201项护理诊断一览表.docx
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201项护理诊断一览表
附录2201项护理诊断一览表(2009~2011)
领域1:
健康促进(HealthPromotion)
健康维护能力低下(IneffectiveHealthMaintenance)
自我健康管理无效(IneffectiveSelfHealthManagement)
持家能力障碍(ImpairedHomeMaintenance)
有免疫状态改善的趋势(ReadinessforEnhancedImmunizationStatus)
忽视自我健康管理(SelfNeglect)
有营养改善的趋势(ReadinessforEnhancedNutrition)
家庭执行治疗方案无效(IneffectiveFamilyTherapeuticRegimenManagement)
有自我健康管理改善的趋势(ReadinessforEnhancedSelfHealthManagement)
领域2:
营养(Nutrition)
无效性婴儿喂养型态(IneffectiveInfantFeedingPattern)
营养失调:
低于机体需要量(ImbalancedNutrition:
LessThanBodyRequirements)
营养失调:
高于机体需要量(ImbalancedNutrition:
MoreThanBodyRequirements)
有营养失调的危险:
高于机体需要量(RiskforImbalancedNutrition:
MoreThanBodyRequirements)吞咽障碍(ImpairedSwallowing)
有血糖不稳定的危险(RiskforUnstableGlucoseLevel)
新生儿黄疸(NeonatalJaundice)
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)
体液过多(ExcessFluidVolume)
有体液不足的危险(RiskforDeficientFluidVolume)
有体液失衡的危险(RiskforImbalancedFluidVolume)
领域3:
排泄(EliminationandExchange)
排尿障碍(ImpairedUrinaryElimination)
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)
有排尿功能改善的趋势(ReadinessforEnhancedUrinaryElimination)
排便失禁(BowelIncontinence)
便秘(Constipation)
感知性便秘(PerceivedConstipation)
有便秘的危险(RiskforConstipation)腹泻(Diarrhea)
胃肠动力失调(DysfunctionalGastrointestinalMotility)
有胃肠动力失调的危险(RiskforDysfunctionalGastrointestinalMotility)
气体交换障碍(ImpairedGasExchange)
领域4:
活动/休息(Activity/Rest)
失眠(Insomnia)
睡眠型态紊乱(DisturbedSleepPattern)
睡眠剥夺(SleepDeprivation)
有睡眠改善的趋势(ReadinessforEnhancedSleep)
有废用综合征的危险(RiskforDisuseSyndrome)
缺乏娱乐活动(DeficientDiversionalActivity)
久坐的生活方式(SedentaryLifestyle)
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)
术后康复迟缓(DelayedSurgicalRecovery)
能量场紊乱(DisturbedEnergyField)
疲乏(Fatigue)
活动无耐力(ActivityIntolerance)
有活动无耐力的危险(RiskforActivityIntolerance)
有出血的危险(RiskforBleeding)
低效性呼吸型态(IneffectiveBreathingPattern)
心输出量减少(DecreasedCardiacOutput)
外周组织灌注无效(IneffectivePeripheralTissuePerfusion)
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)
有胃肠道灌注无效的危险(RiskforIneffectiveGastrointestinalTissuePerfusion)有肾脏灌注无效的危险(RiskforIneffectiveRenalPerfusion)
有休克的危险(RiskforShock)
自主呼吸障碍(ImpairedSpontaneousVentilation)
呼吸机依赖(DysfunctionalVentilatoryWeaningResponse)
有自理能力增强的趋势(ReadinessforEnhancedSelf-Care)
沐浴/卫生自理缺陷(Bathing/HygieneSelf-CareDeficit))
穿着/修饰自理缺陷(Dressing/groomingSelf-CareDeficit)
进食自理缺陷(FeedingSelf-CareDeficit)
如厕自理缺陷(ToiletingSelf-CareDeficit)
领域5:
感知/认知(Perception/Cognition)
单侧身体忽视(UnilateralNeglect)
环境认知障碍综合征(ImpairedEnvironmentalInterpretationSyndrome)
漫游状态(Wandering)
感知觉紊乱(具体说明:
视觉、听觉、方位感、味觉、触觉、嗅觉)(DisturbedSensoryPerception〔Specify:
Visual,Auditory,Kinesthetic,Gustatory,Tactile,Olfactory)
急性意识障碍(AcuteConfusion)
慢性意识障碍(ChronicConfusion)
有急性意识障碍的危险(RiskforAcuteConfusion)
知识缺乏(DeficientKnowledge)
有知识增进的趋势(ReadinessforEnhancedKnowledge)
记忆功能障碍(ImpairedMemory)
有决策能力增强的趋势(ReadinessforEnhancedDecision-Making)
活动计划无效(IneffectiveActivityPlanning)
语言沟通障碍(ImpairedVerbalCommunication)
有沟通增进的趋势(ReadinessforEnhancedCommunication)
领域6:
自我感知(Self-Perception)
有个人尊严受损的危险(RiskforCompromisedHumanDignity)
无望感(Hopelessness)
自我认同紊乱(DisturbedPersonalIdentity)
有孤独的危险(RiskforLoneliness)
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)
有自我概念改善的趋势(ReadinessforEnhancedSelf-Concept)
情境性低自尊(SituationallowSelf-Esteem)
长期性低自尊(ChronicLowSelf-Esteem)
有情境性低自尊的危险(RiskforSituationalLowSelf-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(RiskforImpairedParent/Infant/ChildAttachment)
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)
母乳喂养有效(EffectiveBreastfeeding)母乳喂养无效(IneffectiveBreastfeeding)
母乳喂养中断(InterruptedBreastfeeding)
父母角色冲突(ParentalRoleConflict)
有关系改善的趋势(ReadinessforEnhancedRelationship)
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(IneffectiveSexualityPatterns)
有生育进程改善的趋势(ReadinessforEnhancedChildbearingProcess)
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)
创伤后综合征(PostTraumaSyndrome)
有创伤后综合征的危险(RiskforPostTraumaSyndrome)
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)
焦虑(Anxiety)
对死亡的焦虑(DeathAnxiety)
有威胁健康的行为(Risk-ProneHealthBehavior)
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)
社区应对无效(IneffectiveCommunityCoping)
有应对增强的趋势(ReadinessforEnhancedCoping)
有社区应对增强的趋势(ReadinessforEnhancedCommunityCoping)
有家庭应对增强的趋势(ReadinessforEnhancedFamilyCoping)
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)
个人恢复能力障碍(ImpairedIndividualResilience)
有恢复能力受损的危险(RiskforCompromisedResilience)
有恢复能力增强的趋势(ReadinessforEnhancedResilience)
持续性悲伤(ChronicSorrow)
压力负荷过重(StressOverload)
自主性反射失调(AutonomicDysreflexia)
有自主性反射失调的危险(RiskforAutonomicDysreflexia)
婴儿行为紊乱(DisorganizedInfantBehavior)
有婴儿行为紊乱的危险(RiskforDisorganizedInfantBehavior)
有婴儿行为调节改善的趋势(ReadinessforEnhancedOrganizedInfantBehavior)颅内调适能力降低(DecreasedIntracranialAdaptiveCapacity)
领域10:
生活准则(LifePrinciples)
有希望增强的趋势(ReadinessforEnhancedHope)
有精神安适增进的趋势(ReadinessforEnhancedSpiritualWell-being)
抉择冲突(DecisionalConflict)
道德困扰(MoralDistress)
不依从行为(Noncompliance)
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)
有感染的危险(RiskforInfection)
清理呼吸道无效(IneffectiveAirwayClearance)
有误吸的危险(RiskforAspiration)
有婴儿猝死综合症的危险(RiskforSuddenInfantDeathSyndrome)
牙齿受损(ImpairedDentition)
有跌倒的危险(RiskforFalls)
有受伤害的危险(RiskforInjury)
有手术期体位性损伤的危险(RiskforPerioperative-PositioningInjury)
口腔黏膜受损(ImpairedOralMucousMembrane)
有外周神经血管功能障碍的危险(RiskforPeripheralNeurovascularDysfunction)防护能力低下(IneffectiveProtection)
皮肤完整性受损(ImpairedSkinIntegrity)
有皮肤完整性受损的危险(RiskforImpairedSkinIntegrity)
有窒息的危险(RiskforSuffocation)
组织完整性受损(ImpairedTissueIntegrity)
有外伤的危险(RiskforTrauma)
有血管损伤的危险(RiskforVascularTrauma)
自伤(Self-Mutilation)
有自伤的危险(RiskforSelf-Mutilation)
有自杀的危险(RiskforSuicide)
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)
受污染(Contamination)
有受污染的危险(RiskforContamination)有中毒的危险(RiskforPoisoning)
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)
有舒适增进的趋势(ReadinessforEnhancedComfort)
舒适度减弱(ImpairedComfort)
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)
成人身心功能衰退(AdultFailuretoThrive)
生长发展迟缓(DelayedGrowthandDevelopment)
有发展迟缓的危险(RiskforDelayedDevelopment)
有生长比例失调的危险(RiskforDisproportionateGrowth)