This nursing care plan guide contains 18 NANDA nursing diagnosis 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 metabolic needs of the body 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 absence of disease, cannot tolerate a sudden expansion in blood volume. Heart failure is a progressive and chronic condition that is managed by significant lifestyle changes and adjunct medical therapy to improve quality of life. Heart failure is caused by 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.
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 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 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 18 nursing care plans (NCP) and nursing diagnosis for patients with Heart Failure:
- Decreased Cardiac Output
- Activity Intolerance
- Excess Fluid Volume
- Risk for Impaired Gas Exchange
- Risk for Impaired Skin Integrity
- Deficient Knowledge
- Acute Pain
- Ineffective Tissue Perfusion
- Ineffective Breathing Pattern
- Ineffective Airway Clearance
- Impaired Gas Exchange
- Risk for Decreased Cardiac Output
- Other Nursing Care Plans
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 management with lifestyle changes, adherence to therapeutic regimen, and medication, recurrence of acute HF lessen, unnecessary hospitalization decreases, and quality of life improves.
- Lack of understanding/misconceptions about interrelatedness of cardiac function/disease/failure
- Statements of concern/misconceptions
- Recurrent, preventable episodes of HF
- 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.
|Discuss normal heart function. Include information regarding patient’s variance from normal function. Explain difference between heart attack and HF.||Knowledge of disease process and expectations can facilitate adherence to prescribed treatment regimen.|
|Reinforce treatment rationale. Include SOs in teaching as appropriate, especially for complicated regimens such as dobutamine infusion home therapy when patient does not respond to customary combination therapy or cannot be weaned from dobutamine, or those awaiting heart transplant.||Patient may believe it is acceptable to alter postdischarge regimen when feeling well and symptom-free or when feeling below par, which can increase the risk of exacerbation of 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 pump, change dressing for peripherally inserted central catheter (PICC) line, monitor I&O and signs and symptoms of HF.
|Encourage developing a regular home exercise program, and provide guidelines for sexual activity.||Promotes maintenance of muscle tone and organ function for overall sense of well-being. Changing sexual habits may be difficult (sex in morning when well rested, patient on top, inclusion of other physical expressions of affection) but provides opportunity for continuing satisfying sexual relationship.|
|Discuss importance of being as active as possible without becoming exhausted and of rest between activities.||Excessive physical activity or overexertion can further weaken the heart, exacerbating failure, and necessitates adjustment of exercise program.|
|Discuss importance of sodium limitation. Provide list of 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 effect of diuretic. Most common source of sodium is table salt and obviously salty foods, although canned soups, luncheon meats, and dairy products also may contain high levels of sodium.|
|Refer to dietitian for counseling specific to individual dietary customs.||Identifies dietary needs, especially in 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.|
|Review medications, purpose, and side effects. Provide both oral and written instructions.||Understanding therapeutic needs and importance of prompt reporting of side effects can prevent occurrence of drug-related complications. Anxiety may block comprehension of input or details, and patient/ SO may refer to written material at later date to refresh memory.|
|Recommend taking diuretic early in morning.||Provides adequate time for drug effect before bedtime to prevent interruption of sleep.|
|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 effect. Early detection of changes allows for timely intervention and may prevent complications, such as digitalis toxicity.|
|Explain and discuss patient’s role in control of risk factors (smoking, unhealthy diet) and precipitating or aggravating factors (high-salt diet, inactivity, overexertion, exposure to extremes in temperature).||Adds to body of knowledge, and permits patient to make informed decisions regarding control of condition 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 maximum of 1 drink per day may be tolerated unless cardiomyopathy is alcohol-induced (requiring complete abstinence).|
|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 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.|
|Provide opportunities for patient and SO to ask questions, discuss concerns, and make necessary lifestyle changes.||Chronicity and debilitating nature of HF often exhausts coping abilities and supportive capacity of both patient and SO, leading to depression.|
|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.|
|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 provider may prevent toxicity.|
|Identify community resources and support groups and visiting home health nurse as indicated. Encourage participation in an outpatient cardiac rehabilitation program.||May need additional assistance with self-monitoring, home management, especially when HF is progressive.|
|Discuss importance of advance directives and of communicating plan 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 patient chooses to refuse life-support measures, an alternative contact person (rather than 911) needs to be designated, should cardiac arrest occur.|
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 Nursing, 5(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 Research, 17(4), 248-256. [Link]
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
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.