D

Deafness

Hearing Loss r/t alteration in sensory reception, transmission, integration

Impaired verbal Communication r/t impaired hearing

Risk for delayed Development: Risk factor: impaired hearing

Risk for Injury r/t alteration in sensory perception

Death

Risk for Sudden Infant Death Syndrome (SIDS) (See death Syndrome, infant, sudden, Risk for, Section III)

Death, Oncoming

Death Anxiety r/t unresolved issues surrounding dying

Compromised family Coping r/t client’s inability to provide support to family

Ineffective Coping r/t personal vulnerability

Fear r/t threat of death

Grieving r/t loss of significant other

Powerlessness r/t effects of illness, oncoming death

Social Isolation r/t altered state of wellness

Spiritual Distress r/t intense suffering

Readiness for enhanced Spiritual Well-Being: desire of client and family to be in harmony with each other and higher power, God

See 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

Decisions, Difficulty Making

Decisional Conflict r/t support system deficit, perceived threat to value system, multiple or divergent sources of information, lack of relevant information, unclear personal values or beliefs

Readiness for enhanced Decision-Making (See Decision-Making, readiness for enhanced, Section III)

Decubitus Ulcer

See Pressure Ulcer

Deep Vein Thrombosis (DVT)

See DVT (Deep Vein Thrombosis)

Defensive Behavior

Defensive Coping r/t nonacceptance of blame, denial of problems or weakness

Ineffective Denial r/t inability to face situation realistically

Dehiscence, Abdominal

Fear r/t threat of death, severe dysfunction

Acute Pain r/t stretching of abdominal wall

Impaired Skin Integrity r/t altered circulation, malnutrition, opening in incision

Delayed Surgical Recovery r/t altered circulation, malnutrition, opening in incision

Impaired Tissue Integrity r/t exposure of abdominal contents to external environment

Risk for deficient Fluid Volume: Risk factor: altered circulation associated with opening of wound and exposure of abdominal contents

Risk for Infection: Risk factor: loss of skin integrity, open surgical wound

Dehydration

Deficient Fluid Volume r/t active fluid volume loss

Impaired Oral Mucous Membrane r/t decreased salivation, fluid deficit

Readiness for enhanced Knowledge: expresses an interest in learning

See cause of Dehydration

Delirium

Acute Confusion r/t effects of medication, response to hospitalization, alcohol abuse, substance abuse, sensory deprivation or overload, infection, polypharmacy

Adult Failure to Thrive r/t delirium

Impaired Memory r/t delirium

Sleep deprivation r/t nightmares

Risk for Injury: Risk factor: altered level of consciousness

Delirium Tremens (DT)

See Alcohol Withdrawal

Delivery

See Labor, Normal

Delusions

Impaired verbal Communication r/t psychological impairment, delusional thinking

Acute Confusion r/t alcohol abuse, delirium, dementia, drug abuse

Ineffective Coping r/t distortion and insecurity of life events

Adult Failure to Thrive r/t delusional state

Fear r/t content of intrusive thoughts

Risk for other-directed Violence: Risk factor: delusional thinking

Risk for self-directed Violence: Risk factor: delusional thinking

Dementia

Chronic Confusion r/t neurological dysfunction

Impaired Environmental Interpretation Syndrome r/t dementia

Adult Failure to Thrive r/t depression, apathy

Interrupted Family Processes r/t disability of family member

Impaired Home Maintenance r/t inadequate support system, neurological dysfunction

Functional urinary Incontinence r/t neurological dysfunction

Insomnia r/t neurological impairment, naps during the day

Impaired physical Mobility r/t neuromuscular impairment

Self-Neglect r/t cognitive impairment

Imbalanced Nutrition: less than body requirements r/t neurological impairment

Self-Care deficit: specify r/t psychological or neuromuscular impairment

Impaired Swallowing r/t neuromuscular changes associated with long-standing dementia

Chronic Sorrow: Significant other r/t chronic long-standing disability, loss of mental function

Risk for Caregiver Role Strain: Risk factors: number of caregiving tasks, duration of caregiving required

Risk for Falls: Risk factor: diminished mental status

Risk for Injury: Risk factors: confusion, decreased muscle coordination

Risk for impaired Skin Integrity: Risk factors: altered nutritional status, immobility

Denial of Health Status

Ineffective Denial r/t lack of perception about the health status effects of illness

Ineffective Self-Health Management r/t denial of seriousness of health situation

Dental Caries

Impaired Dentition r/t ineffective oral hygiene, barriers to self-care, economic barriers to professional care, nutritional deficits, dietary habits

Ineffective Self-Health Maintenance r/t lack of knowledge regarding prevention of dental disease

Depression (Major Depressive Disorder)

Death Anxiety r/t feelings of lack of self-worth

Constipation r/t inactivity, decreased fluid intake

Disturbed Energy Field r/t disharmony

Impaired Environmental Interpretation Syndrome r/t severe mental functional impairment

Adult Failure to Thrive r/t depression

Fatigue r/t psychological demands

Ineffective Health Maintenance r/t lack of ability to make good judgments regarding ways to obtain help

Hopelessness r/t feeling of abandonment, long-term stress

Insomnia r/t inactivity

Self-Neglect r/t depression, cognitive impairment

Powerlessness r/t pattern of helplessness

Chronic low Self-Esteem r/t repeated unmet expectations

Sexual Dysfunction r/t loss of sexual desire

Social Isolation r/t ineffective coping

Chronic Sorrow r/t unresolved grief

Risk for complicated Grieving: Risk factor: lack of previous resolution of former grieving response

Risk for Suicide: Risk factor: grieving, hopelessness

Dermatitis

Anxiety r/t situational crisis imposed by illness

Impaired Comfort r/t itching

Impaired Skin Integrity r/t side effect of medication, allergic reaction

Readiness for enhanced Knowledge: expresses an interest in learning

See Itching

Despondency

Hopelessness r/t long-term stress

See Depression (Major Depressive Disorder)

Destructive Behavior Toward Others

Risk-prone Health Behavior r/t intense emotional state

Ineffective Coping r/t situational crises, maturational crises, disturbance in pattern of appraisal of threat

Risk for other-directed Violence (See Violence, other-directed, risk for, Section III)

Developmental Concerns

Delayed Growth and Development (See Growth and Development, delayed, Section III)

Risk for delayed Development (See Development, delayed, risk for, Section III)

See Growth and Development Lag

Diabetes in Pregnancy

See Gestational Diabetes (Diabetes in Pregnancy)

Diabetes Insipidus

Deficient Fluid Volume r/t inability to conserve fluid

Ineffective Health Maintenance r/t deficient knowledge regarding care of disease, importance of medications

Diabetes Mellitus

Adult Failure to Thrive r/t undetected disease process

Ineffective Health Maintenance r/t complexity of therapeutic regimen

Ineffective Self-Health Management (See Self-Health Management, ineffective, Section III)

Imbalanced Nutrition: less than body requirements r/t inability to use glucose (type 1 [insulin-dependent] diabetes)

Imbalanced Nutrition: more than body requirements r/t excessive intake of nutrients (type 2 diabetes)

Ineffective peripheral Tissue Perfusion r/t impaired arterial circulation

Powerlessness r/t perceived lack of personal control

Sexual Dysfunction r/t neuropathy associated with disease

Vision Loss r/t ineffective tissue perfusion of retina

Risk for unstable blood Glucose level (See Glucose level, blood, unstable, risk for, Section III)

Risk for Infection: Risk factors: hyperglycemia, impaired healing, circulatory changes

Risk for Injury: Risk factors: hypoglycemia or hyperglycemia from failure to consume adequate calories, failure to take insulin

Risk for dysfunctional Gastrointestinal Motility: Risk factor: complication of diabetes

Risk for impaired Skin Integrity: Risk factor: loss of pain perception in extremities

Readiness for enhanced Self-Health Management (See Self-Health Management, readiness for enhanced, Section III)

Readiness for enhanced Knowledge: expresses an interest in learning

See Hyperglycemia; Hypoglycemia

Diabetes Mellitus, Juvenile (IDDM Type 1)

Risk-prone Health Behavior r/t inadequate comprehension, inadequate social support, low self-efficacy, impaired adjustment attributable to adolescent maturational crises

Disturbed Body Image r/t imposed deviations from biophysical and psychosocial norm, perceived differences from peers

Impaired Comfort r/t insulin injections, peripheral blood glucose testing

Ineffective Health Maintenance r/t (See Health Maintenance, ineffective, Section III)

Imbalanced Nutrition: less than body requirements r/t inability of body to adequately metabolize and use glucose and nutrients, increased caloric needs of child to promote growth and physical activity participation with peers

Readiness for enhanced Knowledge: expresses an interest in learning

See Diabetes Mellitus; Child with Chronic Condition; Hospitalized Child

Diabetic Coma

Acute Confusion r/t hyperglycemia, presence of excessive metabolic acids

Deficient Fluid Volume r/t hyperglycemia resulting in polyuria

Ineffective Self-Health Management r/t lack of understanding of preventive measures, adequate blood sugar control

Risk for unstable blood Glucose level (See Glucose level, blood, unstable, risk for, Section III)

Risk for Infection: Risk factors: hyperglycemia, changes in vascular system

See Diabetes Mellitus

Diabetic Ketoacidosis

See Ketoacidosis, Diabetic

Diabetic Retinopathy

Grieving r/t loss of vision

Ineffective Health Maintenance r/t deficient knowledge regarding preserving vision with treatment if possible, use of low-vision aids

Vision Loss r/t change in sensory reception

See Vision Impairment; Blindness

Dialysis

See Hemodialysis; Peritoneal Dialysis

Diaphragmatic Hernia

See Hiatal Hernia

Diarrhea

Diarrhea r/t infection, change in diet, gastrointestinal disorders, stress, medication effect, impaction

Deficient Fluid Volume r/t excessive loss of fluids in liquid stools.

Risk for Electrolyte Imbalance: Risk factor: effect of loss of electrolytes from frequent stools

DIC (Disseminated Intravascular Coagulation)

Fear r/t threat to well-being

Deficient Fluid Volume: hemorrhage r/t depletion of clotting factors

Risk for Bleeding: Risk factors: microclotting within vascular system, depleted clotting factors

Risk for ineffective Gastrointestinal Perfusion (See Gastrointestinal Perfusion, ineffective, risk for, Section III)

Digitalis Toxicity

Decreased Cardiac Output r/t drug toxicity affecting cardiac rhythm, rate

Ineffective Self-Health Management r/t deficient knowledge regarding action, appropriate method of administration of digitalis

Dignity, Loss of

Risk for compromised Human Dignity (See Human Dignity, compromised, risk for, Section III)

Dilation and Curettage (D&C)

Acute Pain r/t uterine contractions

Risk for Bleeding: Risk factor: surgical procedure

Risk for Infection: Risk factor: surgical procedure

Risk for ineffective Sexuality Pattern: Risk factors: painful coitus, fear associated with surgery on genital area

Readiness for enhanced Knowledge: expresses an interest in learning

Dirty Body (for Prolonged Period)

Self-Neglect r/t mental illness, substance abuse, cognitive impairment

Discharge Planning

Impaired Home Maintenance r/t family member’s disease or injury interfering with home maintenance

Deficient Knowledge r/t lack of exposure to information for home care

Readiness for enhanced Knowledge: expresses an interest in learning

Discomforts of Pregnancy

Disturbed Body Image r/t pregnancy-induced body changes

Impaired Comfort r/t enlarged abdomen, swollen feet

Fatigue r/t hormonal, metabolic, body changes

Stress urinary Incontinence r/t enlarged uterus, fetal movement

Insomnia r/t psychological stress, fetal movement, muscular cramping, urinary frequency, shortness of breath

Nausea r/t hormone effect

Acute Pain: headache r/t hormonal changes of pregnancy

Acute Pain: leg cramps r/t nerve compression, calcium/phosphorus/potassium imbalance

Risk for Constipation: Risk factors: decreased intestinal motility, inadequate fiber in diet

Risk for Injury: Risk factors: faintness and/or syncope caused by vasomotor lability or postural hypotension, venous stasis in lower extremities

Dislocation of Joint

Acute Pain r/t dislocation of a joint

Self-Care deficit: specify r/t inability to use a joint

Risk for Injury: Risk factor: unstable joint

Dissecting Aneurysm

Fear r/t threat to well-being

See Abdominal Surgery; Aneurysm, Abdominal Surgery

Disseminated Intravascular Coagulation (DIC)

See DIC (Disseminated Intravascular Coagulation)

Dissociative Identity Disorder (Not Otherwise Specified)

Anxiety r/t psychosocial stress

Ineffective Coping r/t personal vulnerability in crisis of accurate self-perception

Disturbed personal Identity r/t inability to distinguish self caused by multiple personality disorder, depersonalization, disturbance in memory

Impaired Memory r/t altered state of consciousness

See Multiple Personality Disorder (Dissociative Identity Disorder)

Distress

Anxiety r/t situational crises, maturational crises

Death Anxiety r/t denial of one’s own mortality or impending death

Disturbed Energy Field r/t disruption in flow of energy as result of pain, depression, fatigue, anxiety, stress

Disuse Syndrome, Potential to Develop

Risk for Disuse Syndrome: Risk factors: paralysis, mechanical immobilization, prescribed immobilization, severe pain, altered level of consciousness

Diversional Activity, Lack of

Deficient Diversional Activity r/t environmental lack of diversional activity as in frequent hospitalizations, lengthy treatments

Diverticulitis

Constipation r/t dietary deficiency of fiber and roughage

Diarrhea r/t increased intestinal motility caused by inflammation

Deficient Knowledge r/t diet needed to control disease, medication regimen

Imbalanced Nutrition: less than body requirements r/t loss of appetite

Acute Pain r/t inflammation of bowel

Risk for deficient Fluid Volume: Risk factor: diarrhea

Dizziness

Decreased Cardiac Output r/t dysfunctional electrical conduction

Deficient Knowledge r/t actions to take to prevent or modify dizziness and prevent falls

Impaired physical Mobility r/t dizziness

Risk for Falls: Risk factor: difficulty maintaining balance

Risk for ineffective Cerebral tissue perfusion: Risk factor: interruption of cerebral arterial blood flow

Domestic Violence

Impaired verbal Communication r/t psychological barriers of fear

Compromised family Coping r/t abusive patterns

Defensive Coping r/t low self-esteem

Dysfunctional Family Processes r/t inadequate coping skills

Fear r/t threat to self-concept, situational crisis of abuse

Insomnia r/t psychological stress

Post-Trauma Syndrome r/t history of abuse

Powerlessness r/t lifestyle of helplessness

Situational low Self-Esteem r/t negative family interactions

Risk for compromised Resilience: Risk factor: effects of abuse

Risk for other-directed Violence: Risk factor: history of abuse

Down Syndrome

See Child with Chronic Condition; Mental Retardation

Dress Self (Inability to)

Dressing Self-Care deficit r/t intolerance to activity, decreased strength and endurance, pain, discomfort, perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, depression, severe anxiety

Dribbling of Urine

Overflow urinary Incontinence r/t degenerative changes in pelvic muscles and urinary structures

Stress urinary Incontinence r/t degenerative changes in pelvic muscles and urinary structures

Drooling

Impaired Swallowing r/t neuromuscular impairment, mechanical obstruction

Risk for Aspiration: Risk factor: impaired swallowing

Dropout from School

Impaired individual Resilience (See Resilience, individual, impaired, Section III)

Drug Abuse

Anxiety r/t threat to self-concept, lack of control of drug use

Risk-prone Health Behavior r/t addiction

Ineffective Coping r/t situational crisis

Ineffective Denial r/t use of drugs affecting quality of own life and that of significant others

Insomnia r/t effects of drugs

Imbalanced Nutrition: less than body requirements r/t poor eating habits

Powerlessness r/t feeling unable to change patterns of drug abuse

Impaired individual Resilience (See Resilience, individual, impaired, Section III)

Sexual Dysfunction r/t actions and side effects of drug abuse

Sleep deprivation r/t prolonged psychological discomfort

Impaired Social Interaction r/t disturbed thought processes from drug abuse

Spiritual Distress r/t separation from religious, cultural ties

Risk for Injury: Risk factors: hallucinations, drug effects

Risk for other-directed Violence: Risk factor: poor impulse control

See Cocaine Abuse; Substance Abuse

Drug Withdrawal

Anxiety r/t physiological withdrawal

Acute Confusion r/t effects of substance withdrawal

Ineffective Coping r/t situational crisis, withdrawal

Insomnia r/t effects of medication withdrawal

Imbalanced Nutrition: less than body requirements r/t poor eating habits

Risk for other-directed Violence: Risk factors: poor impulse control, hallucinations

Risk for self-directed Violence: Risk factors: poor impulse control, hallucinations

See Drug Abuse

Dry Eye

Risk for dry Eye: Risk factors: (See dry Eye, risk for, Section III)

Readiness for enhanced Knowledge: expresses an interest in learning

See Conjunctivitis; Keratoconjunctivitis Sicca

DT (Delirium Tremens)

See Alcohol Withdrawal

DVT (Deep Vein Thrombosis)

Constipation r/t inactivity, bed rest

Impaired physical Mobility r/t pain in extremity

Acute Pain r/t vascular inflammation, edema

Ineffective peripheral Tissue Perfusion r/t deficient knowledge of aggravating factors

Delayed Surgical Recovery r/t impaired physical mobility

Readiness for enhanced Knowledge: expresses an interest in learning

See Anticoagulant Therapy

Dying Client

See Terminally Ill Adult; Terminally Ill 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

Dysfunctional Eating Pattern

Imbalanced Nutrition: less than body requirements r/t psychological factors

Imbalanced Nutrition: more than body requirements r/t psychological factors

See Anorexia Nervosa; Bulimia; Maturational Issues, Adolescent; Obesity

Dysfunctional Family Unit

See Family Problems

Dysfunctional Ventilatory Weaning

Dysfunctional Ventilatory Weaning Response r/t physical, psychological, situational factors

Dysmenorrhea

Nausea r/t prostaglandin effect

Acute Pain r/t cramping from hormonal effects

Readiness for enhanced Knowledge: expresses an interest in learning

Dyspareunia

Sexual Dysfunction r/t lack of lubrication during intercourse, alteration in reproductive organ function

Dyspepsia

Anxiety r/t pressures of personal role

Acute Pain r/t gastrointestinal disease, consumption of irritating foods

Readiness for enhanced Knowledge: expresses an interest in learning

Dysphagia

Impaired Swallowing r/t neuromuscular impairment

Risk for Aspiration: Risk factor: loss of gag or cough reflex

Dysphasia

Impaired verbal Communication r/t decrease in circulation to brain

Impaired Social Interaction r/t difficulty in communicating

Dyspnea

Activity Intolerance r/t imbalance between oxygen supply and demand

Ineffective Breathing Pattern r/t compromised cardiac or pulmonary function, decreased lung expansion, neurological impairment affecting respiratory center, extreme anxiety

Fear r/t threat to state of well-being, potential death

Impaired Gas Exchange r/t alveolar-capillary damage

Insomnia r/t difficulty breathing, positioning required for effective breathing

Sleep deprivation r/t ineffective breathing pattern

Dysrhythmia

Activity Intolerance r/t decreased cardiac output

Decreased Cardiac Output r/t altered electrical conduction

Fear r/t threat of death, change in health status

Risk for ineffective Cerebral tissue perfusion: Risk factor: decreased blood supply to the brain from dysrhythmia

Readiness for enhanced Knowledge: expresses an interest in learning

Dysthymic Disorder

Ineffective Coping r/t impaired social interaction

Ineffective Health Maintenance r/t inability to make good judgments regarding ways to obtain help

Insomnia r/t anxious thoughts

Chronic low Self-Esteem r/t repeated unmet expectations

Ineffective Sexuality Pattern r/t loss of sexual desire

Social Isolation r/t ineffective coping

See Depression (Major Depressive Disorder)

Dystocia

Anxiety r/t difficult labor, deficient knowledge regarding normal labor pattern

Ineffective Coping r/t situational crisis

Fatigue r/t prolonged labor

Grieving r/t loss of ideal labor experience

Acute Pain r/t difficult labor, medical interventions

Powerlessness r/t perceived inability to control outcome of labor

Risk for Bleeding: Risk factor: hemorrhage secondary to uterine atony

Risk for delayed Development (Infant): Risk factor: difficult labor and birth

Risk for disproportionate Growth: Risk factor: difficult labor and birth

Risk for Infection: Risk factor: prolonged rupture of membranes

Risk for ineffective Cerebral tissue perfusion (fetal): Risk factor: difficult labor and birth

Risk for impaired Tissue Integrity (maternal and fetal): Risk factor: difficult labor

Dysuria

Impaired Urinary Elimination r/t infection/inflammation of the urinary tract

Risk for urge urinary Incontinence: Risk factors: detrusor hyperreflexia from infection in the urinary tract