NR 224 HEART FAILURE (HF) OR CONGESTIVE
HEART FAILURE (CHF) STUDY GUIDE
Heart failure (HF) or Congestive Heart Failure (CHF) is a physiologic state in which he heart cannot
pump enough blood to meet the metabolic needs of the body.
Heart failure results from changes in systolic or diastolic function of the left ventricle. The heart fails
when, because of intrinsic disease or structural it cannot handle a normal bloodvolume or, in absence of
disease, cannot tolerate a sudden expansion in blood volume.
Heart failure is not a disease itself, instead, the term refers to a clinical syndrome characterized by
manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever
the cause, pump failure results in hypoperfusion of tissues, followed by pulmonary and systemic venous
congestion.
Because heart failure causes vascular congestion, it is often called congestive heart failure, although
most cardiac specialist no longer use this term. Other terms used to denote heart failure include chronic
heart failure, cardiac decompensation, cardiac insufficiency and ventricular failure.
Nursing Care Plans
Nursing care for patients with heart failure includes support to improve heart pump function by various
nursing interventions, prevention and identification of complications, and providing a teaching plan for
lifestyle modifications.
Here are 16+ nursing care plans (NCP) for patients with Heart Failure:
Content
1. Decreased Cardiac Output
2. Activity Intolerance
3. Excess Fluid Volume
4. Risk for Impaired Gas Exchange
5. Risk for Impaired Skin Integrity
6. Deficient Knowledge
7. Decreased Cardiac Output
8. Excess Fluid Volume
9. Acute Pain
10. Ineffective Tissue Perfusion
11. Hyperthermia
12. Ineffective Breathing Pattern
13. Activity Intolerance
14. Ineffective Airway Clearance
15. Impaired Gas Exchange
16. Fatigue
17. Other Nursing Care Plans
1
,Decreased Cardiac Output
Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic demands of the
body.
Nursing Diagnosis
Decreased Cardiac Output
May be related to
Altered myocardial contractility/inotropic changes
Alterations in rate, rhythm, electrical conduction
Structural changes (e.g., valvular defects, ventricular aneurysm)
Possibly evidenced by
Increased heart rate (tachycardia), dysrhythmias, ECG changes
Changes in BP (hypotension/hypertension)
Extra heart sounds (S3, S4)
Decreased urine output
Diminished peripheral pulses
Cool, ashen skin; diaphoresis
Orthopnea, crackles, JVD, liver engorgement, edema
Chest pain
Desired Outcomes
Patient will display vital signs within acceptable limits, dysrhythmias absent/controlled, and no
symptoms of failure (e.g., hemodynamic parameters within acceptable limits, urinary output
adequate).
Patient will report decreased episodes of dyspnea, angina.
Patient will Participate in activities that reduce cardiac workload.
Nursing Interventions Rationale
Tachycardia is usually present (even at rest)
to compensate for decreased ventricular
contractility. Premature atrial contractions
(PACs), paroxysmal atrial tachycardia (PAT),
PVCs, multifocal atrial tachycardia (MAT),
Auscultate apical pulse, assess heart rate, rhythm. Document and atrial fibrillation (AF) are common
dysrhythmia if telemetry is available. dysrhythmias associated with HF, although
others may also occur.
Note: Intractable ventricular dysrhythmias
unresponsive to medication suggest
ventricular aneurysm.
Note heart sounds. S1 and S2 may be weak because of
2
, Nursing Interventions Rationale
diminished pumping action. Gallop rhythms
are common (S3and S4), produced as blood
flows into noncompliant chambers.
Murmurs may reflect valvular
incompetence.
Decreased cardiac output may be reflected
in diminished radial, popliteal, dorsalis
pedis, and post tibial pulses. Pulses may be
Palpate peripheral pulses.
fleeting or irregular to palpation, and
pulsus alternans (strong beat alternating
with weak beat) may be present.
In early, moderate, or chronic HF, BP may
be elevated because of increased SVR. In
Monitor BP. advanced HF, the body may no longer be
able to compensate, and
profound hypotension may occur.
Pallor is indicative of diminished peripheral
perfusion secondary to inadequate cardiac
output, vasoconstriction, and anemia.
Inspect skin for pallor, cyanosis.
Cyanosis may develop in refractory HF.
Dependent areas are often blue or mottled
as venous congestion increases.
Kidneys respond to reduced cardiac output
by retaining water and sodium. Urine
Monitor urine output, noting decreasing output and concentrated output is usually decreased during the day
urine. because of fluid shifts into tissues but may
be increased at night because fluid returns
to circulation when patient is recumbent.
May indicate inadequate cerebral
Note changes in sensorium: lethargy, confusion,
perfusion secondary to decreased cardiac
disorientation, anxiety, and depression.
output.
Physical rest should be maintained during
acute or refractory HF to improve efficiency
Encourage rest, semirecumbent in bed or chair. Assist with physical
of cardiac contraction and to decrease
care as indicated.
myocardial oxygen demand/ consumption
and workload.
3
HEART FAILURE (CHF) STUDY GUIDE
Heart failure (HF) or Congestive Heart Failure (CHF) is a physiologic state in which he heart cannot
pump enough blood to meet the metabolic needs of the body.
Heart failure results from changes in systolic or diastolic function of the left ventricle. The heart fails
when, because of intrinsic disease or structural it cannot handle a normal bloodvolume or, in absence of
disease, cannot tolerate a sudden expansion in blood volume.
Heart failure is not a disease itself, instead, the term refers to a clinical syndrome characterized by
manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever
the cause, pump failure results in hypoperfusion of tissues, followed by pulmonary and systemic venous
congestion.
Because heart failure causes vascular congestion, it is often called congestive heart failure, although
most cardiac specialist no longer use this term. Other terms used to denote heart failure include chronic
heart failure, cardiac decompensation, cardiac insufficiency and ventricular failure.
Nursing Care Plans
Nursing care for patients with heart failure includes support to improve heart pump function by various
nursing interventions, prevention and identification of complications, and providing a teaching plan for
lifestyle modifications.
Here are 16+ nursing care plans (NCP) for patients with Heart Failure:
Content
1. Decreased Cardiac Output
2. Activity Intolerance
3. Excess Fluid Volume
4. Risk for Impaired Gas Exchange
5. Risk for Impaired Skin Integrity
6. Deficient Knowledge
7. Decreased Cardiac Output
8. Excess Fluid Volume
9. Acute Pain
10. Ineffective Tissue Perfusion
11. Hyperthermia
12. Ineffective Breathing Pattern
13. Activity Intolerance
14. Ineffective Airway Clearance
15. Impaired Gas Exchange
16. Fatigue
17. Other Nursing Care Plans
1
,Decreased Cardiac Output
Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic demands of the
body.
Nursing Diagnosis
Decreased Cardiac Output
May be related to
Altered myocardial contractility/inotropic changes
Alterations in rate, rhythm, electrical conduction
Structural changes (e.g., valvular defects, ventricular aneurysm)
Possibly evidenced by
Increased heart rate (tachycardia), dysrhythmias, ECG changes
Changes in BP (hypotension/hypertension)
Extra heart sounds (S3, S4)
Decreased urine output
Diminished peripheral pulses
Cool, ashen skin; diaphoresis
Orthopnea, crackles, JVD, liver engorgement, edema
Chest pain
Desired Outcomes
Patient will display vital signs within acceptable limits, dysrhythmias absent/controlled, and no
symptoms of failure (e.g., hemodynamic parameters within acceptable limits, urinary output
adequate).
Patient will report decreased episodes of dyspnea, angina.
Patient will Participate in activities that reduce cardiac workload.
Nursing Interventions Rationale
Tachycardia is usually present (even at rest)
to compensate for decreased ventricular
contractility. Premature atrial contractions
(PACs), paroxysmal atrial tachycardia (PAT),
PVCs, multifocal atrial tachycardia (MAT),
Auscultate apical pulse, assess heart rate, rhythm. Document and atrial fibrillation (AF) are common
dysrhythmia if telemetry is available. dysrhythmias associated with HF, although
others may also occur.
Note: Intractable ventricular dysrhythmias
unresponsive to medication suggest
ventricular aneurysm.
Note heart sounds. S1 and S2 may be weak because of
2
, Nursing Interventions Rationale
diminished pumping action. Gallop rhythms
are common (S3and S4), produced as blood
flows into noncompliant chambers.
Murmurs may reflect valvular
incompetence.
Decreased cardiac output may be reflected
in diminished radial, popliteal, dorsalis
pedis, and post tibial pulses. Pulses may be
Palpate peripheral pulses.
fleeting or irregular to palpation, and
pulsus alternans (strong beat alternating
with weak beat) may be present.
In early, moderate, or chronic HF, BP may
be elevated because of increased SVR. In
Monitor BP. advanced HF, the body may no longer be
able to compensate, and
profound hypotension may occur.
Pallor is indicative of diminished peripheral
perfusion secondary to inadequate cardiac
output, vasoconstriction, and anemia.
Inspect skin for pallor, cyanosis.
Cyanosis may develop in refractory HF.
Dependent areas are often blue or mottled
as venous congestion increases.
Kidneys respond to reduced cardiac output
by retaining water and sodium. Urine
Monitor urine output, noting decreasing output and concentrated output is usually decreased during the day
urine. because of fluid shifts into tissues but may
be increased at night because fluid returns
to circulation when patient is recumbent.
May indicate inadequate cerebral
Note changes in sensorium: lethargy, confusion,
perfusion secondary to decreased cardiac
disorientation, anxiety, and depression.
output.
Physical rest should be maintained during
acute or refractory HF to improve efficiency
Encourage rest, semirecumbent in bed or chair. Assist with physical
of cardiac contraction and to decrease
care as indicated.
myocardial oxygen demand/ consumption
and workload.
3
