NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
What happens in heart failure and where nursing comes in
The heart does not pump effectively: fluid backs up into the lungs and legs, the patient gets short of breath on exertion and when lying flat, and tires with very little activity. Nursing monitors intake and output and daily weights, paces activity and teaches how to manage the disease at home.
What to assess
- Daily weight at the same time each day and intake and output.
- Edema in the legs and sacrum; crackles on auscultation.
- Dyspnea: on exertion, when lying flat or at night.
- Heart rate, blood pressure and oxygen saturation.
- Activity tolerance.
- What they know about sodium, fluids and their medications.
NANDA-I 2024-2026 nursing diagnoses for heart failure
| Code | Diagnosis | When it applies |
|---|---|---|
| 00026 | Excessive fluid volumeProblem-focused | Edema, weight gain and crackles from fluid retention. |
| 00298 | Decreased activity toleranceProblem-focused | Dyspnea and fatigue with less and less exertion. |
| 00030 | Impaired gas exchangeProblem-focused | Pulmonary congestion with low oxygen saturation. |
| 00240 | Risk for decreased cardiac outputRisk | Situations that could further reduce cardiac function. This is the cardiac output diagnosis still in use. |
| 00477 | Excessive fatigue burdenProblem-focused · former code 00093 | Persistent tiredness that limits daily life. |
| 00276 | Ineffective health self-managementProblem-focused | Difficulty following the sodium restriction, daily weights and medications. |
Decreased cardiac output (00029) is no longer current. Decreased cardiac output was retired in 2024-2026 because it was considered outside the independent scope of nursing. You will still see this code in older materials. What to use instead
How to prioritize them
Oxygenation and fluid excess first, then activity tolerance, and self-management for discharge. Your assessment makes the final call: anything that threatens life (airway, breathing, circulation) comes first.
Sample nursing diagnosis statements
Excessive fluid volume related to sodium intake above the prescribed limit and skipped diuretic doses as evidenced by 3.5 kg weight gain in 6 days, 2+ pitting edema to the knees, JVD at 45°, bilateral basilar crackles and a positive fluid balance of 900 mL in 24 hours.
Decreased activity tolerance related to prolonged bed rest and inadequate oxygenation during exertion as evidenced by HR increase of 32 bpm when walking 10 meters, SpO2 of 87% while ambulating, and Borg dyspnea score of 6/10.
Impaired gas exchange related to shallow breathing from pleuritic pain and prolonged supine positioning as evidenced by SpO2 of 86% on room air, drowsiness and PaCO₂ of 55 mmHg on ABG.
Excessive Fatigue Burden related to fragmented sleep and insufficient protein and iron intake as evidenced by tiredness rated 8/10 that does not improve with sleep, 2-hour naps without regaining energy, and giving up household tasks for the past 3 weeks.
Ineffective health self-management related to complex treatment regimen and insufficient knowledge of sodium restriction and weight monitoring as evidenced by skipping the diuretic on workdays, not weighing self at home, 3 kg weight gain in 5 days, and second admission for decompensated heart failure in 6 months.
Fictional cases written by our team. Adapt them to your patient with the PES statement generator.
Nursing care plan summary
Main goals and interventions for the priority diagnoses. Each diagnosis page has the full plan, with rationales and a case study.
Excessive fluid volume (00026)
Goals
- Weight decreases steadily, per the daily target set by the provider, until dry weight is reached.
- Edema decreases to 1+ or resolves within 72 hours.
Interventions
- Weigh every morning before breakfast, after voiding, on the same scale.
- Keep strict intake and output, including medication diluents.
- Monitor response to the prescribed diuretic: urine output, blood pressure, potassium and creatinine.
- Place the patient in semi-Fowler's or Fowler's position if dyspneic.
Decreased activity tolerance (00298)
Goals
- Walks 30 meters on prescribed oxygen with SpO2 ≥ 90% and HR no more than 20 bpm above baseline within 72 hours.
- Returns to baseline HR and SpO2 within 5 minutes after activity within 48 hours.
Interventions
- Measure HR, BP, RR and SpO2 before, during and 3-5 minutes after each activity.
- Stop the activity if SpO2 drops below target (generally 90%; 88% in COPD if ordered), HR rises more than 20-30 bpm above baseline, systolic BP drops, or chest pain, dizziness or severe dyspnea appear. Notify the provider if it does not resolve with rest.
- Increase activity in stages: sitting on the edge of the bed, transferring to the chair, standing, walking in the room and then in the hallway.
- Alternate activities with rest periods and avoid scheduling bathing, dressing changes and tests back to back.
Impaired gas exchange (00030)
Goals
- Patient maintains an oxygen saturation of 92% or higher (or 88-92% with COPD and CO₂ retention).
- Patient is awake and oriented within 12 hours.
Interventions
- Give oxygen as prescribed with the ordered device and flow rate, and document saturation.
- Use semi-Fowler's or Fowler's position and reposition regularly.
- Monitor mental status every shift.
- Encourage coughing and deep breathing or incentive spirometry.
Build the full care plan as a table with the generator.
Frequently asked questions
Is Decreased cardiac output (00029) still a NANDA diagnosis?
No. It was retired in NANDA-I 2024-2026. Risk for decreased cardiac output (00240) remains.
What nursing diagnosis do I use for edema in heart failure?
Excessive fluid volume (00026).
Which teaching-related diagnosis fits heart failure?
Ineffective health self-management (00276) if the patient already struggles to follow the treatment plan, or Inadequate health knowledge (00435) if information is missing.
Other conditions
Study material: the diagnosis selection, sample statements and care plans were written by our editorial team using the NANDA-I 2024-2026 classification. They do not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes. Reviewed November 2, 2026.