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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

5. Deficient Knowledge

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Deficient Knowledge

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. 

Nursing Diagnosis

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.

  • Questioning
  • 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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5. Deficient Knowledge

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:

  1. Albert, N. M. (2012). Fluid management strategies in heart failure. Critical care nurse, 32(2), 20-32.
  2. Albert, N., Trochelman, K., Li, J., & Lin, S. (2010). Signs and symptoms of heart failure: are you asking the right questions?. American Journal of Critical Care, 19(5), 443-452.
  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.
  6. Austin, J., Williams, R., Ross, L., Moseley, L., & Hutchison, S. (2005). Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. European Journal of Heart Failure, 7(3), 411-417.
  7. Barrese, V., & Taglialatela, M. (2013). New advances in beta-blocker therapy in heart failure. Frontiers in physiology, 4, 323.
  8. Bikdeli, B., Strait, K. M., Dharmarajan, K., Li, S. X., Mody, P., Partovian, C., … & Krumholz, H. M. (2015). Intravenous fluids in acute decompensated heart failure. JACC: Heart Failure, 3(2), 127-133.
  9. Bocchi, E. A. (2001). Cardiomyoplasty for treatment of heart failure. European journal of heart failure, 3(4), 403-406.
  10. Bolger, A. P., Coats, A. J., & Gatzoulis, M. A. (2003). Congenital heart disease: the original heart failure syndrome. European Heart Journal, 24(10), 970-976.
  11. Brater, D. C. (2000). Pharmacology of diuretics. The American journal of the medical sciences, 319(1), 38-50.
  12. Brennan, E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688.
  13. Brunner, L. S. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (Vol. 1). Lippincott Williams & Wilkins.
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  27. Fletcher, G. F., Balady, G. J., Amsterdam, E. A., Chaitman, B., Eckel, R., Fleg, J., … & Bazzarre, T. (2001). Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation, 104(14), 1694-1740.
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  32. Gulanick, M., & Myers, J. L. (2021). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Mosby.
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  34. Herman, L. L., & Tivakaran, V. S. (2017). Hydralazine.
  35. Hinkle, J. L., & KH, C. (2017). Brunner & Suddarth’s textbook of medical‑surgical nursing. Vol. 1.
  36. Holme, M. R., & Sharman, T. (2020). Sodium nitroprusside.
  37. 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.
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  39. Joynt, K. E., Whellan, D. J., & O’connor, C. M. (2004). Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. Journal of cardiac failure, 10(3), 258-271.
  40. Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., … & Rich, M. W. (2015). Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure, 8(3), 655-687.
  41. Kemp, C. D., & Conte, J. V. (2012). The pathophysiology of heart failure. Cardiovascular Pathology, 21(5), 365-371.
  42. Kim, W., & Kim, E. J. (2018). Heart failure as a risk factor for stroke. Journal of stroke, 20(1), 33.
  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.
  44. Krämer, B. K., Schweda, F., & Riegger, G. A. (1999). Diuretic treatment and diuretic resistance in heart failure. The American journal of medicine, 106(1), 90-96.
  45. Leier, C. V., & Chatterjee, K. (2007). The physical examination in heart failure—Part I. Congestive Heart Failure, 13(1), 41-47.
  46. Levy, P., Compton, S., Welch, R., Delgado, G., Jennett, A., Penugonda, N., … & Zalenski, R. (2007). Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Annals of emergency medicine, 50(2), 144-152.
  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.
  48. Maisel, W. H., & Stevenson, L. W. (2003). Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. The American journal of cardiology, 91(6), 2-8.
  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.
  53. Nyolczas, N., Dekany, M., Muk, B., & Szabo, B. (2017). Combination of hydralazine and isosorbide-dinitrate in the treatment of patients with heart failure with reduced ejection fraction. Heart Failure: From Research to Clinical Practice, 31-45.
  54. Oh, S. W., & Han, S. Y. (2015). Loop diuretics in clinical practice. Electrolytes & Blood Pressure, 13(1), 17-21.
  55. Pereira, J. D. M. V., Cavalcanti, A. C. D., Lopes, M. V. D. O., Silva, V. G. D., Souza, R. O. D., & Gonçalves, L. C. (2015). Accuracy in inference of nursing diagnoses in heart failure patients. Revista brasileira de enfermagem, 68, 690-696.
  56. Picano, E., Gargani, L., & Gheorghiade, M. (2010). Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart failure reviews, 15(1), 63-72.
  57. Piña, I. L., Apstein, C. S., Balady, G. J., Belardinelli, R., Chaitman, B. R., Duscha, B. D., … & Sullivan, M. J. (2003). Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation, 107(8), 1210-1225.
  58. Platz, E., Merz, A. A., Jhund, P. S., Vazir, A., Campbell, R., & McMurray, J. J. (2017). Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. European journal of heart failure, 19(9), 1154-1163.
  59. Qamer, S. Z., Malik, A., Bayoumi, E., Lam, P. H., Singh, S., Packer, M., … & Ahmed, A. (2019). Digoxin use and outcomes in patients with heart failure with reduced ejection fraction. The American journal of medicine, 132(11), 1311-1319.
  60. Redeker, N. S., Adams, L., Berkowitz, R., Blank, L., Freudenberger, R., Gilbert, M., … & Rapoport, D. (2012). Nocturia, sleep and daytime function in stable heart failure. Journal of Cardiac Failure, 18(7), 569-575.
  61. Reid, M. B., & Cottrell, D. (2005). Nursing care of patients receiving: Intra-aortic balloon counterpulsation. Critical care nurse, 25(5), 40-49.
  62. Rogers, C., & Bush, N. (2015). Heart failure: Pathophysiology, diagnosis, medical treatment guidelines, and nursing management. The Nursing Clinics of North America, 50(4), 787-799.
  63. Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American college of Cardiology, 48(8), 1527-1537.
  64. 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.
  65. Serber, S. L., Rinsky, B., Kumar, R., Macey, P. M., Fonarow, G. C., & Harper, R. M. (2014). Cerebral blood flow velocity and vasomotor reactivity during autonomic challenges in heart failure. Nursing research, 63(3), 194.
  66. Sica, D. A., Carter, B., Cushman, W., & Hamm, L. (2011). Thiazide and loop diuretics. The journal of clinical hypertension, 13(9), 639-643.
  67. Volterrani, M., & Iellamo, F. (2016). Cardiac Rehabilitation in patients with heart failure: New perspectives in exercise training. Cardiac failure review, 2(1), 63.
  68. Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Colvin, M. M., … & Westlake, C. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology, 70(6), 776-803.
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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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