P

Pacemaker

Anxiety r/t change in health status, presence of pacemaker

Death Anxiety r/t worry over possible malfunction of pacemaker

Deficient Knowledge r/t self-care program, when to seek medical attention

Acute Pain r/t surgical procedure

Risk for Bleeding: Risk factor: surgery

Risk for Infection: Risk factors: invasive procedure, presence of foreign body (catheter and generator)

Risk for decreased Cardiac tissue perfusion: Risk factor: pacemaker malfunction

Risk for Powerlessness: Risk factor: presence of electronic device to stimulate heart

Readiness for enhanced Self-Health Management: appropriate health care management of pacemaker

Paget’s Disease

Disturbed Body Image r/t possible enlarged head, bowed tibias, kyphosis

Deficient Knowledge r/t appropriate diet high in protein and calcium, mild exercise

Chronic Sorrow r/t chronic condition with altered body image

Risk for Trauma: fracture: Risk factor: excessive bone destruction

Pain, Acute

Disturbed Energy Field r/t unbalanced energy field

Acute Pain (See Pain, acute, Section III)

Pain, Chronic

Impaired Comfort r/t altered health status

Disturbed Energy Field r/t unbalanced energy field

Chronic Pain (See Pain, chronic, Section III)

Painful Breasts, Engorgement

Impaired Comfort r/t physical condition

Acute Pain r/t distention of breast tissue

Ineffective Role Performance r/t change in physical capacity to assume role of breastfeeding mother

Impaired Tissue Integrity r/t excessive fluid in breast tissues

Risk for ineffective Breastfeeding: Risk factors: pain, infant’s inability to latch on to engorged breast

Risk for Infection: Risk factor: milk stasis

Risk for disturbed Maternal/Fetal Dyad: Risk factor: discomfort

Painful Breasts, Sore Nipples

Ineffective Breastfeeding r/t pain

Insufficient Breast Milk r/t long breastfeeding time/pain response

Impaired Comfort r/t physical condition

Acute Pain r/t cracked nipples

Ineffective Role Performance r/t change in physical capacity to assume role of breastfeeding mother

Impaired Skin Integrity r/t mechanical factors involved in suckling, breastfeeding management

Risk for Infection: Risk factor: break in skin

Pallor of Extremities

Ineffective peripheral Tissue Perfusion r/t interruption of vascular flow

Palpitations (Heart Palpitations)

See Dysrhythmia

Pancreatic Cancer

Death Anxiety r/t possible poor prognosis of disease process

Ineffective family Coping r/t poor prognosis

Fear r/t poor prognosis of the disease

Grieving r/t shortened life span

Deficient Knowledge r/t disease-induced diabetes, home management

Spiritual Distress r/t poor prognosis

Risk for impaired Liver Function: Risk factor: complications from underlying disease

See Cancer; Chemotherapy; Radiation Therapy; Surgery, Perioperative; Surgery, Postoperative; Surgery, Preoperative

Pancreatitis

Ineffective Breathing Pattern r/t splinting from severe pain

Ineffective Denial r/t ineffective coping, alcohol use

Diarrhea r/t decrease in pancreatic secretions resulting in steatorrhea

Adult Failure to Thrive r/t pain

Deficient Fluid Volume r/t vomiting, decreased fluid intake, fever, diaphoresis, fluid shifts

Ineffective Health Maintenance r/t deficient knowledge concerning diet, alcohol use, medication

Nausea r/t irritation of gastrointestinal system

Imbalanced Nutrition: less than body requirements r/t inadequate dietary intake, increased nutritional needs as a result of acute illness, increased metabolic needs caused by increased body temperature

Acute Pain r/t irritation and edema of the inflamed pancreas

Chronic Sorrow r/t chronic illness

Readiness for enhanced Comfort: expresses desire to enhance comfort

Panic Disorder (Panic Attacks)

Ineffective Activity Planning r/t unrealistic perception of events

Anxiety r/t situational crisis

Risk-prone Health Behavior r/t low self-efficacy

Ineffective Coping r/t personal vulnerability

Disturbed personal Identity r/t situational crisis

Post-Trauma Syndrome r/t previous catastrophic event

Social Isolation r/t fear of lack of control

Risk for Loneliness: Risk factor: inability to socially interact because of fear of losing control

Risk for Post-Trauma Syndrome: Risk factors: perception of the event, diminished ego strength

Risk for Powerlessness: Risk factor: ineffective coping skills

Readiness for enhanced Coping: seeks problem-oriented and emotion-oriented strategies to manage condition

See Anxiety; Anxiety Disorder

Paralysis

Disturbed Body Image r/t biophysical changes, loss of movement, immobility

Impaired Comfort r/t prolonged immobility

Constipation r/t effects of spinal cord disruption, inadequate fiber in diet

Ineffective Health Maintenance r/t deficient knowledge regarding self-care with paralysis

Impaired Home Maintenance r/t physical disability

Reflex urinary Incontinence r/t neurological impairment

Impaired physical Mobility r/t neuromuscular impairment

Impaired wheelchair Mobility r/t neuromuscular impairment

Self-Neglect r/t functional impairment

Powerlessness r/t illness-related regimen

Self-Care deficit: specify r/t neuromuscular impairment

Sexual Dysfunction r/t loss of sensation, biopsychosocial alteration

Chronic Sorrow r/t loss of physical mobility

Impaired Transfer Ability r/t paralysis

Risk for Autonomic Dysreflexia r/t cause of paralysis

Risk for Latex Allergy Response: Risk factor: possible repeated urinary catheterizations

Risk for Disuse Syndrome: Risk factor: paralysis

Risk for Falls: Risk factor: paralysis

Risk for Injury: Risk factors: altered mobility, sensory dysfunction

Risk for Post-Trauma Syndrome: Risk factor: event causing paralysis

Risk for impaired Religiosity: Risk factors: immobility, possible lack of transportation

Risk for compromised Resilience: Risk factor: chronic disability

Risk for situational low Self-Esteem: Risk factor: change in body image and function

Risk for impaired Skin Integrity: Risk factors: altered circulation, altered sensation, immobility

Risk for Thermal Injury

Readiness for enhanced Self-Care: expresses desire to enhance knowledge and responsibility for strategies for self-care

See Child with Chronic Condition; Hemiplegia; Hospitalized Child; Neural Tube Defects; Spinal Cord Injury

Paralytic Ileus

Constipation r/t decreased gastric motility

Deficient Fluid Volume r/t loss of fluids from vomiting, retention of fluid in bowel

Dysfunctional Gastrointestinal Motility r/t bowel obstruction

Nausea r/t gastrointestinal irritation

Impaired Oral Mucous Membrane r/t presence of nasogastric tube

Acute Pain r/t pressure, abdominal distention

See Bowel Obstruction

Paranoid Personality Disorder

Ineffective Activity Planning r/t unrealistic perception of events

Anxiety r/t uncontrollable intrusive, suspicious thoughts

Risk-prone Health Behavior r/t intense emotional state

Disturbed personal Identity r/t difficulty with reality testing

Impaired individual Resilience r/t psychological disorder

Chronic low Self-Esteem r/t inability to trust others

Social Isolation r/t inappropriate social skills

Risk for Loneliness: Risk factor: social isolation

Risk for Post-Trauma Syndrome: Risk factor: exaggerated sense of responsibility

Risk for Suicide: Risk factor: psychiatric illness

Risk for other-directed Violence: Risk factor: being suspicious of others and others’ actions

Paraplegia

See Spinal Cord Injury

Parathyroidectomy

Anxiety r/t surgery

Risk for ineffective Airway Clearance: Risk factors: edema or hematoma formation, airway obstruction

Risk for Bleeding: Risk factor: surgery

Risk for impaired verbal Communication: Risk factors: possible laryngeal damage, edema

Risk for Infection: Risk factor: surgical procedure

See Hypocalcemia

Parent Attachment

Risk for impaired Attachment (See Attachment, impaired, risk for, Section III)

Readiness for enhanced Childbearing Process: demonstrates appropriate care of newborn

See Parental Role Conflict

Parental Role Conflict

Parental Role Conflict (See Role Conflict, parental Section III)

Ineffective Relationship r/t unrealistic expectations

Chronic Sorrow r/t difficult parent-child relationship

Risk for Spiritual Distress: Risk factor: altered relationships

Readiness for enhanced Parenting: willingness to enhance parenting

Parenting

Readiness for enhanced Parenting (See Parenting, readiness for enhanced, Section III)

Parenting, Impaired

Impaired Parenting (See Parenting, impaired, Section III)

Chronic Sorrow r/t difficult parent-child relationship

Risk for Spiritual Distress: Risk factor: altered relationships

Parenting, Risk for Impaired

Risk for impaired Parenting (See Parenting, impaired, risk for, Section III)

See Parenting, Impaired

Paresthesia

Risk for Injury r/t inability to feel temperature changes, pain

Risk for Impaired Skin Integrity r/t impaired sensation

Risk for Thermal Injury r/t neuromuscular impairment

Parkinson’s Disease

Impaired verbal Communication r/t decreased speech volume, slowness of speech, impaired facial muscles

Constipation r/t weakness of defecation muscles, lack of exercise, inadequate fluid intake, decreased autonomic nervous system activity

Adult Failure to Thrive r/t depression associated with chronic progressive disease

Imbalanced Nutrition: less than body requirements r/t tremor, slowness in eating, difficulty in chewing and swallowing

Chronic Sorrow r/t loss of physical capacity

Risk for Injury: Risk factors: tremors, slow reactions, altered gait

See Neurologic Disorders

Paroxysmal Nocturnal Dyspnea (PND)

See PND (Paroxysmal Nocturnal Dyspnea)

Patent Ductus Arteriosus (PDA)

See Congenital Heart Disease/Cardiac Anomalies

Patient-Controlled Analgesia (PCA)

See PCA (Patient-Controlled Analgesia)

Patient Education

Deficient Knowledge r/t lack of exposure to information misinterpretation, unfamiliarity with information resources to manage illness

Readiness for enhanced Decision-Making: expresses desire to enhance understanding of choices for decision-making

Deficient Knowledge r/t lack of exposure to information, information misinterpretation

Readiness for enhanced Knowledge (specify): interest in learning

Readiness for enhanced Self-Health Management: expresses desire for information to manage the illness

Readiness for enhanced Spiritual Well-Being: desires to reach harmony with self, others, higher power/God

PCA (Patient-Controlled Analgesia)

Impaired Comfort r/t condition requiring PCA, pruritus from medication side effects

Deficient Knowledge r/t self-care of pain control

Nausea r/t side effects of medication

Risk for Injury: Risk factors: possible complications associated with PCA

Risk for Vascular Trauma: Risk factor: insertion site and length of insertion time

Readiness for enhanced Knowledge: appropriate management of PCA

Pectus Excavatum

See Marfan Syndrome

Pediculosis

See Lice

PEG (Percutaneous Endoscopic Gastrostomy)

See Tube Feeding

Pelvic Inflammatory Disease (PID)

See PID (Pelvic Inflammatory Disease)

Penile Prosthesis

Ineffective Sexuality Pattern r/t use of penile prosthesis

Risk for Infection: Risk factor: invasive surgical procedure

Risk for situational low Self-Esteem: Risk factors: ineffective sexuality pattern

Readiness for enhanced Self-Health Management: seeks information regarding care and use of prosthesis

See Erectile Dysfunction (ED); Impotence

Peptic Ulcer

See Ulcer, Peptic (Duodenal or Gastric)

Percutaneous Transluminal Coronary Angioplasty (PTCA)

See Angioplasty, Coronary

Pericardial Friction Rub

Decreased Cardiac Output

Acute Pain r/t inflammation, effusion

Delayed Surgical Recovery r/t complications associated with cardiac problems

Risk for decreased Cardiac tissue perfusion: Risk factors: inflammation in pericardial sac, fluid accumulation compressing heart

Pericarditis

Activity Intolerance r/t reduced cardiac reserve, prescribed bed rest

Decreased Cardiac Output

Deficient Knowledge r/t unfamiliarity with information sources

Acute Pain r/t biological injury, inflammation

Delayed Surgical Recovery r/t complications associated with cardiac problems

Risk for imbalanced Nutrition: less than body requirements r/t fever, hypermetabolic state associated with fever

Risk for decreased Cardiac tissue perfusion: Risk factor: inflammation in pericardial sac

Perioperative Positioning

Risk for Perioperative Positioning Injury (See Perioperative Positioning Injury, risk for, Section III)

Peripheral Neuropathy

See Neuropathy, Peripheral

Peripheral Neurovascular Dysfunction

Risk for Peripheral Neurovascular Dysfunction (See Peripheral Neurovascular Dysfunction, risk for, Section III)

See Neuropathy, Peripheral; Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease (PVD)

Activity Intolerance r/t imbalance between peripheral oxygen supply and demand

Ineffective Health Maintenance r/t deficient knowledge regarding self-care and treatment of disease

Chronic Pain: intermittent claudication r/t ischemia

Ineffective peripheral Tissue Perfusion r/t disease process

Risk for Falls: Risk factor: altered mobility

Risk for Injury: Risk factors: tissue hypoxia, altered mobility, altered sensation

Risk for Peripheral Neurovascular Dysfunction: Risk factor: possible vascular obstruction

Risk for impaired Skin Integrity: Risk factor: altered circulation or sensation

Readiness for enhanced Self-Health Management: self-care and treatment of disease

See Neuropathy, Peripheral; Peripheral Neurovascular Dysfunction

Peritoneal Dialysis

Ineffective Breathing Pattern r/t pressure from dialysate

Impaired Home Maintenance r/t complex home treatment of client

Deficient Knowledge r/t treatment procedure, self-care with peritoneal dialysis

Acute Pain r/t instillation of dialysate, temperature of dialysate

Chronic Sorrow r/t chronic disability

Risk for unstable blood Glucose level r/t increased concentrations of glucose dialysate

Risk for ineffective Coping: Risk factor: disability requiring change in lifestyle

Risk for imbalanced Fluid Volume: Risk factor: medical procedure

Risk for Infection: peritoneal: Risk factor: invasive procedure, presence of catheter, dialysate

Risk for Powerlessness: Risk factor: chronic condition and care involved

See Child with Chronic Condition; Hemodialysis; Hospitalized Child; Renal Failure; Renal Failure, Acute/Chronic, Child

Peritonitis

Ineffective Breathing Pattern r/t pain, increased abdominal pressure

Constipation r/t decreased oral intake, decrease of peristalsis

Deficient Fluid Volume r/t retention of fluid in bowel with loss of circulating blood volume

Nausea r/t gastrointestinal irritation

Imbalanced Nutrition: less than body requirements r/t nausea, vomiting

Acute Pain r/t inflammation, stimulation of somatic nerves

Risk for dysfunctional Gastrointestinal Motility: Risk factor: gastrointestinal disease

Pernicious Anemia

Diarrhea r/t malabsorption of nutrients

Fatigue r/t imbalanced nutrition: less than body requirements

Impaired Memory r/t anemia; lack of adequate red blood cells

Nausea r/t altered oral mucous membrane; sore tongue, bleeding gums

Imbalanced Nutrition: less than body requirements r/t lack of appetite associated with nausea and altered oral mucous membrane

Impaired Oral Mucous Membrane r/t vitamin deficiency; inability to absorb vitamin B12 associated with lack of intrinsic factor

Risk for Falls: Risk factors: dizziness, lightheadedness

Risk for Peripheral Neurovascular Dysfunction: Risk factor: anemia

Persistent Fetal Circulation

See Congenital Heart Disease/Cardiac Anomalies

Personal Identity Problems

Disturbed personal Identity (See Identity, personal, disturbed, Section III)

Risk for disturbed personal Identity

Personality Disorder

Ineffective Activity Planning r/t unrealistic perception of events

Impaired individual Resilience r/t psychological disorder

See specific disorder Antisocial Personality Disorder; Borderline Personality Disorder; OCD (Obsessive-Compulsive Disorder); Paranoid Personality Disorder

Pertussis (Whooping Cough)

See Respiratory Infections, Acute Childhood

Pesticide Contamination

Contamination r/t use of environmental contaminants; pesticides

Risk for Allergy Response r/t repeated exposure to pesticides

Risk for disproportionate Growth: Risk factor: environmental contamination

Petechiae

See Anticoagulant Therapy; Clotting Disorder; DIC (Disseminated Intravascular Coagulation); Hemophilia

Petit Mal Seizure

Readiness for enhanced Self-Health Management: wears medical alert bracelet; limits hazardous activities such as driving, swimming, working at heights, operating equipment

See Epilepsy

Pharyngitis

See Sore Throat

Phenylketonuria (PKU)

See PKU (Phenylketonuria)

Pheochromocytoma

Anxiety r/t symptoms from increased catecholamines—headache, palpitations, sweating, nervousness, nausea, vomiting, syncope

Ineffective Health Maintenance r/t deficient knowledge regarding treatment and self-care

Insomnia r/t high levels of catecholamines

Nausea r/t increased catecholamines

Risk for adverse reaction to iodinated Contrast media r/t pheochromocytoma

Risk for decreased Cardiac tissue perfusion: Risk factor: hypertension

See Surgery, Perioperative; Surgery, Postoperative; Surgery, Preoperative

Phlebitis

See Thrombophlebitis

Phobia (Specific)

Fear r/t presence or anticipation of specific object or situation

Powerlessness r/t anxiety about encountering unknown or known entity

Impaired individual Resilience r/t psychological disorder

Readiness for enhanced Power: expresses readiness to enhance identification of choices that can be made for change

See Anxiety; Anxiety Disorder; Panic Disorder (Panic Attacks)

Photosensitivity

Ineffective Health Maintenance r/t deficient knowledge regarding medications inducing photosensitivity

Risk for dry Eye r/t pharmaceutical agents/sunlight exposure

Risk for impaired Skin Integrity: Risk factor: exposure to sun

Physical Abuse

See Abuse, Child; Abuse, Spouse, Parent, or Significant Other

Pica

Anxiety r/t stress from urge to eat nonnutritive substances

Imbalanced Nutrition: less than body requirements r/t eating nonnutritive substances

Impaired Parenting r/t lack of supervision, food deprivation

Risk for Constipation: Risk factor: presence of undigestible materials in gastrointestinal tract

Risk for Infection: Risk factor: ingestion of infectious agents via contaminated substances

Risk for Gastrointestinal Motility: Risk factor: abnormal eating behavior

Risk for Poisoning: Risk factor: ingestion of substances containing lead

See Anemia

PID (Pelvic Inflammatory Disease)

Ineffective Health Maintenance r/t deficient knowledge regarding self-care, treatment of disease

Acute Pain r/t biological injury; inflammation, edema, congestion of pelvic tissues

Ineffective Sexuality Pattern r/t medically imposed abstinence from sexual activities until acute infection subsides, change in reproductive potential

Risk for urge urinary Incontinence: Risk factors: inflammation, edema, congestion of pelvic tissues

Risk for Infection: Risk factors: insufficient knowledge to avoid exposure to pathogens; proper hygiene, nutrition, other health habits

See Maturational Issues, Adolescent; STD (Sexually Transmitted Disease)

PIH (Pregnancy-Induced Hypertension/Preeclampsia)

Anxiety r/t fear of the unknown, threat to self and infant, change in role functioning

Death Anxiety r/t threat of preeclampsia

Deficient Diversional Activity r/t bed rest

Interrupted Family Processes r/t situational crisis

Impaired Home Maintenance r/t bed rest

Deficient Knowledge r/t lack of experience with situation

Impaired physical Mobility r/t medically prescribed limitations

Impaired Parenting r/t bed rest

Powerlessness r/t complication threatening pregnancy, medically prescribed limitations

Ineffective Role Performance r/t change in physical capacity to assume role of pregnant woman or resume other roles

Situational low Self-Esteem r/t loss of idealized pregnancy

Impaired Social Interaction r/t imposed bed rest

Risk for imbalanced Fluid Volume: Risk factors: hypertension, altered renal function

Risk for Injury: fetal: Risk factors: decreased uteroplacental perfusion, seizures

Risk for Injury: maternal: Risk factors: vasospasm, high blood pressure

Readiness for enhanced Knowledge: desire for information on managing condition

See Malignant Hypertension (Arteriolar Nephrosclerosis)

Piloerection

Hypothermia r/t exposure to cold environment

Pimples

See Acne

Pink Eye

See Conjunctivitis

Pinworms

Impaired Comfort r/t itching

Impaired Home Maintenance r/t inadequate cleaning of bed linen and toilet seats

Insomnia r/t discomfort

Readiness for enhanced Self-Health Management: proper handwashing; short, clean fingernails; avoiding hand, mouth, nose contact with unwashed hands; appropriate cleaning of bed linen and toilet seats

Pituitary Cushing’s

See Cushing’s Syndrome

PKU (Phenylketonuria)

Risk for delayed Development: Risk factors: not following strict dietary program; eating foods extremely low in phenylalanine; avoiding eggs, milk, any foods containing aspartame (NutraSweet)

Readiness for enhanced Self-Health Management: testing for PKU and following prescribed dietary regimen

Placenta Abruptio

Death Anxiety r/t threat of mortality associated with bleeding

Fear r/t threat to self and fetus

Ineffective Health Maintenance r/t deficient knowledge regarding treatment and control of hypertension associated with placenta abruptio

Acute Pain: abdominal/back r/t premature separation of placenta before delivery

Risk for Bleeding: Risk factor: placenta abruptio

Risk for deficient Fluid Volume: Risk factor: maternal blood loss

Risk for disturbed Maternal/Fetal Dyad: Risk factor: complication of pregnancy

Risk for Powerlessness: Risk factors: complications of pregnancy and unknown outcome

Risk for Shock: Risk factor: hypovolemia

Risk for Spiritual Distress: Risk factor: fear from unknown outcome of pregnancy

Placenta Previa

Death Anxiety r/t threat of mortality associated with bleeding

Disturbed Body Image r/t negative feelings about body and reproductive ability, feelings of helplessness

Ineffective Coping r/t threat to self and fetus

Deficient Diversional Activity r/t long-term hospitalization

Interrupted Family Processes r/t maternal bed rest, hospitalization

Fear r/t threat to self and fetus, unknown future

Impaired Home Maintenance r/t maternal bed rest, hospitalization

Impaired physical Mobility r/t medical protocol, maternal bed rest

Ineffective Role Performance r/t maternal bed rest, hospitalization

Situational low Self-Esteem r/t situational crisis

Spiritual Distress r/t inability to participate in usual religious rituals, situational crisis

Risk for Bleeding: Risk factor: placenta previa

Risk for Constipation: Risk factor: bed rest, pregnancy

Risk for deficient Fluid Volume: Risk factor: maternal blood loss

Risk for imbalanced Fluid Volume: Risk factor: maternal blood loss

Risk for Injury: fetal and maternal: Risk factors: threat to uteroplacental perfusion, hemorrhage

Risk for disturbed Maternal/Fetal Dyad: Risk factor: complication of pregnancy

Risk for impaired Parenting: Risk factors: maternal bed rest, hospitalization

Risk for ineffective peripheral Tissue Perfusion: placental: Risk factors: dilation of cervix, loss of placental implantation site

Risk for Powerlessness: Risk factors: complications of pregnancy and unknown outcome

Risk for Shock: Risk factor: hypovolemia

Plantar Fasciitis

Impaired Comfort r/t pain

Impaired physical Mobility r/t discomfort

Acute Pain r/t inflammation

Chronic Pain r/t inflammation

Pleural Effusion

Ineffective Breathing Pattern r/t pain

Excess Fluid Volume r/t compromised regulatory mechanisms; heart, liver, or kidney failure

Hyperthermia r/t increased metabolic rate secondary to infection

Acute Pain r/t inflammation, fluid accumulation

Pleural Friction Rub

Ineffective Breathing Pattern r/t pain

Acute Pain r/t inflammation, fluid accumulation

See cause of Pleural Friction Rub

Pleural Tap

See Pleural Effusion

Pleurisy

Ineffective Breathing Pattern r/t pain

Impaired Gas Exchange r/t ventilation perfusion imbalance

Acute Pain r/t pressure on pleural nerve endings associated with fluid accumulation or inflammation

Risk for ineffective Airway Clearance: Risk factors: increased secretions, ineffective cough because of pain

Risk for Infection: Risk factor: exposure to pathogens

Risk for impaired physical Mobility: Risk factors: activity intolerance, inability to “catch breath”

PMS (Premenstrual Tension Syndrome)

Fatigue r/t hormonal changes

Excess Fluid Volume r/t alterations of hormonal levels inducing fluid retention

Deficient Knowledge r/t methods to deal with and prevent syndrome

Acute Pain r/t hormonal stimulation of gastrointestinal structures

Risk for Powerlessness: Risk factors: lack of knowledge and ability to deal with symptoms

Risk for compromised Resilience: Risk factor: PMS symptoms

Readiness for enhanced Communication: willingness to express thoughts and feelings about PMS

Readiness for enhanced Self-Health Management: desire for information to manage and prevent symptoms

PND (Paroxysmal Nocturnal Dyspnea)

Anxiety r/t inability to breathe during sleep

Ineffective Breathing Pattern r/t increase in carbon dioxide levels, decrease in oxygen levels

Insomnia r/t suffocating feeling from fluid in lungs on awakening from sleep

Sleep deprivation r/t inability to breathe during sleep

Risk for decreased Cardiac tissue perfusion: Risk factor: hypoxia

Risk for Powerlessness: Risk factor: inability to control nocturnal dyspnea

Readiness for enhanced Sleep: expresses willingness to learn measures to enhance sleep

Pneumonectomy

See Thoracotomy

Pneumonia

Activity Intolerance r/t imbalance between oxygen supply and demand

Ineffective Airway Clearance r/t inflammation and presence of secretions

Impaired Gas Exchange r/t decreased functional lung tissue

Ineffective Self-Health Management r/t deficient knowledge regarding self-care and treatment of disease

Hyperthermia r/t dehydration, increased metabolic rate, illness

Deficient Knowledge r/t risk factors predisposing person to pneumonia, treatment

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

Impaired Oral Mucous Membrane r/t dry mouth from mouth breathing, decreased fluid intake

Risk for acute Confusion: Risk factor: underlying illness

Risk for deficient Fluid Volume: Risk factor: inadequate intake of fluids

Risk for Vascular Trauma: Risk factor: irritation from IV antibiotics

Readiness for enhanced Immunization Status: expresses desire to increase immunization status

See Respiratory Infections, Acute Childhood

Pneumothorax

Fear r/t threat to own well-being, difficulty breathing

Impaired Gas Exchange r/t ventilation-perfusion imbalance

Acute Pain r/t recent injury, coughing, deep breathing

Risk for Injury: Risk factor: possible complications associated with closed chest drainage system

See Chest Tubes

Poisoning, Risk for

Risk for Poisoning (See Poisoning, risk for, Section III)

Poliomyelitis

Readiness for enhanced Immunization Status: expresses desire to increase immunization status

See Paralysis

Polydipsia

Readiness for enhanced Fluid Balance: no excessive thirst when diabetes is controlled

See Diabetes Mellitus

Polyphagia

Readiness for enhanced Nutrition: knowledge of appropriate diet for diabetes

See Diabetes Mellitus

Polyuria

Readiness for enhanced Urinary Elimination: willingness to learn measures to enhance urinary elimination

See Diabetes Mellitus

Postoperative Care

See Surgery, Postoperative

Postpartum Depression

Anxiety r/t new responsibilities of parenting

Disturbed Body Image r/t normal postpartum recovery

Ineffective Childbearing Process r/t depression/lack of support system

Ineffective Coping r/t hormonal changes, maturational crisis

Fatigue r/t childbirth, postpartum state

Risk-prone Health Behavior r/t lack of support systems

Impaired Home Maintenance r/t fatigue, care of newborn

Deficient Knowledge r/t lifestyle changes

Impaired Parenting r/t hormone-induced depression

Ineffective Role Performance r/t new responsibilities of parenting

Sexual Dysfunction r/t fear of another pregnancy, postpartum pain, lochia flow

Sleep deprivation r/t environmental stimulation of newborn

Impaired Social Interaction r/t change in role functioning

Risk for disturbed personal Identity r/t role change/depression/inability to cope

Risk for Post-Trauma Syndrome: Risk factors: trauma or violence associated with labor and birth process, medical/surgical interventions, history of sexual abuse

Risk for situational low Self-Esteem: Risk factor: decreased power over feelings of sadness

Risk for Spiritual Distress: Risk factors: altered relationships, social isolation

Readiness for enhanced Hope: expresses desire to enhance hope and interconnectedness with others

See Depression (Major Depressive Disorder)

Postpartum Hemorrhage

Activity intolerance r/t anemia from loss of blood

Death Anxiety r/t threat of mortality associated with bleeding

Disturbed Body Image r/t loss of ideal childbirth

Interrupted Breastfeeding r/t separation from infant for medical treatment

Insufficient Breast Milk r/t fluid volume depletion

Decreased Cardiac Output r/t hypovolemia

Fear r/t threat to self, unknown future

Deficient Fluid Volume r/t uterine atony, loss of blood

Impaired Home Maintenance r/t lack of stamina

Deficient Knowledge r/t lack of exposure to situation

Acute Pain r/t nursing and medical interventions to control bleeding

Ineffective peripheral Tissue Perfusion r/t hypovolemia

Risk for Bleeding: Risk factor: postpartum complications

Risk for imbalanced Fluid Volume: Risk factor: maternal blood loss

Risk for Infection: Risk factors: loss of blood, depressed immunity

Risk for disturbed Maternal/Fetal Dyad: Risk factor: complication of pregnancy

Risk for impaired Parenting: Risk factor: weakened maternal condition

Risk for Powerlessness: Risk factor: acute illness

Risk for Shock: Risk factor: hypovolemia

Postpartum, Normal Care

Anxiety r/t change in role functioning, parenting

Effective Breastfeeding r/t basic breastfeeding knowledge, support of partner and health care provider

Constipation r/t hormonal effects on smooth muscles, fear of straining with defecation, effects of anesthesia

Fatigue r/t childbirth, new responsibilities of parenting, body changes

Acute Pain r/t episiotomy, lacerations, bruising, breast engorgement, headache, sore nipples, epidural or intravenous (IV) site, hemorrhoids

Sexual Dysfunction r/t recent childbirth

Impaired Skin Integrity r/t episiotomy, lacerations

Sleep deprivation r/t care of infant

Impaired Urinary Elimination r/t effects of anesthesia, tissue trauma

Risk for Constipation: Risk factors: hormonal effects on smooth muscles, fear of straining with defecation, effects of anesthesia

Risk for imbalanced Fluid Volume: Risk factors: shift in blood volume, edema

Risk for urge urinary Incontinence: Risk factors: effects of anesthesia or tissue trauma

Risk for Infection: Risk factors: tissue trauma, blood loss

Readiness for enhanced family Coping: adaptation to new family member

Readiness for enhanced Hope: desire to increase hope

Readiness for enhanced Parenting: expressing willingness to enhance parenting skills

Post-Trauma Syndrome

Post-Trauma Syndrome (See Post-Trauma Syndrome, Section III)

Post-Trauma Syndrome, Risk for

Risk for Post-Trauma Syndrome (See Post-Trauma Syndrome, risk for, Section III)

Post-Traumatic Stress Disorder (PTSD)

See PTSD (Post-Traumatic Stress Disorder)

Potassium, Increase/Decrease

See Hyperkalemia; Hypokalemia

Power/Powerlessness

Powerlessness (See Powerlessness, Section III)

Risk for ineffective Childbearing Process r/t maternal powerlessness

Risk for Powerlessness (See Powerlessness, risk for, Section III)

Readiness for enhanced Power (See Power, readiness for enhanced, Section III)

Preeclampsia

See PIH (Pregnancy-Induced Hypertension/Preeclampsia)

Pregnancy, Cardiac Disorders

See Cardiac Disorders in Pregnancy

Pregnancy-Induced Hypertension/Preeclampsia (PIH)

See PIH (Pregnancy-Induced Hypertension/Preeclampsia)

Pregnancy Loss

Anxiety r/t threat to role functioning, health status, situational crisis

Compromised family Coping r/t lack of support by significant other because of personal suffering

Ineffective Coping r/t situational crisis

Grieving r/t loss of pregnancy, fetus, or child

Complicated Grieving r/t sudden loss of pregnancy, fetus, or child

Acute Pain r/t surgical intervention

Ineffective Role Performance r/t inability to assume parenting role

Ineffective Sexuality Pattern r/t self-esteem disturbance resulting from pregnancy loss and anxiety about future pregnancies

Chronic Sorrow r/t loss of a fetus or child

Spiritual Distress r/t intense suffering

Risk for Bleeding: Risk factor: pregnancy complication

Risk for deficient Fluid Volume: Risk factor: blood loss

Risk for complicated Grieving: Risk factor: loss of pregnancy

Risk for Infection: Risk factor: retained products of conception

Risk for Powerlessness: Risk factor: situational crisis

Risk for Ineffective Relationship r/t poor communication skills in dealing with the loss

Risk for Spiritual Distress: Risk factor: intense suffering

Readiness for enhanced Communication: willingness to express feelings and thoughts about loss

Readiness for enhanced Hope: expresses desire to enhance hope

Readiness for enhanced Spiritual Well-Being: desire for acceptance of loss

Pregnancy, Normal

Anxiety r/t unknown future, threat to self secondary to pain of labor

Disturbed Body Image r/t altered body function and appearance

Interrupted Family Processes r/t developmental transition of pregnancy

Fatigue r/t increased energy demands

Fear r/t labor and delivery

Deficient Knowledge r/t primiparity

Nausea r/t hormonal changes of pregnancy

Imbalanced Nutrition: less than body requirements r/t growing fetus, nausea

Imbalanced Nutrition: more than body requirements r/t deficient knowledge regarding nutritional needs of pregnancy

Sleep deprivation r/t uncomfortable pregnancy state

Impaired Urinary Elimination r/t frequency caused by increased pelvic pressure and hormonal stimulation

Risk for Constipation: Risk factor: pregnancy

Risk for Sexual Dysfunction: Risk factors: altered body function, self-concept, body image with pregnancy

Readiness for enhanced Childbearing Process: appropriate prenatal care

Readiness for enhanced family Coping: satisfying partner relationship, attention to gratification of needs, effective adaptation to developmental tasks of pregnancy

Readiness for enhanced Family Processes: family adapts to change

Readiness for enhanced Nutrition: desire for knowledge of appropriate nutrition during pregnancy

Readiness for enhanced Parenting: expresses willingness to enhance parenting skills

Readiness for enhanced Relationship: meeting developmental goals associated with pregnancy

Readiness for enhanced Self-Health Management: seeks information for prenatal self care

Readiness for enhanced Spiritual Well-Being: new role as parent

See Discomforts of Pregnancy

Premature Dilation of the Cervix (Incompetent Cervix)

Ineffective Activity Planning r/t unrealistic perception of events

Ineffective Coping r/t bed rest, threat to fetus

Deficient Diversional Activity r/t bed rest

Fear r/t potential loss of infant

Grieving r/t potential loss of infant

Deficient Knowledge r/t treatment regimen, prognosis for pregnancy

Impaired physical Mobility r/t imposed bed rest to prevent preterm birth

Powerlessness r/t inability to control outcome of pregnancy

Ineffective Role Performance r/t inability to continue usual patterns of responsibility

Situational low Self-Esteem r/t inability to complete normal pregnancy

Sexual Dysfunction r/t fear of harm to fetus

Impaired Social Interaction r/t bed rest

Risk for Infection: Risk factors: invasive procedures to prevent preterm birth

Risk for Injury: fetal: Risk factors: preterm birth, use of anesthetics

Risk for Injury: maternal: Risk factors: surgical procedures to prevent preterm birth (e.g., cerclage)

Risk for compromised Resilience: Risk factor: complication of pregnancy

Risk for Spiritual Distress: Risk factors: physical/psychological stress

Premature Infant (Child)

Insufficient Breast Milk r/t ineffective sucking, latching on of the infant

Impaired Gas Exchange r/t effects of cardiopulmonary insufficiency

Delayed Growth and Development: developmental lag r/t prematurity, environmental and stimulation deficiencies, multiple caretakers

Disorganized Infant behavior r/t prematurity

Insomnia r/t noisy and noxious intensive care environment

Neonatal Jaundice r/t infant experiences difficulty making transition to extrauterine life

Imbalanced Nutrition: less than body requirements r/t delayed or understimulated rooting reflex, easy fatigue during feeding, diminished endurance

Impaired Swallowing r/t decreased or absent gag reflex, fatigue

Ineffective Thermoregulation r/t large body surface/weight ratio, immaturity of thermal regulation, state of prematurity

Risk for delayed Development: Risk factor: prematurity

Risk for disproportionate Growth: Risk factor: prematurity

Risk for Infection: Risk factors: inadequate, immature, or undeveloped acquired immune response

Risk for Injury: Risk factor: prolonged mechanical ventilation, retinopathy of prematurity (ROP) secondary to 100% oxygen environment

Risk for Neonatal Jaundice r/t to late preterm birth

Readiness for enhanced organized Infant behavior: use of some self-regulatory measures

Premature Infant (Parent)

Ineffective Breastfeeding r/t disrupted establishment of effective pattern secondary to prematurity or insufficient opportunities

Decisional Conflict r/t support system deficit, multiple sources of information

Parental Role Conflict r/t expressed concerns, expressed inability to care for child’s physical, emotional, or developmental needs

Compromised family Coping r/t disrupted family roles and disorganization, prolonged condition exhausting supportive capacity of significant persons

Grieving r/t loss of perfect child possibly leading to complicated grieving

Complicated Grieving (prolonged) r/t unresolved conflicts

Chronic Sorrow r/t threat of loss of a child, prolonged hospitalization

Spiritual Distress r/t challenged belief or value systems regarding moral or ethical implications of treatment plans

Risk for impaired Attachment: Risk factors: separation, physical barriers, lack of privacy

Risk for disturbed Maternal/Fetal Dyad: Risk factor: complication of pregnancy

Risk for Powerlessness: Risk factor: inability to control situation

Risk for compromised Resilience: Risk factor: premature infant

Risk for Spiritual Distress: Risk factors: challenged belief or value systems regarding moral or ethical implications of treatment plans

Readiness for enhanced Family Process: adaptation to change associated with premature infant

See Child with Chronic Condition; Hospitalized Child

Premature Rupture of Membranes

Anxiety r/t threat to infant’s health status

Disturbed Body Image r/t inability to carry pregnancy to term

Ineffective Coping r/t situational crisis

Grieving r/t potential loss of infant

Situational low Self-Esteem r/t inability to carry pregnancy to term

Risk for Infection: Risk factor: rupture of membranes

Risk for Injury: fetal: Risk factor: risk of premature birth

Risk for disturbed Maternal/Fetal Dyad: Risk factor: complication of pregnancy

Premenstrual Tension Syndrome (PMS)

See PMS (Premenstrual Tension Syndrome)

Prenatal Care, Normal

Readiness for enhanced Childbearing Process: appropriate prenatal lifestyle

Readiness for enhanced Knowledge: appropriate prenatal care

Readiness for enhanced Spiritual Well-Being: new role as parent

See Pregnancy, Normal

Prenatal Testing

Anxiety r/t unknown outcome, delayed test results

Acute Pain r/t invasive procedures

Risk for Infection r/t invasive procedures during amniocentesis or chorionic villus sampling

Risk for Injury: fetal r/t invasive procedures

Preoperative Teaching

See Surgery, Preoperative Care

Pressure Ulcer

Impaired Comfort r/t pressure ulcer

Impaired bed Mobility r/t intolerance to activity, pain, cognitive impairment, depression, severe anxiety

Imbalanced Nutrition: less than body requirements r/t limited access to food, inability to absorb nutrients because of biological factors, anorexia

Acute Pain r/t tissue destruction, exposure of nerves

Impaired Skin Integrity: stage I or II pressure ulcer r/t physical immobility, mechanical factors, altered circulation, skin irritants

Impaired Tissue Integrity: stage III or IV pressure ulcer r/t altered circulation, impaired physical mobility

Risk for Infection: Risk factors: physical immobility, mechanical factors (shearing forces, pressure, restraint, altered circulation, skin irritants)

Preterm Labor

Anxiety r/t threat to fetus, change in role functioning, change in environment and interaction patterns, use of tocolytic drugs

Ineffective Coping r/t situational crisis, preterm labor

Deficient Diversional Activity r/t long-term hospitalization

Grieving r/t loss of idealized pregnancy, potential loss of fetus

Impaired Home Maintenance r/t medical restrictions

Impaired physical Mobility r/t medically imposed restrictions

Ineffective Role Performance r/t inability to carry out normal roles secondary to bed rest or hospitalization, change in expected course of pregnancy

Situational low Self-Esteem r/t threatened ability to carry pregnancy to term

Sexual Dysfunction r/t actual or perceived limitation imposed by preterm labor and/or prescribed treatment, separation from partner because of hospitalization

Sleep deprivation r/t change in usual pattern secondary to contractions, hospitalization, treatment regimen

Impaired Social Interaction r/t prolonged bed rest or hospitalization

Risk for Injury: fetal: Risk factors: premature birth, immature body systems

Risk for Injury: maternal: Risk factor: use of tocolytic drugs

Risk for Powerlessness: Risk factor: lack of control over preterm labor

Risk for Vascular Trauma: Risk factor: IV medication

Readiness for enhanced Childbearing Process: appropriate prenatal lifestyle

Readiness for enhanced Comfort: expresses desire to enhance relaxation

Readiness for enhanced Communication: willingness to discuss thoughts and feelings about situation

Problem-Solving Ability

Defensive Coping r/t situational crisis

Risk for chronic low Self-Esteem r/t repeated failures

Readiness for enhanced Communication: willing to share ideas with others

Readiness for enhanced Relationship: shares information and ideas between partners

Readiness for enhanced Resilience: identifies available resources

Readiness for enhanced Spiritual Well-Being: desires to draw on inner strength and find meaning and purpose to life

Projection

Anxiety r/t threat to self-concept

Defensive Coping r/t inability to acknowledge that own behavior may be a problem, blaming others

Chronic low Self-Esteem r/t failure

Impaired Social Interaction r/t self-concept disturbance, confrontational communication style

Risk for Loneliness: Risk factor: blaming others for problems

Risk for Post-Trauma Syndrome: Risk factor: diminished ego strength

See Paranoid Personality Disorder

Prolapsed Umbilical Cord

Fear r/t threat to fetus, impending surgery

Ineffective peripheral Tissue Perfusion: fetal r/t interruption in umbilical blood flow

Risk for Injury: fetal: Risk factors: cord compression, ineffective tissue perfusion

Risk for Injury: maternal: Risk factor: emergency surgery

Prostatectomy

See TURP (Transurethral Resection of the Prostate)

Prostatic Hypertrophy

Ineffective Health Maintenance r/t deficient knowledge regarding self-care and prevention of complications

Insomnia r/t nocturia

Urinary Retention r/t obstruction

Risk for urge urinary Incontinence: Risk factor: small bladder capacity

Risk for Infection: Risk factors: urinary residual after voiding, bacterial invasion of bladder

See BPH (Benign Prostatic Hypertrophy)

Prostatitis

Impaired Comfort r/t inflammation

Ineffective Health Maintenance r/t deficient knowledge regarding treatment

Urge urinary Incontinence r/t irritation of bladder

Ineffective Protection r/t depressed immune system

Protection, Altered

Ineffective Protection (See Protection, ineffective, Section III)

Pruritus

Impaired Comfort r/t itching

Deficient Knowledge r/t methods to treat and prevent itching

Risk for impaired Skin Integrity: Risk factor: scratching from pruritus

Psoriasis

Disturbed Body Image r/t lesions on body

Impaired Comfort r/t irritated skin

Ineffective Health Maintenance r/t deficient knowledge regarding treatment modalities

Powerlessness r/t lack of control over condition with frequent exacerbations and remissions

Impaired Skin Integrity r/t lesions on body

Psychosis

Ineffective Activity Planning r/t compromised ability to process information

Ineffective Health Maintenance r/t cognitive impairment, ineffective individual and family coping

Self-Neglect r/t mental disorder

Impaired individual Resilience r/t psychological disorder

Situational low Self-Esteem r/t excessive use of defense mechanisms (e.g., projection, denial, rationalization)

Risk for disturbed personal Identity r/t psychosis

Risk for Post-Trauma Syndrome: Risk factor: diminished ego strength

See Schizophrenia

PTCA (Percutaneous Transluminal Coronary Angioplasty)

See Angioplasty, Coronary

PTSD (Posttraumatic Stress Disorder)

Anxiety r/t exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Death Anxiety r/t psychological stress associated with traumatic event

Ineffective Breathing Pattern r/t hyperventilation associated with anxiety

Ineffective Coping r/t extreme anxiety

Disturbed Energy Field r/t disharmony of mind, body, spirit

Ineffective Impulse Control r/t re-experience of initial trauma

Insomnia r/t recurring nightmares

Post-Trauma Syndrome r/t exposure to a traumatic event

Sleep deprivation r/t nightmares associated with traumatic event

Spiritual Distress r/t feelings of detachment or estrangement from others

Risk for Powerlessness: Risk factors: flashbacks, reliving event

Risk for ineffective Relationship r/t stressful life events

Risk for self- or other-directed Violence: Risk factors: fear of self or others

Readiness for enhanced Comfort: expresses desire to enhance relaxation

Readiness for enhanced Communication: willingness to express feelings and thoughts

Readiness for enhanced Spiritual Well-Being: desire for harmony after stressful event

Pulmonary Edema

Anxiety r/t fear of suffocation

Ineffective Breathing Pattern r/t presence of tracheobronchial secretions

Impaired Gas Exchange r/t extravasation of extravascular fluid in lung tissues and alveoli

Ineffective Health Maintenance r/t deficient knowledge regarding treatment regimen

Sleep deprivation r/t inability to breathe

Risk for decreased Cardiac tissue perfusion: Risk factor: heart failure

See CHF (Congestive Heart Failure)

Pulmonary Embolism

Decreased Cardiac Output r/t right ventricular failure secondary to obstructed pulmonary artery

Fear r/t severe pain, possible death

Impaired Gas Exchange r/t altered blood flow to alveoli secondary to lodged embolus

Deficient Knowledge r/t activities to prevent embolism, self-care after diagnosis of embolism

Acute Pain r/t biological injury, lack of oxygen to cells

Ineffective peripheral Tissue Perfusion: r/t deep vein thrombus formation

Delayed Surgical Recovery r/t complications associated with respiratory difficulty

See Anticoagulant Therapy

Pulmonary Stenosis

See Congenital Heart Disease/Cardiac Anomalies

Pulse Deficit

Decreased Cardiac Output r/t dysrhythmia

See Dysrhythmia

Pulse Oximetry

Readiness for enhanced Knowledge: information associated with treatment regimen

See Hypoxia

Pulse Pressure, Increased

See Intracranial Pressure, Increased

Pulse Pressure, Narrowed

See Shock, Hypovolemic

Pulses, Absent or Diminished Peripheral

Ineffective peripheral Tissue Perfusion r/t interruption of arterial flow

Risk for Peripheral Neurovascular Dysfunction: Risk factors: fractures, mechanical compression, orthopedic surgery trauma, immobilization, burns, vascular obstruction

See cause of Absent or Diminished Peripheral Pulses

Purpura

See Clotting Disorder

Pyelonephritis

Ineffective Health Maintenance r/t deficient knowledge regarding self-care, treatment of disease, prevention of further urinary tract infections

Insomnia r/t urinary frequency

Acute Pain r/t inflammation and irritation of urinary tract

Impaired Urinary Elimination r/t irritation of urinary tract

Risk for urge urinary Incontinence: Risk factor: irritation of urinary tract

Risk for ineffective Renal Perfusion: Risk factor: infection

Pyloric Stenosis

Imbalanced Nutrition: less than body requirements r/t vomiting secondary to pyloric sphincter obstruction

Acute Pain r/t abdominal fullness

Risk for imbalanced Fluid Volume: Risk factors: vomiting, dehydration

See Hospitalized Child

Pyloromyotomy (Pyloric Stenosis Repair)

See Surgery Preoperative, Perioperative, Postoperative