Ulrich and Canale's Nursing Care Planning Guides, 8th Edition Revised Reprint with 2021-2023 NANDA-I® Updates

Cover image

Title page

Table of Contents

Inside front cover

Copyright

Dedication

About the authors

Reviewers

Preface

    List of Illustrations

1.  Prioritization, delegation, and critical thinking in client management

2.  Nurse-sensitive indicators

    Falls

    Nursing Diagnosis Risk for Adult Falls NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Hospital acquired pressure ulcers/injuries

    Nursing Diagnosis Risk for Adult Pressure Injury NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Health care–associated infections

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Deficient Knowledge NDx

3.  Selected nursing diagnoses, interventions, rationales, and documentation

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Nursing Diagnosis Ineffective Airway Clearance NDx

    Nursing Diagnosis Anxiety NDx

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Decreased Cardiac Output NDx

    Nursing Diagnosis Readiness for Enhanced Comfort NDx

    Nursing Diagnosis Acute Confusion NDx

    Nursing Diagnosis Constipation NDx

    Nursing Diagnosis Contamination NDx

    Nursing Diagnosis Ineffective Coping NDx

    Nursing Diagnosis Readiness for Enhanced Decision-Making NDx

    Nursing Diagnosis Diarrhea NDx

    Nursing Diagnosis Deficient Fluid Volume NDx

    Nursing Diagnosis Excess Fluid Volume NDx

    Nursing Diagnosis Impaired Gas Exchange NDx

    Nursing Diagnosis Risk for Unstable Blood Glucose Level NDx

    Nursing Diagnosis Maladaptive Grieving NDx

    Nursing Diagnosis Risk-Prone Health Behavior NDx

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Impaired Oral Mucous Membrane Integrity NDx

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Readiness for Enhanced Self-Care NDx

    Nursing Diagnosis Readiness for Enhanced Self-Concept NDx

    Nursing Diagnosis Risk for Impaired Skin Integrity NDx

    Nursing Diagnosis Disturbed Sleep Pattern NDx

    Nursing Diagnosis Impaired Swallowing NDx

    Nursing Diagnosis Impaired Urinary Elimination* NDx

    Nursing Diagnosis Urinary Retention NDx

4.  Nursing care of the client having surgery

    Procedural sedation

    Nursing Diagnosis Actual/Risk for Impaired Respiratory Function*

    Nursing Diagnosis Risk for Injury NDx

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Risk for Acute Confusion NDx

    Preoperative care

    Nursing Diagnosis Fear NDx/Anxiety NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Postoperative care

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Ineffective Airway Clearance NDx

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Risk for Thrombosis NDx

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx and Risk for Electrolyte imbalance NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Nausea NDx

    Nursing Diagnosis Risk for Delayed Surgical Recovery NDx

    Nursing Diagnosis Impaired Oral Mucous Membrane Integrity NDx

    Nursing Diagnosis Bathing, Dressing, Feeding, and Toileting Self-Care Deficit

    Nursing Diagnosis Urinary Retention NDx

    Collaborative Diagnosis Risk for Paralytic Ileus

    Nursing Diagnosis Deficient Knowledge NDx

5.  The client with alterations in respiratory function

    Asthma

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance Behaviors NDx; or Ineffective Health Self-Management* NDx

    Chronic obstructive pulmonary disease

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Nursing Diagnosis Risk for Infection NDx (Pneumonia)

    Collaborative Diagnosis Risk for Right-Sided Heart Failure

    Nursing Diagnosis Fear NDx/Anxiety NDx

    Nursing Diagnosis Ineffective Health Self-Management NDx

    Nursing Diagnosis Deficient Knowledge NDx or Ineffective Health Maintenance Behaviors* NDx

    Mechanical ventilation

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Infection NDx (Ventilator-Acquired Pneumonia [VAP])

    Nursing Diagnosis Dysfunctional Ventilatory Weaning Response NDx

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Collaborative Diagnosis Risk for Gastrointestinal Bleeding

    Collaborative Diagnosis Risk for Barotrauma

    Pneumonia

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Acute Pain NDx (Chest)

    Nursing Diagnosis Hyperthermia NDx

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Nursing Diagnosis Risk for Infection NDx: (Extrapulmonary (e.g., Bacteremia, Pericarditis, Endocarditis, Meningitis, Septic Arthritis) and/or Superinfection (e.g., Candidiasis)

    Collaborative Diagnosis Risk for Pleural Effusion

    Collaborative Diagnosis Risk for Atelectasis

    Nursing Diagnosis Deficient Knowledge NDx, Ineffective Health Maintenance Behaviors NDx, or Ineffective Health Self-Management* NDx

    Pneumothorax

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Impaired Gas Exchange NDx

    Nursing Diagnosis Acute Pain NDx (Chest)

    Collaborative Diagnosis Risk for Tension Pneumothorax with Mediastinal Shift

    Nursing Diagnosis Fear NDx/Anxiety NDx

    Nursing Diagnosis Deficient Knowledge NDx, Ineffective Health Maintenance Behaviors NDx, or Ineffective Health Self-Management* NDx

    Pulmonary embolism

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Impaired Gas Exchange NDx

    Nursing Diagnosis Acute Pain NDx (Chest)

    Nursing diagnosis: Risk for bleeding NDx

    Collaborative diagnoses Risk for right-sided heart failure

    Collaborative Diagnosis Risk for Atelectasis

    Nursing Diagnosis Fear NDx/Anxiety NDx

    Nursing Diagnosis Deficient Knowledge NDx, Ineffective Health Maintenance Behaviors NDx, or Ineffective Health Self-Management* NDx

    Thoracic surgery

    Postoperative care plan to use in conjunction with the preoperative care plan

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Acute Pain NDx (Chest)

    Collaborative Diagnosis Risk for Ineffective Lung Expansion

    Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Collaborative Diagnosis Risk for Acute Pulmonary Edema

    Collaborative Diagnosis Risk for Bronchopleural Fistula

    Collaborative Diagnosis Restricted Arm and Shoulder Movement

    Nursing Diagnosis Deficient Knowledge, NDx Ineffective Health Maintenance Behaviors NDx, or Ineffective Health Self-Management* NDx

    Tuberculosis

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Nursing Diagnosis Risk for Infection NDx (Extrapulmonary (e.g., Pericardial, Laryngeal, Skeletal, Joint, Renal, Brain, Adrenal, Lymphatic) and/or Superinfection (e.g., Candidiasis)

    Collaborative Diagnosis Risk for Pleural Effusion

    Collaborative Diagnosis Risk for Atelectasis

    Patient and discharge teaching/continued care

    Nursing Diagnosis Deficient Knowledge, NDx Ineffective Health Maintenance Behaviors NDx, or Ineffective Health Self-Management* NDx

6.  The client with alterations in cardiovascular function

    Abdominal aortic aneurysm

    Related Preoperative Nursing/Collaborative Diagnoses Anxiety NDx /Fear NDx

    Nursing/Collaborative Diagnosis Risk for Imbalanced Fluid Volume NDx and Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Risk for Shock NDx

    Nursing Diagnosis Risk for Thrombosis NDx

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance Behaviors NDx; or Ineffective Health Self-Management* NDx

    Angina pectoris

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Nursing Diagnosis Acute Pain NDx (Radiating or Nonradiating Chest Pain/Discomfort)

    Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Collaborative Diagnosis Risk for Myocardial Infarction

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors NDx*

    Cardiac dysrhythmias

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Nursing Diagnosis Risk for Activity Intolerance NDx

    Nursing Diagnosis Risk for Falls NDx

    Collaborative Diagnosis Risk for Systemic Arterial Embolism

    Collaborative Diagnosis Risk for Sudden Cardiac Death

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance NDx; or Ineffective Health Management NDx*

    Carotid endarterectomy

    Nursing/Collaborative Diagnosis Preoperative

    Nursing Diagnosis Risk for Ineffective Cerebral Tissue Perfusion NDx

    Nursing Diagnosis Risk for Ineffective Cerebral Tissue Perfusion

    Collaborative Diagnosis Risk for Respiratory Distress

    Collaborative Diagnosis Risk for Cranial Nerve Damage (Facial, Hypoglossal, Glossopharyngeal, Vagus, and/or Accessory Nerves)

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance Behaviors NDx; or Ineffective Health Self-Management NDx*

    Deep vein thrombosis

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Acute Pain NDx (Affected Extremity)

    Nursing Diagnosis Risk for Impaired Tissue Integrity NDx

    Collaborative Diagnosis Risk for Pulmonary Embolism

    Nursing Diagnosis Risk for Bleeding NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance Behaviors NDx; or Ineffective Health Self-Management NDx*

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Acute/Chronic Pain NDx (Intermittent Claudication and Rest Pain)

    Nursing Diagnosis Risk for Ineffective Peripheral Tissue Perfusion NDx

    Collaborative Diagnosis Risk for Compartment Syndrome

    Collaborative Diagnosis Risk for Saphenous Nerve Damage

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Self-Management NDx*

    Heart failure

    Nursing Diagnosis Decreased Cardiac Output NDx

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx and Risk for Electrolyte Imbalance NDx

    Collaborative Diagnosis Risk for Renal Insufficiency

     Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Collaborative Diagnosis Risk for Acute Pulmonary Edema

    Nursing Diagnosis Risk for Thrombosis

    Collaborative Diagnosis Risk for Cardiogenic Shock

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Self-Management NDx*

    Heart surgery: Coronary artery bypass grafting or valve replacement

    Related preoperative nursing/collaborative diagnoses Fear NDx/Anxiety NDx

    Nursing Diagnosis Decreased Cardiac Output NDx

    Nursing Diagnosis Risk for Impaired Respiratory Function*

    Nursing/Collaborative Diagnosis Risk for Imbalanced Fluid Volume NDx and Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Risk for Infection NDx

    Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Collaborative Diagnosis Risk for Cardiac Tamponade

    Nursing Diagnosis Risk for Bleeding NDx

    Collaborative Diagnosis Risk for Neurological Dysfunction

    Collaborative Diagnosis Risk for Impaired Renal Function

    Collaborative Diagnosis Risk for Pneumothorax

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Self-Management NDx*

    Hypertension

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Acute Pain NDx (Headache)

    Collaborative Diagnosis Risk for Cerebrovascular Accident/Hypertensive Encephalopathy

    Collaborative Diagnosis Risk for Impaired Renal Function

    Collaborative Diagnosis Risk for Aortic Dissection

    Nursing Diagnosis Ineffective Family Health Self-Management NDx

    Nursing Diagnosis Deficient Knowledge NDx or Ineffective Health Maintenance Behaviors NDx*

    Implantable cardiac devices

    Nursing/Collaborative Diagnosis Preoperative use in Conjunction with the Standardized Preoperative Care Plan

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Collaborative Diagnoses Risk for Pacemaker/Implantable Cardioverter-Defibrillator Malfunction

    Collaborative Diagnoses Risk for Cardiac Tamponade

    Collaborative Diagnoses Risk for Pneumothorax

    Collaborative Diagnoses Risk for Undesired Stimulation of the Heart and/or Certain Nerves and Muscles

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Self-Management NDx*

    Myocardial infarction

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Nursing Diagnosis Acute Pain NDx (Chest Pain/Discomfort that may Radiate to Arm, Neck, Jaw, or Back)

    Nursing Diagnosis Risk for Decreased Activity Tolerance NDx

    Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Nursing Diagnosis Risk for Thrombosis

    Collaborative Diagnosis Risk for Rupture of a Portion of the Heart (e.g., Ventricular Free Wall, Interventricular Septum, Papillary Muscle)

    Collaborative Diagnosis Risk for Pericarditis

    Collaborative Diagnosis Risk for Infarction Extension or Recurrence

    Collaborative Diagnosis Risk for Cardiogenic Shock

    Nursing Diagnosis Deficient Knowledge NDx or Ineffective Health Self-Management NDx*

7.  The client with alterations in neurological function

    Alzheimer’s disease/dementia

    Nursing Diagnosis Chronic Confusion NDx

    Nursing Diagnosis Wandering NDx

    Nursing Diagnosis Self-Care Deficit: Dressing, Bathing, Feeding, and Toileting NDx

    Nursing Diagnosis Ineffective Home Maintenance Behaviors NDx

    Cerebrovascular accident

    Nursing Diagnosis Risk for Ineffective Cerebral Tissue Perfusion NDx

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Unilateral Neglect NDx

    Nursing Diagnosis Impaired Verbal Communication NDx

    Nursing Diagnosis Self-Care Deficit (Bathing, Feeding, Dressing, and Toileting) NDx

    Nursing Diagnosis Acute Confusion NDx; Chronic Confusion NDx

    Collaborative Diagnosis Risk for Decreased Intracranial Adaptive Capacity

    Discharge teaching/continued care

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Traumatic brain injury/craniotomy

    Nursing Diagnosis Acute Pain NDx (Headache)

    Nursing Diagnosis Risk for Acute Confusion NDx

    Collaborative Diagnosis Risk for Meningitis

    Collaborative Diagnosis Risk for Seizures

    Collaborative Diagnosis Risk for Diabetes Insipidus

    Collaborative Diagnosis Risk for Syndrome of Inappropriate Antidiuretic Hormone

    Collaborative Diagnosis Risk for Gastrointestinal Bleeding

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Maintenance Behaviors NDx; or Ineffective Family Health Self-Management NDx*

    Spinal cord injury

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Ineffective Thermoregulation NDx

    Nursing Diagnosis Risk for Autonomic Dysreflexia NDx

    Nursing Diagnosis Self-Care Deficit (Bathing, Dressing, Feeding, and Toileting) NDx

    Nursing Diagnosis Risk for Injury NDx

    Nursing Diagnosis Risk for Thrombosis NDx

    Nursing Diagnosis Sexual Dysfunction NDx

    Nursing Diagnosis Interrupted Family Processes NDx

    Collaborative Diagnosis Risk for Ascending Spinal Cord Injury

    Collaborative Diagnosis Risk for Paralytic Ileus

    Collaborative Diagnosis Risk for Gastrointestinal Bleeding

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors*,† NDx

    Parkinson disease

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Constipation NDx

    Nursing Diagnosis Impaired Verbal Communication NDx

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors NDx*,†

8.  The client with alterations in hematologic and immune function

    Human immunodeficiency virus infection and Acquired immune deficiency syndrome

    Nursing Diagnosis Risk-Prone Health Behavior NDx

    Nursing Diagnosis Ineffective Health Self-Management NDx (Medication Management)

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Infection NDx (Opportunistic Infection)

    Nursing Diagnosis Disturbed Body Image NDx

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx and Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Acute/Chronic Pain NDx

    Nursing Diagnosis Spiritual Distress NDx

    Nursing Diagnosis Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management NDx

    Sepsis

    Nursing Diagnosis Risk for Ineffective Peripheral Tissue Perfusion NDx Risk for Ineffective Cerebral Tissue Perfusion NDx Risk for Decreased Cardiac Tissue Perfusion NDx

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx

    Nursing Diagnosis Impaired Gas Exchange NDx

    Nursing Diagnosis Hyperthermia NDx

    Nursing Diagnosis Risk for Infection NDx (Superinfection)

     Collaborative diagnosis Risk for Disseminated Intravascular Coagulation

    Collaborative Diagnosis Risk for Organ Ischemia/Dysfunction (Multiple Organ Dysfunction Syndrome)

    Splenectomy

9.  The client with alterations in metabolic function

    Diabetes mellitus

    Nursing Diagnosis Risk for Unstable Blood Glucose Level NDx

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Risk for Dysfunctional Gastrointestinal Motility NDx

    Nursing Diagnosis Ineffective Family Health Self-Management NDx

    Nursing Diagnosis Deficient Knowledge NDx or Ineffective Health Self-Management* NDx

    Hyperthyroidism/Thyroidectomy

    Hypothyroidism/Myxedema

10.  The client with alterations in the gastrointestinal tract

    Abdominal trauma

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx; Risk for Electrolyte Imbalance* NDx

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Acute Pain NDx

    Collaborative Diagnosis Risk for Peritonitis

    Collaborative Diagnosis Risk for Septic Shock

    Collaborative Diagnosis Risk for Organ Ischemia/Dysfunction (Multiple Organ Dysfunction Syndrome)

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Appendicitis/Appendectomy

    Bowel diversion: Ileostomy

    Nursing Diagnosis Deficient Knowledge NDx

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx; Risk for Electrolyte Imbalance* NDx

    Nursing Diagnosis Risk for Impaired Tissue Integrity NDx

    Collaborative Diagnosis Risk for Peritonitis

    Collaborative Diagnosis Risk for Stomal Changes

    Collaborative Diagnosis Risk for Stomal Obstruction

    Nursing Diagnosis Ineffective Sexuality Pattern NDx

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Enteral nutrition

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Gastrectomy

    Bariatric surgery

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Collaborative Diagnosis Risk for Overdistention of the Gastric Pouch

    Collaborative Diagnosis Risk for Peritonitis

    Collaborative Diagnosis Risk for Venous Thromboembolism

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Gastrointestinal bleed, acute

    Nursing Diagnosis Risk for Shock NDx

    Nursing Diagnosis Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Risk for Decreased Activity Tolerance NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Inflammatory bowel disease: Ulcerative colitis and Crohn disease

    Nursing/Collaborative Diagnosis Risk for Imbalanced Fluid Volume NDx and Risk for Electrolyte Imbalance NDx*

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Acute/Chronic Pain NDx

    Nursing Diagnosis Risk for Infection NDx

    Collaborative Diagnosis Risk for Renal Calculi

    Collaborative Diagnosis Risk for Perirectal, Rectovaginal, Enterovesical, and Enteroenteric Abscesses and Fistulas

    Collaborative Diagnosis Risk for Toxic Megacolon

    Collaborative Diagnosis Risk for Peritonitis

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Intestinal obstruction and bowel resection

    Nursing/Diagnosis Risk for Imbalanced Fluid Volume NDx; Risk for Electrolyte Imbalance*

    Nursing Diagnosis Acute Pain NDx (Abdominal)

    Nursing Diagnosis Nausea NDx

    Collaborative/Nursing Diagnosis Risk for Peritonitis

    Collaborative Diagnosis Risk for Intestinal Necrosis

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Ineffective Airway Clearance NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Collaborative Diagnosis Risk for Atelectasis

    Collaborative Diagnosis Risk for Venous Thromboembolism NDx

    Collaborative Diagnosis Risk for Paralytic Ileus

    Collaborative Diagnosis Risk for Dehiscence

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

    Parenteral nutrition

    Nursing Diagnosis Risk for Unstable Blood Glucose Level NDx

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance* NDx

    Peptic ulcer

11.  Nursing care of the client with disturbances of the liver, biliary tract, and pancreas

    Cholecystectomy

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Collaborative Diagnosis Risk for Abscess Formation

    Nursing Diagnosis Deficient Knowledge NDx; Or Ineffective Health Self-Management* NDx

    Cirrhosis

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing/Collaborative Diagnosis: Risk for Imbalanced fluid volume NDx Risk for electrolyte imbalance NDx and third-spacing

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Impaired Comfort NDx (Pruritus)

    Nursing Diagnosis Decreased Activity Tolerance NDx

    Collaborative/Nursing Diagnosis Acute Confusion NDx and Chronic Confusion NDx

    Nursing Diagnosis Risk for Bleeding NDx

    Collaborative Diagnosis Risk for Ascites

    Collaborative Diagnosis Risk for Hepatic (Portal-Systemic) Encephalopathy (Hepatic Coma)

    Nursing Diagnosis Risk for Spiritual Distress NDx

    Nursing Diagnosis Ineffective Family Health Self-Management NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management* NDx

    Hepatitis

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Nausea NDx

    Nursing Diagnosis Risk for Bleeding NDx

    Collaborative Diagnosis Risk for Progressive Liver Degeneration (e.g., Fulminant Hepatitis, Chronic Active Hepatitis)

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management; Ineffective Family Health Self-Management* NDx

    Pancreatitis, acute

    Nursing Diagnosis Acute Pain NDx (Epigastric with Radiation to the Back)

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing/Collaborative Diagnosis Risk for Imbalanced Fluid Volume NDx Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Risk for Infection NDx (Sepsis)

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Risk for Shock NDx

    Collaborative Diagnosis Risk for Peritonitis

    Collaborative Diagnosis Risk for Unstable Blood Glucose Level NDx

    Collaborative Diagnosis Risk for Organ Ischemia/Dysfunction

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; or Ineffective Family Health Self-Management* NDx

12.  The client with alterations in the kidney and urinary tract

    Urolithiasis (renal stones)

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Impaired Urinary Elimination NDx

    Nursing Diagnosis Risk for Infection NDx (Urinary Tract)

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management* NDx

    Cystectomy with urinary diversion

    Nephrectomy

    Nursing Diagnosis Ineffective Breathing Pattern NDx

    Nursing Diagnosis Risk for Shock NDx

    Collaborative Diagnosis Risk for Paralytic Ileus

    Collaborative Diagnosis Risk for Pneumothorax

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management* NDx

    Acute kidney injury and chronic kidney disease

    Nursing Diagnosis Excess Fluid Volume NDx

    Nursing Diagnosis Risk for Decreased Cardiac Output NDx

    Nursing Diagnosis Risk for Electrolyte Imbalance NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

     Collaborative diagnosis Risk for metabolic acidosis

    Collaborative Diagnosis Risk for Uremic Syndrome

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx Ineffective Health Self-Management* NDx

13.  The client with alterations in musculoskeletal function

    Amputation

    Nursing Diagnosis Deficient Knowledge NDx

    Nursing Diagnosis Acute/Chronic Pain NDx

    Nursing Diagnosis Impaired Tissue Integrity/Risk for Impaired Tissue Integrity NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Risk for Surgical Site Infection NDx

    Nursing Diagnosis Disturbed Body Image NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management NDx*

    Fracture (hip) with internal fixation or prosthesis insertion

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Risk for Peripheral Neurovascular Dysfunction NDx (Fractured Extremity)

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Risk for Peripheral Neurovascular Dysfunction NDx (Operative Extremity)

    Nursing Diagnosis Impaired Tissue Integrity NDx/Risk for Impaired Tissue Integrity NDx

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management* NDx

    Laminectomy/discectomy with or without fusion

    Nursing Diagnosis Risk for Peripheral Neurovascular Dysfunction NDx

    Nursing Diagnosis Acute Pain NDx

    Nursing Diagnosis Impaired Skin Integrity NDx; Risk for Impaired Skin Integrity NDx

    Collaborative Diagnosis Risk for Respiratory Distress

    Collaborative Diagnosis Risk for Cerebrospinal Fluid Leak

    Collaborative Diagnosis Risk for Laryngeal Nerve Damage

    Collaborative Diagnosis Risk for Paralytic Ileus

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Family Health Self-Management NDx; or Ineffective Health Maintenance Behaviors* NDx

14.  The client with alterations in the breast and reproductive system

    Hysterectomy

    Nursing Diagnosis Urinary Retention NDx

    Nursing Diagnosis Risk for Ineffective Peripheral Tissue Perfusion NDx

    Nursing Diagnosis Risk for Situational Low Self-Esteem NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Nursing Diagnosis Acute Pain NDx (Chest and Arm on Operative Side)

    Nursing Diagnosis Risk for Peripheral Neurovascular Dysfunction NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Collaborative Diagnosis Impaired Tissue Integrity NDx

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx*

    Radical prostatectomy

    Nursing Diagnosis Urinary Retention NDx

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Deficient Knowledge NDx; Ineffective Health Self-Management NDx; Ineffective Family Health Self-Management* NDx

    Transurethral resection of the prostate

    Nursing Diagnosis Impaired Urinary Elimination NDx

    Nursing Diagnosis Impaired Comfort NDx (Bladder Spasms), Acute Pain NDx

    Nursing Diagnosis Risk for Bleeding NDx

    Nursing Diagnosis Risk for Imbalanced Fluid Volume NDx

    Nursing Diagnosis Deficient Knowledge NDx, Ineffective Family Health Self-Management, Ineffective Health Self-Management* NDx

15.  The client receiving treatment for neoplastic disorders

    Chemotherapy

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Acute Pain NDx/Chronic Pain NDx

    Nursing Diagnosis Impaired Oral Mucous Membrane Integrity NDx

    Nursing Diagnosis Risk for Bleeding NDx

    Collaborative Diagnosis Risk for Impaired Renal Function

    Collaborative Diagnosis Risk for Hemorrhagic Cystitis

    Collaborative Diagnosis Risk for Drug Extravasation

    Collaborative Diagnosis Risk for Cardiac Dysrhythmias

    Collaborative Diagnosis Risk for Inflammation and Fibrosis of Lung Tissue

    Collaborative Diagnosis Risk for Neurotoxicity

    Nursing Diagnosis Risk for Disturbed Self-Concept*

    Nursing Diagnosis Knowledge Deficit*NDx, Ineffective Health Self-Management*NDx, Ineffective Family Health Self-Management*NDx

    Internal radiation therapy (brachytherapy)

    External radiation therapy (teletherapy)

    Nursing Diagnosis Deficient Knowledge NDx Pre-Radiation

    Nursing diagnosis Imbalanced nutrition: Less than body requirements NDx

    Nursing Diagnosis Impaired Swallowing NDx

    Nursing Diagnosis Impaired Comfort NDx Pruritus

    Nursing Diagnosis Risk for Impaired Skin Integrity NDx

    Nursing Diagnosis Risk for Impaired Oral Mucous Membrane Integrity NDx

    Nursing Diagnosis Risk for Bleeding NDx

    Collaborative Diagnosis Radiation Cystitis

    Collaborative Diagnosis Radiation Pneumonitis

    Collaborative Diagnosis Lymphedema

    Nursing Diagnosis Disturbed Self-Concept*

    Nursing Diagnosis Deficient Knowledge* NDx Ineffective Health Self-Management* NDx Ineffective Family Health Self-Management* NDx

16.  Nursing care of the elderly client

    Nursing Diagnosis Ineffective Peripheral Tissue Perfusion NDx/Risk For Decreased Cardiac Output NDx

    Nursing Diagnosis Impaired Respiratory Function*

    Nursing Diagnosis Risk for Deficient Fluid Volume NDx

    Nursing Diagnosis Imbalanced Nutrition: Less than Body Requirements NDx

    Nursing Diagnosis Risk for Impaired Skin Integrity NDx

    Nursing Diagnosis Impaired Oral Mucous Membrane Integrity NDx

    Nursing Diagnosis Risk for Decreased Activity Tolerance NDx

    Nursing Diagnosis Impaired Physical Mobility NDx

    Nursing Diagnosis Impaired Urinary Elimination* NDx

    Nursing Diagnosis Risk for Constipation NDx

    Nursing Diagnosis Disturbed Sleep Pattern NDx

    Nursing Diagnosis Risk for Infection NDx

    Nursing Diagnosis Risk for Adult Falls NDx

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Risk for Injury NDx

    Nursing Diagnosis Risk for Injury NDx (Pathologic Fractures)

    Collaborative Diagnosis Drug Toxicity

    Nursing Diagnosis Ineffective Sexuality Pattern NDx

    Nursing Diagnosis Risk for Frail Elderly Syndrome NDx

    Nursing Diagnosis Deficient Knowledge NDx

    Nursing Diagnosis Interrupted Family Processes NDx

17.  End-of-life nursing care

    Nursing Diagnosis Risk for Aspiration NDx

    Nursing Diagnosis Acute/Chronic Pain NDx

    Nursing Diagnosis Risk for Impaired Skin Integrity NDx

    Nursing Diagnosis Mixed Urinary Incontinence NDx/Impaired Bowel Continence NDx

    Nursing Diagnosis Death Anxiety NDx

    Nursing Diagnosis Readiness for Enhanced Grieving NDx

    Nursing Diagnosis Risk for Spiritual Distress NDx

    Nursing Diagnosis Hopelessness NDx

    Nursing Diagnosis Interrupted Family Processes NDx

Bibliography

    General bibliography

    Chapter-by-chapter bibliography

Index

Inside back cover