Conditions › Cardiovascular
Heart Failure Nursing Care Plan and Interventions
Heart failure nursing care focuses on fluid: daily weights, lung sounds, edema and intake and output, plus loop diuretics with potassium checks. For acute shortness of breath, sit the client up, give oxygen and diuretics as ordered, and teach daily weights, sodium limits and when to call.
Heart failure nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Decreased cardiac output | Stable vital signs, better activity tolerance, BNP trending down. | |
| Excess fluid volume | Weight back to dry weight, clearer lungs, less edema. | |
| Impaired gas exchange (pulmonary edema risk) | SpO2 at goal; no orthostatic or nighttime breathlessness. | |
| Health maintenance: needs teaching | Weighs daily and reports a gain of 2 to 3 lb in a day or 5 lb in a week, per teaching. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Heart failure: what it is
The heart can't pump enough blood for the body's needs. Blood backs up behind the weak side, and forward flow to organs drops. 1
Top causes: coronary artery disease, a heart attack and years of high blood pressure.
HFrEF vs HFpEF
HFrEF: a weak squeeze, ejection fraction (EF) 40% or less. HFpEF: a stiff ventricle that can't fill, so EF stays normal. 1
Weak squeeze is the old "systolic" HF. Stiff, poor filling is the old "diastolic" HF.
What causes right-sided HF
Left-sided failure eventually strains the right side. Lung disease (cor pulmonale) or a pulmonary embolism can also cause it. 2
Left fails first, then right: a long-time HF client can have crackles and leg edema at once.
Assessment: what you will see
Left-sided HF: think lungs
The left ventricle can't move blood forward, so it backs up into the lungs: dyspnea, crackles, wet cough, pink frothy sputum, low SpO2. 3,2
Left = Lungs. Crackles at the bases with SpO2 under 92% point to fluid in the lungs.
Orthopnea and PND
Orthopnea: short of breath lying flat, so the client sleeps on extra pillows or in a recliner. PND: waking at night gasping for air. 3,2
Ask how many pillows the client sleeps on. A rising number signals worsening left-sided HF.
Right-sided HF: think body
The right ventricle can't move blood into the lungs, so it backs up in the veins: JVD, swollen legs and ankles, a big liver, ascites. 2
Right = Rest of the body. A congested liver causes nausea, bloating and poor appetite.
BNP in heart failure
Brain natriuretic peptide rises when the heart's chambers are stretched. Normal is under 100 pg/mL. 3
BNP climbing from 500 to 1,500 means worsening HF. Read the trend with the client's symptoms.
Complications and red flags
Acute pulmonary edema
Fluid floods the lungs fast: severe dyspnea, rapid breathing, crackles, pink frothy sputum, bluish skin, restlessness. An emergency. 2
Triggers: very high BP, a heart attack, skipped HF meds or a salty meal.
Priority: what the nurse does first
Can't breathe: first actions
High Fowler's position, oxygen as ordered to keep SpO2 over 92%, notify the provider, and expect an IV loop diuretic. 3,4
Oxygenation is the top priority in HF. Sitting the client up takes seconds and helps at once.
Nursing interventions and treatment
Furosemide (loop diuretic)
Pulls off fluid to lower preload. Watch potassium (it drops), BUN and creatinine. Too much causes dehydration and low BP. 3,4
Give an IV push slowly, over 1 to 2 minutes. A fast push can cause hearing loss.
Core drugs for HFrEF
An ACE inhibitor, ARB or ARNI (sacubitril/valsartan), a beta blocker, an MRA such as spironolactone and an SGLT2 inhibitor, plus a diuretic. 1,5
The diuretic treats the fluid. The others protect the heart long term, so they continue on good days.
ACE inhibitor, ARB, ARNI cautions
Watch BP and potassium (it can rise). ACE inhibitors can cause a dry cough. Swelling of the face or tongue (angioedema) is an emergency. 5
Teach: avoid salt substitutes. They are high in potassium.
Beta blockers in HF
Carvedilol, metoprolol succinate or bisoprolol slow the heart so it fills better. Hold for HR under 50 to 60 or low BP, per orders. 6
Taper, never stop suddenly: angina or a heart attack can follow.
Digoxin in HF
Strengthens each beat and slows the rate. Count the apical pulse for 1 full minute; hold if under 60. 7,4
On furosemide too? Check potassium: low levels make digoxin toxic. Watch for nausea and halos.
Evaluation: is care working?
Daily weights
Same time each morning, after voiding, same scale and clothing. Report a gain of 2 to 3 lb in a day or 5 lb in a week. 1,3
Daily weight plus strict intake and output show whether the diuretic is working.
Signs HF care is working
Daily care without dyspnea, SpO2 at 92% or higher, edema 2+ or less, stable weight and BP in the client's target range. 3
Worse: rising weight, new crackles, more pillows at night. Report it.
Client teaching
Heart failure teaching
Sodium under 2,000 mg a day, weigh every morning, take meds daily, no tobacco, little or no alcohol, stay active as able. 1
Canned foods, frozen meals and fast food hide the most sodium. Teach label reading.
Try 3 heart failure questions
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Physiological Adaptation
A nurse is assessing a client with left-sided heart failure. Which findings should the nurse expect? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, E, F. Left-sided heart failure causes blood to back up into the lungs, producing pulmonary congestion with crackles, dyspnea, and orthopnea. Jugular vein distention, ascites, and peripheral edema occur when blood backs up into the systemic circulation, which is characteristic of right-sided heart failure instead. Remembering 'Left = Lungs, Right = Rest of body' helps differentiate these presentations quickly. Correctly identifying which side is failing guides appropriate nursing interventions.
Checked against: OpenStax Medical-Surgical Nursing, 12.3; OpenStax Medical-Surgical Nursing, 12.7
Question 2 · Physiological Adaptation
A nurse auscultates the lungs of a patient with a history of heart failure and hears discontinuous, popping sounds during inspiration. The nurse should document this finding as which of the following?
Show answer and rationale
Answer: C. Crackles (rales) are discontinuous popping sounds heard on inspiration and suggest fluid in the airways or alveoli, commonly seen in conditions such as CHF and pneumonia. Wheezes are high-pitched, musical, and typically expiratory, associated with narrowed airways such as in asthma or COPD, not this presentation. Bronchial sounds are loud and high-pitched and are abnormal when heard over the peripheral lung fields rather than the trachea. Vesicular sounds are the normal, soft breath sounds heard over the lung periphery and would not present as popping, discontinuous sounds.
Checked against: OpenStax Clinical Nursing Skills, 23.3
Question 3 · Pharmacological and Parenteral Therapies
A nurse is caring for a client receiving furosemide for heart failure. Which findings should the nurse monitor for as potential adverse effects? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, E. Loop diuretics such as furosemide (-ide) cause potent diuresis that can lead to hypokalemia, ototoxicity (including tinnitus), and muscle cramps due to electrolyte loss. Hyperkalemia is not expected with loop diuretics; instead, potassium loss is the concern. Hypoglycemia is not a typical adverse effect of loop diuretics; hyperglycemia is more associated with thiazide diuretics (-thiazide).
Checked against: OpenStax Pharmacology for Nurses, 34.2; OpenStax Medical-Surgical Nursing, 10.3
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Frequently asked questions
What are the priority nursing diagnoses for heart failure?
Common nursing problems for heart failure include decreased cardiac output; excess fluid volume; impaired gas exchange (pulmonary edema risk); health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for heart failure?
High Fowler's position, oxygen as ordered to keep SpO2 over 92%, notify the provider, and expect an IV loop diuretic.
What are the causes of heart failure exacerbations?
Common triggers include eating too much sodium, missing medications (especially diuretics), drinking too much fluid, uncontrolled high blood pressure, new atrial fibrillation or other dysrhythmias, infection and a heart attack. Teaching daily weights helps clients catch fluid buildup before it becomes an emergency.
What are the treatment options for right heart failure?
Treatment targets the cause and the fluid backup. Loop diuretics remove excess fluid, and the underlying problem is treated, such as left-sided heart failure, lung disease or pulmonary hypertension. Nurses monitor daily weights, edema, jugular vein distention, intake and output and potassium on diuretics.
More cardiovascular
Related cheat sheets
Sources
- OpenStax Pharmacology for Nurses, 19.1
- merckmanuals.com
- OpenStax Medical-Surgical Nursing, 12.3
- OpenStax Pharmacology for Nurses, 34.2
- OpenStax Pharmacology for Nurses, 19.2
- OpenStax Pharmacology for Nurses, 19.3
- OpenStax Pharmacology for Nurses, 19.6
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.