A Guide To Managing Congestive Heart Failure in the Skilled Nursing Setting

  • February 19, 2021
  • Dr. Hamad Shafqat

Patients with any chronic condition require professional clinical care. Nursing home management has become an integral part of care for patients suffering from congestive heart failure. Therefore, nurse practitioners must have knowledge about the process of the disease, as well as the application of this knowledge for efficient intervention.

Congestive Heart Failure

The heart is a vital organ of the human body. It maintains blood circulation, thereby fulfilling the body’s requirement for oxygen and nutrients. One of the chronic conditions of the heart in which it cannot pump a sufficient amount of blood is known as congestive heart failure (CHF), or simply heart failure. This results in a more decreased supply of oxygen than usual to the organs.

More than 37.7 million patients suffer from CHF, indicating it to be a rapidly growing health concern. Increased morbidity and mortality rates are also associated with CHF. In adults and P elderly patients, CHF is one of the leading causes of hospitalization (3), and it is also the most common disease of cardiac category present in residents of the nursing homes in the United States (4).

Nursing Care Management In Congestive Heart Failure

The International Heart Failure management guideline has endorsed standard heart failure therapies to manage older patients (5–7). A nurse practitioner in a nursing care management facility is responsible for fulfilling the plan for nursing care goals to help CHF patients. A significant number of CHF patients benefit from skilled nursing facilities as a bridge of transition from hospital to home. It has been reported that approximately 25 percent of CHF patients go to skilled nursing facilities after getting discharged from the hospital (8).

Nursing Care Goals At Skilled Nursing Facility

If a CHF patient is presented with a worsened condition at a skilled nursing facility, their management is patient-centered and highly individualized. A healthcare team that is proactive, well-coordinated, and highly knowledgeable makes and shares a decision for the management of CHF patients. The team also informs the patients and their families about the course of action required in such a condition (4).

The plans of nursing care goals include interventions that can help the heart to improve its pumping function. Along with that, a nurse practitioner should be able to identify the complications, he/she will work to manage and prevent them. Besides, patient education should be part of the nursing care goals, teaching about the modification to be made in the lifestyle of a CHF patient (9).

Fluid overload in the body is caused by CHF as well. Such activities that help reduce fatigue and decrease the fluid overload symptoms are promoted as part of nursing home management (9). A nursing care plan for CHF patients in a skilled nursing facility include the following:

1. Monitoring Of Patient’s Vital Signs

Vital signs of a CHF patient get adversely affected by the low cardiac output. A nurse practitioner monitors the vital signs. Any changes in vital signs that seem to be subnormal are noted immediately. Based on these recordings, any abnormality is brought to the attention of the attending physician, and the nursing care plan is adjusted (10). .

2. Lifestyle Modifications

All those activities and behaviors of patients that increase the workload on the heart are removed in a nursing home management by modifying the lifestyle of the CHF patient. Such an environment is created by nurse practitioners that promote patients to rest peacefully. Resting decreases the demand for oxygen supply in the body (1).

3. Modification In The Diet Of CHF Patients

At a skilled nursing facility, CHF patients are provided with a diet that contains a low quantity of salt, and the meals are fat-free. To reduce energy consumption during the digestion of food, meals are prepared soft. Patients are served with smaller servings because the pressure on the heart is created in the consumption of large servings, thereby increasing the workload on the heart (11).

Nurse practitioners help CHF patients after every meal to be in a Semi-Fowler position. This position supports relieving pressure on the heart. The energy of CHF patients is supplemented through caloric food, and the patient’s immunity is enhanced through the vitamins. All these adjustments in the diet of CHF patients are made to impact their cardiovascular health positively (11).

4. Medicine And Oxygen Therapy

The attending physician at the skilled nursing facility prescribes the medicines based on the symptoms of the patients. In contrast, nurse practitioners are responsible for the correct and timely administration of the prescribed medication (10).

Besides, oxygen is also supplied to the patients in a nursing home to maintain saturation at an optimum level. Nurse practitioners observe extreme care in adjusting the oxygen supply to prevent lungs from getting hyperinflated and also to reduce the chances of emphysema. The nurse practitioner uses a nasal cannula to ensure that ventilation is proper. This also reduces the feeling of suffocation that oxygen masks can create (10).

5. Efficient Clinical Management Through Diagnostic Examinations

The attending physician at the skilled nursing facility is responsible for prescribing the diagnostic tests for CHF patients. However, the responsibility of proper execution of the diagnostic tests lies with nurse practitioners. They also ensure that the attending physician has the diagnostic test results on time for interpretation (12). Based on any changes in the vital signs and diagnostic test results, the attending physician adjusts the nursing care plan accordingly. Electro-Cardio Graph (ECG), chest X-rays, and blood tests are the most common diagnostic tests performed at the skilled nursing facility (12).

6. Patient Education

CHF patients at the skilled nursing facility are counseled to accept and then adapt according to the current status of their health (13). Nursing home management of CHF patients also includes patient education, helping them even in self-care at home (1,13–16).

The modification in lifestyle, self-monitoring, proper diet, self-administration of medicines, and follow-up treatments are some of the topics on which patients are educated at a nursing facility. Patients are also taught about different symptoms that can alert the nurse practitioners of any abnormality, such as palpitations, light-headedness, dizziness, weakness, shortness of breath, and feeling cold (2).

7. Counseling Of Family Members

The nursing staff at the skilled nursing facility counsels the family members of the CHF patients so that they can help patients improve their cardiovascular health. Family members are advised not to let the CHF patients do any strenuous activities and avoid any emotional disturbances. Family members are also advised to keep an eye on harmful activities like smoking or alcohol consumption (17).

Additionally, the nurse practitioners also discuss the diet of CHF patients with the family members. They identify the food item for cardiac diet locally available and explain to the member family the preparation process for a low salt food from the things already present in the home (17).

Nurse practitioners adequately explain and demonstrate the medicine given to the CHF patient, the proper time of administration, and the intervals. Family members are also advised to the hep patient in adherence to their treatment plan and follow-up check-ups (12,13,15).

Why Is A Skilled Nursing Facility Required For The Management Of CHF Patients?

Several issues make skilled nursing home facilities necessary for the management of CHF patients. The characteristics and the healthcare facilities that are needed by the CHF patients in a skilled nursing facility are very different from the adults living in the community. There is an increase in comorbidities in patients of CHF age greater than 75 years. There might be complications present during the initial diagnosis of CHF and then in its management (18).

Problems Associated With The Management Of CHF Patients In Skilled Nursing Facilities

The main problem that nursing practitioners often face while managing CHF patient is their inability to understand their condition. Patients and often family members are also unable to understand the condition of the patient. They cannot also communicate properly with the nurse practitioners (19).

Application Of Ethical Principles In Nursing Care Facilities

Every patient has his/her beliefs, some personal values, and principles according to his/her culture. At a nursing care facility, all these things are kept in consideration while treating patients for their heart condition. All the necessary treatment is provided, which is appropriate according to their need. Nurse practitioners are ethically guided. They take care of the ethical principles related to a person’s justice, respect, and body anatomy. Additionally, nurse practitioners also respect the principles of beneficence, veracity, and the practice of no maleficence. At a nursing care facility, keeping in mind the principles of justice, planning, and implementing interventions are carried out according to the demands of care of illnesses (20).

The Bottom Line

According to the disease process, a nurse practitioner at a skilled nursing facility conceptualizes the need for clinical care for a CHF patient. S/he also designs and implements such intervention of care plan that helps in moderating the disease process. S/he also helps in maintaining the hemodynamics for homeostasis of CHF patients. Such an environment and lifestyle modifications are provided at the skilled nursing facility that allows patients to improve their cardiovascular health. The evaluation of the impacts after interventions in care plans are implemented, is conducted by the nurse practitioners to assess the efficacy and sufficiency of the interventions. The goals of the nursing care plan are appraised for their attainment, which is evident from the ability of the patient for self-care and their improved quality of life.


  1. Mogotlan S. Juta’s Complete Textbook of Medical-Surgical Nursing 2e [Internet]. [cited 2021 Feb 17]. Available from:
  2. Hurst M. Hurst Reviews Medical-Surgical Nursing Review. 1st edition. McGraw-Hill Professional; 2011. 882 p.
  3. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016 Jun;13(6):368–78.
  4. Jurgens CY, Goodlin S, Dolansky M, Ahmed A, Fonarow GC, Boxer R, et al. Heart Failure Management in Skilled Nursing Facilities. Circulation: Heart Failure. 2015 May 1;8(3):655–87.
  5. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation. 2009 Apr 14;119(14):e391–479.
  6. McKelvie RS, Moe GW, Ezekowitz JA, Heckman GA, Costigan J, Ducharme A, et al. The 2012 Canadian Cardiovascular Society heart failure management guidelines update: focus on acute and chronic heart failure. Can J Cardiol. 2013 Feb;29(2):168–81.
  7. McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33(14):1787–847.
  8. Dolansky MA, Xu F, Zullo M, Shishehbor M, Moore SM, Rimm AA. Post-acute care services received by older adults following a cardiac event: a population-based analysis. J Cardiovasc Nurs. 2010 Aug;25(4):342–9.
  9. Vera M. 18 Nursing Diagnosis for Heart Failure Nursing Care Plans [Internet]. Nurseslabs. 2019 [cited 2021 Feb 17]. Available from:
  10. Amakali K. Clinical Care for the Patient with Heart Failure: A Nursing Care Perspective. Cardiovascular Pharmacology [Internet]. 2015 [cited 2021 Feb 17];4(2). Available from:
  11. Stellenberg EL, Bruce JC. Nursing practice: medical-surgical nursing for hospital and community. Edinburgh: Churchill Livingstone Elsevier; 2007.
  12. Malarkey L, McMorrow ME. Saunders Nursing Guide to Laboratory and Diagnostic Tests. 2nd edition. St. Louis, Mo: Saunders; 2011. 738 p.
  13. Paul S. Hospital discharge education for patients with heart failure: what really works and what is the evidence? Crit Care Nurse. 2008 Apr;28(2):66–82.
  14. Smelter SC, Bare BG, Hinkle JL, Cheever KH. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. 12th edition. Lippincott Williams & Wilkins; 2010.
  15. Barber P, Robertson D. Essentials of Pharmacology for Nurses. 1st edition. Maidenhead: Open University Press; 2009. 264 p.
  16. Strömberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. 2005 Mar 16;7(3):363–9.
  17. Pretorius S, Sliwa K, Ruf V, Walker K, Stewart S. Feeding the emergence of advanced heart disease in Soweto: a nutritional survey of black African patients with heart failure. Cardiovasc J Afr. 2012 Jun;23(5):245–51.
  18. Ahluwalia SC, Gross CP, Chaudhry SI, Leo-Summers L, Van Ness PH, Fried TR. Change in comorbidity prevalence with advancing age among persons with heart failure. J Gen Intern Med. 2011 Oct;26(10):1145–51.
  19. Heckman GA, Boscart VM, D’Elia T, Kelley ML, Kaasalainen S, McAiney CA, et al. Managing Heart Failure in Long-Term Care: Recommendations from an Interprofessional Stakeholder Consultation. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2016 Dec;35(4):447–64.
  20. White L. Foundations of Nursing: Caring for the Whole Person. 1st edition. Albany: Delmar Cengage Learning; 2000. 1856 p.