NANDA 2018-2020

Domain 2 • Class 1 • Diagnosis Code 00107 Ineffective infant feeding pattern Approved 1992 • Revised 2006 • Level of Evidence 2.1 Definition Impaired ability of an infant to suck or coordinate the suck-swallow response resulting in inadequate oral nutrition for metabolic needs. Defining characteristics – Inability to coordinate sucking, swallowing, and – Inability to sustain an effective suck breathing – Inability to initiate an effective suck Related factors – Prolonged nil per os (NPO) status – Oral hypersensitivity At risk population – Prematurity Associated condition – Oral hypersensitivity – Neurological delay – Neurological impairment Original literature support available at http://MediaCenter.thieme.com. 176

Domain 2 • Class 1 • Diagnosis Code 00232 Obesity Approved 2013 • Revised 2017 • Level of Evidence 3.2 Definition A condition in which an individual accumulates excessive fat for age and gender that exceeds overweight. Defining characteristics – ADULT: Body mass index (BMI) > 30 kg/m2 – CHILD 2-18 years: Body mass index (BMI) > – CHILD < 2 years: Term not used with children at 95th percentile or 30 kg/m2 for age and gender this age Related factors – Average daily physical activity is less than – High frequency of restaurant or fried food recommended for gender and age – Low dietary calcium intake in children – Portion sizes larger than recommended – Consumption of sugar-sweetened beverages – Sedentary behavior occurring for ≥ 2 hours/day – Disordered eating behaviors – Shortened sleep time – Disordered eating perceptions – Sleep disorder – Energy expenditure below energy intake based on – Solid foods as major food source at < 5 months of standard assessment age – Excessive alcohol consumption – Fear regarding lack of food supply – Frequent snacking At risk population – Parental obesity – Premature pubarche – Economically disadvantaged – Rapid weight gain during childhood – Formula- or mixed-fed infants – Rapid weight gain during infancy, including the – Heritability of interrelated factors – High disinhibition and restraint eating behavior first week, first 4 months, and first year score – Maternal diabetes mellitus – Maternal smoking – Overweight in infancy 177

Associated condition – Genetic disorder Original literature support available at http://MediaCenter.thieme.com. 178

Domain 2 • Class 1 • Diagnosis Code 00233 Overweight Approved 2013 • Revised 2017 • Level of Evidence 3.2 Definition A condition in which an individual accumulates excessive fat for age and gender. Defining characteristics – CHILD 2-18 years: Body mass index (BMI) > 85th percentile or 25 kg/m2 but < 95th percentile – ADULT: Body mass index (BMI) > 25 kg/m2 or 30 kg/m2 for age and gender – CHILD < 2 years: Weight-for-length > 95th percentile Related factors – Average daily physical activity is less than – High frequency of restaurant or fried food recommended for gender and age – Insufficient knowledge of modifiable factors – Low dietary calcium intake in children – Consumption of sugar-sweetened beverages – Portion sizes larger than recommended – Disordered eating behaviors – Sedentary behavior occurring for > 2 hours/day – Disordered eating perceptions – Shortened sleep time – Energy expenditure below energy intake based on – Sleep disorder – Solid foods as major food source at < 5 months of standard assessment – Excessive alcohol consumption age – Fear regarding lack of food supply – Frequent snacking At risk population – ADULT: Body mass index (BMI) approaching 25 – Children with high body mass index (BMI) kg/m2 percentiles – CHILD < 2 years: Weight-for-length approaching – Economically disadvantaged 95th percentile – Formula- or mixed-fed infants – Heritability of interrelated factors – CHILD 2-18 years: Body mass index (BMI) – High disinhibition and restraint eating behavior approaching 85th percentile or 25 kg/m2 score – Children who are crossing body mass index – Maternal diabetes mellitus (BMI) percentiles upward 179

– Premature pubarche – Maternal smoking – Rapid weight gain during childhood – Obesity in childhood – Parental obesity Associated condition – Rapid weight gain during infancy, including the – Genetic disorder first week, first 4 months, and first year Original literature support available at http://MediaCenter.thieme.com. 180

Domain 2 • Class 1 • Diagnosis Code 00234 Risk for overweight Approved 2013 • Revised 2017 • Level of Evidence 3.2 Definition Susceptible to excessive fat accumulation for age and gender, which may compromise health. Risk factors – Average daily physical activity is less than – High frequency of restaurant or fried food recommended for gender and age – Insufficient knowledge of modifiable factors – Low dietary calcium intake in children – Consumption of sugar-sweetened beverages – Portion sizes larger than recommended – Disordered eating behaviors – Sedentary behavior occurring for > 2 hours/day – Disordered eating perceptions – Shortened sleep time – Energy expenditure below energy intake based on – Sleep disorder – Solid foods as major food source at < 5 months of standard assessment – Excessive alcohol consumption age – Fear regarding lack of food supply – Frequent snacking At risk population – ADULT: Body mass index (BMI) approaching 25 – Heritability of interrelated factors kg/m2 – High disinhibition and restraint eating behavior – CHILD < 2 years: Weight-for-length approaching score 95th percentile – Maternal diabetes mellitus – Maternal smoking – CHILD 2-18 years: Body mass index (BMI) – Obesity in childhood approaching 85th percentile or 25 kg/m2 – Parental obesity – Premature pubarche – Children who are crossing body mass index – Rapid weight gain during childhood (BMI) percentiles upward – Rapid weight gain during infancy, including the – Children with high body mass index (BMI) first week, first 4 months, and first year percentiles – Economically disadvantaged – Formula- or mixed-fed infants Associated condition 181

– Genetic disorder Original literature support available at http://MediaCenter.thieme.com. 182

Domain 2 • Class 1 • Diagnosis Code 00103 Impaired swallowing Approved 1986 • Revised 1998, 2017 Definition Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function. Defining characteristics – Inefficient suck – Insufficient chewing First Stage: Oral – Nasal reflux – Piecemeal deglutition – Abnormal oral phase of swallow study – Pooling of bolus in lateral sulci – Choking prior to swallowing – Premature entry of bolus – Coughing prior to swallowing – Prolonged bolus formation – Drooling – Prolonged meal time with insufficient – Food falls from mouth – Food pushed out of mouth consumption – Gagging prior to swallowing – Tongue action ineffective in forming bolus – Inability to clear oral cavity – Incomplete lip closure – Gagging sensation – Inefficient nippling – Gurgly voice quality – Inadequate laryngeal elevation Second Stage: Pharyngeal – Nasal reflux – Recurrent pulmonary infection – Abnormal pharyngeal phase of swallow study – Repetitive swallowing – Alteration in head position – Choking – Heartburn – Coughing – Hematemesis – Delayed swallowing – Hyperextension of head – Fevers of unknown etiology – Food refusal Third Stage: Esophageal – Abnormal esophageal phase of swallow study – Acidic-smelling breath – Bruxism 183

– Difficulty swallowing – Nighttime awakening – Epigastric pain – Nighttime coughing – Food refusal – Odynophagia – Regurgitation – Repetitive swallowing – Reports “something stuck” – Volume limiting – Unexplained irritability surrounding mealtimes – Vomiting – Vomitus on pillow Related factors – Self-injurious behavior – Behavioral feeding problem At risk population – Self-injurious behavior – Developmental delay – Behavioral feeding problem – Prematurity – Failure to thrive – History of enteral feeding Associated condition – Nasal defect – Nasopharyngeal cavity defect – Achalasia – Neurological problems – Acquired anatomic defects – Neuromuscular impairment – Brain injury – Oropharynx abnormality – Cerebral palsy – Protein-energy malnutrition – Conditions with significant hypotonia – Respiratory condition – Congenital heart disease – Tracheal defect – Cranial nerve involvement – Trauma – Esophageal reflux disease – Upper airway anomaly – Laryngeal abnormality – Laryngeal defect – Mechanical obstruction This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 184

Domain 2 • Class 2 This class does not currently contain any diagnoses. 185

Domain 2 • Class 3 This class does not currently contain any diagnoses. 186

Domain 2 • Class 4 • Diagnosis Code 00179 Risk for unstable blood glucose level Approved 2006 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to variation in serum levels of glucose from the normal range, which may compromise health. Risk factors – Ineffective medication management – Insufficient diabetes management – Average daily physical activity is less than – Insufficient dietary intake recommended for gender and age – Insufficient knowledge of disease management – Insufficient knowledge of modifiable factors – Does not accept diagnosis – Nonadherence to diabetes management plan – Excessive stress – Excessive weight gain – Excessive weight loss – Inadequate blood glucose monitoring At risk population – Alteration in mental status – Delay in cognitive development – Compromised physical health status – Rapid growth period Associated condition – Pregnancy Original literature support available at http://MediaCenter.thieme.com. 187

Domain 2 • Class 4 • Diagnosis Code 00194 Neonatal hyperbilirubinemia Approved 2008 • Revised 2010, 2017 • Level of Evidence 2.1 Definition The accumulation of unconjugated bilirubin in the circulation (less than 15 ml/dl) that occurs after 24 hours of life. Defining characteristics – Abnormal blood profile – Yellow sclera – Bruised skin – Yellow-orange skin color – Yellow mucous membranes Related factors – Infants with inadequate nutrition – Deficient feeding pattern – Delay in meconium passage At risk population – Maternal diabetes mellitus – Populations living at high altitudes – ABO incompatibility – Premature infant – Age ≤ 7 days – Previous sibling with jaundice – American Indian ethnicity – Rhesus (Rh) incompatibility – Blood type incompatibility between mother and – Significant bruising during birth infant – East Asian ethnicity – Infant who is breastfed – Infant with low birthweight Associated condition – Bacterial infection – Prenatal infection – Infant with liver malfunction – Sepsis – Infant with enzyme deficiency – Viral infection – Internal bleeding 188

Original literature support available at http://MediaCenter.thieme.com. 189

Domain 2 • Class 4 • Diagnosis Code 00230 Risk for neonatal hyperbilirubinemia Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to the accumulation of unconjugated bilirubin in the circulation (less than 15 ml/dl) that occurs after 24 hours of life which may compromise health. Risk factors – Infants with inadequate nutrition – Deficient feeding pattern – Delay in meconium passage At risk population – Maternal diabetes mellitus – Populations living at high altitudes – ABO incompatibility – Premature infant – Age ≤ 7 days – Previous sibling with jaundice – American Indian ethnicity – Rhesus (Rh) incompatibility – Blood type incompatibility between mother and – Significant bruising during birth infant – East Asian ethnicity – Infant who is breastfed – Infant with low birthweight Associated condition – Bacterial infection – Prenatal infection – Infant with liver malfunction – Sepsis – Infant with enzyme deficiency – Viral infection – Internal bleeding Original literature support available at http://MediaCenter.thieme.com. 190

Domain 2 • Class 4 • Diagnosis Code 00178 Risk for impaired liver function Approved 2006 • Revised 2008, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to a decrease in liver function, which may compromise health. Risk factors – Substance misuse Associated condition – Human immunodeficiency virus (HIV) coinfection – Viral infection – Pharmaceutical agent This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition if no additional risk factors are developed. Original literature support available at http://MediaCenter.thieme.com. 191

Domain 2 • Class 4 • Diagnosis Code 00263 Risk for metabolic imbalance syndrome Approved 2016 • Level of Evidence 2.1 Definition Susceptible to a toxic cluster of biochemical and physiological factors associated with the development of cardiovascular disease arising from obesity and type 2 diabetes, which may compromise health. Risk factors – Risk for unstable blood glucose level (00179) – Risk-prone health behavior (00188) – Ineffective health maintenance (00099) – Sedentary lifestyle (00168) – Obesity (00232) – Stress overload (00177) – Overweight (00233) At risk population – Age > 30 years – Family history of hypertension – Family history of diabetes mellitus – Family history of obesity – Family history of dyslipidemia Associated condition – Unstable blood pressure – Uric acid > 7 mg/dl – Excessive endogenous or exogenous glucocorticoids > 25 g/dl – Microalbuminuria > 30 mg/dl – Polycystic ovary syndrome Original literature support available at http://MediaCenter.thieme.com. 192

Domain 2 • Class 5 • Diagnosis Code 00195 Risk for electrolyte imbalance Approved 2008 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to changes in serum electrolyte levels, which may compromise health. Risk factors – Insufficient knowledge of modifiable factors – Vomiting – Diarrhea – Excessive fluid volume – Insufficient fluid volume Associated condition – Compromised regulatory mechanism – Renal dysfunction – Endocrine regulatory dysfunction – Treatment regimen Original literature support available at http://MediaCenter.thieme.com. 193

Domain 2 • Class 5 • Diagnosis Code 00025 Risk for imbalanced fluid volume Approved 1998 • Revised 2008, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to a decrease, increase, or rapid shift from one to the other of intravascular, interstitial and/or intracellular fluid, which may compromise health. This refers to body fluid loss, gain, or both. Risk factors – To be developed Associated condition – Apheresis – Pancreatitis – Ascites – Sepsis – Burn injury – Trauma – Intestinal obstruction – Treatment regimen This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition if no risk factors are developed. Original literature support available at http://MediaCenter.thieme.com. 194

Domain 2 • Class 5 • Diagnosis Code 00027 Deficient fluid volume Approved 1978 • Revised 1996, 2017 Definition Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium. Defining characteristics – Alteration in mental status – Dry skin – Alteration in skin turgor – Increase in body temperature – Decrease in blood pressure – Increase in heart rate – Decrease in pulse pressure – Increase in hematocrit – Decrease in pulse volume – Increase in urine concentration – Decrease in tongue turgor – Sudden weight loss – Decrease in urine output – Thirst – Decrease in venous filling – Weakness – Dry mucous membranes Related factors – Insufficient knowledge about fluid needs – Barrier to accessing fluid – Insufficient fluid intake At risk population – Factors influencing fluid needs – Extremes of age – Extremes of weight Associated condition – Excessive fluid loss through normal route – Fluid loss through abnormal route – Active fluid volume loss – Pharmaceutical agent – Compromised regulatory mechanism – Deviations affecting fluid absorption – Deviations affecting fluid intake 195

This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 196

Domain 2 • Class 5 • Diagnosis Code 00028 Risk for deficient fluid volume Approved 1978 • Revised 2010, 2013, 2017 Definition Susceptible to experiencing decreased intravascular, interstitial, and/or intracellular fluid volumes, which may compromise health. Risk factors – Insufficient knowledge about fluid needs – Barrier to accessing fluid – Insufficient fluid intake At risk population – Factors influencing fluid needs – Extremes of age – Extremes of weight Associated condition – Excessive fluid loss through normal route – Fluid loss through abnormal route – Active fluid volume loss – Pharmaceutical agent – Compromised regulatory mechanism – Deviations affecting fluid absorption – Deviations affecting fluid intake This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 197

Domain 2 • Class 5 • Diagnosis Code 00026 Excess fluid volume Approved 1982 • Revised 1996, 2013, 2017 • Level of Evidence 2.1 Definition Surplus intake and/or retention of fluid. Defining characteristics – Adventitious breath sounds – Hepatomegaly – Alteration in blood pressure – Increase in central venous pressure (CVP) – Alteration in mental status – Intake exceeds output – Alteration in pulmonary artery pressure (PAP) – Jugular vein distension – Alteration in respiratory pattern – Oliguria – Alteration in urine specific gravity – Orthopnea – Anasarca – Paroxysmal nocturnal dyspnea – Anxiety – Pleural effusion – Azotemia – Positive hepatojugular reflex – Decrease in hematocrit – Presence of S3 heart sound – Decrease in hemoglobin – Pulmonary congestion – Dyspnea – Restlessness – Edema – Weight gain over short period of time – Electrolyte imbalance Related factors – Excessive fluid intake – Excessive sodium intake Associated condition – Compromised regulatory mechanism Original literature support available at http://MediaCenter.thieme.com. 198

Class 1. Domain 3. Code Elimination and exchange 00016 00020 Urinary function 00176 Diagnosis 00018 Impaired urinary elimination 00017 Functional urinary incontinence 00019 Overflow urinary incontinence 00022 Reflex urinary incontinence 00023 Stress urinary incontinence Urge urinary incontinence Class 2. Risk for urge urinary incontinence Code Urinary retention 00011 00015 Gastrointestinal function 00012 Diagnosis 00235 Constipation 00236 Risk for constipation 00013 Perceived constipation 00196 Chronic functional constipation 00197 Risk for chronic functional constipation 00014 Diarrhea Dysfunctional gastrointestinal motility Class 3. Risk for dysfunctional gastrointestinal motility Code Bowel incontinence Integumentary function Diagnosis 199

This class does not currently contain any diagnoses. Class 4. Respiratory function Code Diagnosis 00030 Impaired gas exchange NANDA International, Inc. Nursing Diagnoses: Definitions and Classification 2018–2020, 11th Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2017 NANDA International, Inc. Published 2017 by Thieme Medical Publishers, Inc., New York. Companion website: www.thieme.com/nanda-i. 200

Domain 3 • Class 1 • Diagnosis Code 00016 Impaired urinary elimination Approved 1973 • Revised 2006, 2017 • Level of Evidence 2.1 Definition Dysfunction in urine elimination. Defining characteristics – Urinary incontinence – Urinary retention – Dysuria – Urinary urgency – Frequent voiding – Hesitancy – Nocturia Related factors – Urinary tract infection – Multiple causality Associated condition – Anatomic obstruction – Sensory motor impairment This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition if no specific related factors are developed. Original literature support available at http://MediaCenter.thieme.com. 201

Domain 3 • Class 1 • Diagnosis Code 00020 Functional urinary incontinence Approved 1986 • Revised 1998, 2017 Definition Inability of a usually continent person to reach the toilet in time to avoid unintentional loss of urine. Defining characteristics – Time required to reach toilet is too long after sensation of urge – Completely empties bladder – Early morning urinary incontinence – Voiding prior to reaching toilet – Sensation of need to void – Weakened supporting pelvic structure Related factors – Neuromuscular impairment – Alteration in environmental factor – Psychological disorder Associated condition – Alteration in cognitive functioning – Impaired vision This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 202

Domain 3 • Class 1 • Diagnosis Code 00176 Overflow urinary incontinence Approved 2006 • Revised 2017 • Level of Evidence 2.1 Definition Involuntary loss of urine associated with overdistention of the bladder. Defining characteristics – Involuntary leakage of small volume of urine – Nocturia – Bladder distention – High post-void residual volume – Severe pelvic organ prolapse – Treatment regimen Related factors – Urethral obstruction – Fecal impaction Associated condition – Bladder outlet obstruction – Detrusor external sphincter dyssynergia – Detrusor hypocontractility Additional modifiable related factors to be developed. Original literature support available at http://MediaCenter.thieme.com. 203

Domain 3 • Class 1 • Diagnosis Code 00018 Reflex urinary incontinence Approved 1986 • Revised 1998, 2017 Definition Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached. Defining characteristics – Predictable pattern of voiding – Sensation of urgency to void without voluntary – Absence of voiding sensation – Absence of urge to void inhibition of bladder contraction – Inability to voluntarily inhibit voiding – Sensations associated with full bladder – Inability to voluntarily initiate voiding – Incomplete emptying of bladder with lesion above pontine micturition center Related factors – To be developed Associated condition – Neurological impairment above level of sacral micturition center – Neurological impairment above level of pontine micturition center – Tissue damage This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 204

Domain 3 • Class 1 • Diagnosis Code 00017 Stress urinary incontinence Approved 1986 • Revised 2006, 2017 • Level of Evidence 2.1 Definition Sudden leakage of urine with activities that increase intra-abdominal pressure. Defining characteristics – Involuntary leakage of small volume of urine in the absence of overdistended bladder – Involuntary leakage of small volume of urine – Involuntary leakage of small volume of urine in the absence of detrusor contraction Related factors – Weak pelvic floor muscles Associated condition – Intrinsic urethral sphincter deficiency – Degenerative changes in pelvic floor muscles – Increase in intra-abdominal pressure Original literature support available at http://MediaCenter.thieme.com. 205

Domain 3 • Class 1 • Diagnosis Code 00019 Urge urinary incontinence Approved 1986 • Revised 2006, 2017 • Level of Evidence 2.1 Definition Involuntary passage of urine occurring soon after a strong sensation or urgency to void. Defining characteristics – Inability to reach toilet in time to avoid urine loss – Involuntary loss of urine with bladder spasms – Involuntary loss of urine with bladder – Urinary urgency contractions Related factors – Ineffective toileting habits – Involuntary sphincter relaxation – Alcohol consumption – Caffeine intake – Fecal impaction Associated condition – Detrusor hyperactivity with impaired bladder contractility – Atrophic urethritis – Atrophic vaginitis – Impaired bladder contractility – Bladder infection – Treatment regimen – Decrease in bladder capacity Original literature support available at http://MediaCenter.thieme.com. 206

Domain 3 • Class 1 • Diagnosis Code 00022 Risk for urge urinary incontinence Approved 1998 • Revised 2008, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to involuntary passage of urine occurring soon after a strong sensation or urgency to void, which may compromise health. Risk factors – Ineffective toileting habits – Involuntary sphincter relaxation – Alcohol consumption – Caffeine intake – Detrusor hyperactivity with impaired bladder – Fecal impaction contractility Associated condition – Impaired bladder contractility – Treatment regimen – Atrophic urethritis – Atrophic vaginitis – Bladder infection – Decrease in bladder capacity Original literature support available at http://MediaCenter.thieme.com. 207

Domain 3 • Class 1 • Diagnosis Code 00023 Urinary retention Approved 1986 • Revised 2017 Definition Inability to empty bladder completely. Defining characteristics – Overflow incontinence – Residual urine – Absence of urinary output – Sensation of bladder fullness – Bladder distention – Small voiding – Dribbling of urine – Dysuria – Reflex arc inhibition – Frequent voiding – Strong sphincter Related factors – To be developed Associated condition – Blockage in urinary tract – High urethral pressure This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 208

Domain 3 • Class 2 • Diagnosis Code 00011 Constipation Approved 1975 • Revised 1998, 2017 Definition Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool. Defining characteristics – Hypoactive bowel sounds – Inability to defecate – Abdominal pain – Increase in intra-abdominal pressure – Abdominal tenderness with palpable muscle – Indigestion – Liquid stool resistance – Pain with defecation – Abdominal tenderness without palpable muscle – Palpable abdominal mass – Palpable rectal mass resistance – Percussed abdominal dullness – Anorexia – Rectal fullness – Atypical presentations in older adults – Rectal pressure – Borborygmi – Severe flatus – Bright red blood with stool – Soft, paste-like stool in rectum – Change in bowel pattern – Straining with defecation – Decrease in stool frequency – Vomiting – Decrease in stool volume – Distended abdomen – Fatigue – Hard, formed stool – Headache – Hyperactive bowel sounds Related factors – Habitually suppresses urge to defecate – Inadequate dietary habits – Abdominal muscle weakness – Inadequate oral hygiene – Average daily physical activity is less than – Inadequate toileting habits – Insufficient fiber intake recommended for gender and age – Insufficient fluid intake – Confusion – Irregular defecation habits – Decrease in gastrointestinal motility – Laxative abuse – Dehydration – Depression – Eating habit change 209

– Emotional disturbance – Obesity – Recent environmental change Associated condition – Prostate enlargement – Electrolyte imbalance – Rectal abscess – Hemorrhoids – Rectal anal fissure – Hirschprung's disease – Rectal anal stricture – Inadequate dentition – Rectal prolapse – Iron salts – Rectal ulcer – Neurological impairment – Rectocele – Postsurgical bowel obstruction – Tumor – Pregnancy This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 210

Domain 3 • Class 2 • Diagnosis Code 00015 Risk for constipation Approved 1998 • Revised 2013, 2017 Definition Susceptible to a decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool, which may compromise health. Risk factors – Habitually suppresses urge to defecate – Inadequate dietary habits – Abdominal muscle weakness – Inadequate oral hygiene – Average daily physical activity is less than – Inadequate toileting habits – Insufficient fiber intake recommended for gender and age – Insufficient fluid intake – Confusion – Irregular defecation habits – Decrease in gastrointestinal motility – Laxative abuse – Dehydration – Obesity – Depression – Recent environmental change – Eating habit change – Emotional disturbance – Prostate enlargement – Rectal abscess Associated condition – Rectal anal fissure – Rectal anal stricture – Electrolyte imbalance – Rectal prolapse – Hemorrhoids – Rectal ulcer – Hirschprung's disease – Rectocele – Inadequate dentition – Tumor – Iron salts – Neurological impairment – Postsurgical bowel obstruction – Pregnancy This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 211

Domain 3 • Class 2 • Diagnosis Code 00012 Perceived constipation Approved 1988 Definition Self-diagnosis of constipation combined with abuse of laxatives, enemas, and/or suppositories to ensure a daily bowel movement. Defining characteristics – Laxative abuse – Suppository abuse – Enema abuse – Expects daily bowel movement – Impaired thought process – Expects daily bowel movement at same time every day Related factors – Cultural health beliefs – Family health beliefs This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 212

Domain 3 • Class 2 • Diagnosis Code 00235 Chronic functional constipation Approved 2013 • Revised 2017 • Level of Evidence 2.2 Definition Infrequent or difficult evacuation of feces, which has been present for at least 3 of the prior 12 months. Defining characteristics Adult: Presence of ≥ 2 of the following symptoms on Rome III classification system: – Lumpy or hard stools in ≥ 25% defecations – Sensation of anorectal obstruction/blockage for ≥ – Straining during ≥ 25% of defecations 25% of defecations – Sensation of incomplete evacuation for ≥ 25% of – Manual maneuvers to facilitate ≥ 25% of defecations defecations (digital manipulation, pelvic floor support) – ≤ 3 evacuations per week Child > 4 years: Presence of ≥ 2 criteria on Rome III Pediatric classification system for ≥ 2 months: – ≤ 2 defecations per week – Presence of large fecal mass in the rectum – ≥ 1 episode of fecal incontinence per week – Large diameter stools that may obstruct the toilet – Stool retentive posturing – Painful or hard bowel movements Child ≤ 4 years: Presence of ≥ 2 criteria on Rome III Pediatric classification system for ≥ 1 month: – ≤ 2 defecations per week – Presence of large fecal mass in the rectum – ≥ 1 episode of fecal incontinence per week – Large diameter stools that may obstruct the toilet – Stool retentive posturing – Painful or hard bowel movements 213

General – Palpable abdominal mass – Positive fecal occult blood test – Distended abdomen – Prolonged straining – Fecal impaction – Type 1 or 2 on Bristol Stool Chart – Leakage of stool with digital stimulation – Pain with defecation – Impaired mobility – Insufficient dietary intake Related factors – Insufficient fluid intake – Insufficient knowledge of modifiable factors – Decrease in food intake – Low caloric intake – Dehydration – Low-fiber diet – Depression – Sedentary lifestyle – Diet disproportionally high in fat – Diet disproportionally high in protein – Multiple sclerosis – Frail elderly syndrome – Myotonic dystrophy – Habitually suppresses urge to defecate – Panhypopituitarism – Paraplegia Associated condition – Parkinson's disease – Pelvic floor dysfunction – Amyloidosis – Perineal damage – Anal fissure – Pharmaceutical agent – Anal stricture – Polypharmacy – Autonomic neuropathy – Porphyria – Cerebral vascular accident – Postinflammatory stenosis – Chronic intestinal pseudoobstruction – Pregnancy – Chronic renal insufficiency – Proctitis – Colorectal cancer – Scleroderma – Dementia – Slow colon transit time – Dermatomyositis – Spinal cord injury – Diabetes mellitus – Surgical stenosis – Extra intestinal mass – Hemorrhoids – Hirschprung's disease – Hypercalcemia – Hypothyroidism – Inflammatory bowel disease – Ischemic stenosis Original literature support available at http://MediaCenter.thieme.com. 214

Domain 3 • Class 2 • Diagnosis Code 00236 Risk for chronic functional constipation Approved 2013 • Revised 2017 • Level of Evidence 2.2 Definition Susceptible to infrequent or difficult evacuation of feces, which has been present nearly 3 of the prior 12 months, which may compromise health. Risk factors – Impaired mobility – Insufficient dietary intake – Decrease in food intake – Insufficient fluid intake – Dehydration – Insufficient knowledge of modifiable factors – Depression – Low caloric intake – Diet disproportionally high in fat – Low-fiber diet – Diet disproportionally high in protein – Sedentary lifestyle – Frail elderly syndrome – Habitually suppresses urge to defecate – Multiple sclerosis – Myotonic dystrophy Associated condition – Panhypopituitarism – Paraplegia – Amyloidosis – Parkinson's disease – Anal fissure – Pelvic floor dysfunction – Anal stricture – Perineal damage – Autonomic neuropathy – Pharmaceutical agent – Cerebral vascular accident – Polypharmacy – Chronic intestinal pseudoobstruction – Porphyria – Chronic renal insufficiency – Postinflammatory stenosis – Colorectal cancer – Pregnancy – Dementia – Proctitis – Dermatomyositis – Scleroderma – Diabetes mellitus – Slow colon transit time – Extra intestinal mass – Spinal cord injury – Hemorrhoids – Surgical stenosis – Hirschprung's disease – Hypercalcemia – Hypothyroidism – Inflammatory bowel disease – Ischemic stenosis 215

Original literature support available at http://MediaCenter.thieme.com. 216

Domain 3 • Class 2 • Diagnosis Code 00013 Diarrhea Approved 1975 • Revised 1998, 2017 Definition Passage of loose, unformed stools. Defining characteristics – Hyperactive bowel sounds – Loose liquid stools, > 3 in 24 hours – Abdominal pain – Bowel urgency – Laxative abuse – Cramping – Substance misuse Related factors – Exposure to unsanitary food preparation – Anxiety – Malabsorption – Increase in stress level – Parasite – Treatment regimen At risk population – Exposure to contaminant – Exposure to toxin Associated condition – Enteral feedings – Gastrointestinal inflammation – Gastrointestinal irritation – Infection This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 217

Domain 3 • Class 2 • Diagnosis Code 00196 Dysfunctional gastrointestinal motility Approved 2008 • Revised 2017 • Level of Evidence 2.1 Definition Increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal system. Defining characteristics – Difficulty with defecation – Distended abdomen – Abdominal cramping – Hard, formed stool – Abdominal pain – Increase in gastric residual – Absence of flatus – Nausea – Acceleration of gastric emptying – Regurgitation – Bile-colored gastric residual – Vomiting – Change in bowel sounds – Diarrhea – Malnutrition – Sedentary lifestyle Related factors – Stressors – Unsanitary food preparation – Anxiety – Change in water source – Prematurity – Eating habit change – Immobility – Gastroesophageal reflux disease – Infection At risk population – Pharmaceutical agent – Treatment regimen – Aging – Ingestion of contaminated material Associated condition – Decrease in gastrointestinal circulation – Diabetes mellitus – Enteral feedings – Food intolerance 218

Original literature support available at http://MediaCenter.thieme.com. 219

Domain 3 • Class 2 • Diagnosis Code 00197 Risk for dysfunctional gastrointestinal motility Approved 2008 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal system, which may compromise health. Risk factors – Malnutrition – Sedentary lifestyle – Anxiety – Stressors – Change in water source – Unsanitary food preparation – Eating habit change – Immobility – Prematurity At risk population – Gastroesophageal reflux disease – Infection – Aging – Pharmaceutical agent – Ingestion of contaminated material – Treatment regimen Associated condition – Decrease in gastrointestinal circulation – Diabetes mellitus – Enteral feedings – Food intolerance Original literature support available at http://MediaCenter.thieme.com. 220

Domain 3 • Class 2 • Diagnosis Code 00014 Bowel incontinence Approved 1975 • Revised 1998, 2017 Definition Involuntary passage of stool. Defining characteristics – Inability to expel formed stool despite recognition of rectal fullness – Bowel urgency – Constant passage of soft stool – Inability to recognize rectal fullness – Does not recognize urge to defecate – Inattentive to urge to defecate – Fecal staining – Inability to delay defecation – Inadequate dietary habits – Incomplete emptying of bowel Related factors – Laxative abuse – Stressors – Difficulty with toileting self-care – Environmental factor – Impaction – Generalized decline in muscle tone – Impaired reservoir capacity – Immobility – Lower motor nerve damage – Pharmaceutical agent Associated condition – Rectal sphincter abnormality – Upper motor nerve damage – Abnormal increase in abdominal pressure – Abnormal increase in intestinal pressure – Alteration in cognitive functioning – Chronic diarrhea – Colorectal lesion – Dysfunctional rectal sphincter This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 221

Domain 3 • Class 3 This class does not currently contain any diagnoses. 222

Domain 3 • Class 4 • Diagnosis Code 00030 Impaired gas exchange Approved 1980 • Revised 1996, 1998, 2017 Definition Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane. Defining characteristics – Hypercapnia – Hypoxemia – Abnormal arterial blood gases – Hypoxia – Abnormal arterial pH – Irritability – Abnormal breathing pattern – Nasal flaring – Abnormal skin color – Restlessness – Confusion – Somnolence – Decrease in carbon dioxide (CO2) level – Tachycardia – Diaphoresis – Visual disturbance – Dyspnea – Headache upon awakening – Ventilation-perfusion imbalance Related factors – To be developed Associated condition – Alveolar-capillary membrane changes This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 223

Class 1. Domain 4. Code Activity/rest 00095 00096 Sleep/rest 00165 Diagnosis 00198 Insomnia Sleep deprivation Class 2. Readiness for enhanced sleep Code Disturbed sleep pattern 00040 00091 Activity/exercise 00085 Diagnosis 00089 Risk for disuse syndrome 00237 Impaired bed mobility 00238 Impaired physical mobility 00090 Impaired wheelchair mobility 00088 Impaired sitting Impaired standing Class 3. Impaired transfer ability Code Impaired walking 00273 00093 Energy balance 00154 Diagnosis Imbalanced energy field Class 4. Fatigue Wandering Cardiovascular/pulmonary responses 224

Code Diagnosis 00092 Activity intolerance 00094 Risk for activity intolerance 00032 Ineffective breathing pattern 00029 Decreased cardiac output 00240 Risk for decreased cardiac output 00033 Impaired spontaneous ventilation 00267 Risk for unstable blood pressure 00200 Risk for decreased cardiac tissue perfusion 00201 Risk for ineffective cerebral tissue perfusion 00204 Ineffective peripheral tissue perfusion 00228 Risk for ineffective peripheral tissue perfusion 00034 Dysfunctional ventilatory weaning response Class 5. Self-care Code Diagnosis 00098 Impaired home maintenance 00108 Bathing self-care deficit 00109 Dressing self-care deficit 00102 Feeding self-care deficit 00110 Toileting self-care deficit 00182 Readiness for enhanced self-care 00193 Self-neglect NANDA International, Inc. Nursing Diagnoses: Definitions and Classification 2018–2020, 11th Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2017 NANDA International, Inc. Published 2017 by Thieme Medical Publishers, Inc., New York. Companion website: www.thieme.com/nanda-i. 225