Nursing Diagnoses Accepted for Use and Research (20152017)

Activity Intolerance [specify level]

Activity Intolerance, risk for
Activity Planning, ineffective
Activity Planning, risk for ineffective
Adverse Reaction to Iodinated Contrast Media, risk for
Airway Clearance, ineffective
Allergy Response, risk for
Anxiety [specify level]
Aspiration, risk for
Attachment, risk for impaired
Autonomic Dysreflexia
Autonomic Dysreflexia, risk for
Behavior, disorganized infant
Behavior, risk for disorganized infant
Behavior, readiness for enhanced organized infant
Bleeding, risk for
Blood Glucose Level, risk for unstable
Body Image, disturbed
Body Temperature, risk for imbalanced
Breast Milk, insufficient
Breastfeeding, ineffective
Breastfeeding, interrupted
Breastfeeding, readiness for enhanced
Breathing Pattern, ineffective
Cardiac Output, decreased
Caregiver Role Strain
Caregiver Role Strain, risk for
Cardiac Output, risk for decreased
Cardiovascular Function, risk for impaired
Childbearing Process, ineffective
Childbearing Process, readiness for enhanced
Childbearing Process, risk for ineffective
Chronic Pain Syndrome
Comfort, impaired
Comfort, readiness for enhanced
Communication, impaired verbal
Communication, readiness for enhanced
Confusion, acute
Confusion, risk for acute
Confusion, chronic
Constipation
Constipation, perceived
Constipation, risk for
Contamination
Contamination, risk for
Coping, compromised family
Coping, defensive
Coping, disabled family
Coping, ineffective
Coping, ineffective community
Coping, readiness for enhanced
Coping, readiness for enhanced community
Coping, readiness for enhanced family
Corneal Injury, risk for
Death Anxiety
Decision-Making, readiness for enhanced
Decisional Conflict
Delayed Surgical Recovery, risk for
Denial, ineffective
Dentition, impaired
Development, risk for delayed
Diarrhea
Disuse Syndrome, risk for
Diversional Activity, deficient
Dry Eye, risk for
Electrolyte Imbalance, risk for
Emancipated Decision-Making, impaired
Emancipated Decision-Making, readiness for enhanced
Emancipated Decision-Making, risk for impaired
Emotional Control, labile
Falls, risk for
Family Processes, dysfunctional
Family Processes, interrupted
Family Processes, readiness for enhanced

Fatigue
Fear [specify focus]
Feeding Pattern, ineffective infant
Fluid Balance, readiness for enhanced
Fluid Volume, deficient
Fluid Volume, excess
Fluid Volume, risk for deficient
Fluid Volume, risk for imbalanced
Frail Elderly Syndrome
Frail Elderly Syndrome, risk for
Functional Constipation, chronic
Functional Constipation, chronic, risk for
Gas Exchange, impaired
Gastrointestinal Motility, dysfunctional
Gastrointestinal Motility, risk for dysfunctional
Gastrointestinal Perfusion, risk for ineffective
Grieving
Grieving, complicated
Grieving, risk for complicated
Growth, risk for disproportionate
Health, deficient community
Health Behavior, risk-prone
Health Maintenance, ineffective
Health Management, ineffective
Health Management, ineffective family
Health Management, readiness for enhanced
Home Maintenance, impaired
Hope, readiness for enhanced
Hopelessness
Human Dignity, risk for compromised
Hyperthermia
Hypothermia
Hypothermia, risk for
Impaired Oral Mucous Membrane, risk for
Impaired Tissue Integrity, risk for
Impulse Control, ineffective
Incontinence, bowel
Incontinence, functional urinary
Incontinence, overflow urinary
Incontinence, reflex urinary
Incontinence, stress urinary
Incontinence, urge urinary
Incontinence, risk for urge urinary
Infection, risk for
Injury, risk for
Insomnia
Intracranial Adaptive Capacity, decreased
Jaundice, neonatal
Jaundice, risk for neonatal
Knowledge, deficient [specify learning need]
Knowledge [specify], readiness for enhanced
Labor Pain
Latex Allergy Response,
Latex Allergy Response, risk for
Lifestyle, sedentary
Liver Function, risk for impairment
Loneliness, risk for
Maternal/Fetal Dyad, risk for disturbed
Memory, impaired
Mobility, impaired bed
Mobility, impaired physical
Mobility, impaired wheelchair
Mood Regulation, impaired
Moral Distress
Nausea
Noncompliance [ineffective Adherence] [specify]
Nutrition: less than body requirements, imbalanced
Nutrition, readiness for enhanced
Obesity
Oral Mucous Membrane, impaired
Overweight
Overweight, risk for
Pain, acute
Pain, chronic

Parenting, impaired
Parenting, readiness for enhanced
Parenting, risk for impaired
Perioperative Hypothermia, risk for
Perioperative Positioning Injury, risk for
Peripheral Neurovascular Dysfunction, risk for
Personal Identity, disturbed
Personal Identity, risk for disturbed
Physical Mobility, impaired
Poisoning, risk for
Post-Trauma Syndrome [specify stage]
Post-Trauma Syndrome, risk for
Power, readiness for enhanced
Powerlessness [specify level]
Powerlessness, risk for
Pressure Ulcer, risk for
Protection, ineffective
Rape-Trauma Syndrome
Relationship, ineffective
Relationship, readiness for enhanced
Relationship, risk for ineffective
Religiosity, impaired
Religiosity, readiness for enhanced
Religiosity, risk for impaired
Relocation Stress Syndrome
Relocation Stress Syndrome, risk for
Renal Perfusion, risk for ineffective
Resilience, impaired
Resilience, readiness for enhanced
Resilience, risk for impaired
Role Conflict, parental
Role Performance, ineffective
Self-Care, readiness for enhanced
Self-Care Deficit, bathing
Self-Care Deficit, dressing
Self-Care Deficit, feeding
Self-Care Deficit, toileting
Self-Concept, readiness for enhanced
Self-Esteem, chronic low
Self-Esteem, risk for chronic low
Self-Esteem, risk for situational low
Self-Esteem, situational low
Self-Mutilation
Self-Mutilation, risk for
Self-Neglect
Sexual Dysfunction
Sexuality Pattern, ineffective
Shock, risk for
Sitting, impaired
Skin Integrity, impaired
Skin Integrity, risk for impaired
Sleep Deprivation
Sleep Pattern, disturbed
Sleep, readiness for enhanced
Social Interaction, impaired
Social Isolation
Sorrow, chronic
Spiritual Distress
Spiritual Distress, risk for
Spiritual Well-Being, readiness for enhanced
Standing, impaired
Stress Overload
Sudden Infant Death Syndrome, risk for
Suffocation, risk for
Suicide, risk for
Surgical Recovery, delayed
Swallowing, impaired
Thermal Injury, risk for
Thermoregulation, ineffective
Tissue Integrity, impaired
Tissue Perfusion, ineffective peripheral
Tissue Perfusion, risk for decreased cardiac
Tissue Perfusion, risk for ineffective cerebral
Tissue Perfusion, risk for ineffective peripheral

Knock-wash hands-introduce self-provide

privacy-raise the bed
ID patient (2 identifiers: name and DOB)
Allergies
MSE: LOC, Ox3, speech (quality, quantity,
congruence)
VSPain (when, where, how long, what
helps?) Sensory: numbness, tingling,
burning Location/duration
Eyes (lids, pupils, EOM, sclera) Nose
(inspect) Ears (inspect) Skin intact?
Mouth (tongue, teeth, mucous membrane
color & moisture)
Throat/neck: swallowing; lymph node
chains
Anterior thorax: shape heart sounds (S1 &
S2, apical heart rate, apical impulse), lung
sounds (6 on front, 2 each side), breathing
pattern, accessory muscle use
Wounds, lesions, drains, tubes? SOB,
cough, mucous production, treatments
Abdomen: ( look, listen, feel) Shape,
symmetry, pulsations, BS x 4 quads, light
palpation
Wounds, lesions, drains, tubes? Nausea,
vomiting, constipation, diarrhea, treatments
Posterior thorax: excursion, symmetry Lung
sounds (8 on back)
Wounds, lesions, drains, tubes, pressure
points (scapula, spinal processes, sacrum)
Upper ext: pulses, edema, turgor, cap refill,
pressure points, grips and pushes
Wounds, lesions, drains, tubes?
Genitals: femoral pulses Urinating? Last BM?
Pain, penile/vaginal drainage, I/O
Wounds, lesions, drains, tubes?
Lower extremities: pulses (popliteal, post
tib, dorsalis pedis), edema (how deep & how
high) feet: cap refill, push, flex, homans
sign
Wounds, lesions, drains, tubes,
treatments?
Is there anything I can do for you before
leaving? Is there anything I can bring you
when I return?
SEE the SCENE: Check every tube, every
attachment. O2, IV, drains. Bed down, rails
up. Call bell. Personal belongings. Phone.
TV. State when returning.

Transfer Ability, impaired

Trauma, risk for
Unilateral Neglect
Urinary Elimination, impaired
Urinary Elimination, readiness for enhanced
Urinary Retention [acute/chronic]
Urinary Tract Injury, risk for
Vascular Trauma, risk for
Ventilation, impaired spontaneous
Ventilatory Weaning Response, dysfunctional
Violence, [actual/] risk for other-directed
Violence, [actual/] risk for self-directed
Walking, impaired
Wandering [specify sporadic or continuous]

6. Young Adulthood: 18 to 35
Ego Development Outcome: Intimacy and
Solidarity vs. Isolation
Basic Strengths: Affiliation and Love
In the initial stage of being an adult we seek one
or more companions and love. As we try to find
mutually satisfying relationships, primarily
through marriage and friends, we generally also
begin to start a family, though this age has been
pushed back for many couples who today don't
start their families until their late thirties. If

negotiating this stage is successful, we can

experience intimacy on a deep level.
If we're not successful, isolation and
distance from others may occur. And when
we don't find it easy to create satisfying
relationships, our world can begin to shrink
as, in defense, we can feel superior to
others.
Our significant relationships are with marital
partners and friends.

significant problem in working with clients from

diverse cultural backgrounds.

Space refers to the distance between individuals

when they interact. All communication occurs in
the context of space. According to Hall (1966),
there are four distinct zones of interpersonal
space: intimate, personal, social and
consultative, and public. Rules concerning
personal distance vary from culture to culture.
Territoriality refers to feelings or an attitude
7. Middle Adulthood: 35 to 55 or 65
Ego Development Outcome: Generativity toward ones personal area. Each person has
their own territorial behavior. Feelings of
vs. Self absorption or Stagnation
territoriality or violation of the clients personal
Basic Strengths: Production and Care
Now work is most crucial. Erikson observed and intimate space can cause discomfort and
may result in a clients refusing treatment or not
that middle-age is when we tend to be
occupied with creative and meaningful work returning for further care.
and with issues surrounding our family. Also,
middle adulthood is when we can expect to Social organization refers to the manner in
"be in charge," the role we've longer envied. which a cultural group organizes itself around the
The significant task is to perpetuate culture family group. Family structure and organization,
and transmit values of the culture through
religious values and beliefs, and role
the family (taming the kids) and working to
assignments may all relate to ethnicity and
establish a stable environment. Strength
culture.
comes through care of others and
production of something that contributes to Time is an important aspect of interpersonal
the betterment of society, which Erikson
communication. Cultural groups can be past,
calls generativity, so when we're in this
present, or future oriented. Preventive health
stage we often fear inactivity and
care requires some future time orientation
meaninglessness.
because preventive actions are motivated by a
As our children leave home, or our
future reward.
relationships or goals change, we may be
faced with major life changes the mid-life
crisis and struggle with finding new
meanings and purposes. If we don't get
through this stage successfully, we can
become self-absorbed and stagnate.
Significant relationships are within the
workplace, the community and the family.
8. Late Adulthood: 55 or 65 to Death
Ego Development Outcome: Integrity vs.
Despair
Basic Strengths: Wisdom
Erikson felt that much of life is preparing for
the middle adulthood stage and the last
stage is recovering from it. Perhaps that is
because as older adults we can often look
back on our lives with happiness and are
content, feeling fulfilled with a deep sense that
life has meaning and we've made a contribution
to life, a feeling Erikson calls integrity. Our
strength comes from a wisdom that the world is
very large and we now have a detached concern
for the whole of life, accepting death as the
completion of life.
On the other hand, some adults may reach this
stage and despair at their experiences and
perceived failures. They may fear death as they
struggle to find a purpose to their lives,
wondering "Was the trip worth it?" Alternatively,
they may feel they have all the answers (not
unlike going back to adolescence) and end with
a strong dogmatism that only their view has been
correct.
The significant relationship is with all of mankind
"my-kind.

Environmental control refers to the ability of

the person to control nature and to plan and
direct factors in the environment that affect them.
Many Americans believe they control nature to
meet their needs and thus are more likely to
seek health care when needed. If persons come
from a cultural group in which there is less belief
in internal control and more in external control,
there may be a fatalistic view in which seeking
health care is viewed as useless.

Biological variations, especially genetic

variations, exist between individuals in different
racial groups. It is a well-known fact that people
differ culturally. Less recognized and understood
are the biological differences that exist among
people in various racial groups. Although there is
as much diversity within cultural and racial
groups as there is across and among cultural
and racial groups, knowledge of general baseline
data relative to the specific cultural group is an
excellent starting point to provide culturally
appropriate care. There is some evidence
suggesting that different races metabolize drugs
in different ways and at different rates (Echizen,
Horari, & Ishizaki, 1989). For example, Chinese
people are more sensitive to the cardiovascular
effects of Propranolol than are White people.
Primaquine is metabolized by oxidation and is
used in the treatment of malaria. Although
Primaquine is given to individuals who lack the
enzymes necessary for glucose metabolism or
the red blood cells, hemolysis of the red blood
cells occurs. Approximately 100 million people in
the world are affected by this particular enzyme
deficiency and thus are unable to ingest
Communication embraces the entire world of
human interaction and behavior. Communication Primaquine. Approximately 35% of African
is the means by which culture is transmitted and Americans have this particular enzyme
deficiency. Antihypertensives are another
preserved. Both verbal and nonverbal
category of drugs that are metabolized differently
communication are learned in ones culture.
depending on race. For example, African
Communication often presents the most
Americans tend to need higher doses of beta-

adrenergic blocking agents such as Inderal.

Chinese men tend to need only about half as
much Inderal as compared to White American
males. One category of differences between
racial groups is susceptibility to disease. The
increased or decreased incidence may be
genetically, environmentally, or geneenvironmentally induced. American Indians have
a tuberculosis incidence that is 7 to 15 times that
of non-Indians. African Americans have a
tuberculosis incidence three times that of White
Americans. Urban American Jews have been the
most resistant to tuberculosis. Ethnic minorities

now account for more than two thirds of all the

reported cases of tuberculosis in the United
States, partly as a result of the increased
incidence of tuberculosis among ethnic
minorities affected with HIV (Centers for Disease
Control, 1998). Diabetes is quite rare among
American Eskimos. Diabetes has a high
incidence within certain American Indian tribes,
including the Seminole, Pima, and Papago.
NIDDM, or Type 2 diabetes, is a major health
problem for Native American Indians, occurring
as early as the teens or early twenties. Agespecific death rates for diabetes appear to be 2.6

higher for Native Americans between 25 and 54

years of age, compared with the rest of the
general population. The incidence of
hypertension is higher in African Americans than
Whites. The onset by age is earlier in African
Americans, and the hypertension is more severe
and associated with the higher mortality in
African Americans. It is important to remember
that susceptibility to disease may also be
environmental or a combination of both genetic
and environmental factors.