Last updated on February 20th, 2023 at 08:45 am
CHF can affect either both sides of the heart or just one side. The three types of CHF are biventricular, left-sided, and right-sided heart failure. In left-sided heart failure, the left ventricle becomes enlarged (hypertrophy) and becomes dilated together with the left atrium in order to compensate for the increased pressure.
Right-sided heart failure usually happens after left-sided heart failure. Pooling of blood in the left heart chambers causes an increase in pressure, impairing the normal blood drainage from the lungs to the left atrium.
The pressure in the pulmonary veins increases, causing the right ventricle to compensate by pumping more vigorously.
In time, the cardiac muscles of the right chambers wear down, causing right-sided heart failure. Failure of both sides of the heart is called biventricular heart failure.
Congestion is one of the common features of heart failure, thus the term “congestive heart failure” is still used by many medical professionals.
Signs and Symptoms of Heart Failure
- Dyspnea (shortness of breath) upon exertion or lying down
- Jugular vein distention (JVD)
- Fatigue and reduced ability to exercise
- Peripheral edema (swelling of limbs, ankles, and feet)
- Pulmonary edema
- Ascites (swelling of the abdominal cavity)
- Irregular and/or rapid heartbeat
- Cough and wheezing – may come with white or blood-tinged sputum
- Nausea and lack of appetite
- Decreased level of alertness and concentration
- Increased urinary frequency at night
- Chest pain if the HF is caused by myocardial infarction (heart attack)
Causes of Heart Failure
- Myocardial Infarction (heart attack) and Coronary Artery Disease (CAD). These are the most common causes of heart failure. Fat buildup on the arterial walls leads to the reduction of blood flow, resulting to cardiac arrest.
- Hypertension. Having a high blood pressure causes the heart to work harder than normal in order to facilitate the blood circulation throughout the body. This makes the cardiac muscles stiffer and/or weaker, leading to heart failure.
- Alcohol, tobacco, and drug abuse. The toxic effects of alcohol, nicotine, and drugs (e.g. cocaine) may lead to the damage of the cardiac muscles known as cardiomyopathy.
- Congenital heart defects. Faulty heart chambers or valves at birth can directly affect the functionality of the heart.
- Other heart conditions. Viral infections such as COVID-19 may cause inflammation of the cardiac muscles known as myocarditis.
- Chronic diseases. HIV, diabetes, arrythmias, and thyroid problems may lead to heart failure.
- Certain medications. Non-steroidal inflammatory drugs (NSAIDS), several anaesthesia drugs, chemotherapy agents, and some antihypertensives puts a person at a higher risk for heart problems which may eventually lead to heart failure.
Complications of Heart Failure
- Kidney damage. A reduction of blood flow from the heart to the kidneys may result to reduce capacity of the kidneys to remove toxic waste. If left untreated, this may lead to kidney failure which may require the patient to undergo dialysis.
- Liver damage. Fluid build up may result to an increased pressure to the liver. If left untreated, this may result to liver damage known as scarring.
- Other cardiac issues. Heart failure may result to faulty heart valves and arrythmias if there is an increased pressure in the heart or enlargement of the heart.
Diagnostic Tests for Heart Failure
- Physical examination – crackles heard upon auscultation, signs of edema upon inspection
- Blood tests – CBC, biochemistry, N-terminal pro-B-type natriuretic peptide (NT-proBNP)
- Imaging – Chest X-Ray, Echocardiogram, CT scan, MRI, coronary angiogram (insertion of a catheter and injecting a dye for visualization)
- Electrocardiogram
- Stress test – letting the patient walk on a treadmill while attached to an ECG machine
- Myocardial biopsy – insertion of a biopsy cord in a vein in the neck or groin to take heart muscle tissue samples
Treatment for Heart Failure
- Medications. Several medications are used in combination to treat heart failure. These include:
- Angiotensin-converting enzyme (ACE) inhibitors – promotes vasodilation of the blood vessels, lowering the pressure and improving the blood flow (e.g. lisinopril and enalapril).
- Beta blockers – reduces heart rate and blood pressure (e.g. bisoprolol and carvedilol).
- Angiotensin II receptor blockers – similar to ACE inhibitors and can be used if the patient does not tolerate ACE inhibitors (e.g. losartan and valsartan).
- Digitalis or digoxin – improves the contraction of heart muscles, regulate heart rhythm and reduces heartbeat.
- Inotropes – to improve the function of the heart to pump blood in severe heart failure.
- Diuretics – to facilitate elimination of excess fluid in the body through urination (e.g. furosemide and spironolactone).
- Inotropes. These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
2. Surgical interventions. These include coronary bypass surgery, heart valve repair or replacement, and heart transplant. It may also involve the insertion of medical devices such as implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and ventricular assist devices (VADs).
3. Lifestyle changes. A crucial part of the treatment plan for a patient with heart failure is to change several habits that are linked to the disease. These include smoking cessation, blood pressure control, diabetes management, dietary changes, stress management, exercise and increase in physical activity.
CHF Nursing Diagnosis
CHF Nursing Care Plan 1
Nursing Diagnosis: Decreased Cardiac Output related to increased preload and afterload and impaired contractility as evidenced by irregular heartbeat, heart rate of 128, dyspnea upon exertion, and fatigue.
Desired outcome: The patient will be able to maintain adequate cardiac output.
| CHF Nursing Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician. |
| Administer the cardiac medications, and diuretics as prescribed. | To alleviate the symptoms of heart failure and to treat the underlying condition. |
| Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value of at least 94%. |
| Educate patient on stress management, deep breathing exercises, and relaxation techniques. | Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. |
CHF Nursing Care Plan 2
Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures as evidenced by shortness of breath, SpO2 level of 85%, and crackles upon auscultation.
Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.
| CHF Nursing Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. |
| Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value within the target of at least 94%. |
| Encourage small but frequent meals. | To avoid abdominal distention and diaphragm elevation which lead to a decrease in lung capacity. |
| Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. | Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively. |
CHF Nursing Care Plan 3
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Congestive Heart Failure as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of congestive heart failure and its management.
| CHF Nursing Interventions | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of CHF and to help the patient overcome blocks to learning. | |
| Explain what CHF is, its types (specifically whether the CHF of the patient is left-sided, right-sided, or biventricular). Avoid using medical jargons and explain in layman’s terms. | To provide information on CHF and its pathophysiology in the simplest way possible. |
| Educate the patient about lifestyle changes that can help manage CHF. Create a plan for Activities of Daily Living (ADLs) with the patient that involve smoking cessation, increase in physical activity, dietary changes, blood pressure control, stress management, and diabetes management (if patient has diabetes). | Smoking, sedentary lifestyle, poor dietary choices, poor blood pressure control, chronic stress, and unmanaged diabetes are linked to CHF. |
| Inform the patient the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) to treat heart failure. Ask the patient to repeat or demonstrate the self-administration details to you. | To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. |
| Refer the patient to a dietitian and physiotherapist. | To enable to patient to receive more information in managing diet and physical activity from specific members of the healthcare team. |
CHF Nursing Care Plan 4
Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
| CHF Nursing Interventions | Rationales |
| Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. | To create a baseline of activity levels and mental status related to fatigue and activity intolerance. |
| Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep. | To gradually increase the patient’s tolerance to physical activity. |
| Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. | To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room. |
| Refer the patient to physiotherapy / occupational therapy team as required. | To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity. |
CHF Nursing Care Plan 5
Nursing Diagnosis: Excess Fluid Volume related to decreased cardiac output and increased glomerular filtration rate (GFR) as evidenced by S3 heart sound, blood pressure level of 190/85, orthopnea, pitting edema of the ankles, and weight gain
Desired Outcome: The patient will demonstrate a balanced input and output, and stabilized fluid volume
| CHF Nursing Interventions | Rationales |
| Assess vital signs and auscultate lungs to find any crackles or wheezes. | Heart failure, especially left-sided HF may lead to pulmonary congestion, as evidenced by crackles or wheezes upon auscultation of the lungs. |
| Commence a fluid balance chart, monitoring the input and output of the patient. | To monitor patient’s fluid volume accurately and effectiveness of actions to monitor the progress of excess fluid volume. |
| Restrict fluid intake as instructed by the physician. | To reduce fluid volume and manage edema. |
| Weigh the patient on a daily basis. | Diuretics are needed to manage heart failure, but may put the patient at risk for sudden fluid loss, which is reflected through his/her weight. |
| Monitor patient’s serum electrolytes and renal function to the physician as needed. | The use of diuretics may result to excessive fluid shifts and electrolyte loss. |
CHF Nursing Care Plan 6
Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
| CHF Nursing Interventions | Rationale |
| Administer prescribed medications that alleviate the symptoms of acute chest pain (angina). | Aspirin may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, calcium channel blockers, and Ranolazine. |
| Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication. | To monitor effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered. |
| Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value of at least 94%. |
| Place the patient in complete bed rest during angina attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques. | Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload. |
CHF Nursing Care Plan 7
Nursing Diagnosis: Ineffective Breathing Pattern related to pulmonary congestion secondary to CHF as evidenced by shortness of breath, SpO2 level of 85%, cough, respiratory rate of 25 bpm, and frothy sputum
Desired Outcome: The patient will achieve effective breathing pattern as evidenced by normal respiratory rate, oxygen saturation within target range, and verbalize ease of breathing.
| CHF Nursing Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. |
| Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value within the target range at least 96% (88-92% in a COPD patient) |
| Administer the prescribed bronchodilators, steroids, or combination inhalers / nebulizers, as prescribed. | Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Inhalers or nebulizers – To facilitate relaxation of the airway. |
| Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. | Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively. |
With proper use of the nursing process, a patient can benefit from various nursing interventions to assess, monitor, and manage heart failure and promote client safety and wellbeing.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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