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.
Patient education is important in the management and promoting of understanding of heart failure. When the patient recognizes that the diagnosis of HF can be successfully managed with lifestyle changes, adherence to the therapeutic regimen, and medication, recurrence of acute HF lessens, unnecessary hospitalization decreases, and quality of life improves.
May be related to
Common related factors for this nursing diagnosis:
- Lack of understanding/misconceptions about interrelatedness of cardiac function/disease/failure
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.
- Statements of concern/misconceptions
- Recurrent, preventable episodes of HF
Patient goals and outcomes
Common goals and expected outcomes:
- Identify relationship of ongoing therapies (treatment program) to reduction of recurrent episodes and prevention of complications.
- List signs/symptoms that require immediate intervention.
- Identify own stress/risk factors and some techniques for handling.
- Initiate necessary lifestyle/behavioral changes.
Nursing Interventions and Rationales
The following are the nursing interventions for this heart failure nursing care plan.
1. Discuss normal heart function. Include information regarding the patient’s variance from normal function. Explain the difference between heart attack and HF.
Knowledge of disease processes and expectations can facilitate adherence to the prescribed treatment regimens.
2. Reinforce treatment rationale. Include SOs in teaching as appropriate, especially for complicated regimens such as dobutamine infusion home therapy when the patient does not respond to customary combination therapy or cannot be weaned from dobutamine or those awaiting a heart transplant.
Patients may believe it is acceptable to alter the postdischarge regimen when feeling well and symptom-free or when feeling below par, which can increase the risk of exacerbating symptoms. Understanding of regimen, medications, and restrictions may augment cooperation with control of symptoms. Home IV therapy requires a significant commitment by caregivers to troubleshoot infusion pumps, change the dressing for peripherally inserted central catheter (PICC) line, monitor I&O and signs and symptoms of HF.
3. Encourage developing a regular home exercise program, and provide guidelines for sexual activity.
Promotes maintenance of muscle tone and organ function for the overall sense of well-being. Changing sexual habits may be difficult (sex in the morning when well-rested, patient on top, inclusion of other physical expressions of affection) but provides an opportunity for continuing a satisfying sexual relationship.
4. Discuss the importance of being as active as possible without becoming exhausted and rest between activities.
Excessive physical activity or overexertion can further weaken the heart, exacerbating failure, and necessitates adjustment of exercise program.
5. Discuss the importance of sodium limitation. Provide a list of the sodium content of common foods that are to be avoided and limited. Encourage reading of labels on food and drug packages.
Dietary intake of sodium of more than 3 grams per day can offset the effect of diuretics. The most common source of sodium is table salt and obviously salty foods, although canned soups, luncheon meats, and dairy products also may contain high sodium levels.
6. Refer to a dietitian for counseling specific to individual dietary customs.
Identifies dietary needs, especially in the presence of nausea, vomiting, and resulting wasting syndrome (cardiac cachexia). Eating six small meals and using liquid dietary supplements and vitamin supplements can limit inappropriate weight loss.
7. Review medications, purpose, and side effects. Provide both oral and written instructions.
Understanding therapeutic needs and the importance of prompt reporting of side effects can prevent the occurrence of drug-related complications. Anxiety may block comprehension of input or details, and patient/ SO may refer to written material later to refresh memory.
8. Recommend taking diuretic early in the morning.
Provides adequate time for drug effects before bedtime to prevent interruption of sleep.
9. Instruct and receive return demonstration of ability to take and record daily pulse and blood pressure and when to notify health care provider: parameters above or below preset rate, changes in rhythm, and regularity.
Promotes self-monitoring of drug effects. Early detection of changes allows for timely intervention and may prevent complications, such as digitalis toxicity.
10. Explain and discuss the patient’s role in controlling risk factors (smoking, unhealthy diet) and precipitating or aggravating factors (high-salt diet, inactivity, overexertion, exposure to extremes in temperature).
It adds to the body of knowledge and permits the patient to make informed decisions regarding condition control and prevention of complications. Smoking potentiates vasoconstriction; sodium intake promotes water retention or edema formation; improper balance between activity and rest and exposure to temperature extremes may result in exhaustion and/or increased myocardial workload and increased risk of respiratory infections. Alcohol can depress cardiac contractility. Limitation of alcohol use to social occasions or a maximum of 1 drink per day may be tolerated unless cardiomyopathy is alcohol-induced (requiring complete abstinence).
11. Review signs and symptoms that require immediate medical attention: rapid and significant weight gain, edema, shortness of breath, increased fatigue, cough, hemoptysis, fever.
Self-monitoring increases patient responsibility in health maintenance and aids in the prevention of complications, e.g., pulmonary edema, pneumonia. Weight gain of more than 3 lb in a week requires medical adjustment of diuretic therapy. Note: Patient should weigh self daily in morning without clothing, after voiding, and before eating.
12. Provide opportunities for patients and SO to ask questions, discuss concerns, and make necessary lifestyle changes.
HF’s chronicity and debilitating nature often exhaust both the patient’s and significant other’s coping abilities and supportive capacity, leading to depression.
13. Discuss general health risks (such as infection), recommending avoidance of crowds and individuals with respiratory infections, obtaining yearly influenza immunization and one-time pneumonia immunization.
This population is at increased risk for infection because of circulatory compromise.
14. Stress importance of reporting signs and symptoms of digitalis toxicity: development of gastrointestinal (GI) and visual disturbances, changes in pulse rate and rhythm, worsening of heart failure.
Early recognition of developing complications and involvement of healthcare providers may prevent toxicity.
15. Identify community resources and support groups and visiting home health nurses as indicated. Encourage participation in an outpatient cardiac rehabilitation program.
May need additional assistance with self-monitoring, home management, especially when HF is progressive.
16. Discuss the importance of advance directives and communicating plans and wishes to family and primary care providers.
Up to 50% of all deaths from heart failure are sudden, with many occurring at home, possibly without significant worsening of symptoms. If the patient chooses to refuse life-support measures, an alternative contact person (rather than 911) should be designated, should cardiac arrest occur.
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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.