Sample Nursing Care Plan for CHF

By Rosie, RN — March 11, 2026

Congestive heart failure is one of the most common patient scenarios you’ll see in nursing school — and for good reason. CHF touches nearly every body system, demands strong assessment skills, and asks you to prioritize competing problems all at once. If your instructor just handed you a CHF patient and said “write a care plan,” you’re in the right place.

This post walks through a complete sample nursing care plan for a CHF patient using real NANDA-I nursing diagnoses, evidence-based interventions, and measurable evaluation criteria. We’ll cover three priority nursing diagnoses — Decreased Cardiac Output, Excess Fluid Volume, and Impaired Gas Exchange — so you can see how each step of ADPIE connects to the one before it.

A quick note before we dive in: this is a sample. Your patient is unique, and your care plan should reflect the clinical picture in front of you. Use this as a framework for understanding how the pieces fit together — not as a template to copy and paste.

🌼 If you need help building an individualized care plan for your own patient, PlanRN can walk you through it.

Meet the Patient

Margaret Torres is a 68-year-old woman who presents to the ED with progressive shortness of breath over the past five days, worsening bilateral lower extremity edema, and a seven-pound weight gain over the past week. She reports orthopnea requiring three pillows to sleep and waking up gasping for air two to three times per night. She admits to running out of her furosemide ten days ago and eating several high-sodium meals over the holidays. She denies chest pain but endorses fatigue and decreased appetite.

Her history includes heart failure with reduced ejection fraction (HFrEF, last EF 35%), hypertension, type 2 diabetes mellitus, and hyperlipidemia. Home medications include furosemide 40 mg PO daily (non-adherent), lisinopril 10 mg PO daily, carvedilol 12.5 mg PO BID, metformin 1000 mg PO BID, and atorvastatin 40 mg PO at bedtime. She has a documented sulfa allergy (rash).

Key Assessment Findings

Vital signs on admission: T 98.4°F, HR 102, BP 158/94, RR 26, SpO₂ 89% on room air. Physical exam reveals jugular venous distension, bilateral crackles in lower lung fields, an S3 gallop, a soft and mildly distended abdomen, 3+ pitting edema bilateral lower extremities to mid-shin, skin cool to touch in extremities, and capillary refill of 4 seconds.

Labs and diagnostics: BNP 1,840 pg/mL, Na 132, K 3.3, BUN 38, Cr 1.6. Chest X-ray shows cardiomegaly with bilateral pleural effusions and pulmonary vascular congestion. Daily weight: 187 lbs (baseline dry weight 178 lbs).

If you’re already noticing connections between these findings and potential nursing diagnoses, good — that’s your clinical reasoning at work. Let’s build the care plan.

🌼 Want to skip the manual work? PlanRN walks you through every step of ADPIE for your own patient scenario. Start your first care plan free.

Nursing Diagnosis #1: Decreased Cardiac Output

Diagnosis Statement

Decreased Cardiac Output related to impaired ventricular contractility as evidenced by S3 gallop, elevated BNP (1,840 pg/mL), cardiomegaly on chest X-ray, and ejection fraction of 35% (Herdman & Kamitsuru, 2021).

This is your priority nursing diagnosis for Mrs. Torres. Her heart isn’t pumping effectively, and nearly every other problem — the edema, the breathing difficulty, the poor perfusion — cascades from this central issue. When you’re prioritizing nursing diagnoses, ask yourself: “What’s driving everything else?” For CHF patients, the answer is almost always decreased cardiac output.

Planning: SMART Goals

• Patient will maintain cardiac output as evidenced by heart rate between 60–100 bpm within 24 hours (Moorhead et al., 2018).
• Patient will demonstrate improved cardiac function with BNP levels decreased to less than 1,000 pg/mL by 72 hours (Moorhead et al., 2018).
• Patient will maintain systolic blood pressure between 120–140 mmHg within 24 hours (Moorhead et al., 2018).
• Patient will demonstrate improved peripheral perfusion with capillary refill less than 3 seconds within 24 hours (Moorhead et al., 2018).
• Patient will exhibit absence of S3 gallop on cardiac auscultation within 72 hours (Moorhead et al., 2018).

Notice that each of these goals is specific, measurable, and time-bound. You can objectively evaluate whether Mrs. Torres met these targets — that’s the whole point.

Interventions

• Monitor continuous cardiac rhythm and assess for arrhythmias, documenting any changes from baseline (Butcher et al., 2018).
• Assess heart rate, blood pressure, and heart sounds every 4 hours, noting presence of S3 or S4 gallops (Butcher et al., 2018).
• Administer prescribed ACE inhibitors or ARBs as ordered and monitor for hypotension and hyperkalemia (Butcher et al., 2018).
• Administer prescribed beta-blockers as ordered, monitoring heart rate and blood pressure before and after administration (Butcher et al., 2018).
• Monitor capillary refill, peripheral pulses, and skin color/temperature every 4 hours to assess perfusion (Butcher et al., 2018).
• Position patient in semi-Fowler’s or high-Fowler’s position to reduce cardiac workload and improve venous return (Butcher et al., 2018).
• Encourage rest periods between activities and assist with activities of daily living to minimize cardiac workload (Butcher et al., 2018).
• Monitor laboratory values including BNP, electrolytes, and renal function daily (Butcher et al., 2018).
• Educate patient on signs and symptoms of worsening heart failure to report immediately (Ackley & Ladwig, 2020).

Evaluation

By 24 hours, Mrs. Torres maintains a heart rate of 65–85 bpm. Her systolic blood pressure stabilizes to 125–135 mmHg. Capillary refill improves to less than 2 seconds. By 72 hours, BNP decreases to 650 pg/mL, and S3 gallop is no longer auscultated. Goals met.

Nursing Diagnosis #2: Excess Fluid Volume

Diagnosis Statement

Excess Fluid Volume related to decreased cardiac output and medication non-adherence as evidenced by 3+ bilateral lower extremity edema, 7-pound weight gain over one week, jugular venous distension, and bilateral pleural effusions (Herdman & Kamitsuru, 2021).

This one connects directly to the first nursing diagnosis. When cardiac output drops, the kidneys retain sodium and water, and fluid backs up into the tissues and lungs. Mrs. Torres’s medication non-adherence made things worse — she was off her diuretic for ten days and eating high-sodium meals. Understanding that chain of events is key to writing interventions that actually target the problem.

Planning: SMART Goals

• Patient will lose 5–7 pounds of excess fluid weight within 72 hours (Moorhead et al., 2018).
• Patient will demonstrate reduced lower extremity edema to 1+ or less within 48 hours (Moorhead et al., 2018).
• Patient will exhibit absence of jugular venous distension when positioned at 45 degrees within 48 hours (Moorhead et al., 2018).
• Patient will maintain daily fluid intake of 2,000 mL as ordered within 24 hours (Moorhead et al., 2018).
• Patient will demonstrate understanding of fluid and sodium restrictions by verbalizing daily limits of 2,000 mg sodium within 24 hours (Moorhead et al., 2018).

Interventions

• Weigh patient daily at the same time using the same scale, reporting weight gain of 2–3 pounds in 24 hours (Butcher et al., 2018).
• Administer prescribed diuretics as ordered and monitor urine output, aiming for 0.5–1 mL/kg/hour (Butcher et al., 2018).
• Assess and document degree of peripheral edema using a 0–4+ scale every 8 hours (Butcher et al., 2018).
• Monitor jugular venous distension by positioning patient at 45 degrees and measuring JVD height (Butcher et al., 2018).
• Restrict fluid intake to 2,000 mL per 24 hours as ordered, providing patient with marked container for tracking (Butcher et al., 2018).
• Monitor intake and output every 8 hours, calculating fluid balance and reporting positive balance greater than 500 mL (Butcher et al., 2018).
• Implement sodium restriction of 2,000 mg daily, coordinating with dietary services for appropriate meal planning (Butcher et al., 2018).
• Monitor electrolyte levels, particularly sodium and potassium, due to diuretic therapy (Butcher et al., 2018).
• Educate patient and family on importance of daily weights and when to contact healthcare provider (Ackley & Ladwig, 2020).
• Teach patient to identify high-sodium foods and provide written list of foods to avoid (Ackley & Ladwig, 2020).

Evaluation

By 48 hours, Mrs. Torres demonstrates trace lower extremity edema and absence of jugular venous distension when positioned at 45 degrees. She maintains daily fluid intake of 2,800 mL within 24 hours, and verbalizes understanding of her fluid and sodium restrictions by stating her daily limit of 2,000 mg sodium. By 72 hours, she has lost 6–7 pounds of fluid weight. Goals met.

Nursing Diagnosis #3: Impaired Gas Exchange

Diagnosis Statement

Impaired Gas Exchange related to pulmonary edema and pleural effusions as evidenced by SpO₂ 89% on room air, bilateral crackles in lower lung fields, and pulmonary vascular congestion on chest X-ray (Herdman & Kamitsuru, 2021).

When the left side of the heart can’t keep up, fluid backs into the pulmonary vasculature. That’s what’s causing Mrs. Torres’s crackles, her low oxygen saturation, and her shortness of breath. This nursing diagnosis addresses the respiratory consequences of her heart failure — and it’s the reason she showed up in the ED unable to catch her breath.

Planning: SMART Goals

• Patient will maintain oxygen saturation ≥ 92% on room air within 48 hours (Moorhead et al., 2018).
• Patient will demonstrate improved respiratory status with respiratory rate between 12–20 breaths per minute within 24 hours (Moorhead et al., 2018).
• Patient will exhibit decreased or absent bilateral lower lobe crackles within 48 hours (Moorhead et al., 2018).
• Patient will report decreased shortness of breath rated 3 or less on a 0–10 scale within 48 hours (Moorhead et al., 2018).
• Patient will sleep through the night without episodes of paroxysmal nocturnal dyspnea for 2 consecutive nights by 72 hours (Moorhead et al., 2018).

Interventions

• Monitor oxygen saturation continuously and assess respiratory rate, depth, and effort every 2–4 hours (Butcher et al., 2018).
• Auscultate lung sounds every 4 hours, documenting presence and location of crackles, wheezes, or diminished sounds (Butcher et al., 2018).
• Administer supplemental oxygen as prescribed to maintain SpO₂ ≥ 92%, titrating as needed (Butcher et al., 2018).
• Position patient in high-Fowler’s or orthopneic position to optimize lung expansion and reduce work of breathing (Butcher et al., 2018).
• Encourage deep breathing exercises and use of incentive spirometry every 2 hours while awake (Butcher et al., 2018).
• Monitor arterial blood gases as ordered and report significant changes in pH, PaCO₂, or PaO₂ (Butcher et al., 2018).
• Assess for signs of respiratory distress including use of accessory muscles, nasal flaring, and cyanosis (Butcher et al., 2018).
• Administer prescribed medications to improve cardiac output and reduce pulmonary congestion as ordered (Butcher et al., 2018).
• Monitor for orthopnea and paroxysmal nocturnal dyspnea, documenting frequency and severity (Butcher et al., 2018).
• Educate patient on energy conservation techniques and pacing activities to prevent dyspnea (Ackley & Ladwig, 2020).
• Coordinate with respiratory therapy for pulmonary function assessments and breathing treatments as needed (Butcher et al., 2018).

Evaluation

By 24 hours, Mrs. Torres demonstrates a respiratory rate of 14–18 breaths per minute. By 48 hours, oxygen saturation is maintained at 95–98% on room air, she reports shortness of breath rated 0–1 on a 0–10 scale, and bilateral lower lobe crackles are coarse but diminishing. She sleeps through the night without episodes of paroxysmal nocturnal dyspnea for 3 consecutive nights by 72 hours. Goals met.

🌼 This is the kind of clinical thinking PlanRN helps you build. Paste your own patient scenario and PlanRN walks you through assessment, diagnoses, planning, interventions, and evaluation — step by step. Start free at planrn.com.

Why These Three Nursing Diagnoses?

When you’re working with a CHF patient, you could easily identify five or six legitimate nursing diagnoses. So why these three? Prioritization.

Decreased Cardiac Output is the root cause — it’s driving the fluid overload and the respiratory compromise. Excess Fluid Volume is the body’s response to that failing pump, and it’s directly worsened by Mrs. Torres’s medication non-adherence. Impaired Gas Exchange is the immediate, life-threatening consequence that brought her to the ED. Together, these three form a clinical chain: the heart fails, fluid accumulates, the lungs flood.

Other nursing diagnoses you might consider for this patient include Activity Intolerance, Deficient Knowledge (related to medication adherence and dietary restrictions), and Risk for Electrolyte Imbalance. Those are absolutely valid — they’re just not the priority when your patient’s SpO₂ is 89% and she’s gained seven pounds in a week.

Learning to prioritize isn’t about getting it “right” in some abstract sense — it’s about asking “What threatens my patient’s life or safety right now?” and starting there.

Wrapping Up

If you’ve read through this entire care plan, you’ve done more than memorize a sample — you’ve followed the clinical reasoning from assessment findings to nursing diagnoses to goals to interventions to evaluation. That’s the ADPIE process in action, and it’s exactly the kind of thinking your instructors are looking for.

A few things to remember: always use your patient’s actual assessment data, not textbook generics. Always tie every intervention back to a specific nursing diagnosis. And always write goals you can actually measure — because if you can’t evaluate it, you can’t prove your care made a difference.

You’ve got this. And if you want a tool that walks you through this process for your own patient, PlanRN is here for that.

Start your first care plan free at planrn.com →

References

Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier.

Butcher, H. K., Bulechek, G. M., Dochterman, J. M., & Wagner, C. M. (2018). Nursing interventions classification (NIC) (7th ed.). Elsevier.

Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2021). NANDA International nursing diagnoses: Definitions and classification 2021–2023 (12th ed.). Thieme.

Moorhead, S., Swanson, E., Johnson, M., & Maas, M. L. (Eds.). (2018). Nursing outcomes classification (NOC): Measurement of health outcomes (6th ed.). Elsevier.