HL0607NANDA护理诊断一览表(2015-2017)Word下载.docx
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有母乳喂养改善的趋势(Readinessforenhancedbreastfeeding)乳汁不足(InsufficientBreastMilk)
无效性婴儿喂养型态(IneffectiveInfantFeedingPattern)
营养失调:
低于机体需要量(ImbalancedNutrition:
LessThanBodyRequirements)有营养改善的趋势(ReadinessforEnhancedNutrition)
吞咽障碍(ImpairedSwallowing)
有血糖不稳定的危险(RiskforUnstableBloodGlucoseLevel)新生儿黄疸(NeonatalJaundice)
有新生儿黄疸的危险(RiskforNeonatalJaundice)
有肝功能受损的危险(RiskforImpairedLiverFunction)有电解质失衡的危险(RiskforElectrolyteImbalance)
有体液平衡改善的趋势(ReadinessforEnhancedFluidBalance)体液不足(DeficientFluidVolume)
有体液不足的危险(RiskforDeficientFluidVolume)体液过多(ExcessFluidVolume)
有体液失衡的危险(RiskforImbalancedFluidVolume)
领域3:
排泄(EliminationandExchange)
慢性功能性便秘(Chronicfunctionalconstipation)
有慢性功能性便秘的危险(Riskforchronicfunctionalconstipation)排尿障碍(ImpairedUrinaryElimination)
有排尿功能改善的趋势(ReadinessforEnhancedUrinaryElimination)功能性尿失禁(FunctionalUrinaryIncontinence)
溢出性尿失禁(OverflowUrinaryIncontinence)反射性尿失禁(ReflexUrinaryIncontinence)压力性尿失禁(StressUrinaryIncontinence)急迫性尿失禁(UrgeUrinaryIncontinence)
有急迫性尿失禁的危险(RiskforUrgeUrinaryIncontinence)尿潴留(UrinaryRetention)
便秘(Constipation)
有便秘的危险(RiskforConstipation)感知性便秘(PerceivedConstipation)腹泻(Diarrhea)
胃肠动力失调(DysfunctionalGastrointestinalMotility)
有胃肠动力失调的危险(RiskforDysfunctionalGastrointestinalMotility)排便失禁(BowelIncontinence)
气体交换障碍(ImpairedGasExchange)
领域4:
活动/休息(Activity/Rest)坐起障碍(Impairedsitting)
站立障碍(Impairedstanding)
有心输出量减少的危险(Riskfordecreasedcardiacoutput)
有心血管功能受损的危险(Riskforimpairedcardiovascularfunction)失眠(Insomnia)
睡眠剥夺(SleepDeprivation)
有睡眠改善的趋势(ReadinessforEnhancedSleep)睡眠型态紊乱(DisturbedSleepPattern)
有失用综合征的危险(RiskforDisuseSyndrome)床上活动障碍(ImpairedBedMobility)
躯体活动障碍(ImpairedPhysicalMobility)
借助轮椅活动障碍(ImpairedWheelchairMobility)移动能力障碍(ImpairedTransferAbility)
行走障碍(ImpairedWalking)疲乏(Fatigue)
漫游状态(Wandering)
活动无耐力(ActivityIntolerance)
有活动无耐力的危险(RiskforActivityIntolerance)低效性呼吸型态(IneffectiveBreathingPattern)
心输出量减少(DecreasedCardiacOutput)
有胃肠道灌注无效的危险(RiskforIneffectiveGastrointestinalPerfusion)有肾脏灌注无效的危险(RiskforIneffectiveRenalPerfusion)
自主呼吸障碍(ImpairedSpontaneousVentilation)
有心脏组织灌注不足的危险(RiskforDecreasedCardiacTissuePerfusion)有脑组织灌注无效的危险(RiskforIneffectiveCerebralTissuePerfusion)外周组织灌注无效(IneffectivePeripheralTissuePerfusion)
有外周组织灌注无效的危险RiskforIneffectivePeripheralTissuePerfusion
呼吸机依赖(DysfunctionalVentilatoryWeaningResponse)
持家能力障碍(ImpairedHomeMaintenance)沐浴自理缺陷(BathingSelf-CareDeficit)穿着自理缺陷(DressingSelf-CareDeficit)进食自理缺陷(FeedingSelf-CareDeficit)如厕自理缺陷(ToiletingSelf-CareDeficit)
有自理能力改善的趋势(ReadinessforEnhancedSelf-Care)自我忽视(Self-Neglect)
领域5:
感知/认知(Perception/Cognition)
情绪控制失调(Labileemotionalcontrol)单侧身体忽视(UnilateralNeglect)
急性意识障碍(AcuteConfusion)
有急性意识障碍的危险(RiskforAcuteConfusion)慢性意识障碍(ChronicConfusion)
冲动控制无效(IneffectiveImpulseControl)
知识缺乏(DeficientKnowledge)
有知识增进的趋势(ReadinessforEnhancedKnowledge)记忆功能障碍(ImpairedMemory)
有沟通增进的趋势(ReadinessforEnhancedCommunication)语言沟通障碍(ImpairedVerbalCommunication)
领域6:
自我感知(Self-Perception)
有希望增强的趋势(Readinessforenhancedhope)无望感(Hopelessness)
有个人尊严受损的危险(RiskforCompromisedHumanDignity)自我认同紊乱(DisturbedPersonalIdentity)
有自我认同紊乱的危险(RiskforDisturbedPersonalIdentity)
有自控能力增强的趋势(ReadinessforEnhancedSelf-Control)长期低自尊(ChronicLowSelf-Esteem)
有长期低自尊的危险(RiskforChronicLowSelf-Esteem)
有情境性低自尊的危险(RiskforSituationalLowSelf-Esteem)情境性低自尊(SituationalLowSelf-Esteem)
体像紊乱(DisturbedBodyImage)
领域7:
角色关系(RoleRelationships)照顾者角色紧张(CaregiverRoleStrain)
有照顾者角色紧张的危险(RiskforCaregiverRoleStrain)养育功能障碍(ImpairedParenting)
有养育功能改善的趋势(ReadinessforEnhancedParenting)
有养育功能障碍的危险(RiskforImpairedParenting)有依附关系受损的危险(RiskforImpairedAttachment)家庭运作过程失常(DysfunctionalFamilyProcesses)家庭运作过程改变(InterruptedFamilyProcesses)
有家庭运作过程改善的趋势(ReadinessforEnhancedFamilyProcesses)关系无效(IneffectiveRelationship)
有关系改善的趋势(ReadinessforEnhancedRelationship)有关系无效的危险RiskforIneffectiveRelationship
父母角色冲突(ParentalRoleConflict)
无效性角色行为(IneffectiveRolePerformance)社会交往障碍(ImpairedSocialInteraction)
领域8:
性(Sexuality)
性功能障碍(SexualDysfunction)
性生活型态无效(IneffectiveSexualityPattern)生育进程无效(IneffectiveChildbearingProcess)
有生育进程改善的趋势(ReadinessforEnhancedChildbearingProcess)有生育进程无效的危险(RiskforIneffectiveChildbearingProcess)
有母体与胎儿双方受干扰的危险(RiskForDisturbedMaternal–FetalDyad)领域9:
应对/应激耐受性(Coping/StressTolerance)
有社区应对增强的趋势(Readinessforenhancedcommunitycoping)情绪调控受损(Impairedmoodregulation)
有恢复能力障碍的危险(Riskforimpairedresilience)创伤后综合征(Post-TraumaSyndrome)
有创伤后综合征的危险(RiskforPost-TraumaSyndrome)
强暴创伤综合征(Rape-TraumaSyndrome)
迁移应激综合征(RelocationStressSyndrome)
有迁移应激综合征的危险(RiskforRelocationStressSyndrome)活动计划无效(IneffectiveActivityPlanning)
有活动计划无效的危险(RiskforIneffectiveActivityPlanning)焦虑(Anxiety)
妥协性家庭应对(CompromisedFamilyCoping)无能性家庭应对(DisabledFamilyCoping)防卫性应对(DefensiveCoping)
应对无效(IneffectiveCoping)
有应对增强的趋势(ReadinessforEnhancedCoping)社区应对无效(IneffectiveCommunityCoping)
有家庭应对增强的趋势(ReadinessforEnhancedFamilyCoping)对死亡的焦虑(DeathAnxiety)
无效性否认(IneffectiveDenial)恐惧(Fear)
悲伤(Grieving)
复杂性悲伤(ComplicatedGrieving)
有复杂性悲伤的危险(RiskforComplicatedGrieving)有能力增强的趋势(ReadinessforEnhancedPower)无能为力感(Powerlessness)
有无能为力感的危险(RiskforPowerlessness)恢复能力障碍(ImpairedResilience)
有恢复能力增强的趋势(ReadinessforEnhancedResilience)
持续性悲伤(ChronicSorrow)
压力负荷过重(StressOverload)
颅内调适能力降低(DecreasedIntracranialAdaptiveCapacity)自主反射失调(AutonomicDysreflexia)
有自主反射失调的危险(RiskforAutonomicDysreflexia)
婴儿行为紊乱(DisorganizedInfantBehavior)
有婴儿行为调节改善的趋势ReadinessforEnhancedOrganizedInfantBehavior)有婴儿行为紊乱的危险(RiskforDisorganizedInfantBehavior)
领域10:
生活准则(LifePrinciples)
独立决策能力减弱(Impairedemancipateddecision-making)
有独立决策能力增强的趋势(Readinessforenhancedemancipateddecision-making)有独立决策能力减弱的危险(Riskforimpairedemancipateddecision-making)
有精神安适增进的趋势(ReadinessforEnhancedSpiritualWell-Being)有决策能力增强的趋势(ReadinessforEnhancedDecisionMaking)
抉择冲突(DecisionalConflict)道德困扰(MoralDistress)
宗教信仰减弱(Impairedreligiosity)
有宗教信仰增强的趋势(ReadinessforEnhancedReligiosity)有宗教信仰减弱的危险(RiskforImpairedReligiosity)
精神困扰(SpiritualDistress)
有精神困扰的危险(RiskforSpiritualDistress)领域11:
安全/防护(Safety/Protection)
有角膜受损的危险(Riskforcornealinjury)
有尿道损伤的危险(Riskforurinarytractinjury)
有口腔黏膜受损的危险(Riskforimpairedoralmucousmembrane)有压疮的危险(Riskforpressureulcer)
有组织完整性受损(Riskforimpairedtissueintegrity)
有体温过低的危险(Riskforhypothermia)
有手术期体温过低的危险(Riskforperioperativehypothermia)有感染的危险(RiskforInfection)
清理呼吸道无效IneffectiveAirwayClearance)有误吸的危险(RiskforAspiration)
有出血的危险(RiskforBleeding)有干眼症的危险(RiskforDryEye)有跌倒的危险(RiskforFalls)
有受伤的危险(RiskforInjury)
有手术期体位性损伤的危险(RiskforPerioperativePositioningInjury)有热损伤的危险(RiskforThermalInjury)
牙齿受损(ImpairedDentition)
口腔黏膜受损(ImpairedOralMucousMembrane)
有外周神经血管功能障碍的危险(RiskforPeripheralNeurovascularDysfunction)有休克的危险(RiskforShock)
皮肤完整性受损(ImpairedSkinIntegrity)
有皮肤完整性受损的危险(RiskforImpairedSkinIntegrity)
有婴儿猝死综合征的危险(RiskforSuddenInfantDeathSyndrome)有窒息的危险(RiskforSuffocation)
术后康复迟缓(DelayedSurgicalRecovery)组织完整性受损(ImpairedTissueIntegrity)有外伤的危险(RiskforTrauma)
有血管损伤的危险(RiskforVascularTrauma)
有对他人施行暴力的危险(RiskforOther-DirectedViolence)有对自己施行暴力的危险(RiskforSelf-DirectedViolence)自残(Self-Mutilation)
有自残的危险(RiskforSelf-Mutilation)有自杀的危险(RiskforSuicide)
受污染(Contamination)
有受污染的危险(RiskforContamination)有中毒的危险(RiskforPoisoning)
有碘造影剂不良反应的危险(RiskforAdverseReactiontoIodinatedContrastMedi)a有过敏反应的危险(RiskforAllergyResponse)
乳胶过敏反应(LatexAllergyResponse)
有乳胶过敏反应的危险(RiskforLatexAllergyResponse)有体温失调的危险(RiskforImbalancedBodyTemperature)体温过高(Hyperthermia)
体温过低(Hypothermia)
体温调节无效(IneffectiveThermoregulation)领域12:
舒适(Comfort)
分娩疼痛(Laborpain)
慢性疼痛综合征(Chronicpainsyndrome)有孤独的危险(Riskforloneliness)
舒适度减弱(ImpairedComfort)
有舒适增进的趋势(ReadinessforEnhancedComfort)恶心(Nausea)
急性疼痛(AcutePain)慢性疼痛(ChronicPain)
社交孤立(SocialIsolation)
领域13:
生长/发展(Growth/Development)
有发育迟缓的危险(RiskforDelayedDevelopment)
有生长比例失调的危险(RiskforDisproportionateGrowth)