluid balance, and an increase indicates fluid volume excess.

2. Follow a low-sodium diet and/or fluid restriction
The client senses thirst because the body senses dehydration. Oral care can alleviate the sensation without an increase in fluid intake.

3. Encourage or provide oral care q2
Heart failure causes venous congestion, resulting in increased capillary pressure. When hydrostatic pressure exceeds interstitial pressure, fluids leak out of the capillaries and present as edema in the legs and sacrum. Elevation of legs increases venous return to the heart.

4. Change position frequently. Elevate feet when sitting. Inspect skin surface, keep dry, and provide padding as indicated.
Edema formation, slowed circulation, altered nutritional intake, and prolonged immobility (including bed rest) are cumulative stressors that affect skin integrity and require close supervision/ preventive interventions.

5. Provide small, frequent, easily digestible meals.
Reduced gastric motility can adversely affect digestion and absorption. Small, frequent meals may enhance digestion/ prevent abdominal discomfort.

6. Institute/instruct patient regarding fluid restrictions as appropriate.
This helps reduce extracellular volume.

7. Administer medications as indicated.
Medications for diuresis are detailed on Decreased Cardiac Output nursing diagnosis.

8. Maintain fluid and sodium restrictions as indicated.
Reduces total body water and prevents fluid reaccumulation.

9. Consult with a dietitian.
It may be necessary to provide a diet that meets caloric needs within sodium restriction to the patient.

10. Monitor chest x-ray.
Reveals changes indicative of resolution of pulmonary congestion.

11. Assist with rotating tourniquets and/or phlebotomy, dialysis, or ultrafiltration as indicated.
Although not frequently used, mechanical fluid removal rapidly reduces circulating volume, especially in pulmonary edema refractory to other therapies.

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3. Excess Fluid Volume

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

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.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for cardiovascular system disorders:

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about heart failure nursing care plans and nursing diagnosis:

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  3. 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.
  4. 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.
  5. 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.
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  43. 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.
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  47. 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.
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  49. 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.
  50. 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.
  51. 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.
  52. Nicholson, C. (2007). Heart failure: A clinical nursing handbook (Vol. 31). John Wiley & Sons.
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Originally published on July 14, 2013. 

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Matt Vera BSN, R.N.
Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

22 thoughts on “18 Heart Failure Nursing Care Plans”

  10. 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!

    Reply

  12. This is great!! I am a student nurse, currently working on my unit for Chronic health conditions. This has really helped me a lot.

    Thank you!
    Gina

    Reply

  15. Please,can I also have a detailed pathophysiology of peripartum cardiomyopathy as well as its nursing care plans. Thanks a lot once again.

    Reply

  17. 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!!!

    Reply

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