Heart Failure Nursing Diagnosis & Care Plan

Heart failure is one of the most common medical diagnoses in healthcare, especially for medical-surgical and adult gerontology nurses. Understanding the pathophysiology of the disease process and potential complications that can arise in your patients will help when building a comprehensive and accurate nursing care plan. 

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What is Heart Failure?

Heart failure is the heart’s inability to pump blood effectively to meet the body’s needs. As a result, blood often backs up and causes fluid in the lungs. Heart failure is a lifelong condition that can be treated and managed, but there is ultimately no cure.¹

Understanding heart failure means understanding how the heart normally functions. There are four main chambers of the heart, and each is crucial to the heart's pumping effectively. 

• Right Atrium (Reservoir): Receives deoxygenated blood from the body
• Left Atrium (Reservoir): Receives oxygenated blood from the body
• Right Ventricle (Pump): Pumps deoxygenated blood to the lungs
• Left Ventricle (Pump): Pumps oxygen-rich blood into systemic circulation

There are two main types of heart failure – right-sided and left-sided:

• Right-sided heart failure is when there is an overcirculation of blood, resulting in congestion in the systemic circulation. 
• Left-sided heart failure is when there is an overcirculation of blood, resulting in pulmonary circulation congestion.² 

Heart Failure Causes and Risk Factors

Understanding the causes and/or risk factors of heart failure is essential for not only properly caring for your patients but also writing an effective care plan.

• Age (over 65)
• Sedentary lifestyle
• Obesity
• Smoking
• Genetics and familial history
• Illegal drug use
• Alcohol abuse
• Unhealthy Diet
• Ethnicity (Black or African American)
• Long-term health conditions
  • Anemia
  • Coronary artery disease
  • Myocardial infarction
  • Atrial fibrillation
  • Aortic stenosis
  • Hypertension
  • Thyroid disease
  • Sleep apnea
  • Chronic kidney disease
• Undergoing chemotherapy or radiation
• Infections
  • HIV

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Heart Failure Signs and Symptoms 

There are numerous signs and symptoms of heart failure, and not all patients will experience all of them. Instead, they may present with a combination of some. It’s important to know that any presentation could be an indication that your patient is in heart failure. 

Signs and symptoms of heart failure include:

• Extreme tiredness
• Overall weakness
• Tachycardia
• Irregular heartbeat
• Shortness of breath
• Edema in the lower extremities
• Wheezing
• Cough
• Rapid weight gain
• Abdominal swelling
• Chest pain
• Nausea
• Lack of appetite
• Decreased ability to concentrate
• Orthopnea⁴ 

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Heart Failure Treatment Options

Through a variety of lifestyle modifications and medications, heart failure is treatable and manageable. Unfortunately, it does not have a cure, though, and once diagnosed, it is a disease that your patient will have forever. Current treatment recommendations include:

• Heart-healthy diet (lower salt intake)
• Weight loss
• Regular physical exercise
• Smoking cessation
• Adopting a healthy lifestyle free of drugs and alcohol
• Manage stress
• Medications 
  • Diuretics
  • Aldosterone antagonists
  • ACE inhibitors
  • Beta blockers⁵

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Heart Failure Diagnosis

Heart failure is diagnosed based on a patient’s symptomology, but also diagnostic tests. Tests include:

• Chest X-ray
• EKG
• Ejection fraction
• Echo
• Stress test
• Cardiac MRI
• Myocardial biopsy
• Coronary angiogram
• Blood work

Symptoms are grouped based on the New York Heart Association (NYHA) classification system:

• Class 1 heart failure: There are no heart failure symptoms.
• Class 2 heart failure: Everyday activities can be done without difficulty, but exertion causes shortness of breath or fatigue.
• Class 3 heart failure: It's difficult to complete everyday activities.
• Class 4 heart failure: Shortness of breath occurs even at rest. This category includes the most severe heart failure.⁷

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How to Develop a Heart Failure Nursing Care Plan

When developing a heart failure nursing care plan, the first step is determining a patient’s goals. Although you’ll generate parts of the nursing care plan on your own, the nursing diagnosis must be on the NANDA-I-approved nursing diagnosis list.

According to the North American Nursing Diagnosis Association (NANDA),  a nursing diagnosis is “a clinical judgment about the human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community.”

A nursing diagnosis is rooted in Maslow’s Hierarchy of Needs pyramid and helps prioritize treatments. Based on the nursing diagnosis, you’ll set goals to resolve your patient’s problems through nursing interventions determined in the next step.

NANDA-I separates nursing diagnoses into four categories:

• Problem-focused: A diagnosis based on patient problems present during a nursing assessment.
• Risk: A diagnosis based on risk factors that requires intervention from a nurse or healthcare team before a real problem develops.
• Health promotion: A diagnosis that intends to improve the overall well-being of an individual, family, or community.
• Syndrome: Based on a cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions.

Determining the most important goals for the patient and the corresponding nursing diagnosis provides the basis to create a heart failure care plan that can best support the patient while reaching those goals.

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Heart Failure Nursing Care Plan Components

A nursing care plan has several key components, including: 

• Nursing Diagnosis
• Expected outcome
• Nursing interventions and rationales
• Evaluation

Each of the five main components is essential to the overall nursing process and care plan. A properly written care plan must include these sections. Otherwise, it won’t make sense.

• Nursing diagnosis: A clinical judgment that helps nurses determine the plan of care for their patients
• Expected outcome: The measurable action for a patient to be achieved in a specific time frame. 
• Nursing interventions and rationales: Actions to be taken to achieve expected outcomes and reasoning behind them.
• Evaluation: Determines the effectiveness of the nursing interventions and determines if expected outcomes are met within the time set.

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Heart Failure Nursing Care Plan Examples

All nursing diagnoses must be NANDA-I approved and have corresponding definitions to help guide nurses in writing a nursing care plan.

Heart failure itself isn’t a NANDA diagnosis, and individuals who are diagnosed with heart failure will have other nursing diagnoses and care plans that incorporate the heart failure diagnosis.

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Other Nursing Care Plans

• Hypertension Nursing Care Plan
• Acute Pain Nursing Care Plan
• Infection Nursing Care Plan
• Constipation Nursing Care Plan
• Decreased Cardiac Output Nursing Care Plan
• COPD Nursing Care Plan
• Pneumonia Nursing Care Plan
• Diabetes Mellitus Nursing Care Plan
• Fluid Volume Deficit Nursing Care Plan
• Sepsis Nursing Care Plan
• Impaired Physical Mobility Nursing Care Plan
• Risk for Falls Nursing Care Plan
• Atrial Fibrillation (AFib) Nursing Care Plan

References

Nursing Care Plan