18 Heart Failure Nursing Care Plans

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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
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Ineffective Breathing Pattern

Ineffective Breathing Pattern occurs when there is spasm and inflammation of the lung tissue and parenchyma. These results in the inability of the patient to move air in and out of the lungs as needed to maintain adequate tissue oxygenation and perfusion.

Nursing Diagnosis

  • Ineffective Breathing Pattern

Common related factors for this nursing diagnosis:

  • Fatigue
  • Decreased lung expansion
  • Pulmonary congestion secondary to CHF

Possibly evidenced by

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

  • weakness
  • rales on BLF
  • productive cough
  • frothy sputum
  • pursed lip breathing
  • tachypnea

Desired Outcomes

Common goals and expected outcomes:

  • Patient’s respiratory pattern will be effective without causing fatigue

Nursing Assessment and Rationales

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

1. Establish rapport
To gain comfort feelings from the patient and significant others,

2. Monitor and record vital signs
To gain baseline data

3. Inspect thorax for symmetry of respiratory movement
Determines adequacy of breathing

4. Observe breathing pattern for SOB, nasal flaring, pursed-lip breathing or prolonged expiratory phase and use of accessory muscles
Identifies increased work of breathing.

5. Measure tidal volume and vital capacity
Indicates the volume of air moving in and out of the lungs

6. Assess emotional response
Detects use of hyperventilation as a causative factor

Nursing Interventions and Rationales

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

1. Position patient in optimal body alignment in semi- fowler’s position for breathing

2. Assist patient to use relaxation techniques
Reduces muscle tension, decreases work of breathing

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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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  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.
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  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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  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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  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.
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  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.
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Originally published on July 14, 2013. 

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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”

  1. 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
  2. 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
  3. Please,can I also have a detailed pathophysiology of peripartum cardiomyopathy as well as its nursing care plans. Thanks a lot once again.

    Reply
  4. 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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