NANDA 2018-2020

Domain 11 • Class 2 • Diagnosis Code 00048 Impaired dentition Approved 1998 • Revised 2017 Definition Disruption in tooth development/eruption pattern or structural integrity of individual teeth. Defining characteristics – Incomplete tooth eruption for age – Loose tooth – Absence of teeth – Malocclusion – Abraded teeth – Premature loss of primary teeth – Dental caries – Root caries – Enamel discoloration – Tooth fracture – Erosion of enamel – Tooth misalignment – Excessive oral calculus – Toothache – Excessive oral plaque – Facial asymmetry – Halitosis Related factors – Inadequate dietary habits – Inadequate oral hygiene – Barrier to self-care – Insufficient knowledge of dental health – Difficulty accessing dental care – Malnutrition – Excessive intake of fluoride – Excessive use of abrasive oral cleaning agents – Habitual use of staining substance At risk population – Genetic predisposition – Economically disadvantaged Associated condition – Oral temperature sensitivity – Pharmaceutical agent – Bruxism – Chronic vomiting 426

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. 427

Domain 11 • Class 2 • Diagnosis Code 00219 Risk for dry eye Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to eye discomfort or damage to the cornea and conjunctiva due to reduced quantity or quality of tears to moisten the eye, which may compromise health. Risk factors – Low humidity – Prolonged reading – Air conditioning – Smoking – Air pollution – Sunlight exposure – Caffeine intake – Vitamin A deficiency – Excessive wind – Insufficient knowledge of modifiable factors – Female gender – History of allergy At risk population – Neurological lesion with sensory or motor reflex – Aging loss – Contact lens wearer – Ocular surface damage Associated condition – Treatment regimen – Autoimmune disease – Hormonal change – Mechanical ventilation Original literature support available at http://MediaCenter.thieme.com. 428

Domain 11 • Class 2 • Diagnosis Code 00261 Risk for dry mouth Approved 2016 • Level of Evidence 2.1 Definition Susceptible to discomfort or damage to the oral mucosa due to reduced quantity or quality of saliva to moisten the mucosa, which may compromise health. Risk factors – Excitement – Smoking – Dehydration – Depression – Pregnancy – Excessive stress – Radiation therapy to the head and neck – Systemic diseases Associated condition – Chemotherapy – Fluid restriction – Inability to feed orally – Oxygen therapy – Pharmaceutical agent Original literature support available at http://MediaCenter.thieme.com. 429

Domain 11 • Class 2 • Diagnosis Code 00155 Risk for falls Approved 2000 • Revised 2013, 2017 Definition Susceptible to increased susceptibility to falling, which may cause physical harm and compromise health. Risk factors – Inadequate supervision Children – Insufficient automobile restraints – Absence of stairway gate – Insufficient lighting – Absence of window guard – Unfamiliar setting – Use of restraints Environment – Use of throw rugs – Cluttered environment – Faintness when turning neck – Exposure to unsafe weatherrelated condition – Impaired mobility – Insufficient anti-slip material in bathroom – Incontinence – Sleeplessness Physiological – Urinary urgency – Alteration in blood glucose level – Insufficient knowledge of modifiable factors – Decrease in lower extremity strength – Diarrhea – Living alone – Difficulty with gait – Faintness when extending neck Other – Alcohol consumption At risk population – Age ≥ 65 years 430

– Age ≤ 2 years – Male gender when < 1 year of age – History of falls – Neoplasm Associated condition – Neuropathy – Orthostatic hypotension – Acute illness – Pharmaceutical agent – Alteration in cognitive functioning – Postoperative recovery period – Anemia – Proprioceptive deficit – Arthritis – Use of assistive device – Condition affecting the foot – Vascular disease – Hearing impairment – Impaired balance – Impaired vision – Lower limb prosthesis 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. 431

Domain 11 • Class 2 • Diagnosis Code 00245 Risk for corneal injury Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Susceptible to infection or inflammatory lesion in the corneal tissue that can affect superficial or deep layers, which may compromise health. Risk factors – Insufficient knowledge of modifiable factors – Exposure of the eyeball – Oxygen therapy – Periorbital edema At risk population – Pharmaceutical agent – Tracheostomy – Prolonged hospitalization Associated condition – Blinking < 5 times per minute – Glasgow Coma Scale score < 6 – Intubation – Mechanical ventilation Original literature support available at http://MediaCenter.thieme.com. 432

Domain 11 • Class 2 • Diagnosis Code 00035 Risk for injury Approved 1978 • Revised 2013, 2017 Definition Susceptible to physical damage due to environmental conditions interacting with the individual's adaptive and defensive resources, which may compromise health. Risk factors – Insufficient knowledge of modifiable factors – Malnutrition – Compromised nutritional source – Nosocomial agent – Exposure to pathogen – Physical barrier – Exposure to toxic chemical – Unsafe mode of transport – Immunization level within community – Impaired primary defense mechanisms At risk population – Biochemical dysfunction – Extremes of age – Effector dysfunction – Immune dysfunction Associated condition – Sensory integration dysfunction – Tissue hypoxia – Abnormal blood profile – Alteration in cognitive functioning – Alteration in psychomotor functioning – Alteration in sensation – Autoimmune dysfunction 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. 433

Domain 11 • Class 2 • Diagnosis Code 00250 Risk for urinary tract injury Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Susceptible to damage of the urinary tract structures from use of catheters, which may compromise health. Risk factors – Obesity – Confusion – Deficient patient or caregiver knowledge regarding care of urinary catheter At risk population – Extremes of age Associated condition – Long term use of urinary catheter – Medullary injury – Anatomical variation in the pelvic organs – Multiple catheterizations – Condition preventing ability to secure catheter – Retention balloon inflated to ≥ 30 ml – Detrusor sphincter dyssynergia – Use of large caliber urinary catheter – Impaired cognition – Latex allergy Original literature support available at http://MediaCenter.thieme.com. 434

Domain 11 • Class 2 • Diagnosis Code 00087 Risk for perioperative positioning injury Approved 1994 • Revised 2006, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to inadvertent anatomical and physical changes as a result of posture or positioning equipment used during an invasive/surgical procedure, which may compromise health. Risk factors – Obesity – Sensoriperceptual disturbance from anesthesia – Immobilization Associated condition – Disorientation – Edema – Emaciation – Muscle weakness Due to limited amount of the patient contact preoperatively, nurses may not be able to intervene on many of these associated conditions. Original literature support available at http://MediaCenter.thieme.com. 435

Domain 11 • Class 2 • Diagnosis Code 00220 Risk for thermal injury Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to extreme temperature damage to skin and mucous membranes, which may compromise health. Risk factors – Insufficient knowledge of safety precautions – Smoking – Fatigue – Unsafe environment – Inadequate protective clothing – Inadequate supervision – Extremes of environmental temperature – Inattentiveness – Insufficient caregiver knowledge of safety – Neuromuscular impairment – Neuropathy precautions – Treatment regimen At risk population – Extremes of age Associated condition – Alcohol intoxication – Drug intoxication – Alteration in cognitive functioning Original literature support available at http://MediaCenter.thieme.com. 436

Domain 11 • Class 2 • Diagnosis Code 00045 Impaired oral mucous membrane integrity Approved 1982 • Revised 1998, 2013, 2017 • Level of Evidence 2.1 Definition Injury to the lips, soft tissue, buccal cavity, and/or oropharynx. Defining characteristics – Oral discomfort – Oral edema – Bad taste in mouth – Oral fissure – Bleeding – Oral lesion – Cheilitis – Oral mucosal pallor – Coated tongue – Oral nodule – Decrease in taste sensation – Oral pain – Desquamation – Oral papule – Difficulty eating – Oral ulcer – Difficulty speaking – Oral vesicles – Enlarged tonsils – Presence of mass – Exposure to pathogen – Purulent oral-nasal drainage – Geographic tongue – Purulent oral-nasal exudates – Gingival hyperplasia – Smooth atrophic tongue – Gingival pallor – Spongy patches in mouth – Gingival pocketing deeper than 4 mm – Stomatitis – Gingival recession – White patches in mouth – Halitosis – White plaque in mouth – Hyperemia – White, curd-like oral exudate – Impaired ability to swallow – Xerostomia – Macroplasia – Mucosal denudation – Inadequate oral hygiene – Insufficient knowledge of oral hygiene Related factors – Malnutrition – Mouth breathing – Alcohol consumption – Smoking – Barrier to dental care – Stressors – Barrier to oral self-care – Chemical injury agent – Decrease in salivation – Dehydration 437

– Depression – Immunosuppression – Inadequate nutrition – Infection – Loss of oral support structure At risk population – Mechanical factor – Nil per os (NPO) > 24 hours – Economically disadvantaged – Oral trauma – Radiation therapy Associated condition – Sjögren's Syndrome – Surgical procedure – Allergy – Trauma – Alteration in cognitive functioning – Treatment regimen – Autoimmune disease – Autosomal disorder – Behavioral disorder – Chemotherapy – Cleft lip – Cleft palate – Decrease in hormone level in women – Decrease in platelets – Immunodeficiency Original literature support available at http://MediaCenter.thieme.com. 438

Domain 11 • Class 2 • Diagnosis Code 00247 Risk for impaired oral mucous membrane integrity Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Susceptible to injury to the lips, soft tissues, buccal cavity, and/or oropharynx, which may compromise health. Risk factors – Inadequate oral hygiene – Insufficient knowledge of oral hygiene – Alcohol consumption – Malnutrition – Barrier to dental care – Mouth breathing – Barrier to oral self-care – Smoking – Chemical injury agent – Stressors – Decrease in salivation – Dehydration – Immunosuppression – Depression – Infection – Inadequate nutrition – Loss of oral support structure – Mechanical factor At risk population – Nil per os (NPO) > 24 hours – Oral trauma – Economically disadvantaged – Radiation therapy – Surgical procedure Associated condition – Sjögren's Syndrome – Trauma – Allergy – Treatment regimen – Alteration in cognitive functioning – Autoimmune disease – Autosomal disorder – Behavioral disorder – Chemotherapy – Cleft lip – Cleft palate – Decrease in hormone level in women – Decrease in platelets – Immunodeficiency 439

Original literature support available at http://MediaCenter.thieme.com. 440

Domain 11 • Class 2 • Diagnosis Code 00086 Risk for peripheral neurovascular dysfunction Approved 1992 • Revised 2013, 2017 Definition Susceptible to disruption in the circulation, sensation, and motion of an extremity, which may compromise health. Risk factors – Orthopedic surgery – Trauma – To be developed – Vascular obstruction Associated condition – Burn injury – Fracture – Immobilization – Mechanical compression 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. Original literature support available at http://MediaCenter.thieme.com. 441

Domain 11 • Class 2 • Diagnosis Code 00038 Risk for physical trauma Approved 1980 • Revised 2013, 2017 Definition Susceptible to physical injury of sudden onset and severity which require immediate attention. Risk factors – Insufficient protection from heat source – Misuse of headgear External – Misuse of seat restraint – Nonuse of seat restraints – Absence of call-for-aid device – Obstructed passageway – Absence of stairway gate – Playing with dangerous object – Absence of window guard – Playing with explosive – Access to weapon – Pot handle facing front of stove – Bathing in very hot water – Proximity to vehicle pathway – Bed in high position – Slippery floor – Children riding in front seat of car – Smoking in bed – Defective appliance – Smoking near oxygen – Delay in ignition of gas appliance – Struggling with restraints – Dysfunctional call-for-aid device – Unanchored electric wires – Electrical hazard – Unsafe operation of heavy equipment – Exposure to corrosive product – Unsafe road – Exposure to dangerous machinery – Unsafe walkway – Exposure to radiation – Use of cracked dishware – Exposure to toxic chemical – Use of throw rugs – Flammable object – Use of unstable chair – Grease on stove – Use of unstable ladder – Icicles hanging from roof – Wearing loose clothing around open flame – Inadequate stair rails – Inadequately stored combustible – Inadequately stored corrosive – Insufficient anti-slip material in bathroom – Insufficient lighting Internal 442

– Emotional disturbance – Insufficient vision – Impaired balance – Weakness – Insufficient knowledge of safety precautions – High crime neighborhood At risk population – History of trauma – Economically disadvantaged – Decrease in eye-hand coordination – Extremes of environmental temperature – Decrease in muscle coordination – Gas leak Associated condition – Alteration in cognitive functioning – Alteration in sensation 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. 443

Domain 11 • Class 2 • Diagnosis Code 00213 Risk for vascular trauma Approved 2008 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to damage to vein and its surrounding tissues related to the presence of a catheter and/or infused solutions, which may compromise health. Risk factors – Prolonged period of time catheter is in place – Rapid infusion rate – Inadequate available insertion site Associated condition – Irritating solution Original literature support available at http://MediaCenter.thieme.com. 444

Domain 11 • Class 2 • Diagnosis Code 00249 Risk for pressure ulcer Approved 2013 • Revised 2017 • Level of Evidence 2.2 Definition Susceptible to localized injury to the skin and/or underlying tissue usually over a bony prominence as a result of pressure, or pressure in combination with shear (NPUAP, 2007). Risk factors – Insufficient knowledge of modifiable factors – Pressure over bony prominence – Decrease in mobility – Scaly skin – Dehydration – Self-care deficit – Dry skin – Shearing forces – Extended period of immobility on hard surface – Skin moisture – Hyperthermia – Smoking – Inadequate nutrition – Surface friction – Incontinence – Use of linen with insufficient moisture wicking – Insufficient caregiver knowledge of pressure property ulcer prevention At risk population – History of cerebral vascular accident – History of pressure ulcer – ADULT: Braden Scale score of < 17 – History of trauma – American Society of Anesthesiologists (ASA) – Low score on Risk Assessment Pressure Sore Physical Status classification score ≥ 1 (RAPS) scale – CHILD: Braden Q Scale of ≤ 15 – New York Heart Association (NYHA) Functional – Extremes of age – Extremes of weight Classification ≥ 1 – Female gender Associated condition – Elevated skin temperature by 1-2 ° C – Hip fracture – Alteration in cognitive functioning – Impaired circulation – Alteration in sensation – Anemia 445

– Cardiovascular disease – Lymphopenia – Decrease in serum albumin level – Pharmaceutical agent – Decrease in tissue oxygenation – Physical immobilization – Decrease in tissue perfusion – Reduced triceps skin fold thickness – Edema Original literature support available at http://MediaCenter.thieme.com. 446

Domain 11 • Class 2 • Diagnosis Code 00205 Risk for shock Approved 2008 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to an inadequate blood flow to the body's tissues that may lead to life-threatening cellular dysfunction, which may compromise health. Risk factors – Infection – Sepsis – To be developed – Systemic inflammatory response syndrome Associated condition (SIRS) – Hypotension – Hypovolemia – Hypoxemia – Hypoxia 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. 447

Domain 11 • Class 2 • Diagnosis Code 00046 Impaired skin integrity Approved 1975 • Revised 1998. 2017 • Level of Evidence 2.1 Definition Altered epidermis and/or dermis. Defining characteristics – Hematoma – Localized area hot to touch – Acute pain – Redness – Alteration in skin integrity – Bleeding – Hypothermia – Foreign matter piercing skin – Moisture – Pressure over bony prominence Related factors – Secretions External – Psychogenic factor – Chemical injury agent – Excretions – Immunodeficiency – Humidity – Impaired circulation – Hyperthermia Internal – Alteration in fluid volume – Inadequate nutrition At risk population – Extremes of age Associated condition – Alteration in metabolism – Alteration in pigmentation 448

– Alteration in sensation – Pharmaceutical agent – Alteration in skin turgor – Radiation therapy – Arterial puncture – Vascular trauma – Hormonal change 449

Domain 11 • Class 2 • Diagnosis Code 00047 Risk for impaired skin integrity Approved 1975 • Revised 1998, 2010, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to alteration in epidermis and/or dermis, which may compromise health. Risk factors – Hypothermia External – Moisture – Secretions – Chemical injury agent – Excretions – Pressure over bony prominence – Humidity – Psychogenic factor – Hyperthermia – Immunodeficiency Internal – Impaired circulation – Pharmaceutical agent – Alteration in fluid volume – Radiation therapy – Inadequate nutrition – Vascular trauma At risk population – Extremes of age Associated condition – Alteration in metabolism – Alteration in pigmentation – Alteration in sensation – Alteration in skin turgor – Arterial puncture – Hormonal change 450

Domain 11 • Class 2 • Diagnosis Code 00156 Risk for sudden infant death Approved 2002 • Revised 2013, 2017 • Level of Evidence 3.2 Definition Susceptible to unpredicted death of an infant. Risk factors – Insufficient prenatal care – Soft sleep surface – Delay in prenatal care – Soft, loose objects placed near infant – Exposure to second hand smoke – Infant less than 4 months, placed in sitting – Infant overheating – Infant overwrapping devices for routine sleep – Infant placed in prone position to sleep – Infant placed in side-lying position to sleep – Native American Ethnicity – Postnatal exposure to alcohol At risk population – Postnatal exposure to elicit drug – Prematurity – African American Ethnicity – Prenatal exposure to alcohol – Age 2-4 months – Prenatal exposure to elicit drug – Infant not breastfed exclusively or fed with – Young parental age expressed breast milk – Low birth weight – Male gender – Maternal smoking during pregnancy Associated condition – Cold weather 451

Domain 11 • Class 2 • Diagnosis Code 00036 Risk for suffocation Approved 1980 • Revised 2013, 2017 Definition Susceptible to inadequate air availability for inhalation, which may compromise health. Risk factors – Playing with plastic bag – Propped bottle in infant's crib – Access to empty refrigerator/freezer – Small object in airway – Eating large mouthfuls of food – Smoking in bed – Emotional disturbance – Soft underlayment – Gas leak – Unattended in water – Insufficient knowledge of safety precautions – Unvented fuel-burning heater – Low-strung clothesline – Vehicle running in closed garage – Pacifier around infant's neck – Face/neck injury Associated condition – Impaired motor functioning – Alteration in cognitive functioning – Alteration in olfactory function – Face/neck disease 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. 452

Domain 11 • Class 2 • Diagnosis Code 00100 Delayed surgical recovery Approved 1998 • Revised 2006, 2013, 2017 • Level of Evidence 2.1 Definition Extension of the number of postoperative days required to initiate and perform activities that maintain life, health, and well-being. Defining characteristics – Inability to resume employment – Loss of appetite – Discomfort – Postpones resumption of work – Evidence of interrupted healing of surgical area – Requires assistance for self-care – Excessive time required for recuperation – Impaired mobility Related factors – Pain – Postoperative emotional response – Malnutrition – Obesity At risk population – Extremes of age – History of delayed wound healing Associated condition – Persistent vomiting – Pharmaceutical agent – American Society of Anesthesiologists (ASA) – Prolonged surgical procedure Physical Status classification score ≥ 2 – Psychological disorder in postoperative period – Surgical site contamination – Diabetes mellitus – Trauma at surgical site – Edema at surgical site – Extensive surgical procedure – Impaired mobility – Perioperative surgical site infection – Persistent nausea 453

Original literature support available at http://MediaCenter.thieme.com. 454

Domain 11 • Class 2 • Diagnosis Code 00246 Risk for delayed surgical recovery Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Susceptible to an extension of the number of postoperative days required to initiate and perform activities that maintain life, health, and well-being, which may compromise health. Risk factors – Pain – Postoperative emotional response – Malnutrition – Obesity At risk population – History of delayed wound healing – Extremes of age Associated condition – Persistent vomiting – Pharmaceutical agent – American Society of Anesthesiologists (ASA) – Prolonged surgical procedure Physical Status classification score ≥ 2 – Psychological disorder in postoperative period – Surgical site contamination – Diabetes mellitus – Trauma at surgical site – Edema at surgical site – Extensive surgical procedure – Impaired mobility – Perioperative surgical site infection – Persistent nausea Original literature support available at http://MediaCenter.thieme.com. 455

Domain 11 • Class 2 • Diagnosis Code 00044 Impaired tissue integrity Approved 1986 • Revised 1998, 2013, 2017 • Level of Evidence 2.1 Definition Damage to the mucous membrane, cornea, integumentary system, muscular fascia, muscle, tendon, bone, cartilage, joint capsule, and/or ligament. Defining characteristics – Localized area hot to touch – Redness – Acute pain – Tissue damage – Bleeding – Destroyed tissue – Insufficient knowledge about maintaining tissue – Hematoma integrity Related factors – Insufficient knowledge about protecting tissue integrity – Chemical injury agent – Excessive fluid volume – Exposure to high-voltage power supply – Humidity – Imbalanced nutritional state – Peripheral neuropathy – Insufficient fluid volume – Pharmaceutical agent – Radiation therapy At risk population – Surgical procedure – Vascular trauma – Extremes of age – Extremes of environmental temperature Associated condition – Alteration in metabolism – Alteration in sensation – Arterial puncture – Impaired circulation – Impaired mobility 456

Original literature support available at http://MediaCenter.thieme.com. 457

Domain 11 • Class 2 • Diagnosis Code 00248 Risk for impaired tissue integrity Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Susceptible to damage to the mucous membrane, cornea, integumentary system, muscular fascia, muscle, tendon, bone, cartilage, joint capsule, and/or ligament, which may compromise health. Risk factors – Insufficient knowledge about maintaining tissue integrity – Chemical injury agent – Excessive fluid volume – Insufficient knowledge about protecting tissue – Humidity integrity – Imbalanced nutritional state – Insufficient fluid volume – Exposure to high-voltage power supply At risk population – Peripheral neuropathy – Pharmaceutical agent – Extremes of age – Radiation therapy – Extremes of environmental temperature – Surgical procedure – Vascular trauma Associated condition – Alteration in metabolism – Alteration in sensation – Arterial puncture – Impaired circulation – Impaired mobility Original literature support available at http://MediaCenter.thieme.com. 458

Domain 11 • Class 2 • Diagnosis Code 00268 Risk for venous thromboembolism Approved 2016 • Level of Evidence 2.1 Definition Susceptible to the development of a blood clot in a deep vein, commonly in the thigh, calf or upper extremity, which can break off and lodge in another vessel, which may compromise health. Risk factors – Obesity – Dehydration – Impaired mobility At risk population – History of cerebral vascular accident (CVA) – History of previous venous thromboembolism – Age > 60 years – Less than 6 weeks postpartum – Critical care admission – Current smoker – First degree relative with history of venous thromboembolism Associated condition – Thrombophilia – Trauma of upper extremity – Cerebral vascular accident (CVA) – Use of estrogen-containing contraceptives – Current cancer diagnosis – Use of hormone replacement therapy – Trauma below the waist – Varicose veins – Significant medical comorbidity – Postoperative for major surgery – Postoperative for orthopedic surgery – Surgery and total anesthesia time > 90 minutes 459

Domain 11 • Class 3 • Diagnosis Code 00272 Risk for female genital mutilation Approved 2016 • Level of Evidence 2.1 Definition Susceptible to full or partial ablation of the female external genitalia and other lesions of the genitalia, whether for cultural, religious or any other non- therapeutic reasons, which may compromise health. Risk factors – Lack of family knowledge about impact of practice on psychosocial health – Lack of family knowledge about impact of practice on physical health – Lack of family knowledge about impact of practice on reproductive health At risk population – Residing in country where practice is accepted – Favorable attitude of family towards practice – Female gender – Family leaders belong to ethnic group in which – Belonging to ethnic group in which practice is practice is accepted accepted – Belonging to family in which any female member – Planning to visit family's country of origin has been subjected to practice Original literature support available at http://MediaCenter.thieme.com. 460

Domain 11 • Class 3 • Diagnosis Code 00138 Risk for other-directed violence Approved 1980 • Revised 1996, 2013, 2017 Definition Susceptible to behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful to others. Risk factors – Pattern of threatening violence – Pattern of violent anti-social behavior – Access to weapon – Suicidal behavior – Impulsiveness – Negative body language – History of substance misuse – Pattern of indirect violence – History of witnessing family violence – Pattern of other-directed violence – Perinatal complications At risk population – Prenatal complications – Psychotic disorder – History of childhood abuse – History of cruelty to animals – History of fire-setting – History of motor vehicle offense Associated condition – Alteration in cognitive functioning – Neurological impairment – Pathological intoxication 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. 461

Domain 11 • Class 3 • Diagnosis Code 00140 Risk for self-directed violence Approved 1994 • Revised 2013, 2017 Definition Susceptible to behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful to self. Risk factors – Insufficient personal resources – Social isolation – Behavioral cues of suicidal intent – Suicidal ideation – Conflict about sexual orientation – Suicidal plan – Conflict in interpersonal relationship(s) – Verbal cues of suicidal intent – Employment concern – Engagement in autoerotic sexual acts – Marital status – Occupation At risk population – Pattern of difficulties in family background – Age ≥ 45 years – Psychological disorder – Age 15-19 years – History of multiple suicide attempts Associated condition – Mental health issue – Physical health issue 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. 462

Domain 11 • Class 3 • Diagnosis Code 00151 Self-mutilation Approved 2000 • Revised 2017 Definition Deliberate self-injurious behavior causing tissue damage with the intent of causing nonfatal injury to attain relief of tension. Defining characteristics – Inhalation of harmful substance – Insertion of object into body orifice – Abrading – Picking at wound – Biting – Scratches on body – Constricting a body part – Self-inflicted burn – Cuts on body – Severing of a body part – Hitting – Ingestion of harmful substance Related factors – Irresistible urge to cut self – Isolation from peers – Absence of family confidant – Labile behavior – Alteration in body image – Loss of control over problem-solving situation – Dissociation – Low self-esteem – Disturbance in interpersonal relationships – Mounting tension that is intolerable – Eating disorder – Negative feeling – Emotional disturbance – Pattern of inability to plan solutions – Feeling threatened with loss of significant – Pattern of inability to see long-term consequences – Perfectionism relationship – Requires rapid stress reduction – Impaired self-esteem – Substance misuse – Impulsiveness – Use of manipulation to obtain nurturing – Inability to express tension verbally – Ineffective communication between parent and relationship with others adolescent – Ineffective coping strategies – Irresistible urge for self-directed violence At risk population – Childhood surgery – Adolescence 463

– Battered child – Developmental delay – Childhood illness – Family divorce – Family history of self-destructive behavior – Living in nontraditional setting – Family substance misuse – Peers who self-mutilate – History of childhood abuse – Sexual identity crisis – History of self-directed violence – Violence between parental figures – Incarceration – Depersonalization Associated condition – Psychotic disorder – Autism – Borderline personality disorder – Character disorder 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. 464

Domain 11 • Class 3 • Diagnosis Code 00139 Risk for self-mutilation Approved 1992 • Revised 2000, 2013, 2017 Definition Susceptible to deliberate self-injurious behavior causing tissue damage with the intent of causing nonfatal injury to attain relief of tension. Risk factors – Irresistible urge to cut self – Isolation from peers – Absence of family confidant – Labile behavior – Alteration in body image – Loss of control over problem-solving situation – Dissociation – Low self-esteem – Disturbance in interpersonal relationships – Mounting tension that is intolerable – Eating disorder – Negative feeling – Emotional disturbance – Pattern of inability to plan solutions – Feeling threatened with loss of significant – Pattern of inability to see long-term consequences – Perfectionism relationship – Requires rapid stress reduction – Impaired self-esteem – Substance misuse – Impulsiveness – Use of manipulation to obtain nurturing – Inability to express tension verbally – Ineffective communication between parent and relationship with others adolescent – Ineffective coping strategies – Irresistible urge for self-directed violence At risk population – History of childhood abuse – History of self-directed violence – Adolescence – Incarceration – Battered child – Living in nontraditional setting – Childhood illness – Loss of significant relationship – Childhood surgery – Peers who self-mutilate – Developmental delay – Sexual identity crisis – Family divorce – Violence between parental figures – Family history of self-destructive behavior – Family substance misuse 465

Associated condition – Depersonalization – Psychotic disorder – Autism – Borderline personality disorder – Character disorder 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. 466

Domain 11 • Class 3 • Diagnosis Code 00150 Risk for suicide Approved 2000 • Revised 2013, 2017 Definition Susceptible to self-inflicted, life-threatening injury. Risk factors – Marked change in school performance Behavioral – Purchase of a gun – Stockpiling medication – Changing a will – Sudden euphoric recovery from major depression – Giving away possessions – Impulsiveness – Substance misuse – Making a will – Marked change in attitude – Loss of independence – Marked change in behavior – Insufficient social support Psychological – Legal difficulty – Loneliness – Guilt – Loss of significant relationship – Social isolation Situational – Access to weapon – Loss of autonomy Social – Cluster suicides – Disciplinary problems – Disruptive family life – Grieving – Helplessness – Hopelessness Verbal 467

– Reports desire to die – Threat of killing self Other – Homosexual youth – Institutionalization – Chronic pain – Living alone – Male gender At risk population – Native American ethnicity – Relocation – Adolescence – Retired – Adolescents living in nontraditional settings – Widowed – Caucasian ethnicity – Young adult males – Divorced status – Economically disadvantaged – Terminal illness – Older adults – Family history of suicide – History of childhood abuse – History of suicide attempt Associated condition – Physical illness – Psychiatric disorder 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. 468

Domain 11 • Class 4 • Diagnosis Code 00181 Contamination Approved 2006 • Revised 2017 • Level of Evidence 2.1 Definition Exposure to environmental contaminants in doses sufficient to cause adverse health effects. Defining characteristics – Neurological effects of pesticide exposure Pesticides – Pulmonary effects of pesticide exposure – Renal effects of pesticide exposure – Dermatological effects of pesticide exposure – Gastrointestinal effects of pesticide exposure – Neurological effects of chemical exposure – Pulmonary effects of chemical exposure Chemicals – Renal effects of chemical exposure – Dermatological effects of chemical exposure – Neurological effects of biologic exposure – Gastrointestinal effects of chemical exposure – Pulmonary effects of biologic exposure – Immunological effects of chemical exposure – Renal effects of biologic exposure Biologics – Pulmonary effects of pollution exposure – Dermatological effects of biologic exposure – Hepatic effects of waste exposure – Gastrointestinal effects of biologic exposure – Pulmonary effects of waste exposure Pollution – Neurological effects of pollution exposure Waste – Dermatological effects of waste exposure – Gastrointestinal effects of waste exposure 469

Radiation – Neurological effects of radiation exposure – Oncological effects of radiation exposure – Genetic effects of radiation exposure – Immunological effects of radiation exposure Related factors – Ingestion of contaminated material External – Playing where environmental contaminants are – Carpeted flooring used – Chemical contamination of food – Unprotected exposure to chemical – Chemical contamination of water – Unprotected exposure to heavy metal – Flaking, peeling surface in presence of young – Unprotected exposure to radioactive material – Use of environmental contaminant in the home children – Use of noxious material in insufficiently – Inadequate breakdown of contaminant – Inadequate household hygiene practices ventilated area – Inadequate municipal services – Use of noxious material without effective – Inadequate personal hygiene practices – Inadequate protective clothing protection – Inappropriate use of protective clothing – Smoking Internal – Concomitant exposure – Inadequate nutrition At risk population – Exposure to disaster – Exposure to radiation – Children < 5 years – Female gender – Economically disadvantaged – Gestational age during exposure – Exposure to areas with high contaminant level – Older adults – Exposure to atmospheric pollutants – Previous exposure to contaminant – Exposure to bioterrorism Associated condition – Pregnancy – Pre-existing disease Original literature support available at http://MediaCenter.thieme.com. 470

Domain 11 • Class 4 • Diagnosis Code 00180 Risk for contamination Approved 2006 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to exposure to environmental contaminants, which may compromise health. Risk factors – Inappropriate use of protective clothing External – Ingestion of contaminated material – Playing where environmental contaminants are – Carpeted flooring – Chemical contamination of food used – Chemical contamination of water – Unprotected exposure to chemical – Flaking, peeling surface in presence of young – Unprotected exposure to heavy metal – Unprotected exposure to radioactive material children – Use of environmental contaminant in the home – Inadequate breakdown of contaminant – Use of noxious material in insufficiently – Inadequate household hygiene practices – Inadequate municipal services ventilated area – Inadequate personal hygiene practices – Use of noxious material without effective – Inadequate protective clothing protection Internal – Smoking – Concomitant exposure – Inadequate nutrition At risk population – Exposure to disaster – Exposure to radiation – Children < 5 years – Female gender – Economically disadvantaged – Gestational age during exposure – Exposure to areas with high contaminant level – Older adults – Exposure to atmospheric pollutants – Previous exposure to contaminant – Exposure to bioterrorism 471

Associated condition – Pregnancy – Pre-existing disease Original literature support available at http://MediaCenter.thieme.com. 472

Domain 11 • Class 4 • Diagnosis Code 00265 Risk for occupational injury Approved 2016 • Level of Evidence 2.1 Definition Susceptible to sustain a work-related accident or illness, which may compromise health. Risk factors – Insufficient knowledge – Misinterpretation of information Individual – Psychological distress – Unsafe acts of overconfidence – Excessive stress – Unsafe acts of unhealthy negative habits – Improper use of personal protective equipment – Inadequate role performance – Inadequate time management – Ineffective coping strategies Environmental – Inadequate physical environment – Labor relationships – Distraction from social relationships – Lack of personal protective equipment – Exposure to biological agents – Night shift work rotating to day shift work – Exposure to chemical agents – Occupational burnout – Exposure to extremes of temperature – Physical workload – Exposure to noise – Shift work – Exposure to radiation – Exposure to teratogenic agents – Exposure to vibration Original literature support available at http://MediaCenter.thieme.com. 473

Domain 11 • Class 4 • Diagnosis Code 00037 Risk for poisoning Approved 1980 • Revised 2006, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to accidental exposure to, or ingestion of, drugs or dangerous products in sufficient doses, which may compromise health. Risk factors – Access to pharmaceutical agent – Occupational setting without adequate safeguards External – Access to dangerous product – Access to illicit drugs potentially contaminated by poisonous additives Internal – Emotional disturbance – Insufficient knowledge of poisoning prevention – Inadequate precautions against poisoning – Insufficient vision – Insufficient knowledge of pharmacological agents Associated condition – Alteration in cognitive functioning Original literature support available at http://MediaCenter.thieme.com. 474

Domain 11 • Class 5 • Diagnosis Code 00218 Risk for adverse reaction to iodinated contrast media Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to noxious or unintended reaction associated with the use of iodinated contrast media that can occur within seven days after contrast agent injection, which may compromise health. Risk factors – Generalized weakness – Dehydration – History of previous adverse effect from iodinated contrast media At risk population – Contrast media precipitates adverse event – Extremes of age – Fragile vein – History of allergy – Unconsciousness Associated condition – Chronic illness – Concurrent use of pharmaceutical agents Original literature support available at http://MediaCenter.thieme.com. 475