13 Heart Failure Nursing Care Plans

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In this nursing care plan guide are 13 NANDA nursing diagnosis for 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.

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.

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 isa progressive and chronic condition that is managed by significant lifestyle changes and adjunct medical therapy to improve quality of life. Heart failure is caused from 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

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
  • Cough that is initially dry and nonproductive
  • Frothy sputum that is sometimes blood-tinged
  • Inadequate tissue perfusioon
  • Weak, thready pulse
  • Fatigue

Right-Sided Heart Failure

  • Congestion of the viscera and peripheral tissues
  • Edema of the lower extremities

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 13 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. Other Nursing Care Plans
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Risk for Impaired Skin Integrity

Nursing Diagnosis

Risk factors may include

  • Prolonged bedrest
  • Edema, decreased tissue perfusion
  • Decreased activity level
  • Prolonged sitting
  • Presence of edema
  • Altered circulation

Desired Outcomes

  • Maintain skin integrity.
  • Demonstrate behaviors/techniques to prevent skin breakdown.

Nursing Interventions

Nursing InterventionsRationale
Nursing Assessment
Inspect skin, noting skeletal prominences, presence of edema, areas of altered circulation, or obesity and/or emanciation.Skin is at risk because of impaired peripheral circulation, physical immobility, and alterations in nutritional status.
Check fit of shoes and slippers and change as needed.Dependent edema may cause shoes to fit poorly, increasing risk of pressure and skin breakdown on feet.
Therapeutic Interventions
Provide gentle massage around reddened or blanched areas.Improves blood flow, minimizing tissue hypoxia. Note: Direct massage of compromised area may cause tissue injury.
Encourage frequent position changes, assist with active and passive range of motion (ROM) exercises.Reduces pressure on tissues, improving circulation and reducing time any one area is deprived of full blood flow.
Provide frequent skin care: minimize contact with moisture and excretions.Excessive dryness or moisture damages skin and hastens breakdown.
Avoid intramuscular route for medication.Interstitial edema and impaired circulation impede drug absorption and predispose to tissue breakdown and development of infection.
Provide alternating pressure, egg-crate mattress, sheepskin elbow and heel protectors.Reduces pressure to skin, may improve circulation.
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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:

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