Ineffective Health Maintenance r/t deficient knowledge regarding care of wound, isolation, and observation of infected animal
Acute Pain r/t multiple immunization injections
Risk for ineffective Cerebral tissue perfusion: Risk factor: rabies virus
Readiness for enhanced Immunization Status: desires to enhance immunization status
Activity Intolerance r/t fatigue from possible anemia
Disturbed Body Image r/t change in appearance, hair loss
Diarrhea r/t irradiation effects
Fatigue r/t malnutrition from lack of appetite, nausea, and vomiting
Deficient Knowledge r/t what to expect with radiation therapy
Nausea r/t side effects of radiation
Imbalanced Nutrition: less than body requirements r/t anorexia, nausea, vomiting, irradiation of areas of pharynx and esophagus
Impaired Oral Mucous Membrane r/t irradiation effects
Ineffective Protection r/t suppression of bone marrow
Risk for Powerlessness: Risk factors: medical treatment and possible side effects
Risk for compromised Resilience: Risk factor: radiation treatment
Risk for impaired Skin Integrity: Risk factor: irradiation effects
Risk for Spiritual Distress: Risk factors: radiation treatment, prognosis
Risk-prone Health Behavior r/t multiple stressors
Impaired individual Resilience r/t poor impulse control
Stress overload r/t multiple coexisting stressors
Risk for Self-Mutilation: Risk factor: command hallucinations
Risk for Suicide: Risk factor: desire to kill self
Risk for other-directed Violence: Risk factors: panic state, manic excitement, organic brain syndrome
Rape-Trauma Syndrome (See Rape-Trauma Syndrome, Section III)
Chronic Sorrow r/t forced loss of virginity
Risk for ineffective Childbearing Process r/t to trauma and violence
Risk for chronic low Self-Esteem r/t perceived lack of respect from others/feeling violated
Risk for ineffective Relationship r/t to trauma and violence
Risk for Post-Trauma Syndrome: Risk factors: trauma or violence associated with rape
Risk for Powerlessness: Risk factor: inability to control thoughts about incident
Risk for Spiritual Distress: Risk factor: forced loss of virginity
Impaired Skin Integrity r/t mechanical trauma
Risk for Latex Allergy Response: Risk factor: allergy to products associated with latex
Risk for Infection: Risk factors: traumatized tissue, broken skin
Readiness for enhanced Immunization Status: desire to prevent infectious disease
Defensive Coping r/t situational crisis, inability to accept blame for consequences of own behavior
Ineffective Denial r/t fear of consequences, actual or perceived loss
Impaired individual Resilience r/t psychological disturbance
Risk for Post-Trauma Syndrome: Risk factor: survivor’s role in event
Readiness for enhanced Communication: expressing desire to share thoughts and feelings
Readiness for enhanced Spiritual Well-Being: possibility of seeking harmony with self, others, higher power, God
Impaired Home Maintenance r/t lack of knowledge, insufficient finances
Risk for Allergy Response r/t repeated exposure to environmental contamination
Deficient Knowledge r/t lack of information about disease process, possible complications, self-care needs regarding disease process and medication
Ineffective peripheral Tissue Perfusion r/t transient reduction of blood flow
Constipation r/t decreased activity level, decreased fluid intake, inadequate fiber in diet, decreased peristalsis, side effects from antidepressant or antipsychotic therapy
Risk for Constipation: Risk factor: habitual denial or ignoring of urge to defecate
Constipation r/t pain on defecation
Deficient Knowledge r/t possible causes of rectal bleeding, pain, treatment modalities
Constipation r/t painful defecation
Ineffective Health Maintenance r/t deficient knowledge of postoperative care of surgical site, dietary measures, exercise to prevent constipation
Acute Pain r/t surgical procedure
Urinary Retention r/t edema from surgery
Risk for Bleeding: Risk factor: surgery
Risk for urge urinary Incontinence: Risk factor: edema from surgery
Risk for Infection: Risk factors: surgical procedure, possible contamination of site with feces
Anxiety r/t threat to or change in health status
Defensive Coping r/t denial of obvious problems, weaknesses
Self-Neglect r/t functional impairment
Powerlessness r/t health care environment
Impaired individual Resilience r/t psychological disturbance
Ineffective Role Performance r/t powerlessness over health status
Anxiety r/t situational or maturational crises
Death Anxiety r/t feelings of not having accomplished goals in life
Risk for Spiritual Distress: Risk factor: inability to forgive
Ineffective Coping r/t loss of normal function
Impaired physical Mobility r/t injury, surgery, psychosocial condition warranting rehabilitation
Self-Care deficit: specify r/t impaired physical mobility
Readiness for enhanced Comfort: expresses desire to enhance feeling of comfort
Readiness for enhanced Self-Concept: accepts strengths and limitations
Readiness for enhanced Self-Health Management: expression of desire to manage rehabilitation
Anxiety r/t disturbed energy field
Readiness for enhanced Comfort: expresses desire to enhance relaxation
Readiness for enhanced Religiosity: requests religious materials or experiences
Readiness for enhanced Resilience: desire to enhance resilience
Readiness for enhanced Self-Concept: willingness to enhance self-concept
Readiness for enhanced Self-Health Management: desire to manage illness
Readiness for enhanced Spiritual Well-Being: seeking comfort from higher power
Impaired Religiosity (See Religiosity, impaired, Section III)
Risk for impaired Religiosity (See Religiosity, impaired, risk for, Section III)
Readiness for enhanced Religiosity (See Religiosity, readiness for enhanced, Section III)
Spiritual Distress r/t separation from religious or cultural ties
Risk for impaired Religiosity: Risk factors: ineffective support, coping, caregiving
Risk for Spiritual Distress: Risk factors: physical or psychological stress
Readiness for enhanced Spiritual Well-Being: desire for increased spirituality
Relocation Stress Syndrome (See Relocation Stress Syndrome, Section III)
Risk for Relocation Stress Syndrome (See Relocation Stress Syndrome, risk for, Section III)
Activity Intolerance r/t effects of anemia, congestive heart failure
Death Anxiety r/t unknown outcome of disease
Decreased Cardiac Output r/t effects of congestive heart failure, elevated potassium levels interfering with conduction system
Ineffective Coping r/t depression resulting from chronic disease
Fatigue r/t effects of chronic uremia and anemia
Excess Fluid Volume r/t decreased urine output, sodium retention, inappropriate fluid intake
Noncompliance r/t complex medical therapy
Imbalanced Nutrition: less than body requirements r/t anorexia, nausea, vomiting, altered taste sensation, dietary restrictions
Impaired Oral Mucous Membrane r/t irritation from nitrogenous waste products
Chronic Sorrow r/t chronic illness
Spiritual Distress r/t dealing with chronic illness
Impaired Urinary Elimination r/t effects of disease, need for dialysis
Risk for Electrolyte Imbalance: Risk factor: renal dysfunction
Risk for Infection: Risk factor: altered immune functioning
Risk for Injury: Risk factors: bone changes, neuropathy, muscle weakness
Risk for impaired Oral Mucous Membrane: Risk factors: dehydration, effects of uremia
Risk for ineffective Renal Perfusion: Risk factor: renal disease
Disturbed Body Image r/t growth retardation, bone changes, visibility of dialysis access devices (shunt, fistula), edema
Deficient Diversional Activity r/t immobility during dialysis
See Child with Chronic Condition; Hospitalized Child; Renal Failure
Anxiety r/t change in health status
Risk for deficient Fluid Volume: Risk factor: loss of large volumes of urine
See Renal Failure
Decisional Conflict r/t harvesting of kidney from traumatized donor
Moral Distress r/t conflict among decision makers, end-of-life decisions, time constraints for decision-making
Spiritual Distress r/t grieving from loss of significant person
Readiness for enhanced Communication: expressing thoughts and feelings about situation
Readiness for enhanced family Coping: decision to allow organ donation
Readiness for enhanced Decision-Making: expresses desire to enhance understanding and meaning of choices
Readiness for enhanced Resilience: decision to donate organs
Readiness for enhanced Spirituality: inner peace resulting from allowance of organ donation
See Nephrectomy
Anxiety r/t possible rejection, procedure
Impaired Health Maintenance r/t long-term home treatment after transplantation, diet, signs of rejection, use of medications
Deficient Knowledge r/t specific nutritional needs, possible paralytic ileus, fluid or sodium restrictions
Ineffective Protection r/t immunosuppression therapy
Impaired Urinary Elimination r/t possible impaired renal function
Risk for Bleeding: Risk factor: surgical procedure
Risk for Infection: Risk factor: use of immunosuppressive therapy to control rejection
Risk for ineffective Renal Perfusion: Risk factor: transplanted kidney
Risk for Shock: Risk factor: possible hypovolemia
Risk for Spiritual Distress: Risk factor: obtaining transplanted kidney from someone’s traumatic loss
Readiness for enhanced Spiritual Well-Being: acceptance of situation
Ineffective Airway Clearance r/t sequelae of attempts to breathe in utero resulting in meconium aspiration
Ineffective Breathing Pattern r/t prolonged ventilator dependence
Fatigue r/t increased energy requirements and metabolic demands
Impaired Gas Exchange r/t decreased surfactant, immature lung tissue
Risk for Infection: Risk factors: tissue destruction or irritation as a result of aspiration of meconium fluid
See Bronchopulmonary Dysplasia; Hospitalized Child; Premature Infant, Child
Activity Intolerance r/t generalized weakness, dyspnea, fatigue, poor oxygenation
Ineffective Airway Clearance r/t excess tracheobronchial secretions
Anxiety/Fear r/t oxygen deprivation, difficulty breathing
Ineffective Breathing Pattern r/t inflamed bronchial passages, coughing
Deficient Fluid Volume r/t insensible losses (fever, diaphoresis), inadequate oral fluid intake
Impaired Gas Exchange r/t insufficient oxygenation as a result of inflammation or edema of epiglottis, larynx, bronchial passages
Hyperthermia r/t infectious process
Imbalanced Nutrition: less than body requirements r/t anorexia, fatigue, generalized weakness, poor sucking and breathing coordination, dyspnea
Risk for Aspiration: Risk factors: inability to coordinate breathing, coughing, sucking
Risk for Infection: transmission to others: Risk factor: virulent infectious organisms
Risk for Injury (to pregnant others): Risk factors: exposure to aerosolized medications (e.g., ribavirin, pentamidine), resultant potential fetal toxicity
Risk for Suffocation: Risk factors: inflammation of larynx, epiglottis
Insomnia r/t leg discomfort during sleep relieved by frequent leg movement
Sleep deprivation r/t frequent leg movements
See Stress
Nausea r/t chemotherapy, postsurgical anesthesia, irritation to gastrointestinal system, stimulation of neuropharmacological mechanisms
Imbalanced Nutrition: less than body requirements r/t inability to ingest food
Anxiety r/t change in vision, threat of loss of vision
Deficient Knowledge r/t symptoms, need for early intervention to prevent permanent damage
Vision Loss r/t impaired visual impairment
Risk for impaired Home Maintenance: Risk factors: postoperative care, activity limitations, care of affected eye
Risk for compromised Resilience: Risk factor: possible loss of vision
Risk for Injury: Risk factors: prolonged mechanical ventilation, ROP secondary to 100% oxygen environment
Ineffective Breathing Pattern r/t neuromuscular impairment
Compromised family Coping r/t acute situational crisis
Deficient Fluid Volume r/t vomiting, hyperventilation
Excess Fluid Volume: cerebral r/t cerebral edema
Impaired Gas Exchange r/t hyperventilation, sequelae of increased intracranial pressure
Grieving r/t uncertain prognosis and sequelae
Ineffective Health Maintenance r/t deficient knowledge regarding use of salicylates during viral illness of child
Imbalanced Nutrition: less than body requirements r/t effects of liver dysfunction, vomiting
Situational low Self-Esteem: family r/t negative perceptions of self, perceived inability to manage family situation, expressions of guilt
Impaired Skin Integrity r/t effects of decorticate or decerebrate posturing, seizure activity
Risk for Injury: Risk factors: combative behavior, seizure activity
Risk for impaired Liver Function: Risk factor: infection
Risk for ineffective Cerebral tissue perfusion: Risk factor: infection
Anxiety r/t unknown outcome of pregnancy
Neonatal Jaundice r/t Rh factor incompatibility
Deficient Knowledge r/t treatment regimen from lack of experience with situation
Powerlessness r/t perceived lack of control over outcome of pregnancy
Risk for Injury: fetal: Risk factors: intrauterine destruction of red blood cells, transfusions
Risk for Neonatal Jaundice r/t Rh factor incompatibility
Readiness for enhanced Self-Health Management: prenatal care, compliance with diagnostic and treatment regimen
Ineffective Coping r/t seriousness of condition
Impaired physical Mobility r/t myalgia and muscle weakness
Impaired Urinary Elimination r/t presence of myoglobin in the kidneys
Risk for deficient Fluid Volume: Risk factor: reduced blood flow to kidneys
Risk for ineffective Renal Perfusion: Risk factor: possible renal failure
Risk for Shock: Risk factor: hypovolemia
Readiness for enhanced Self-Health Management: seeks information to avoid condition
See Renal Failure
Imbalanced Nutrition: less than body requirements r/t loss of appetite
Risk for compromised Resilience: Risk factor: chronic, painful, progressive disease
Ineffective Breathing Pattern r/t fractured ribs
Acute Pain r/t movement, deep breathing
See Ventilator Client (if relevant)
Defensive Coping r/t situational crisis, psychological impairment, substance abuse
Risk for Post-Trauma Syndrome: Risk factor: perception of the event
Risk for Relocation Stress Syndrome (See Relocation Stress Syndrome, risk for, Section III)
Impaired Home Maintenance r/t lack of knowledge, insufficient finances
Ineffective Role Performance (See Role Performance, ineffective, Section III)