Heart Failure CHF Nursing Diagnosis with Care Plans

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Heart failure, also known as congestive heart failure (CHF), is a complex cardiac condition that requires thorough nursing assessment and care.

Understanding Heart Failure

Heart failure occurs when the heart muscle cannot pump blood effectively to meet the body’s needs. This can result from various underlying conditions, including coronary artery disease, hypertension, and valvular heart disease.

Types of Heart Failure

Heart failure can be classified into two main types:

  1. Systolic heart failure: The heart’s ability to contract is impaired.
  2. Diastolic heart failure: The heart’s ability to relax and fill with blood is impaired.

Stages of Heart Failure

The American Heart Association and American College of Cardiology classify heart failure into four stages:

  • Stage A: High risk for developing heart failure
  • Stage B: Structural heart disease but without signs or symptoms
  • Stage C: Structural heart disease with prior or current symptoms
  • Stage D: Refractory heart failure requiring specialized interventions

Nursing Assessment for Heart Failure

A thorough nursing assessment is essential for developing an accurate nursing diagnosis and care plan. Key areas to assess include:

1. Health History

  • Past medical history
  • Current medications
  • Family history of cardiac conditions
  • Risk factors (e.g., smoking, obesity, hypertension)

2. Physical Examination

  • Vital signs (blood pressure, heart rate, respiratory rate, temperature)
  • Oxygen saturation
  • Presence of edema
  • Jugular venous distension
  • Lung sounds (crackles, wheezes)
  • Heart sounds (S3 gallop, murmurs)

3. Diagnostic Tests

  • Electrocardiogram (ECG)
  • Chest X-ray
  • Echocardiogram
  • B-type natriuretic peptide (BNP) levels
  • Complete blood count (CBC)
  • Renal function tests

Common Nursing Diagnoses for Heart Failure

Based on the assessment findings, nurses can identify several potential nursing diagnoses for patients with heart failure. Here are five nursing diagnoses with their corresponding care plans:

1. Decreased Cardiac Output

Nursing Diagnosis Statement: Decreased Cardiac Output related to impaired myocardial contractility as evidenced by dyspnea, fatigue, and decreased ejection fraction.

Related factors/causes:

  • Altered heart rate/rhythm
  • Reduced myocardial contractility
  • Increased afterload
  • Valvular dysfunction

Nursing Interventions and Rationales:

  1. Monitor vital signs and hemodynamic parameters regularly.
    Rationale: Allows early detection of changes in cardiac function.
  2. Administer prescribed medications (e.g., diuretics, ACE inhibitors, beta-blockers).
    Rationale: Improves cardiac function and reduces symptoms.
  3. Position the patient in a semi-Fowler’s position.
    Rationale: Reduces venous return and improves breathing.
  4. Educate the patient on energy conservation techniques.
    Rationale: Helps manage fatigue and reduces cardiac workload.
  5. Monitor for signs of fluid overload (e.g., edema, weight gain).
    Rationale: Early detection allows prompt intervention.

Desired Outcomes:

  • The patient will demonstrate improved cardiac output as evidenced by stable vital signs and reduced symptoms of fatigue and dyspnea.
  • The patient will verbalize understanding of energy conservation techniques and medication regimen.

2. Excess Fluid Volume

Nursing Diagnosis Statement: Excess Fluid Volume related to decreased cardiac output and sodium-water retention as evidenced by peripheral edema, weight gain, and crackles on lung auscultation.

Related factors/causes:

  • Decreased cardiac output
  • Activation of renin-angiotensin-aldosterone system
  • Impaired renal perfusion

Nursing Interventions and Rationales:

  1. Implement and monitor fluid restrictions as ordered.
    Rationale: Helps prevent fluid overload and reduces cardiac workload.
  2. Weigh patient daily at the same time and under the same conditions.
    Rationale: Allows early detection of fluid retention.
  3. Administer diuretics as prescribed and monitor response.
    Rationale: Promotes fluid elimination and reduces edema.
  4. Educate the patient on a low-sodium diet and the importance of adherence.
    Rationale: Reduces fluid retention and supports the management of heart failure.
  5. Monitor intake and output closely.
    Rationale: Helps assess fluid balance and effectiveness of interventions.

Desired Outcomes:

  • The patient will demonstrate reduced fluid volume as evidenced by decreased edema and stable weight.
  • The patient will verbalize understanding of fluid and sodium restrictions.

3. Activity Intolerance

Nursing Diagnosis Statement: Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by dyspnea and fatigue with minimal exertion.

Related factors/causes:

  • Decreased cardiac output
  • Reduced oxygen-carrying capacity of blood
  • Skeletal muscle deconditioning

Nursing Interventions and Rationales:

  1. Assess patient’s tolerance to activity using a standardized scale (e.g., Borg Scale).
    Rationale: Provides a baseline for planning appropriate activity levels.
  2. Implement a progressive activity plan, starting with low-intensity activities.
    Rationale: Gradually improves exercise tolerance and prevents overexertion.
  3. Teach energy conservation techniques (e.g., sitting while performing tasks).
    Rationale: Reduces oxygen demand and manages fatigue.
  4. Administer oxygen therapy as prescribed during activities.
    Rationale: Improves oxygenation and reduces shortness of breath.
  5. Collaborate with physical therapy for individualized exercise plans.
    Rationale: Ensures safe and effective activity progression.

Desired Outcomes:

  • Patient will demonstrate improved activity tolerance as evidenced by increased ability to perform ADLs without excessive fatigue or dyspnea.
  • Patient will verbalize understanding of energy conservation techniques and activity limitations.

4. Ineffective Breathing Pattern

Nursing Diagnosis Statement: Ineffective Breathing Pattern related to pulmonary congestion as evidenced by dyspnea, orthopnea, and use of accessory muscles.

Related factors/causes:

  • Pulmonary edema
  • Decreased lung compliance
  • Anxiety

Nursing Interventions and Rationales:

  1. Position the patient in a high Fowler’s position or orthopneic position.
    Rationale: Promotes lung expansion and reduces respiratory effort.
  2. Teach and encourage pursed-lip breathing and diaphragmatic breathing.
    Rationale: Improves oxygenation and reduces the work of breathing.
  3. Administer oxygen therapy as prescribed.
    Rationale: Improves oxygenation and reduces respiratory distress.
  4. Auscultate lung sounds regularly.
    Rationale: Allows early detection of worsening pulmonary congestion.
  5. Teach anxiety-reduction techniques (e.g., relaxation exercises).
    Rationale: Reduces anxiety-induced dyspnea and improves breathing pattern.

Desired Outcomes:

  • The patient will demonstrate an improved breathing pattern, as evidenced by normal respiratory rate and depth and reduced use of accessory muscles.
  • The patient will verbalize understanding of breathing techniques and positioning to improve oxygenation.

5. Knowledge Deficit

Nursing Diagnosis Statement: Knowledge Deficit related to lack of exposure to information about heart failure management as evidenced by verbalization of misunderstandings and non-adherence to treatment plan.

Related factors/causes:

  • Lack of exposure to heart failure education
  • Misinterpretation of information
  • Cognitive limitations

Nursing Interventions and Rationales:

  1. Assess the patient’s current knowledge and learning needs.
    Rationale: Allows tailoring of education to patient’s specific needs.
  2. Provide education on heart failure pathophysiology, symptoms, and management.
    Rationale: Improves patient understanding and promotes self-management.
  3. Teach the importance of medication adherence and potential side effects.
    Rationale: Promotes treatment adherence and early recognition of adverse effects.
  4. Instruct on daily weight monitoring and when to report changes.
    Rationale: Enables early detection of fluid retention and prompt intervention.
  5. Provide written materials and utilize the teach-back method.
    Rationale: Reinforces learning and assesses understanding.

Desired Outcomes:

  • The patient will verbalize an accurate understanding of heart failure and its management.
  • The patient will demonstrate adherence to the treatment plan, including medication regimen and lifestyle modifications.

Conclusion

Effective nursing care for patients with heart failure requires a comprehensive understanding of the condition, thorough assessment skills, and the ability to develop and implement appropriate care plans.

By utilizing these nursing diagnoses and interventions, nurses can significantly improve outcomes and quality of life for patients with heart failure.

References

  1. American Heart Association. (2022). Types of Heart Failure. Retrieved from https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure
  2. Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … & Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.
  3. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
  4. Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
  5. Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., … & Rich, M. W. (2015). Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure, 8(3), 655-687.
  6. Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Van Der Meer, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 37(27), 2129-2200.
  7. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.
  8. Seferovic, P. M., Ponikowski, P., Anker, S. D., Bauersachs, J., Chioncel, O., Cleland, J. G., … & Coats, A. J. (2019). Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, 21(10), 1169-1186.

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