Heart failure (HF) is a chronic condition where the heart is unable to pump blood efficiently to meet the body’s needs. It can affect one or both sides of the heart and often develops due to conditions like high blood pressure, coronary artery disease, or previous heart attacks. The heart compensates by working harder, but over time, this leads to symptoms such as fatigue, shortness of breath, fluid retention, and reduced exercise tolerance.
Types of Heart Failure
- Left-sided heart failure: The most common type, where the left ventricle cannot pump blood effectively to the body, leading to fluid buildup in the lungs (pulmonary congestion).
- Right-sided heart failure: Often a result of left-sided failure, right-sided heart failure affects the lungs and causes fluid buildup in the abdomen, legs, and feet.
- Congestive heart failure: A term sometimes used to describe when the heart failure results in fluid congestion in the body.
Risk Factors
Risk factors for heart failure include hypertension, diabetes, obesity, smoking, high cholesterol, and a family history of heart disease. Older adults are more likely to experience heart failure due to the gradual decline in heart function with age
Symptoms
Common symptoms of heart failure include:
- Shortness of breath, especially when lying flat or during physical activity
- Swelling in the legs, ankles, or abdomen
- Fatigue and weakness
- Difficulty concentrating or confusion
- Rapid or irregular heartbeat.
Management
While heart failure is a chronic condition, its symptoms can be managed with lifestyle changes, medications, and in some cases, medical devices. Medications like ACE inhibitors, diuretics, beta-blockers, and aldosterone antagonists can help control symptoms and improve quality of life
Nurse Journal. In severe cases, surgical options such as heart transplants or the implantation of devices like pacemakers may be considered.
Proper management and treatment can help reduce symptoms, improve heart function, and enhance the patient’s overall quality of life.
Here is a complete nursing care plan for heart failure, including assessments, nursing diagnoses, goals, interventions, and rationales:
| Nursing Diagnosis | Goal/Expected Outcome | Interventions | Rationale |
|---|---|---|---|
| Decreased Cardiac Output | The patient will maintain adequate cardiac output, as evidenced by stable blood pressure, heart rate, and peripheral circulation. | 1. Monitor vital signs (heart rate, blood pressure, respiratory rate) every 4 hours. 2. Administer prescribed medications (e.g., diuretics, ACE inhibitors) as ordered. 3. Assess for signs of fluid retention (e.g., edema, weight gain). | Monitoring vitals helps detect early changes in heart function, such as reduced cardiac output. Diuretics and ACE inhibitors help improve heart performance by reducing fluid buildup and stress on the heart. Fluid retention signals worsening heart failure and is crucial for timely intervention. |
| Excess Fluid Volume | The patient will experience a reduction in edema and improve urinary output within 48 hours. | 1. Administer diuretics as prescribed. 2. Monitor daily weight to assess fluid retention. 3. Educate the patient on a low-sodium diet and fluid restriction. 4. Elevate the patient’s legs to reduce peripheral edema. | Diuretics promote fluid elimination, relieving edema. Daily weight tracking helps identify early signs of fluid buildup. Reducing sodium intake minimizes fluid retention. Leg elevation helps reduce swelling in the lower extremities by promoting venous return. |
| Ineffective Breathing Pattern | The patient will maintain an effective breathing pattern as evidenced by normal respiratory rate, no signs of shortness of breath, and improved oxygen saturation. | 1. Assess respiratory status regularly (e.g., rate, depth, use of accessory muscles). 2. Position the patient in a semi-Fowler’s position to promote lung expansion. 3. Administer supplemental oxygen if ordered. 4. Encourage pursed-lip breathing exercises. | Respiratory assessment identifies changes in breathing patterns that may indicate worsening heart failure. Semi-Fowler’s position facilitates better lung expansion and oxygenation. Oxygen therapy ensures adequate oxygen levels. Pursed-lip breathing reduces shortness of breath by improving airflow. |
| Risk for Impaired Skin Integrity | The patient will exhibit no signs of pressure ulcers or skin breakdown. | 1. Inspect skin regularly for signs of redness or breakdown, particularly over bony prominences. 2. Reposition the patient at least every 2 hours. 3. Apply skin barrier cream to areas at risk for breakdown. | Regular skin inspection helps detect early signs of breakdown, which can lead to ulcers. Repositioning prevents pressure injuries by redistributing body weight. Barrier creams protect skin from moisture, reducing the risk of breakdown. |
| Activity Intolerance | The patient will report an improvement in energy levels and ability to perform daily activities within 2 weeks. | 1. Encourage gradual increase in activity, starting with short walks. 2. Educate the patient on pacing activities and resting when needed. 3. Monitor oxygen saturation during activity. | Gradual increases in activity improve endurance without overexertion. Educating the patient on pacing prevents fatigue and reduces the risk of worsening symptoms. Monitoring oxygen levels ensures the patient is maintaining adequate oxygenation during physical activity. |
Evaluation
After the interventions, evaluate the patient’s progress towards the goals. For instance:
- Decreased Cardiac Output: Monitor for stable vitals and reduced signs of fluid retention.
- Excess Fluid Volume: Ensure weight loss and reduction in edema.
- Ineffective Breathing Pattern: Check for improved respiratory rate and oxygen saturation.
- Risk for Impaired Skin Integrity: Observe for intact skin and absence of ulcers.
- Activity Intolerance: Confirm increased activity tolerance without undue fatigue or shortness of breath.
Reference
- NurseJournal.org. (2024). How to manage heart failure in nursing care: Key strategies. Retrieved from NurseJournal.org
- Nurse Journal.Nurse.org. (2024). Heart failure: Nursing interventions and care plan development. Retrieved from Nurse.org
- NCLEX Practice Tests.National Institute of Health (NIH). (2024). Heart Failure: Diagnosis, Treatment, and Prevention. Retrieved from NIH.gov
