Nursing Analysis Record | Nanda Nursing Analysis Record

nanda nursing diagnosis list book cover
November 21, 2020 0 Comments

Click on on the Hyperlink to view the specified class:

1.Classification of Nursing Diagnoses by Useful Well being Patterns.

2.Classification of Nursing Diagnoses as Primary Human Wants.

3.Classification of Nursing Diagnoses: Definitions, danger components and attribute.

A nursing prognosis is an expert judgment primarily based on the applying of scientific data which determines potential or precise experiences and responses to well being issues and life processes. The checklist of NANDA nursing prognosis may be utilized to people, households or communities. Included with the checklist of NANDA nursing prognosis is an array of generally utilized interventions from which the caregiver can select to implement to the given affected person. Standardized nursing language is a physique of phrases used within the occupation that’s thought-about to be understood in frequent. Using frequent phrases promotes affected person security by permitting nurses to rapidly and effectively perceive the elements of a affected person’s wants. Using standardized phrases permits nursing employees to keep away from sifting via lengthy narratives with a purpose to decide a specific affected person’s wants and deliberate course of care.

nanda nursing diagnosis list book cover

nanda nursing prognosis checklist

The North American Nursing Analysis Affiliation (NANDA) is a physique of pros that manages an official checklist of nursing diagnoses. The preliminary group was shaped in 1973 after a convention was referred to as for the aim of classifying a listing of nursing diagnoses grouped in alphabetical order. Kristine Gebbie and Mary Ann Lavin invited attendees from america and Canada to the assembly in St. Louis, Missouri. There the nurses created three elements to start the launch of an organized set of diagnoses. The Nationwide Clearinghouse for Nursing Diagnoses situated at St. Louis College, the Nationwide Convention Group, and a Nursing Analysis Publication composed the three buildings. NANDA was formally shaped in 1982. The group publishes the NANDA-I Definitions and Classification guide that may be bought by healthcare services and particular person nurses. The affiliation exists with a purpose to constantly refine the terminology used and to develop and promote the lists with a purpose to foster uniformity amongst professionals.

The NANDA nursing prognosis checklist is a vital and useful gizmo that promotes affected person security by standardizing evidence-based nursing diagnoses. The method permits nurses to implement interventions with predictable outcomes. The presence of uniform and correct documentation offered by the utilization of the diagnoses assists in acquiring reimbursement of medical payments. NANDA is comprised of goal-oriented nurses who’re dedicated to repeatedly growing the standard of affected person care whereas selling and enhancing ranges of affected person security. The group welcomes strategies from nurses exterior of the affiliation on the creation of latest or modification of current nursing diagnoses. The group conducts analysis which is funded by the NANDA Basis.

Well being care services maintain a standardized NANDA nursing prognosis checklist on website at every affected person care unit. Generally, pre-printed types of diagnoses are stored on the nursing station to allow the nurse to have easy accessibility to a course of care that he/she needs to implement. The types turn into a part of the affected person’s chart for simple accessibility by different employees members and finally turns into a part of the affected person’s everlasting file.

You could find All detailed prognosis in our website, you might have additionally a short of nursing prognosis checklist beneath:

EXCHANGES | COMMUNICATION | RELATIONS| VALUES | CHOICE | MOVEMENT | PERCEPTIONS | KNOWLEDGE | SENSATIONS AND EMOTIONS

EXCHANGES

– Extra nutrient:

Dietary larger metabolic wants

– Dietary Deficiency:

Dietary consumption beneath metabolic wants.

– Danger of dietary extra:

Nutrient consumption prone to be larger metabolic wants.

– Danger of an infection:

Excessive danger of contamination by pathogens.

– Danger of impaired physique temperature:

Danger of lack of ability to keep up physique temperature inside regular limits.

– Hypothermia:

Discount in physique temperature beneath the traditional limits.

– Hyperthermia:

Elevation of physique temperature above the traditional limits.

– Ineffective Thermoregulation:

Fluctuations in physique temperature between hypothermia and hyperthermia.

– Dysreflexia:

Non-inhibition of inflow of the sympathetic nervous system faces a noxious stimuli that threaten the lifetime of an individual with a spinal twine as much as D7 or above.

– Constipation:

Change in regular bowel habits characterised by a lower in stool frequency and the emission of arduous, dry stools.

– Pseudo-constipation:

Self-diagnosis of constipation and use of laxatives, enemas or suppositories to make sure every day bowel.

– Colic Constipation:

Emission of arduous, dry stools as a result of a slower passage of meals residues.

– Diarrhea:

Change in bowel habits characterised by the frequent free stools, liquid and unformed.

– Fecal incontinence:

Change in bowel habits characterised by fecal accidents.

– Altered urinary elimination:

Disturbance in urinary excretion.

– Urinary Stress Incontinence:

Urine move of lower than 50 mL that happens when belly strain will increase.

– Urinary incontinence reflex:

Involuntary move of urine occurring at considerably predictable intervals when the bladder reaches a specified quantity.

– Urinary incontinence by decreasing the time warning:

Involuntary move of urine shortly after a robust urge to urinate is felt.

– Useful Incontinence:

Involuntary and unpredictable move of urine.

– Urinary Incontinence full (true):

Steady and unpredictable move of urine.

– Urinary retention (acute or continual)

Incomplete bladder evacuation. Sturdy strain on the urethra prevents the bladder from emptying

utterly inhibits urination or till the rise in belly strain trigger involuntary urine move.

– Decreased tissue perfusion:

(Specify) (cardio-pulmonary, cerebral, gastrointestinal, peripheral, renal)

Lower in diet and mobile oxygenation secondary to decreased blood move in capillaries.

The blood provide to tissues and cardiac output are usually immediately linked. Nevertheless, tissue perfusion could also be inadequate with out decreased cardiac output.

– Extra fluid quantity:

Enhance water retention accompanied by edema.

– Fluid Quantity Deficit:

Vascular dehydration, mobile or intracellular secondary to dysfunction of regulatory mechanisms which precipitated an extreme demand natural or lower the capability of alternative.

– Danger of deficit fluid quantity:

Vascular danger of dehydration, intracellular or cell loss might end result from lively or dysfunction of regulatory mechanisms which might trigger extreme demand or a drop in alternative capability.

– Decreased cardiac output:

Quantity of blood pumped from the guts inadequate for tissue perfusion.

Word: In case of enhance in basal metabolic price, cardiac output could also be regular with out adequately meet the wants of the tissues. Cardiac output and blood move to tissues are usually immediately linked: the lower in cardiac output ends in impaired tissue perfusion. Nevertheless, tissue perfusion could also be inadequate with out decreased cardiac output.

– Disruption of gasoline alternate:

Decreased alternate of oxygen and / or carbon dioxide between the alveoli and vasculature.

This response can happen solely following a medical drawback however may end result from an ineffective airway clearance and / or ineffective respiration sample.

– Ineffective airway clearance:

Lack of ability to clear the airways obstructions that impede the free passage of air.

– Mode of respiration ineffective:

Option to encourage and / or expire doesn’t enable fill or empty the lungs correctly.

– Lack of ability to maintain spontaneous respiration:

Depletion of power reserves making the individual unable to keep up respiration enough to make sure their primary wants.

– Intolerance cessation of assisted air flow:

Lack of ability to adapt to a lower in mechanical air flow and which interrupts extends the withdrawal course of.

– Danger of accident:

State of affairs through which an individual could also be injured as a result of the circumstances underneath which it’s past the capability of adaptation and protection.

– Danger of choking:

Elevated hazard of unintentional suffocation (lack of air).

– Danger of poisoning:

Excessive danger of unintentionally come into contact with dangerous substances in enough portions to trigger poisoning (opposed results of a prescription remedy or a drug).

– Danger of trauma:

Excessive danger of unintentional harm to tissue (wound, burn, fracture …)

– Danger of aspiration [suction]:

Danger of inhaling gastric secretions and / or oropharyngeal, solids or liquids into the trachea and bronchi (due to a malfunction or absence of regular protecting mechanisms).

– Danger of immobility syndrome:

Danger of degradation of organ perform as a result of inactivity musculoskeletal prescribed or inevitable.

Word: In line with NANDA issues as a result of immobility together with strain ulcers, constipation, stasis of pulmonary secretions, thrombosis, urinary tract an infection, urinary retention, lack of energy or endurance, postural hypotension, decreased the amplitude of joint actions, disorientation, impaired physique picture and emotions of helplessness.

– Alteration of protecting mechanisms:

Decreased capacity to guard themselves from inner and exterior threats similar to sickness or accidents.

– Harm to tissue integrity:

Mucosal lesion within the cornea, the integument or subcutaneous tissues.

– Violation of the integrity of the oral mucosa:

Out of the tissue layers of the oral cavity.

– Violation of the integrity of the pores and skin:

Pores and skin lesion; break within the integument, the biggest multifunctional organ of the physique.

– Danger of harm to the pores and skin:

Danger of pores and skin lesion.

– Decreased intracranial adaptive capability

– Disruption of the power discipline

COMMUNICATION

– Impaired verbal communication:

Problem or lack of ability to make use of or perceive language in interpersonal reactions.

RELATIONS

– Disruption of social interplay:

Social relations extreme, insufficient or ineffective.

– Social isolation:

Loneliness that the individual regards as imposed by others and he or she perceives as threatening or destructive.

– Danger of loneliness:

Subjective state of an individual prone to experiencing a wave dysphoria.

– Disturbance within the efficiency of the function:

Upheaval in the way in which an individual perceives the train of its function

– Disturbance within the train of parenting:

Unfitness of a father or mother or designated individual to create an surroundings that promotes most development and growth of one other human being.

You will need to add a preamble to this prognosis that adaptation to parenting is a part of the traditional evolution in the direction of maturity which results in the nurse (e) actions in well being promotion and prevention points.

– Danger of disruption within the train of parenting:

Danger {that a} father or mother or surrogate turns into unable to create an surroundings that promotes most development and growth of one other human being.

You will need to add a preamble to this prognosis that adaptation to parenting is a part of the traditional evolution in the direction of maturity which results in the nurse (e) actions in well being promotion and prevention points.

– Sexual Dysfunction:

Change in sexual functioning perceived as unsatisfactory, demeaning or inappropriate.

– Disruption of household dynamics:

Dysfunction inside a household that works successfully generally.

– Failure within the efficiency of the function of caregiver:

The caretaker of a sick or disabled has issue to carry out the function of caregiver.

– Danger of failure within the efficiency of the function of caregiver:

The caretaker of a sick or disabled is prone to expertise issue in exercising the function of caregiver.

– Disruption of household dynamics:

Dysfunction or danger of dysfunction inside a household that works successfully generally.

– Battle going through parenting:

State of affairs the place a father or mother or an individual with a dependent baby adjustments roles or function seem to vary as a result of intrinsic components (sickness, hospitalization, divorce, separation, for instance)

– Disruption of sexuality:

State of affairs the place an individual experiences or might expertise a change in sexual well being.

Sexual well being is a optimistic integration elements of somatic, emotional, mental and social elements of sexual being, in order that it enriches persona, communication and love (WHO, 1975)

VALUES

– Religious misery:

Disruption of the life precept that animates the entire being of an individual and that integrates and transcends its organic and psychosocial.

– Religious well-being: doable updating

CHOICE

– Ineffective particular person coping methods:

Problem in adaptive behaviors and use drawback fixing strategies to satisfy the calls for of life and fulfill its roles.

– Lack of ability to adapt to a change in well being standing:

Lack of ability to switch life-style or conduct primarily based on a change in well being standing.

– Coping Methods defensive:

Protection system towards something that appears to threaten a optimistic self-image, leading to a scientific overestimation of oneself.

– Denial not constructive:

Acutely aware or unconscious try to disavow data or which means of an occasion to cut back nervousness or worry on the expense of his well being.

– Ineffective household coping methods: lack of help

Deteriorating relationship between the affected person and a key individual or different that makes it and the affected person unable to carry out successfully the difference work essential to the issue well being.

– Ineffective household coping methods: help compromise:

Assist, consolation, help and encouragement that often supplies a key individual, member of the family or buddies, are compromised or ineffective. The affected person didn’t have sufficient help to help the work required to adapt their well being drawback.

– Efficient household coping methods: development potential:

State of affairs the place a member of the family who takes care of the shopper has executed the work essential to adapt.

It demonstrates the need and the need to enhance his well being and that of the shopper and supply alternative for private development.

– Ineffective household coping methods: potential for enchancment

– Ineffective coping methods of a neighborhood

– Assist for ineffective therapy program:

Find out how to set up the therapy program of a illness or penalties of sickness and to combine it into every day life doesn’t enable to attain sure well being targets.

– Non-observance (specify):

Refusal knowingly adhere to really helpful therapy.

Word: it’s tough to deal with the causes of this drawback due to the paradox of the time period. On the one hand nursing employees perceives the noncompliance negatively. However, the affected person sees the refusal to stick to therapy with no consideration. Because the nurse should respect the affected person’s alternative with him she’s going to search different methods to attain the identical targets.

– Assist for ineffective therapy program by the household

– Assist for ineffective therapy program by a joint collectivity

– Efficient administration of the therapy program by the person

– Battle determination (specify):

Uncertainty concerning the line of motion to take when the selection between acts antagonists includes danger, loss or questioning of non-public values.

– Searching for a greater customary of well being: (specify the conduct)

Needs of people whose well being standing is steady to vary private habits of well being and / or its surroundings to enhance its degree of well being.

A steady state of well being is outlined because the individual has taken steps to stop the illness age-appropriate, she stated good or glorious well being and, the place acceptable, the indicators and signs of illness are stabilized .

MOVEMENT

– Impaired bodily mobility:

Location limiting the power to maneuver independently.

– Danger of peripheral neuromuscular dysfunction:

Danger of circulatory dysfunction. sensory or motor in a limb.

– Danger of harm in perioperative

– Intolerance to exercise:

Lack of bodily or psychological power that forestalls an individual from persevering with or finishing the required or desired every day actions.

– Fatigue:

Overwhelming feeling of exhaustion and extended decreasing the capability of bodily and psychological work.

– Danger of exercise intolerance:

State of affairs through which an individual may run out of bodily or emotional power to pursue or perform every day actions required or desired.

– Disruption in sleep patterns:

Disruption of sleep that the affected person inconvenient or not possible to have the approach to life they need.

– Lack of leisure:

Boredom ensuing from declining curiosity in leisure actions or lack of ability to have (due to inner or exterior components Related or not the desire).

– Incapacity (partial or whole) to prepare and preserve the house:

Lack of ability to keep up unaided a protected and conducive to private development.

– Troublesome to remain wholesome:

State of affairs through which an individual doesn’t know the place to get assist to remain wholesome, is unable to seek out or have no idea what conduct stand going through help providers.

If this nursing prognosis is the results of an addition drawback of nursing (lack of understanding, impaired verbal communication, impaired considering processes, coping methods ineffective particular person or household …) and if the identical issue encouraging is discovered, we advocate to combine interventions for issue sustaining well being prognosis precedence.

– Incapacity (partial or whole) to eat:

Feeding issue: issue short-term, everlasting or steadily growing.

Word: the notion of non-public care shouldn’t be restricted to pae hygiene, it additionally encompasses the practices of well being promotion, the power to take cost and considering.

– Incapacity (partial or whole) to swallow:

Decreased capacity to maneuver voluntarily liquids and / or solids from the mouth to the abdomen.

– Breastfeeding ineffective:

The mom or child are struggling to grasp the method of breastfeeding and don’t derive satisfaction.

– Breastfeeding interrupted:

Suspension of the method of breastfeeding as a result of the mom is unable to breastfeed or breast-feeding shouldn’t be really helpful towards.

– Breastfeeding environment friendly (studying want):

The mom and child proficient sufficient with the nursing course of and derive satisfaction.

– Energy Mode ineffective in infants:

Disturbance of sucking reflex of a child or issue coordinating sucking and swallowing.

– Incapacity (partial or whole) to scrub / carry out its hygiene:

Problem bathing and hygiene self-care with out help; issue short-term, everlasting or steadily growing.

Word: the notion of non-public care shouldn’t be restricted to private care, it additionally encompasses the practices of well being promotion, the power to be taught and methods to suppose.

– Incapacity (partial or whole) to decorate / look of care:

Problem dressing and deal with its look with out help; issue short-term, everlasting or steadily growing.

Word: the notion of non-public care shouldn’t be restricted to private care, it additionally encompasses the practices of well being promotion, the power to be taught and methods to suppose.

– Incapacity (partial or whole) to make use of the bathroom:

Problem utilizing the bathroom with out assist; issue short-term, everlasting or steadily growing.

Word: the notion of non-public care shouldn’t be restricted to private care, it additionally encompasses the practices of well being promotion, the power to be taught and methods to suppose.

– Disturbance of development and growth:

Deviations from established norms for the age group of individual.

– Syndrome of maladjustment to a change of surroundings:

Physiological disturbances and / or psychosocial ensuing from a change of medium.

– Danger of behavioral disorganization in infants

– Behavioral disorganization in infants

– Group of toddler conduct: potential for enchancment

PERCEPTIONS

– Disturbance of physique picture:

Change in how an individual perceives his physique picture.

– Disturbance of shallowness:

Hostile judgment for oneself or talents that may be expressed immediately or not directly.

– Disturbance of continual shallowness:

Depreciation and upkeep of long-standing destructive emotions vis-?-vis himself or his talents.

– Disruption of situational shallowness:

Hostile judgment for oneself in response to a loss or a change in an individual who beforehand had a optimistic picture of itself.

– Disturbance of non-public identification:

Lack of ability to differentiate between the self and the skin world.

– Altered sensory notion:

(Specify: auditory, gustatory, kinesthetic, olfactory, tactile, visible)

Response diminished, exaggerated or inappropriate to a change within the quantity or nature of the stimuli acquired by the senses.

– The hemibody Negligence:

State through which an individual doesn’t see one aspect of the physique or don’t concentrate.

The non-perception or inattention extends to the quick area round half of his physique.

– Lack of hope:

Subjective state through which an individual sees little or no alternate options or private selections good and is unable to mobilize its oi-these for its personal account.

– Emotions of powerlessness:

Impression that his actions could have no impact. Feeling powerless towards a standard state of affairs or a sudden occasion.

KNOWLEDGE

– Lack of expertise (specify the necessity for studying):

The affected person or the important thing individual in his life doesn’t have the correct info wanted to make knowledgeable selections about their state of affairs and the obtainable therapy modalities and therapy plan.

– Syndrome of misinterpretation of the surroundings:

Disorientation to individual, locations, time and circumstances for greater than three to 6 months, requiring the applying of safeguards.

– Acute Confusion:

Sudden and transient look of a set of behavioral adjustments accompanied by disturbance of consideration, cognition, psychomotor exercise, the extent of consciousness and / or sleep-wake cycle.

– Continual Confusion:

Irreversible injury, lengthy and / or progressive capacity to interpret environmental stimuli

and mental processes that manifests as impaired reminiscence, orientation and conduct.

– Alteration of operations of thought:

Enterprise disruption and cognitive actions.

– Reminiscence issues:

Forgot flanges info or abilities acquired. The reminiscence impairment could also be brought on by physiological or situational and be short-term or everlasting.

SENSATIONS AND EMOTIONS

– Acute ache:

Misery or malaise skilled and reported by the individual.

– Continual Ache:

Ache lasting for greater than six months.

Word: Ache signifies that one thing is mistaken. Continual ache will also be recurring (eg migraine) as fixed. A method or one other, it’s debilitating.

The continual ache syndrome usually manifests as discovered behaviors and plainly the predisposing components are psychological order. This can be a complicated scientific entity, separate and related components from different nursing diagnoses: helplessness, lack of leisure, disruption of household dynamics, partially or completely unable to eat, to scrub self-care or hygiene, sev?tir or deal with its look, utilizing the bathroom …

– Mourning [grief] dysfunctional:

Delayed or exaggerated response to a perceived lack of precise or potential.

– Mourning [grief] prematurely:

Response to a loss earlier than it occurs.

Word: It could be a wholesome response requiring solely supportive interventions and knowledge.

– Danger of violence towards self or to others:

Habits prone to trigger hurt to oneself or others. The injury can vary from neglect to abuse and even dying and the harm could also be psychological or bodily.

– Danger of self hurt:

Excessive danger of harm with out intent to kill himself producing tissue injury and a way of reduction.

– Publish-traumatic response:

Painful and extended response to unexpected calamity.

– Rape trauma syndrome:

Violent sexual penetration made underneath duress and towards the desire of the sufferer. Trauma syndrome following a sexual assault or tried assault consists of an acute disruption of life-style and a long-term strategy of reorganization. This syndrome consists of three components: trauma, and blended response silent response.

Word: This part makes use of the feminine, however even when the victims are principally girls, males will also be victims.

– Rape trauma syndrome: Blended response. cf: rape trauma syndrome

– Rape trauma syndrome: silent response. cf: rape trauma syndrome

– Nervousness:

(Gentle, average, extreme or panic)

Obscure sense of unease house typically undetermined or unknown.

– Worry:

Worry associated to an identifiable supply confirmed that the small individual.

NANDA has helped to extend affected person security and continuity of care by the event of its standardized checklist. Its use has helped to permit higher effectivity and simpler affected person care utilizing nanda Nursing Analysis Record.

Leave a Reply

Your email address will not be published. Required fields are marked *