Heart Failure Nursing Care Plan: 2 Sample Plans and Interventions

Heart failure means the heart cannot pump enough blood to meet the body's needs. Fluid backs up into the lungs (left-sided) or the body (right-sided). Your priorities are breathing, fluid balance, and teaching the client to catch early warning signs at home.

A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation

Each care plan below follows the nursing process (ADPIE).

CARE PLAN 1 · NURSING DIAGNOSIS

Excess Fluid Volume

Related to

Reduced cardiac output and kidney perfusion
Sodium and water retention
Not taking diuretics as prescribed

As evidenced by

Weight gain of 1 kg (2.2 lb) or more in a day or 2.3 kg (5 lb) in a week
Crackles in the lung bases
Pitting edema and jugular vein distention
Intake greater than output

PLANNING · EXPECTED OUTCOMES

Short-term goals

Lungs clear or improving within 24 to 48 hours
Weight down toward the client's dry weight

Long-term goals

Client keeps a stable weight at home with daily weights and a low-sodium diet
Client states when to call the provider

ASSESSMENT

Daily weight, same scale, same time, before breakfast
Strict intake and output
Lung sounds, edema, and JVD every shift
Potassium, sodium, BUN, and creatinine

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Give diuretics as ordered and check potassium	Loop diuretics remove fluid but waste potassium, which raises the risk of dysrhythmias.
Restrict sodium and fluids as ordered	Less sodium means less water retention.
Raise the head of the bed	Upright positioning reduces venous return and eases breathing.
Teach daily weights and the 2-and-5 rule	Weight gain is the earliest sign of fluid building up.

EVALUATION

Weight is decreasing and output is greater than intake
Crackles and edema are decreasing
Client demonstrates how to log daily weights

CARE PLAN 2 · NURSING DIAGNOSIS

Decreased Cardiac Output

Related to

Weak contraction of the heart muscle
Increased afterload

As evidenced by

Fatigue and activity intolerance
Tachycardia
Low ejection fraction
Cool skin and weak peripheral pulses

PLANNING · EXPECTED OUTCOMES

Short-term goals

Heart rate and BP stay within the ordered range
Client tolerates activity without chest pain or severe shortness of breath

Long-term goals

Client follows the medication plan and paces activities at home

ASSESSMENT

Apical pulse, BP, and rhythm
Peripheral pulses, skin color, and capillary refill
Urine output
Response to activity

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Give ordered medications such as beta blockers, ACE inhibitors or ARBs, and digoxin	These lower cardiac workload and improve pumping over time.
Cluster care and plan rest periods	Rest lowers oxygen demand on a weak heart.
Hold digoxin for an apical pulse under 60 (or per policy) and report	Slow pulse can signal digoxin toxicity.
Teach energy conservation	Pacing activities prevents exhaustion and symptom flares.

EVALUATION

Vital signs stay within the goal range
Client walks in the hall with only mild fatigue
Client names their heart medications and why they take them

Practice this in Priority Care

Decide who to see first on a busy unit, including clients in heart failure.

Play Priority Care

Quick answers

What is the priority nursing diagnosis for heart failure?

Usually Excess Fluid Volume or Impaired Gas Exchange, because fluid in the lungs threatens breathing first.

Why weigh a heart failure client every day?

Weight is the fastest, most reliable sign of fluid buildup. A quick gain can show up before the client feels short of breath.

For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.