NANDA 2018-2020

organized 102 organized behavior – disorganized infant behavior 359 – readiness for enhanced organized infant behavior 362 – risk for disorganized infant behavior 361 other-directed violence, risk for other-directed violence 416 overflow urinary incontinence 191 overload 102 overweight 170 – risk for overweight 172 P pain – acute pain 445 – chronic pain 446 – chronic pain syndrome 448 – labor pain 449 parental role conflict 298 parenting – impaired parenting 283 – readiness for enhanced parenting 288 – risk for impaired parenting 286 pattern formation 45, 59, 59 perceived 102 perceived constipation 200 perception, cognition diagnoses revised 10 perioperative hypothermia, risk for perioperative hypothermia 438 perioperative positioning injury, risk for perioperative positioning injury 395 peripheral 104 peripheral vascular 104 personal identity – disturbed personal identity 269 – risk for disturbed personal identity 270 PES format 112 physical trauma, risk for physical trauma 401 planning, intervention 41 poisoning, risk for poisoning 428 post-trauma syndrome 316 – risk for post-trauma syndrome 318 526

potential diagnosis identification 60 potential new diagnoses 65 power – powerlessness 343 – readiness for enhanced power 345 – risk for powerlessness 344 powerlessness 343 pressure ulcer, risk for pressure ulcer 404 principles of nursing diagnosis – applications, use of 43 – assessmentassessment – clinical judgment 37 – collaborative health care team 34, 34 – component parts of 116, 136 – concept knowledge 37 – defining characteristics 39, 137 – definitions 38, 38, 39, 115 – evaluation 42 – health promotion diagnosis 35 – introduction 34 – learning, format used to 40 – NANDA-I taxonomy 34 – planning, intervention 41 – prioritization 38 – problem-focused diagnosis 35, 38 – process of diagnosis 36, 36 – related factors 39 – risk diagnosis 35, 38 – risk factors 39 – syndrome defined 35, 134 problem-focused diagnosis – defined 133 – FAQs 113, 123–125 – principles of nursing diagnosis 35, 38 problem-focused value 106 protection, ineffective protection 154 R rape-trauma syndrome 319 readiness for 102 527

readiness for enhanced breastfeeding 162 readiness for enhanced childbearing process 310 readiness for enhanced comfort 443, 451, 453 readiness for enhanced communication 262 readiness for enhanced community coping 330 readiness for enhanced coping 328 readiness for enhanced decision-making 366 readiness for enhanced emancipated decision-making 370 readiness for enhanced family coping 334 readiness for enhanced family processes 294 readiness for enhanced health literacy 143 readiness for enhanced health management 152 readiness for enhanced hope 267 readiness for enhanced knowledge 260 readiness for enhanced nutrition 158 readiness for enhanced organized infant behavior 362 readiness for enhanced parenting 288 readiness for enhanced power 345 readiness for enhanced relationship 297 readiness for enhanced religiosity 374 readiness for enhanced resilience 66, 70, 348 readiness for enhanced self-care 247 readiness for enhanced self-concept 271 readiness for enhanced sleep 215 readiness for enhanced spiritual well-being 365 references 5, 131 reflex urinary incontinence 192 related factors 137 – FAQs 122 – LOE 2.1 5 – principles of nursing diagnosis 39 – risk factors relationship 123 relationship – ineffective relationship 295 – readiness for enhanced relationship 297 – risk for ineffective relationship 296 religiosity – impaired religiosity 372 – readiness for enhanced religiosity 374 528

– risk for impaired religiosity 373 relocation stress syndrome 66, 69–70, 320 – risk for relocation stress syndrome 321 renal 104 resilience – impaired resilience 346 – readiness for enhanced resilience 348 – risk for impaired resilience 347 retention, urinary retention 196 review process – expedited 4 – full 4 – procedure to appeal 4 risk diagnosis 133 – FAQs 114, 123–125, 128 – LOE 2.1 5 – principles of nursing diagnosis 35, 38 risk factors 137 – FAQs 122 – principles of nursing diagnosis 39 risk for 102 risk for activity intolerance 229 risk for acute confusion 255 risk for acute substance withdrawal syndrome 352 risk for adverse reaction to iodinated contrast media 429 risk for allergy reaction 430 risk for aspiration 385 risk for autonomic dysreflexia 355 risk for bleeding 386 risk for caregiver role strain 281 risk for chronic functional constipation 203 risk for chronic low self-esteem 273 risk for complicated grieving 341 risk for complicated immigration transition 315 risk for compromised human dignity 268 risk for constipation 199 risk for contamination 426 risk for corneal injury 392 risk for decreased cardiac output 233 529

risk for decreased cardiac tissue perfusion 236 risk for deficient fluid volume 185 risk for delayed development 459 risk for delayed surgical recovery 411 risk for disorganized infant behavior 361 risk for disproportionate growth 7 risk for disturbed maternal-fetal dyad 311 risk for disturbed personal identity 270 risk for disuse syndrome 217 risk for dry eye 388 risk for dry mouth 389 risk for dysfunctional gastrointestinal motility 206 risk for electrolyte imbalance 182 risk for falls 390 risk for female genital mutilation 415 risk for frail elderly syndrome 147 risk for hypothermia 437 risk for imbalanced fluid volume 183 risk for impaired attachment 289 risk for impaired emancipated decision-making 369 risk for impaired liver function 180 risk for impaired oral mucous membrane integrity 399 risk for impaired parenting 286 risk for impaired religiosity 373 risk for impaired resilience 347 risk for impaired skin integrity 407 risk for impaired tissue integrity 413 risk for ineffective activity planning 323 risk for ineffective cerebral tissue perfusion 237 risk for ineffective childbearing process 309 risk for ineffective peripheral tissue perfusion 239 risk for ineffective relationship 296 risk for ineffective thermoregulation 440 risk for infection 382 risk for injury 393 risk for latex allergy reaction 433 risk for loneliness 454 risk for metabolic imbalance syndrome 181 risk for neonatal hyperbilirubinemia 179 530

risk for occupational injury 427 risk for other-directed violence 416 risk for overweight 172 risk for perioperative hypothermia 438 risk for perioperative positioning injury 395 risk for peripheral neurovascular dysfunction 400 risk for physical trauma 401 risk for poisoning 428 risk for post-trauma syndrome 318 risk for powerlessness 344 risk for pressure ulcer 122, 404 risk for relocation stress syndrome 321 risk for self-directed violence 417 risk for self-mutilation 420 risk for shock 405 risk for situational low self-esteem 275 risk for spiritual distress 377 risk for sudden infant death 408 risk for suffocation 409 risk for suicide 422 risk for surgical site infection 383 risk for thermal injury 396 risk for unstable blood glucose level 177 risk for unstable blood pressure 235 risk for urge urinary incontinence 195 risk for urinary tract injury 394 risk for vascular trauma 403 risk for venous thromboembolism 414 risk value 106 risk-prone 102 risk-prone health behavior 149 role conflict, parental role conflict 298 role performance, ineffective role performance 299 role strain – caregiver role strain 278 – risk for caregiver role strain 281 S safety, protection diagnoses, new 8 531

screening assessment 52, 52, 53 SEA TOW mnemonic 70, 71, 119 second opinion 70 sedentary 102 sedentary lifestyle 144 self-care – bathing self-care deficit 243 – dressing self-care deficit 244 – feeding self-care deficit 245 – readiness for enhanced self-care 247 – toileting self-care deficit 246 self-concept, readiness for enhanced self-concept 271 self-directed violence, risk for self-directed violence 417 self-esteem – chronic low self-esteem 272 – risk for chronic low self-esteem 273 – risk for situational low self-esteem 275 – situational low self-esteem 274 self-mutilation 418 – risk for self-mutilation 420 self-neglect 248 sexual dysfunction 305 sexual function, sexual dysfunction 305 sexuality pattern, ineffective sexuality pattern 306 shock, risk for shock 405 sitting, impaired sitting 221 situational 102 situational low self-esteem 274 skin 104 skin integrity – impaired skin integrity 406 – risk for impaired skin integrity 407 sleep – disturbed sleep pattern 216 – readiness for enhanced sleep 215 – sleep deprivation 214 sleep deprivation 214 sleep pattern, disturbed sleep pattern 216 SNAPPS diagnostic aid 124 532

social interaction, impaired social interaction 301 social isolation 455 sorrow, chronic sorrow 349 spiritual distress 375 – risk for spiritual distress 377 spiritual well-being, readiness for enhanced spiritual well-being 365 spontaneous ventilation, impaired spontaneous ventilation 234 stable blood pressure, risk for unstable blood pressure 235 standardized nursing language 110 standing, impaired standing 222 Status of the Diagnosis axis 106, 136 stress, stress overload 350 stress overload 350 stress urinary incontinence 193 Structure of the Nursing Diagnosis Statement When Included in a Care Plan (NANDA Position Statement) 27 structuring nursing curricula 81, 82, 128–129 Subject of the Diagnosis axis 102, 135 subjective data 57 sudden death, risk for sudden infant death 408 suffocation, risk for suffocation 409 suicide, risk for suicide 422 surgical recovery – delayed surgical recovery 410 – risk for delayed surgical recovery 411 surgical site infection, risk for surgical site infection 383 swallowing, impaired swallowing 173 syndrome 35, 134 – acute substance withdrawal syndrome 351 – chronic pain syndrome 448 – frail elderly syndrome 145 – neonatal abstinence syndrome 358 – post-trauma syndrome 316 – rape-trauma syndrome 319 – relocation stress syndrome 320 – risk for acute substance withdrawal syndrome 352 – risk for disuse syndrome 217 – risk for frail elderly syndrome 147 – risk for metabolic imbalance syndrome 181 533

– risk for post-trauma syndrome 318 – risk for relocation stress syndrome 321 T tactile 104 taxonomyNANDA-I Taxonomy II – classes, types in 77 – classification 79, 80, 137 – defined 138 – domains, classes in 76, 80 – introduction to 74, 76–77 – terminology vs. 74 teaching, learning nursing diagnoses 127 thermal injury, risk for thermal injury 396 thermoregulation – ineffective thermoregulation 439 – risk for ineffective thermoregulation 440 Three Pillar Model of Nursing Practice 109 Time axis 106, 136 tissue 104 tissue integrity – impaired tissue integrity 412 – risk for impaired tissue integrity 413 tissue perfusion – ineffective peripheral tissue perfusion 238 – risk for decreased cardiac tissue perfusion 236 – risk for ineffective cerebral tissue perfusion 237 – risk for ineffective peripheral tissue perfusion 239 toileting self-care, toileting self-care deficit 246 toileting self-care deficit 246 transfer ability, impaired transfer ability 223 trauma – risk for physical trauma 401 – risk for vascular trauma 403 types of nursing diagnoses 115 U unilateral neglect 251 unstable 102 534

urge urinary incontinence 194 urinary 104 urinary retention 196 urinary tract 104 Use of Taxonomy II as an Assessment Framework (NANDA Position Statement) 27 V vascular 104 venous 104 venous thromboembolism, risk for venous thromboembolism 414 ventilatory weaning response, dysfunctional ventilatory weaning response 240 verbal communication, impaired verbal communication 263 visual 104 W walking, impaired walking 224 wandering 227 535

Concepts A activity planning 322–323 activity tolerance 228–229 acute substance withdrawal syndrome 351–352 adaptive capacity 357 adverse reaction to iodinated contrast media 429 airway clearance 384 allergy reaction 430 anxiety 324 aspiration 385 attachment 289 autonomic dysreflexia 353, 355 B balanced energy field 225 balanced fluid volume 183 balanced nutrition 157 bathing self-care 243 bleeding 386 blood glucose level 177 body image 276 breast milk production 159 breastfeeding 160–162 breathing pattern 230 C cardiac output 231, 233 childbearing process 307, 309–310 chronic pain syndrome 448 comfort 442–443, 450–453 communication 262 confusion 254–256 536

constipation 197, 199–200 contamination 424, 426 coping 326–331, 333–334 D death anxiety 335 decision-making 366 decisional conflict 367 denial 336 dentition 387 development 459 diarrhea 204 disuse syndrome 217 diversional activity engagement 142 dressing self-care 244 dry eye 388 dry mouth 389 E eating dynamics 163–164 electrolyte balance 182 elimination 189 emancipated decision-making 368–370 emotional control 257 F falls 390 family processes 290, 293–294 fatigue 226 fear 337 feeding dynamics 166 feeding pattern 168 feeding self-care 245 female genital mutilation 415 fluid volume 184–186 frail elderly syndrome 145, 147 functional constipation 201, 203 G gas exchange 209 537

gastrointestinal motility 205–206 grieving 339–341 H health 148 health behavior 149 health literacy 143 health maintenance 150 health management 151–153 home maintenance 242 hope 266–267 human dignity 268 hyperbilirubinemia 178 hyperbilirubinemia 179 hyperthermia 434 hypothermia 435, 437 I immigration transition 315 impulse control 258 incontinence 190–195, 207 infection 382 injury 392–394 insomnia 213 K knowledge 259–260 L labor pain 449 latex allergy reaction 431, 433 lifestyle 144 liver function 180 loneliness 454 M maternal-fetal dyad 311 memory 261 metabolic imbalance syndrome 181 mobility 218–220 538

mood regulation 342 moral distress 371 mucous membrane integrity 397, 399 N nausea 444 neonatal abstinence syndrome 358 neurovascular function 400 nutrition 158 O obesity 169 occupational injury 427 organized behavior 359, 361–362 other-directed violence 416 overweight 170, 172 P pain 445–446 parenting 283, 286, 288 perioperative hypothermia 438 perioperative positioning injury 395 personal identity 269–270 physical trauma 401 poisoning 428 post-trauma syndrome 316, 318 power 343–345 pressure ulcer 404 protection 154 R rape-trauma syndrome 319 relationship 295–297 religiosity 372–374 relocation stress syndrome 320–321 resilience 346–348 retention 196 role conflict 298 role performance 299 role strain 278, 281 539

S self-care 247 self-concept 271 self-directed violence 417 self-esteem 272–275 self-mutilation 418, 420 self-neglect 248 sexual function 305 sexuality pattern 306 shock 405 sitting 221 skin integrity 406–407 sleep 214–215 sleep pattern 216 social interaction 301 social isolation 455 sorrow 349 spiritual distress 375, 377 spiritual well-being 365 spontaneous ventilation 234 stable blood pressure 235 standing 222 stress 350 sudden death 408 suffocation 409 suicide 422 surgical recovery 410–411 surgical site infection 383 swallowing 173 T thermal injury 396 thermoregulation 439–440 tissue integrity 412–413 tissue perfusion 236–239 toileting self-care 246 transfer ability 223 trauma 403 540

U unilateral neglect 251 V venous thromboembolism 414 ventilatory weaning response 240 verbal communication 263 W walking 224 wandering 227 541

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