Readiness for enhanced Childbearing Process: demonstrates appropriate feeding and baby care techniques, along with attachment to infant and providing a safe environment
Anxiety r/t situational crisis, back injury
Ineffective Coping r/t situational crisis, back injury
Disturbed Energy Field r/t chronic pain
Impaired physical Mobility r/t pain
Risk for Constipation: Risk factors: decreased activity, side effect of pain medication
Risk for Disuse Syndrome: Risk factor: severe pain
Readiness for enhanced Knowledge: expresses an interest in learning
Risk for Infection: Risk factor: compromised immune system
Risk for Shock: Risk factor: development of systemic inflammatory response from presence of bacteria in blood stream
Impaired Mobility r/t chronic physically limiting condition
Self-Neglect (See Neglect, self, Section III)
Bathing Self-Care deficit (See Self-Care deficit, bathing, Section III)
Dysfunctional Family Processes r/t inadequate coping skills
Sleep deprivation r/t prolonged psychological discomfort
Chronic Sorrow r/t situational crises
Risk for Post-Trauma Syndrome: Risk factors: physical abuse, incest, rape, molestation
Risk for Self-Mutilation: Risk factors: feelings of rejection, dysfunctional family
Risk for Suicide: Risk factor: childhood abuse.
See Child Abuse
Impaired Home Maintenance r/t deficient knowledge regarding prevention of bedbug infestation
Deficient Diversional Activity r/t prolonged bed rest
Impaired bed Mobility r/t neuromuscular impairment
Social Isolation r/t prolonged bed rest
Ineffective Health Maintenance r/t unachieved developmental level, neuromuscular immaturity, diseases of the urinary system.
Disturbed Body Image r/t loss of motor control on one side of face
Imbalanced Nutrition: less than body requirements r/t difficulty with chewing
Acute Pain r/t inflammation of facial nerve
Risk for Injury (eye): Risk factor: decreased tears, decreased blinking of eye
Readiness for enhanced Knowledge: expresses an interest in learning
Grieving r/t loss of significant person
Risk for complicated Grieving: Risk factor: emotional instability, lack of social support
Risk for Spiritual Distress: Risk factor: death of a loved one
Anxiety r/t surgical intervention, possible liver transplantation
Impaired Comfort r/t inflammation of skin, itching
Imbalanced Nutrition: less than body requirements r/t decreased absorption of fat and fat-soluble vitamins, poor feeding
Risk for Bleeding: Risk factors: vitamin K deficiency, altered clotting mechanisms
Risk for ineffective Breathing Pattern: Risk factors: enlarged liver, development of ascites
Risk for impaired Skin Integrity: Risk factor: pruritus
See Child with Chronic Condition; Cirrhosis (as complication); Hospitalized Child; Terminally Ill Child, Adolescent; Infant/Toddler; Preschool Child; School-Age Child/Preadolescent; Death of Child, Parent
Contamination r/t exposure to bioterrorism
Risk for Infection: Risk factor: exposure to harmful biological agent
Risk for Post-Trauma Syndrome: Risk factor: perception of event of bioterrorism
Ineffective Activity Planning r/t unrealistic perception of events
Risk-prone Health Behavior r/t low state of optimism
Disturbed Energy Field r/t disharmony of mind, body, spirit
Fatigue r/t psychological demands
Ineffective Health Maintenance r/t lack of ability to make good judgments regarding ways to obtain help
Self-Care deficit: specify r/t depression, cognitive impairment
Chronic low Self-Esteem r/t repeated unmet expectations
Social Isolation r/t ineffective coping
Risk for complicated Grieving: Risk factor: lack of previous resolution of former grieving response
Risk for Loneliness: Risk factors: stress, conflict
Risk for Spiritual Distress: Risk factor: mental illness
Risk for Suicide: Risk factor: psychiatric disorder, poor support system
See Depression (Major Depressive Disorder); Manic Disorder, Bipolar I
Urinary Retention r/t high urethral pressure caused by weak detrusor, inhibition of reflex arc, blockage, strong sphincter
Disturbed Body Image r/t difficulty maintaining control of urinary elimination
Functional urinary Incontinence r/t altered environment; sensory, cognitive, mobility deficit
Stress urinary Incontinence r/t degenerative change in pelvic muscles and structural supports
Urge urinary Incontinence r/t decreased bladder capacity, increased urine concentration, overdistention of bladder
Readiness for enhanced Knowledge: Expresses an interest in learning
Risk for Bleeding (See Bleeding, risk for, Section III)
Risk for delayed Surgical Recovery: Risk factor: bleeding tendency
Disturbed Body Image r/t effects of surgery
Readiness for enhanced Knowledge: Expresses an interest in learning
Interrupted Family Processes r/t shift in health status of family member (change in visual acuity)
Impaired Home Maintenance r/t decreased vision
Ineffective Role Performance r/t alteration in health status (change in visual acuity)
Self-Care deficit: specify r/t inability to see to be able to perform activities of daily living
Vision Loss r/t impaired sensory reception, transmission, or integration
Risk for delayed Development: Risk factor: vision impairment
Risk for Injury: Risk factor: sensory dysfunction
Readiness for enhanced Knowledge: expresses an interest in learning
Ineffective Protection r/t abnormal blood profile
Risk for Bleeding: Risk factor: abnormal blood profile
See cause of Blood Disorder
Risk for unstable blood Glucose level (See Glucose level, blood, unstable, risk for, Section III)
Anxiety r/t perceived defect of body
Disturbed Body Image r/t overinvolvement in physical appearance
Chronic low Self-Esteem r/t lack of self valuing because of perceived body defects
Social Isolation r/t distancing self from others because of perceived self body defects
Risk for Suicide: Risk factor: perceived defects of body affecting self-valuing and hopes
Ineffective Thermoregulation (See Thermoregulation, ineffective, Section III)
Fear r/t unknown outcome of results of biopsy
Acute Pain r/t bone marrow aspiration
Readiness for enhanced Knowledge: expresses an interest in learning
See disease necessitating bone marrow biopsy (e.g., Leukemia)
Ineffective Activity Planning r/t unrealistic perception of events
Anxiety r/t perceived threat to self-concept
Defensive Coping r/t difficulty with relationships, inability to accept blame for own behavior
Ineffective Coping r/t use of maladjusted defense mechanisms (e.g., projection, denial)
Powerlessness r/t lifestyle of helplessness
Social Isolation r/t immature interests
Ineffective family Therapeutic Regimen Management r/t manipulative behavior of client
Risk for Caregiver Role Strain: Risk factors: inability of care receiver to accept criticism, care receiver taking advantage of others to meet own needs or having unreasonable expectations
Risk for Self-Mutilation: Risk factors: ineffective coping, feelings of self-hatred
Risk for Spiritual Distress: Risk factor: poor relationships associated with abnormal behaviors
Risk for self-directed Violence: Risk factors: feelings of need to punish self, manipulative behavior
Deficient Fluid Volume r/t profuse diarrhea
Readiness for enhanced Knowledge: expresses an interest in learning
Bowel Incontinence r/t decreased awareness of need to defecate, loss of sphincter control, fecal impaction
Readiness for enhanced Knowledge: expresses an interest in learning
Constipation r/t decreased motility, intestinal obstruction
Deficient Fluid Volume r/t inadequate fluid volume intake, fluid loss in bowel
Imbalanced Nutrition: less than body requirements r/t nausea, vomiting
Constipation r/t decreased or absent peristalsis
Deficient Fluid Volume r/t inability to ingest fluids, loss of fluids in bowel
Delayed Surgical Recovery r/t inability to obtain adequate nutritional status
Risk for dysfunctional Gastrointestinal Motility (See Gastrointestinal Motility, dysfunctional, risk for, Section III)
Bowel Incontinence r/t loss of control of rectal sphincter
Readiness for enhanced Knowledge: expresses an interest in learning
Ineffective Health Maintenance r/t deficient knowledge regarding self-care with prostatic hypertrophy
Urinary Retention r/t obstruction of urethra
Risk for urge urinary Incontinence: Risk factors: detrusor muscle instability with impaired contractility, involuntary sphincter relaxation
Risk for Infection: Risk factors: urinary residual after voiding, bacterial invasion of bladder
Readiness for enhanced Knowledge: expresses an interest in learning
Decreased Cardiac Output r/t slow heart rate supplying inadequate amount of blood for body function
Risk for ineffective Cerebral tissue perfusion: Risk factors: decreased cardiac output secondary to bradycardia, vagal response
Readiness for enhanced Knowledge: expresses an interest in learning
Ineffective Breathing Pattern r/t neuromuscular impairment, pain, musculoskeletal impairment, perception or cognitive impairment, anxiety, fatigue or decreased energy, effects of drugs
See cause of Bradypnea
Acute Confusion r/t pressure from tumor
Grieving r/t potential loss of physiosocial-psychosocial well-being
Decreased Intracranial Adaptive Capacity r/t presence of brain tumor
Acute Pain r/t pressure from tumor
Vision Loss r/t tumor growth compressing optic nerve and/or brain tissue
Risk for Injury: Risk factors: sensory-perceptual alterations, weakness
See Cancer; Chemotherapy; Child with Chronic Condition; Craniectomy/Craniotomy; Hospitalized Child; Radiation Therapy; Terminally Ill Child, Adolescent; Terminally Ill Child, Infant/Toddler; Terminally Ill Child, Preschool Child; Terminally Ill Child, School-Age Child/Preadolescent; Terminally Ill Child/Death of Child, Parent
Activity Intolerance r/t increased contractions with increased gestation
Anxiety r/t uncertainty about beginning labor
Stress urinary Incontinence r/t increased pressure on bladder with contractions
Insomnia r/t contractions when lying down
Ineffective Sexuality Pattern r/t fear of contractions associated with loss of infant
Fear r/t potential for diagnosis of cancer
Risk for Spiritual Distress: Risk factor: fear of diagnosis of cancer
Readiness for enhanced Knowledge: expresses an interest in learning
Death Anxiety r/t diagnosis of cancer
Ineffective Coping r/t treatment, prognosis
Sexual Dysfunction r/t loss of body part, partner’s reaction to loss
Chronic Sorrow r/t diagnosis of cancer, loss of body integrity
Risk for Spiritual Distress: Risk factor: fear of diagnosis of cancer
Readiness for enhanced Knowledge: expresses an interest in learning
Fear r/t potential for diagnosis of cancer
Readiness for enhanced Knowledge: expresses an interest in learning
Risk for Infection: Risk factors: possible contaminated breast pump, incomplete emptying of breast
Risk for impaired Skin Integrity: Risk factor: high suction
Readiness for enhanced Knowledge: expresses an interest in learning
Readiness for enhanced Breastfeeding (See Breastfeeding, readiness for enhanced, Section III)
Ineffective Breastfeeding (See Breastfeeding, ineffective, Section III)
See Infant Feeding Pattern, Ineffective; Painful Breasts, Engorgement; Painful Breasts, Sore Nipples
Ineffective Breathing Pattern r/t neuromuscular impairment, pain, musculoskeletal impairment, perception or cognitive impairment, anxiety, decreased energy or fatigue
Fear: maternal r/t danger to infant, self
Impaired Gas Exchange: fetal r/t compressed umbilical cord
Risk for Aspiration: fetal: Risk factor: birth of body before head
Risk for delayed Development: Risk factor: compressed umbilical cord
Risk for impaired Tissue Integrity: fetal: Risk factor: difficult birth
Risk for impaired Tissue Integrity: maternal: Risk factor: difficult birth
Ineffective Airway Clearance r/t excessive thickened mucus secretion
Readiness for enhanced Self-Health Management: wishes to stop smoking
Readiness for enhanced Knowledge: expresses an interest in learning
Activity Intolerance r/t imbalance between oxygen supply and demand
Excess Fluid Volume r/t sodium and water retention
Imbalanced Nutrition: less than body requirements r/t poor feeding, increased caloric needs as a result of increased work of breathing
See Child with Chronic Condition; Hospitalized Child; Respiratory Conditions of the Neonate
Risk for Aspiration: Risk factor: temporary loss of gag reflex
Risk for Injury: Risk factors: complication of pneumothorax, laryngeal edema, hemorrhage (if biopsy done)
Risk for ineffective Cerebral tissue perfusion: Risk factors: interruption of carotid blood flow to brain
Disturbed Body Image r/t misperception about actual appearance, body weight
Compromised family Coping r/t chronically unresolved feelings of guilt, anger, hostility
Defensive Coping r/t eating disorder
Fear r/t food ingestion, weight gain
Imbalanced Nutrition: less than body requirements r/t induced vomiting, excessive exercise, laxative abuse.
Powerlessness r/t urge to purge self after eating
Impaired physical Mobility r/t sore foot
Impaired Walking r/t pain associated with surgery
Risk for Infection: Risk factors: surgical incision, advanced age
Readiness for enhanced Knowledge: expresses an interest in learning
Disturbed Body Image r/t altered physical appearance
Deficient Diversional Activity r/t long-term hospitalization
Fear r/t pain from treatments, possible permanent disfigurement
Deficient Fluid Volume r/t loss of protective skin
Grieving r/t loss of bodily function, loss of future hopes and plans
Hypothermia r/t impaired skin integrity
Impaired physical Mobility r/t pain, musculoskeletal impairment, contracture formation
Imbalanced Nutrition: less than body requirements r/t increased metabolic needs, anorexia, protein and fluid loss
Acute Pain r/t burn injury, treatments
Ineffective peripheral Tissue Perfusion r/t circumferential burns, impaired arterial/venous circulation
Post-Trauma Syndrome r/t life-threatening event
Impaired Skin Integrity r/t injury of skin
Delayed Surgical Recovery r/t ineffective tissue perfusion
Risk for ineffective Airway Clearance: Risk factors: potential tracheobronchial obstruction, edema
Risk for deficient Fluid Volume: Risk factors: loss from skin surface, fluid shift
Risk for Infection: Risk factors: loss of intact skin, trauma, invasive sites
Risk for Peripheral Neurovascular Dysfunction: Risk factor: eschar formation with circumferential burn
Risk for Post-Trauma Syndrome: Risk factors: perception, duration of event that caused burns
Readiness for enhanced Knowledge: expresses an interest in learning