Nanda Nursing Diagnosis

Nursing Diagnosis : Deficient Fluid volume NANDA Definition for Deficient Fluid volume: Decreased intravascular, interstitial, and or intracellular fluid Defining Characteristics Deficient Fluid volume : Decreased urine output, increased urine concentration, weakness, sudden weight loss,  decreased venous filling,  increased body temperature,  decreased pulse volume or pressure, change in mental state,  elevated hematocrit, decreased skin or tongue turgor; dry skin/mucous membranes,  thirst,  increased pulse rate,  decreased blood pressure. Related Factors: Active fluid volume loss; failure of regulatory mechanisms NOC Outcomes (Nursing Outcomes Classification) : Suggested NOC Labels · Fluid Balance · Hydration · Nutritional Status: Food and Fluid Intake Client Outcomes · Maintains urine output more than 1300 ml/day (or at least 30 ml/hr) · Maintains normal blood pressure, pulse, and body temperature · Maintains elastic skin turgor; moist tongue and mucous membranes; and orienta

Nursing Diagnosis: Decreased Cardiac output Nursing Care Plans for Decreased Cardiac output NANDA Definition : Inadequate blood pumped by the heart to meet metabolic demands of the body Defining Characteristics : Altered heart rate/rhythm: arrhythmias (tachycardia, bradycardia); palpitations; EKG changes; altered preload: jugular vein distention; fatigue; edema; murmurs; increased/decreased central venous pressure (CVP); increased/decreased pulmonary artery wedge pressure (PAWP); weight gain; altered afterload: cold/clammy skin; shortness of breath/dyspnea; oliguria; prolonged capillary refill; decreased peripheral pulses; variations in blood pressure readings; increased/decreased systemic vascular resistance (SVR); increased/decreased pulmonary vascular resistance (PVR); skin color changes; altered contractility: crackles; cough; orthopnea/paroxysmal nocturnal dyspnea; cardiac output less than 4 L/min; cardiac index less than 2.5 L/min; decreased ejection fraction, stroke volume inde

Nursing Diagnosis : Constipation Nursing care plans For Diagnosis Constipation NANDA Definition: A decrease in a person's normal frequency of defecation, accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool Defining Characteristics: Change in bowel pattern; bright red blood with stool; presence of soft paste-like stool in rectum; distended abdomen; dark, black, or tarry stool; increased abdominal pressure; percussed abdominal dullness; pain with defecation; decreased volume of stool; straining with defecation; decreased frequency; dry, hard, formed stool; palpable rectal mass; feeling of rectal fullness or pressure; abdominal pain; unable to pass stool; anorexia; headache; change in abdominal growing (borborygmi); indigestion; atypical presentation in older adults (e.g., change in mental status, urinary incontinence, unexplained falls, elevated body temperature); severe flatus; generalized fatigue; hypoactive or hyperactive bowel s

Nursing Diagnosis: Chronic Pain Nursing Care Plans For Chronic Pain NANDA  Definition: Pain is whatever the experiencing person says it is, existing whenever the person says it does,  an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe, constant or recurring, without an anticipated or predictable end and a duration >6 months; a state in which an individual experiences pain that persists for a month beyond the usual course of an acute illness or a reasonable duration for an injury to heal, is associated with a chronic pathologic process, or recurs at intervals for months or years. Defining Characteristics: Subjective Pain is always subjective and cannot be proved or disproved. The client's report of pain is the most reliable indicator of pain. Clients with cognitive abilities who can speak or point should use a pain rating scale (eg 0 to 10) t

Nursing Diagnosis: Chronic Confusion Nursing Care Plans For Chronic Confusion NANDA Definition: Irreversible, long-standing, and/or progressive deterioration of intellect and personality characterized by a decreased ability to interpret environmental stimuli and a decreased capacity for intellectual thought processes, which manifest as disturbances of memory, orientation, and behavior Defining Characteristics: Altered interpretation/response to stimuli; clinical evidence of organic impairment; altered personality; impaired memory (short and long term); impaired socialization; no change in level of consciousness Related Factors: Multi-infarct dementia; Korsakoff's psychosis; head injury; Alzheimer's disease; cerebrovascular accident NOC Outcomes (Nursing Outcomes Classification) Suggested NOC Labels • Cognitive Orientation • Information Processing • Memory • Neurological Status: Consciousness Client Outcomes • Remains content and free from harm • Functions at maximal cog

Nursing Diagnosis: Bowel incontinence Nursing Care Plans For Bowel incontinence NANDA Definition: Change in normal bowel habits characterized by involuntary passage of stool. Defining Characteristics: Constant dribbling of soft stool, fecal odor; inability to delay defecation; rectal urgency; self-report of inability to feel rectal fullness or presence of stool in bowel; fecal staining of underclothing; recognizes rectal fullness but reports inability to expel formed stool; inattention to urge to defecate; inability to recognize urge to defecate, red perianal skin Related Factors: Change in stool consistency (diarrhea, constipation, fecal impaction); abnormal motility (metabolic disorders, inflammatory bowel disease, infectious disease, drug induced motility disorders, food intolerance); defects in rectal vault function (low rectal compliance from ischemia, fibrosis, radiation, infectious proctitis, Hirschprung's disease, local or infiltrating neoplasm, severe rectocele); sphincter

Pregnancy-induced hypertension (PIH) is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It typically occurs in nulliparous women and may be nonconvulsive or convulsive. Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups. Eclampsia, the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease. About 5% of women with preeclampsia develop eclampsia; of these, about 15% die of eclampsia or its complications. Fetal mortality is high because of the increased incidence of premature delivery PIH and its complications are the most common cause of maternal death in developed

Nursing Diagnosis: Bathing hygiene Self care deficit NANDA Definition: Impaired ability to perform or complete bathing/hygiene activities for oneself Defining Characteristics: Inability to: wash body or body parts; obtain or get to water source; regulate temperature or flow of bath water; get bath supplies; dry body; get in and out of bathroom Impaired physical mobility-functional level classification: Completely independent Requires use of equipment or device Requires help from another person for assistance, supervision, or teaching Requires help from another person and equipment or device Dependent does not participate in activity Related Factors: Decreased or lack of motivation; weakness and tiredness; severe anxiety; inability to perceive body part or spatial relationship; perceptual or cognitive impairment; pain; neuromuscular impairment; musculoskeletal impairment; environmental barriers NOC Outcomes (Nursing Outcomes Classification) Suggested NOC Labels • Self-Care: Activities