Heart Failure Nursing Care Plan

1. Improving cardiac output

• Monitor apical pulse for a full minute, rhythm, blood pressure and peripheral pulses; tachycardia is the earliest compensation and an irregular rhythm suggests new atrial fibrillation, which can drop output by up to 20 percent.
• Auscultate for an S3 gallop — in an adult it is a hallmark of volume overload and a failing ventricle.
• Assess mentation, skin temperature, capillary refill and urine output each shift; these are bedside indicators of whether organs are being perfused, and they change before laboratory values do.
• Keep the patient in semi- to high-Fowler's position to reduce venous return and ease the work of the heart and diaphragm.
• Space nursing activities and allow uninterrupted rest periods; clustering everything at once produces a demand the failing heart cannot meet.
• Give prescribed medications on schedule and evaluate their effect: ACE inhibitors or ARBs and ARNI to reduce afterload, beta blockers to slow the rate and improve remodeling long-term, aldosterone antagonists, SGLT2 inhibitors and digoxin for contractility and rate control.
• Hold and report per parameters — check apical rate before beta blockers and digoxin, and blood pressure before vasodilators.

2. Relieving congestion and improving gas exchange

• Auscultate lungs at least every shift and after any change in symptoms; new or ascending crackles mean rising pulmonary pressure.
• Monitor respiratory rate, effort, oxygen saturation and the ability to speak in full sentences — a patient who can no longer finish a sentence is decompensating now.
• Deliver supplemental oxygen as ordered and titrate to the target saturation rather than to a fixed flow.
• Sit the patient upright with the legs dependent during acute dyspnea to pool blood peripherally and drop preload quickly.
• Encourage deep breathing, incentive spirometry and position changes to prevent atelectasis in a patient who is short of breath and reluctant to move.
• Report frothy, pink-tinged sputum, severe restlessness and a drop in saturation immediately — this is flash pulmonary edema and needs urgent treatment.

3. Managing fluid volume excess

• Weigh daily at the same time, on the same scale, in similar clothing after voiding; weight is a more sensitive measure of fluid status than intake and output records.
• Record accurate intake and output and honor the prescribed fluid restriction, spreading allowance across the day and offering ice chips and mouth care for thirst.
• Assess edema by location and depth, inspect the sacrum in bed-bound patients, and measure abdominal girth if ascites is present.
• Administer loop diuretics as ordered, preferably in the morning so diuresis does not disrupt sleep, and evaluate response by urine output and weight change.
• Monitor potassium, sodium, magnesium, BUN and creatinine — loop diuretics waste potassium and magnesium, which sets up arrhythmias and digoxin toxicity, while overdiuresis raises creatinine.
• Watch for orthostatic hypotension and dizziness once diuresis begins, and teach the patient to change position slowly.

4. Building activity tolerance

• Check heart rate, rhythm, blood pressure and symptoms before, during and after activity; stop for chest pain, dyspnea, dizziness, a drop in systolic pressure or a heart rate rise more than about 20 beats above baseline.
• Progress activity gradually from dangling to chair to hallway, letting recovery time rather than distance guide advancement.
• Teach energy conservation: sit to bathe and dress, keep frequently used items at waist level, alternate heavy and light tasks, and plan the most demanding activity for the time of day energy is best.
• Refer to cardiac rehabilitation, which measurably improves function, symptoms and rehospitalization rates.

5. Nutrition, skin and comfort

• Support a low-sodium diet — usually about 2 g daily — and teach label reading, since most dietary sodium comes from processed foods rather than the salt shaker.
• Offer small, frequent, easily digested meals; a large meal diverts blood to the gut and worsens dyspnea.
• Inspect edematous and dependent skin every shift, reposition regularly, and protect stretched tissue, which breaks down and heals poorly.
• Elevate edematous limbs when the patient is sitting, and avoid pillows under the knees, which pool blood and encourage clots.
• Provide calm reassurance and a nurse's presence during dyspnea; anxiety raises catecholamines and heart rate, which worsens the very symptom the patient fears.

What are the nursing diagnoses for Heart Failure?

Priority nursing diagnoses for Heart Failure: Decreased cardiac output; Excess fluid volume; Activity intolerance; Impaired gas exchange.

What are the nursing interventions for Heart Failure?

Monitor apical pulse for a full minute, rhythm, blood pressure and peripheral pulses; tachycardia is the earliest compensation and an irregular rhythm suggests new atrial fibrillation, which can drop output by up to 20 percent. Auscultate for an S3 gallop — in an adult it is a hallmark of volume overload and a failing ventricle. Assess mentation, skin temperature, capillary refill and urine output each shift; these are bedside indicators of whether organs are being perfused, and they change before laboratory values do. Keep the patient in semi- to high-Fowler's position to reduce venous return and ease the work of the heart and diaphragm. Space nursing activities and allow uninterrupted rest periods; clustering everything at once produces a demand the failing heart cannot meet. Give prescribed medications on schedule and evaluate their effect: ACE inhibitors or ARBs and ARNI to reduce afterload, beta blockers to slow the rate and improve remodeling long-term, aldosterone antagonists, SGLT2 inhibitors and digoxin for contractility and rate control.

What are the nursing care goals for Heart Failure?

The client will demonstrate improved cardiac output as evidenced by blood pressure and heart rate within their target range, palpable peripheral pulses, warm dry skin and clear mentation. The client will show reduced congestion with clearing breath sounds, respiratory rate within normal range and oxygen saturation above the ordered threshold. The client will achieve stable fluid balance with a steady daily weight, urine output greater than 30 mL/hr and decreasing edema. The client will perform self-care activities with a heart rate and blood pressure response within acceptable limits and no reported dyspnea. The client will verbalize the daily weight rule, sodium and fluid limits, and the exact symptoms that require a call before discharge.

What should you assess in a patient with Heart Failure?

Shortness of breath with exertion, lying flat, or waking the patient at night; Fatigue, weakness and reduced exercise tolerance out of proportion to activity; Reports of tight shoes or rings, swollen ankles, or clothing not fitting; Palpitations, chest heaviness, dizziness or near-fainting; Loss of appetite, early fullness or nausea from hepatic and bowel congestion; Anxiety and a sense of suffocation during episodes of dyspnea; Crackles that do not clear with coughing, wheezing, tachypnea, use of accessory muscles; S3 gallop, tachycardia, irregular rhythm, murmurs, displaced apical impulse; Jugular venous distention, hepatojugular reflux, hepatomegaly, ascites; Dependent pitting edema, sacral edema in bed-bound patients, rapid weight gain; Falling oxygen saturation, cool clammy extremities, delayed capillary refill, weak thready pulses; Decreased urine output during the day with nocturia, rising BUN and creatinine; Restlessness or confusion from reduced cerebral perfusion; Chest x-ray congestion, elevated BNP, echocardiographic ejection fraction