Congestive Heart Failure (CHF) Nursing Care Plan: Diagnosis, Interventions & Management – devshopsimplenursing

Congestive Heart Failure (CHF) Nursing Diagnosis & Care Plan

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By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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Jump to Sections

  1. What is Congestive Heart Failure?
  2. Nursing Process for CHF
  3. Nursing Diagnoses for CHF
  4. Nursing Goals for CHF Patients/
  5. Nursing Interventions for CHF & Rationales
  6. Evaluation: How to Measure Patient Progress
  7. Discharge & Home Care Guidelines for CHF Patients
  8. Recommended References

A congestive heart failure (CHF) nursing diagnosis calls for close monitoring and a solid game plan to keep symptoms in check.

A well-structured CHF nursing care plan helps manage fluid overload, boost heart function, and improve patient outcomes.

What is Congestive Heart Failure?

Recognizing the risk factors, causes, and symptoms of CHF is key to early detection and effective nursing care. 

As the condition progresses, fluid buildup and worsening symptoms make timely intervention critical. A deeper understanding of CHF helps nurses implement the right interventions and improve patient outcomes.

Overview of CHF 

CHF is a progressive, chronic condition where the heart cannot pump blood effectively. This leads to fluid buildup in the lungs and other parts of the body. 

It affects the left and right sides of the heart, presenting as either systolic (reduced ejection fraction) or diastolic (preserved ejection fraction) heart failure.

Causes & Risk Factors 

Several lifestyle factors and underlying conditions contribute to the development of CHF.

Identifying and managing them is essential in preventing disease progression and improving patient outcomes.

Signs & Symptoms 

CHF symptoms develop as the heart struggles to pump blood, leading to fluid buildup and decreased oxygen delivery.

Common signs and symptoms include: 

  • Shortness of breath (dyspnea) – Worsens with exertion or while lying flat
  • Peripheral edema – Swelling in legs, ankles, and feet 
  • Fatigue and weakness – Due to decreased cardiac output 
  • Cough and wheezing – Fluid accumulation in the lungs 
  • Rapid or irregular heartbeat (tachycardia, arrhythmias) 
  • Weight gain – From fluid retention 
  • Nocturia – Increased urination at night due to fluid shifts 

Nursing Process for CHF 

Effective CHF management starts with a structured nursing process. 

Nursing Assessment for CHF 

A thorough nursing assessment includes reviewing health history, conducting diagnostic tests, and performing a physical exam. These steps help determine the appropriate CHF nursing diagnosis and guide the development of a personalized care plan.

Health History 

  • History of heart disease, high blood pressure, or diabetes 
  • Smoking, alcohol, and drug use 
  • Medication compliance and adherence 
  • Dietary habits (high sodium intake, fluid intake) 
  • History of recent weight gain or swelling 

Physical Examination 

  • Vital signs: Tachycardia, irregular pulse, high or low BP 
  • Lung sounds: Crackles or wheezing indicating fluid buildup 
  • Heart sounds: S3 or S4 gallop indicating heart strain 
  • Edema: Pitting edema in lower extremities 
  • Jugular venous distention (JVD): Indicator of right-sided heart failure 

Diagnostic Tests 

  • Echocardiogram: Evaluates ejection fraction and cardiac function 
  • Brain natriuretic peptide test: Elevated in heart failure 
  • Chest X-ray: Shows pulmonary congestion or cardiomegaly 
  • Electrocardiogram (ECG): Detects arrhythmias or ischemia 
  • Serum electrolytes and kidney function tests: Monitors for imbalances 

Nursing Diagnoses for CHF 

An accurate congestive heart failure nursing diagnosis ensures the patient receives targeted, effective care.

Decreased Cardiac Output 

  • Related to myocardial dysfunction and impaired ventricular function 
  • Evidence: Tachycardia, hypotension, reduced ejection fraction, fatigue  

Excess Fluid Volume 

  • Related to sodium and water retention due to decreased kidney perfusion 
  • Evidence: Weight gain, edema, pulmonary congestion, JVD  

Impaired Gas Exchange

  • Related to pulmonary edema and decreased oxygenation 
  • Evidence: Dyspnea, crackles in lungs, cyanosis, decreased oxygen saturation

Activity Intolerance 

  • Related to reduced oxygen supply to tissues 
  • Evidence: Shortness of breath with exertion, fatigue, weakness 

Risk for Unstable Blood Pressure 

  • Related to fluid overload or inadequate cardiac output 
  • Evidence: Fluctuating BP readings, dizziness, syncope 

Ineffective Health Maintenance 

  • Related to lack of knowledge or noncompliance with treatment 
  • Evidence: Poor medication adherence, worsening symptoms, frequent hospitalizations 

Nursing Goals for CHF Patients 

Clear nursing goals help guide patient care and ensure targeted nursing interventions based on an accurate nursing diagnosis for CHF.

These objectives help prevent complications and enhance quality of life.

  • Improve cardiac output to enhance perfusion and oxygen delivery 
  • Manage fluid volume to prevent overload and complications 
  • Enhance respiratory function to reduce shortness of breath and improve oxygenation 
  • Promote patient education and self-care to ensure adherence to treatment plans and prevent readmission 

Nursing Interventions for CHF & Rationales 

Effective nursing interventions for CHF improve patient outcomes and prevent disease progression. 

Each intervention — backed by evidence-based rationales — ensures safe, effective CHF nursing care,  which helps patients manage symptoms and reduce complications.

Improve Cardiac Output 

Keeping the heart pumping efficiently is a top priority in CHF nursing care. 

A well-structured nursing care plan for congestive cardiac failure focuses on maintaining adequate output to ensure oxygen and nutrients reach vital organs. The right nursing interventions for CHF help reduce heart strain and control symptoms.

Monitor vitals and ECG 

  • Rationale: Detects arrhythmias and signs of worsening cardiac function 

Administer prescribed medications 

  • Diuretics (e.g., Furosemide): Reduces fluid overload 
  • Angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), e.g., Lisinopril, Losartan: Lowers BP and improves heart function 
  • Beta-blockers (e.g., Metoprolol): Reduces heart workload  

Encourage rest and monitor exertion 

  • Rationale: Prevents overexertion and reduces myocardial oxygen demand 

Manage Fluid Volume and Prevent Overload 

Fluid buildup is one of the biggest challenges in CHF nursing care, leading to swelling, weight gain, and difficulty breathing. 

An accurate nursing diagnosis for heart failure helps guide interventions that prevent complications and improve patient outcomes.

Monitor daily weights and intake and output (I&O) 

  • Rationale: Sudden weight gain signals fluid retention and worsening CHF 

Educate on sodium and fluid restrictions 

  • Rationale: Reduces fluid retention and prevents worsening symptoms 

Assess for edema and pulmonary congestion 

  • Rationale: Early detection of worsening CHF and need for medication adjustment 

Optimize Oxygenation & Respiratory Function 

Maintaining proper oxygenation is crucial for patients with CHF, as fluid accumulation in the lungs can impair gas exchange. 

These interventions can help ease respiratory distress and improve overall lung function.

Monitor oxygen saturation and provide oxygen therapy 

  • Rationale: Ensures adequate oxygen supply to tissues 

Position patient in semi-Fowler’s for easier breathing 

  • Rationale: Improves lung expansion and reduces work of breathing  

Educate on breathing exercises 

  • Rationale: Prevents respiratory complications and improves lung function  

Encourage Lifestyle Modifications & Self-Care 

Long-term management of CHF extends beyond the hospital setting, requiring lifestyle adjustments and patient education. 

The following interventions are key components of an effective CHF nursing care plan to enhance patient quality of life.

Educate on diet and medication adherence 

  • Rationale: Helps prevent fluid overload and improves heart function  

Support smoking cessation and exercise routines 

  • Rationale: Reduces CHF risk factors and promotes cardiovascular health  

Provide emotional and mental health support 

  • Rationale: CHF can cause anxiety and depression, impacting self-care adherence 

Evaluation: How to Measure Patient Progress 

Ongoing assessment determines the effectiveness of CHF nursing interventions. 

Adjustments to the nursing care plan for heart failure may be necessary if symptoms persist or worsen.

Signs of improved cardiac output 

  • Stable vital signs and improved perfusion 
  • Reduced fatigue and better tolerance to activity  

Reduced fluid retention and dyspnea 

  • No new weight gain or edema 
  • Decreased shortness of breath and improved oxygenation  

Adherence to treatment plans 

  • Consistent medication compliance 
  • Following dietary restrictions and self-monitoring symptoms  

Discharge & Home Care Guidelines for CHF Patients 

Comprehensive discharge planning supports long-term disease management. 

The following guidelines are critical to patient education to prevent readmission and promote self-care.

Medication Compliance 

  • Take all medications as prescribed.
  • Monitor for side effects and report concerns to a healthcare provider.

Dietary Adjustments 

  • Limit sodium intake (<2g/day) to prevent fluid retention
  • Restrict fluid intake if advised by a healthcare provider  

Monitoring for Symptoms of Worsening CHF 

  • Watch for sudden weight gain (>2-3 lbs in a day) 
  • Report increased shortness of breath or swelling 
  • Monitor blood pressure and pulse regularly  

Access to reliable, evidence-based resources is essential for developing a strong nursing care plan for CHF. 

It also ensures effective CHF nursing interventions and rationales. The following references provide guidance on congestive heart management and best practices.

Nursing Care Plan Resources

Keeping CHF Care Simple

Managing congestive heart failure (CHF) takes a mix of clinical know-how, patient education, and solid, evidence-based interventions. 

A well-structured nursing care plan for CHF helps:

  • Control symptoms
  • Prevent complications
  • Improve patient outcomes

By making accurate CHF nursing diagnoses and using targeted nursing interventions for heart failure, nurses play a vital role in delivering top-notch care and keeping patients on the right track.

References and Sources 

  1. American Heart Association (AHA). (2024). Heart failure guidelines. 
  1. Centers for Disease Control and Prevention (CDC). (2024). Managing congestive heart failure.
  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2022). Nursing care plans: Guidelines for individualizing patient care (11th ed.). F.A. Davis.  
  1. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care (9th ed.).
  2. Elsevier. National Institutes of Health (NIH). (2024). CHF treatment and patient education.