NANDA-I Nursing Diagnoses: 2024-2026
A curated list of current diagnoses, their levels of evidence, and related factors based on the Thirteenth Edition.
Domain 1. Health Promotion
Decreased diversional activity engagement (00097)
Level of Evidence: 2.1
Related Factors
- Current setting does not allow engagement in activities
- Impaired physical mobility
- Inadequate available activities
- Inadequate motivation
- Inadequate physical endurance
- Prolonged inactivity
- Psychological distress
- Unaddressed environmental constraints
Risk for decreased diversional activity engagement (00448)
Level of Evidence: 2.1
Risk Factors
- Current setting does not allow engagement in activities
- Impaired physical mobility
- Inadequate available activities
- Inadequate motivation
- Inadequate physical endurance
- Psychological distress
- Unaddressed environmental constraints
- Unaddressed physical discomfort
Excessive sedentary behaviors (00355)
Level of Evidence: 3.2
Related Factors
- Conflict between cultural beliefs and health practices
- Difficulty adapting areas for physical activity
- Exceeds screen time recommendations for age
- Impaired physical mobility
- Inadequate interest in physical activity
- Inadequate knowledge of consequences of sedentarism
- Inadequate knowledge of health benefits associated with physical activity
- Inadequate motivation for physical activity
- Inadequate physical endurance
- Inadequate resources for physical activity
- Inadequate role models
- Inadequate self-efficacy
- Inadequate self-esteem
- Inadequate social support
- Inadequate time management skills
- Inadequate training for physical exercise
- Negative affect toward physical activity
- Pain
- Parenting practices that inhibit child's physical activity
- Perceived physical disability
- Perceived safety risk
Risk for excessive sedentary behaviors (00394)
Level of Evidence: 3.2
Risk Factors
- Conflict between cultural beliefs and health practices
- Difficulty adapting areas for physical activity
- Exceeds screen time recommendations for age
- Impaired physical mobility
- Inadequate interest in physical activity
- Inadequate knowledge of consequences of sedentarism
- Inadequate knowledge of health benefits associated with physical activity
- Inadequate motivation for physical activity
- Inadequate physical endurance
- Inadequate resources for physical activity
- Inadequate role models
- Inadequate self-efficacy
Imbalanced energy field (00273)
Level of Evidence: 2.3
Related Factors
- Anxiety
- Excessive stress
- Pain
- Unaddressed physical discomfort
- Unaddressed psychological discomfort
Ineffective health self-management (00276)
Level of Evidence: 3.3
Related Factors
- Competing demands
- Competing lifestyle preferences
- Conflict between cultural beliefs and health practices
- Conflict between health behaviors and social norms
- Conflict between spiritual beliefs and treatment regimen
- Confusion
- Decreased quality of life
- Depressive symptoms
- Difficulty accessing community resources
- Difficulty managing complex treatment regimen
- Difficulty navigating complex health care systems
- Difficulty performing aspects of treatment regimen
- Difficulty with decision-making
- Excessive stress
- Inadequate commitment to a plan of action
- Inadequate health literacy
- Inadequate knowledge of treatment regimen
- Inadequate number of cues to action
- Inadequate role models
- Inadequate self-efficacy
- Inadequate social support
- Negative feelings toward treatment regimen
- Nonacceptance of condition
- Perceived barrier to treatment regimen
- Perceived social stigma associated with condition
- Substance misuse
- Unaware of seriousness of condition
- Unaware of susceptibility to sequelae
- Unrealistic expectation of treatment benefit
Risk for ineffective health self-management (00369)
Level of Evidence: 3.3
Risk Factors
- Competing demands
- Competing lifestyle preferences
- Conflict between cultural beliefs and health practices
- Conflict between health behaviors and social norms
- Conflict between spiritual beliefs and treatment regimen
- Confusion
- Decreased quality of life
- Depressive symptoms
- Difficulty accessing community resources
- Difficulty managing complex treatment regimen
- Difficulty navigating complex health care systems
- Difficulty performing aspects of treatment regimen
- Difficulty with decision-making
- Excessive stress
- Inadequate commitment to a plan of action
- Inadequate health literacy
- Inadequate knowledge of treatment regimen
- Inadequate number of cues to action
- Inadequate role models
- Inadequate self-efficacy
- Inadequate social support
- Negative feelings toward treatment regimen
- Nonacceptance of condition
- Perceived barrier to treatment regimen
- Perceived social stigma associated with condition
- Substance misuse
- Unaware of seriousness of condition
- Unaware of susceptibility to sequelae
- Unrealistic expectation of treatment benefit
Readiness for enhanced health self-management (00293)
Level of Evidence: 3.3
No related factors listed for this diagnosis.
Ineffective family health management (00080)
Level of Evidence: 2.1
Related Factors
- Competing demands on family unit
- Competing lifestyle preferences within family unit
- Conflict between health behaviors and social norms
- Conflict between spiritual beliefs and treatment regimen
- Difficulty accessing community resources
- Difficulty dealing with role changes associated with condition
- Difficulty managing complex treatment regimen
- Difficulty navigating complex health care systems
- Difficulty performing aspects of treatment regimen
- Difficulty with decision-making
- Family conflict
- Inadequate commitment to a plan of action
- Inadequate health literacy of caregiver
- Inadequate knowledge of treatment regimen
- Inadequate number of cues to action
- Inadequate self-efficacy
- Inadequate social support
- Ineffective communication skills
- Ineffective coping skills
- Negative feelings toward treatment regimen
- Nonacceptance of condition
- Perceived barrier to treatment regimen
- Perceived social stigma associated with condition
- Substance misuse
- Unaware of seriousness of condition
- Unaware of susceptibility to sequelae
- Unrealistic expectation of treatment benefit
- Unsupportive family relationships
Risk for ineffective family health management (00410)
Level of Evidence: 2.1
Risk Factors
- Competing demands on family unit
- Competing lifestyle preferences within family unit
- Conflict between health behaviors and social norms
- Conflict between spiritual beliefs and treatment regimen
- Difficulty accessing community resources
- Difficulty dealing with role changes associated with condition
- Difficulty managing complex treatment regimen
- Difficulty navigating complex health care systems
- Difficulty performing aspects of treatment regimen
- Difficulty with decision-making
- Family conflict
- Inadequate commitment to a plan of action
- Inadequate health literacy of caregiver
- Inadequate knowledge of treatment regimen
- Inadequate number of cues to action
- Inadequate self-efficacy
- Inadequate social support
- Ineffective communication skills
- Ineffective coping skills
- Negative feelings toward treatment regimen
- Nonacceptance of condition
- Perceived barrier to treatment regimen
- Perceived social stigma associated with condition
- Substance misuse
- Unaware of seriousness of condition
- Unaware of susceptibility to sequelae
- Unrealistic expectation of treatment benefit
- Unsupportive family relationships
Ineffective community health management (00356)
Level of Evidence: 2.1
Related Factors
- Inadequate access to health personnel
- Inadequate community support for programs
- Inadequate consumer satisfaction with programs
- Inadequate expertise within the community
- Inadequate health resources
- Inadequate program budget
- Inadequate program evaluation plan
- Inadequate program outcome data
- Programs incompletely address health problems
Risk for ineffective community health management (00413)
Level of Evidence: 2.1
Risk Factors
- Inadequate access to health personnel
- Inadequate community support for programs
- Inadequate consumer satisfaction with programs
- Inadequate expertise within the community
- Inadequate health resources
- Inadequate program budget
- Inadequate program evaluation plan
- Inadequate program outcome data
- Programs incompletely address health problems
Domain 2. Nutrition
Inadequate nutritional intake (00343)
Level of Evidence: 3.2
Related Factors
- Altered taste perception
- Depressive symptoms
- Difficulty establishing social interaction
- Difficulty independently performing activities of daily living
- Difficulty independently performing instrumental activities of daily living
- Dry mouth
- Food aversion
- Food insecurity
- Impaired oral mucous membrane integrity
- Impaired swallowing
- Inaccurate information
- Inadequate appetite
- Inadequate caregiver knowledge of feeding strategies
- Inadequate caregiver knowledge of metabolic needs
- Inadequate caregiver knowledge of strategies to manage appetite
- Inadequate cooking skills
- Inadequate food supply
- Inadequate interest in food
- Inadequate knowledge of nutrient requirements
- Inadequate physical activity for nutrient absorption
- Inadequate social support
- Inappropriate management of food allergies
- Inappropriate utensils
- Interrupted chestfeeding
- Satiety immediately upon ingesting food
- Unaddressed inadequate dentition
- Unattractive food presentation
- Unpleasant ambient environment
- Unrealistic expectation of ability to ingest food
- Weakened muscles required for swallowing
- Weakening of muscles required for mastication
Risk for inadequate nutritional intake (00409)
Level of Evidence: 3.2
Risk Factors
- Altered taste perception
- Depressive symptoms
- Difficulty establishing social interaction
- Difficulty independently performing activities of daily living
- Difficulty independently performing instrumental activities of daily living
- Dry mouth
- Food aversion
- Food insecurity
- Impaired oral mucous membrane integrity
- Impaired swallowing
- Inaccurate information
- Inadequate appetite
- Inadequate caregiver knowledge of feeding strategies
- Inadequate caregiver knowledge of metabolic needs
- Inadequate caregiver knowledge of strategies to manage appetite
- Inadequate cooking skills
- Inadequate food supply
- Inadequate interest in food
- Inadequate knowledge of nutrient requirements
- Inadequate physical activity for nutrient absorption
- Inadequate social support
- Inappropriate management of food allergies
- Inappropriate utensils
- Interrupted chestfeeding
- Satiety immediately upon ingesting food
- Unaddressed inadequate dentition
- Unattractive food presentation
- Unpleasant ambient environment
- Unrealistic expectation of ability to ingest food
- Weakened muscles required for swallowing
- Weakening of muscles required for mastication
Readiness for enhanced nutritional intake (00419)
Level of Evidence: 2.1
No related factors listed for this diagnosis.
Impaired swallowing (00103)
Level of Evidence: 3.2
Related Factors
- Behavioral feeding problem
- Decreased attention
- Protein-energy malnutrition
- Self-injurious behavior
Neonatal hyperbilirubinemia (00194)
Level of Evidence: 2.1
Related Factors
- Inadequate fluid intake
- Inadequate fluid volume
- Inadequate meconium passage
- Inadequate parental feeding behavior
- Malnourished infants
Risk for neonatal hyperbilirubinemia (00230)
Level of Evidence: 2.1
Risk Factors
- Inadequate fluid intake
- Inadequate fluid volume
- Inadequate meconium passage
- Inadequate parental feeding behavior
- Malnourished infants
Excessive fluid volume (00026)
Level of Evidence: 2.1
Related Factors
- Excessive fluid intake
- Excessive sodium intake
- Inadequate knowledge about fluid needs
- Ineffective medication self-management
Risk for excessive fluid volume (00370)
Level of Evidence: 2.1
Risk Factors
- Excessive fluid intake
- Excessive sodium intake
- Inadequate knowledge about fluid needs
- Ineffective medication self-management
Inadequate fluid volume (00421)
Level of Evidence: 2.1
Related Factors
- Difficulty obtaining fluids
- Impaired physical mobility
- Inadequate fluid intake
- Inadequate knowledge about fluid needs
- Inadequate muscle mass
- Ineffective medication self-management
- Malnutrition
Risk for inadequate fluid volume (00420)
Level of Evidence: 2.1
Risk Factors
- Difficulty obtaining fluids
- Impaired physical mobility
- Inadequate fluid intake
- Inadequate knowledge about fluid needs
- Inadequate muscle mass
- Ineffective medication self-management
- Malnutrition
Domain 3. Elimination and Exchange
Impaired urinary elimination (00016)
Level of Evidence: 3.1
Related Factors
- Alcohol consumption
- Caffeine consumption
- Fecal impaction
- Improper toileting posture
- Inadequate privacy
- Ineffective overweight self-management
- Ineffective toileting habits
- Involuntary sphincter relaxation
- Pelvic organ prolapse
- Tobacco use
- Unaddressed environmental constraints
- Use of aspartame
- Weakened bladder muscle
- Weakened pelvic floor
Impaired gas exchange (00030)
Level of Evidence: 3.3
Related Factors
- Ineffective airway clearance
- Ineffective breathing pattern
- Pain
Domain 4. Activity/Rest
Ineffective sleep pattern (00337)
Level of Evidence: 2.1
Related Factors
- Anxiety
- Average daily physical activity is less than recommended for age and gender
- Caffeine consumption within 6 hours of sleep
- Decreased sleep efficiency
- Depressive symptoms
- Excessive caregiving burden
- Excessive processed food intake
- Excessive stress
- Excessive sugar intake
- Excessive use of interactive electronic devices
- Fear
- Impaired resilience
- Inadequate glycemic control
- Inadequate knowledge of age-related sleep shifts
- Inadequate knowledge of importance of sleep hygiene behaviors
- Inadequate privacy
Impaired physical mobility (00085)
Level of Evidence: 2.1
Related Factors
- Anxiety
- Cultural belief regarding acceptable activity
- Decreased muscle control
- Disuse
- Inadequate environmental support
- Inadequate knowledge of physical activity benefits
- Inadequate muscle mass
- Inadequate muscle strength
- Inadequate physical endurance
- Ineffective overweight self-management
- Joint stiffness
- Malnutrition
- Pain
- Prolonged immobility
- Reluctance to initiate movement
- Sedentary behaviors
- Unaddressed physical discomfort
Risk for impaired physical mobility (00324)
Level of Evidence: 2.1
Risk Factors
- Anxiety
- Cultural belief regarding acceptable activity
- Decreased muscle control
- Disuse
- Inadequate environmental support
- Inadequate knowledge of physical activity benefits
- Inadequate muscle mass
- Inadequate muscle strength
- Inadequate physical endurance
- Ineffective overweight self-management
- Joint stiffness
- Malnutrition
- Pain
- Prolonged immobility
- Reluctance to initiate movement
- Sedentary behaviors
- Unaddressed physical discomfort
Decreased activity tolerance (00298)
Level of Evidence: 3.2
Related Factors
- Depressive symptoms
- Fear of pain
- Imbalance between oxygen supply/demand
- Impaired physical mobility
- Inadequate muscle mass
- Inexperience with an activity
- Malnutrition
- Muscle weakness
- Pain
- Prolonged inactivity
- Sedentary behaviors
- Unaddressed vitamin D deficiency
Risk for decreased activity tolerance (00299)
Level of Evidence: 3.2
Risk Factors
- Depressive symptoms
- Fear of pain
- Imbalance between oxygen supply/demand
- Impaired physical mobility
- Inadequate muscle mass
- Inexperience with an activity
- Malnutrition
- Muscle weakness
- Pain
- Prolonged inactivity
- Sedentary behaviors
- Unaddressed vitamin D deficiency
Ineffective breathing pattern (00032)
Level of Evidence: 3.3
Related Factors
- Anxiety
- Body position that inhibits lung expansion
- Excessive airway secretions
- Excessive fatigue burden
- Increased physical exertion
- Ineffective cough
- Ineffective overweight self-management
- Pain
- Respiratory muscle fatigue
Decreased self-care ability syndrome (00331)
Level of Evidence: 2.1
Related Factors
- Anxiety
- Decreased motivation
- Impaired physical comfort
- Impaired physical mobility
- Impaired postural balance
- Muscle hypotonia
- Pain
- Prolonged inactivity
- Self-neglect
- Unaddressed environmental constraints
- Weakness
Domain 5. Perception / cognition
Acute confusion (00128)
Level of Evidence: 2.1
Related Factors
- Environmental sensory deprivation
- Environmental sensory overstimulation
- Hyperthermia
- Inadequate fluid volume
- Inappropriate use of physical restraint
- Protein-energy malnutrition
- Sedentary behaviors
- Severe pain
- Substance misuse
- Unaddressed sleep deprivation
- Unaddressed vitamin B12 deficiency
- Urinary retention
Risk for acute confusion (00173)
Level of Evidence: 2.2
Risk Factors
- Environmental sensory deprivation
- Environmental sensory overstimulation
- Hyperthermia
- Inadequate fluid volume
- Inappropriate use of physical restraint
- Protein-energy malnutrition
- Sedentary behaviors
- Severe pain
- Substance misuse
- Unaddressed sleep deprivation
- Unaddressed vitamin B12 deficiency
- Urinary retention
Chronic confusion (00129)
Level of Evidence: 3.1
Related Factors
- Chronic sorrow
- Excessive alcohol consumption
- Inadequate environmental sensory stimulation
- Sedentary behaviors
- Substance misuse
Impaired verbal communication (00051)
Level of Evidence: 3.2
Related Factors
- Dyspnea
- Emotional lability
- Inability to speak language of caregiver
- Inadequate self-concept
- Inadequate self-esteem
- Inadequate stimulation
- Perceived vulnerability
- Psychological barriers
- Substance misuse
- Unaddressed environmental constraints
- Values incongruent with cultural norms
Domain 6. Self-perception
Readiness for enhanced self-concept (00167)
Level of Evidence: 2.1
No related factors listed for this diagnosis.
Disrupted body image (00497)
Level of Evidence: 3.2
Related Factors
- Conflict between spiritual beliefs and treatment regimen
- Conflict between values and cultural norms
- Distrust of body function
- Fear of disease recurrence
- Inadequate self-efficacy
- Inadequate self-esteem
- Ineffective overweight self-management
- Negative body consciousness
- Residual limb pain
- Unaddressed body shaming
- Unrealistic expectation of treatment outcome
- Unrealistic self-expectations
Domain 7. Role relationship
Impaired parenting behaviors (00436)
Level of Evidence: 3.1
Related Factors
- Decreased emotion recognition abilities
- Depressive symptoms
- Difficulty establishing social interaction
- Difficulty managing complex treatment regimen
- Difficulty solving problems
- Emotional vacillation
- Excessive use of interactive electronic devices
- Impaired family processes
- Inadequate knowledge about child development
- Inadequate knowledge about child health maintenance
- Inadequate parental role model
- Inadequate self-efficacy
- Inadequate social support
- Inadequate transportation
- Inattentive to child’s needs
- Marital conflict
- Nonrestorative sleep-wake cycle
- Perceived economic strain
- Substance misuse
- Unaddressed intimate partner violence
Impaired social interaction (00052)
Level of Evidence: 2.1
Related Factors
- Confusion
- Depressive symptoms
- Disturbed thought processes
- Impaired physical mobility
- Inadequate communication skills
- Inadequate knowledge about how to enhance mutuality
- Inadequate personal hygiene practices
- Inadequate self-concept
- Inadequate social skills
- Inadequate social support
- Maladaptive grieving
- Sociocultural dissonance
- Unaddressed environmental constraints
- Unaddressed halitosis
Domain 8. Sexuality
Impaired sexual function (00386)
Level of Evidence: 2.1
Related Factors
- Conflicts between spiritual beliefs and health practices
- Depressive symptoms
- Difficulty focusing on erotic cues
- Dysfunctional sexual beliefs
- Excessive alcohol consumption
- Excessive stress
- Fear of intimacy
- Inaccurate information about sexual function
- Inadequate knowledge about sexual function
- Inadequate privacy
- Inadequate role models
- Ineffective overweight self-management
- Negative evaluation of one's body
- Nonacceptance of condition
- Perceived vulnerability
- Unaddressed abuse
- Unrealistic sexual performance expectations
- Value conflict
Risk for impaired maternal-fetal dyad (00349)
Level of Evidence: 3.2
Risk Factors
- Alcohol consumption during pregnancy
- Inadequate partner support
- Inadequate prenatal care
- Inadequate social support
- Substance misuse
- Tobacco use during pregnancy
- Unaddressed abuse
Domain 9. Coping / stress tolerance
Post-trauma syndrome (00141)
Level of Evidence: 2.1
Related Factors
- Diminished ego strength
- Environment not conducive to needs
- Exaggerated sense of responsibility
- Inadequate social support network
Risk for post-trauma syndrome (00145)
Level of Evidence: 2.1
Risk Factors
- Diminished ego strength
- Environment not conducive to needs
- Exaggerated sense of responsibility
- Inadequate social support
Maladaptive coping (00405)
Level of Evidence: 2.1
Related Factors
- High degree of threat
- Impaired resilience
- Inaccurate threat appraisal
- Inadequate access to resources
- Inadequate confidence in ability to deal with a situation
- Inadequate knowledge of resources
- Inadequate knowledge of stress management strategies
- Inadequate preparation for stressors
- Inadequate sense of control
- Inadequate social support
- Inadequate use of emotion-focused strategies
- Inadequate use of problem-focused strategies
Ineffective emotion regulation (00372)
Level of Evidence: 2.1
Related Factors
- Excessive stress
- Fatigue
- Inadequate knowledge about symptom control
- Inadequate knowledge of disease process
- Inadequate self-esteem
- Muscle weakness
- Social distress
- Substance misuse
Domain 10. Life principles
Moral distress (00175)
Level of Evidence: 2.1
Related Factors
- Conflict among decision-makers
- Difficulty making end-of-life decisions
- Difficulty making treatment decision
- Information available for decision-making conflicts
- Time constraint for decision-making
- Values incongruent with cultural norms
Impaired religiosity (00169)
Level of Evidence: 2.1
Related Factors
- Anxiety
- Cultural barrier to practicing religion
- Depressive symptoms
- Fear of death
- Inadequate social support
- Inadequate sociocultural interaction
- Inadequate transportation
- Ineffective caregiving
- Ineffective use of coping strategies
- Insecurity
- Pain
- Spiritual distress
- Unaddressed environmental constraints
Domain 11. Safety / protection
Impaired immune response (00361)
Level of Evidence: 2.1
Related Factors
- Depressive symptoms
- Difficulty managing complex treatment regimen
- Hopelessness
- Inadequate access to vaccines
- Inadequate immunization level within community
- Inadequate self-efficacy
- Ineffective health self-management
- Ineffective overweight self-management
- Ineffective sleep pattern
- Maladaptive stress response
- Malnutrition
- Prolonged immobility
- Sedentary behavior occurring for ≥ 2 hours/day
- Substance misuse
- Tainted dietary source
- Vaccine hesitancy
Contamination (00181)
Level of Evidence: 2.1
Related Factors
- Carpeted flooring
- Chemical contamination of food
- Chemical contamination of water
- Flaking, peeling surface in presence of young children
- Inadequate breakdown of contaminant
- Inadequate household hygiene practices
- Inadequate municipal services
- Inadequate personal hygiene practices
- Inadequate protective clothing
- Inappropriate use of protective clothing
- Individuals who ingested contaminated material
- Playing where environmental contaminants are used
- Unprotected exposure to chemical
- Unprotected exposure to heavy metal
- Unprotected exposure to radioactive material
- Use of environmental contaminant in the home
- Use of noxious material in inadequately ventilated area
- Use of noxious material without effective protection
- Concomitant exposure
- Malnutrition
- Tobacco use
Domain 12. Comfort
Impaired physical comfort (00380)
Level of Evidence: 2.1
Related Factors
- Excessive physical activity
- Impaired bowel elimination
- Impaired tissue integrity
- Inadequate health resources
- Inadequate knowledge of modifiable factors
- Inadequate situational control
- Inappropriate room temperature control
- Ineffective airway clearance
- Ineffective nausea self-management
- Unaddressed excessive perspiration
- Unaddressed excessive shivering
- Unaddressed excessive sinus drainage
- Unaddressed frequent bowel movements
- Unaddressed frequent voiding
- Unaddressed hunger
- Unaddressed muscle spasm
- Unaddressed muscle tension
- Unaddressed needs
- Unaddressed thirst
- Unaddressed tiredness
- Unaddressed unpleasant environmental stimuli
- Unaddressed vertigo
- Unaddressed vomiting
Acute pain (00132)
Level of Evidence: 2.1
Related Factors
- Biological injury agent
- Inappropriate use of chemical agent
- Physical injury agent
Chronic pain (00133)
Level of Evidence: 2.1
Related Factors
- Difficulty establishing social interaction
- Ineffective fatigue self-management
- Ineffective overweight self-management
- Ineffective sexuality pattern
- Injury agent
- Malnutrition
- Prolonged computer use
- Psychological distress
- Repeated handling of heavy loads
- Whole-body vibration
Domain 13. Growth / development
Delayed child growth (00348)
Level of Evidence: 2.2
Related Factors
- Abnormal eating pattern
- Affectional deprivation
- Inadequate access to safe drinking water
- Inadequate diet for age
- Inadequate parental feeding techniques
- Inadequate parental knowledge regarding nutrition
- Parents inattentive to second-hand smoke
- Unsanitary housing
Delayed child development (00314)
Level of Evidence: 2.3
Related Factors
- Inadequate access to health personnel
- Inadequate attachment behavior
- Inadequate stimulation
- Unaddressed abuse
- Unaddressed psychological neglect
- Depressive symptoms
- Excessive anxiety
- Excessive stress
- Inadequate emotional support
- Unaddressed domestic violence
Risk for delayed child development (00305)
Level of Evidence: 2.3
Risk Factors
- Infant or child factors:
- Inadequate access to health personnel
- Inadequate attachment behavior
- Inadequate stimulation
- Unaddressed abuse
- Unaddressed psychological neglect
- Caregiver factors:
- Depressive symptoms
- Excessive anxiety
- Excessive stress
- Inadequate emotional support
- Unaddressed domestic violence
Delayed infant motor development (00315)
Level of Evidence: 3.1
Related Factors
- Infant factors:
- Difficulty with sensory processing
- Inadequate curiosity
- Inadequate initiative
- Inadequate persistence
- Caregiver factors:
- Anxiety about infant care
- Birth parent postpartum depressive symptoms
- Carries infant in arms for excessive time
- Does not allow infant to choose physical activities
- Does not allow infant to choose toys
- Does not encourage infant to grasp
- Does not encourage infant to reach
- Does not encourage sufficient play with other children
- Does not engage infant in games about body parts
- Does not supply fine motor toys for infant
- Does not supply gross motor toys for infant
- Does not teach movement words
- Inadequate time between periods of infant stimulation
- Limits infant experiences in the prone position
- Negative opinion of infant temperament
- Overstimulation of infant
- Perceived infant care incompetence
Risk for delayed infant motor development (00316)
Level of Evidence: 3.1
Risk Factors
- Infant factors:
- Difficulty with sensory processing
- Inadequate curiosity
- Inadequate initiative
- Inadequate persistence
- Caregiver factors:
- Anxiety about infant care
- Birth parent postpartum depressive symptoms
- Carries infant in arms for excessive time
- Does not allow infant to choose toys
- Does not encourage infant to grasp
- Does not encourage infant to reach
- Does not encourage sufficient play with other children
- Does not engage infant in games about body parts
Impaired infant neurodevelopmental organization (00451)
Level of Evidence: 2.1
Related Factors
- Environmental overstimulation
- Excessive stress
- Feeding intolerance
- Inadequate caregiver knowledge of behavioral cues
- Inadequate caregiver recognition of infant behavioral cues
- Inadequate caregiver responsiveness to infant
- Inadequate containment within environment
- Inadequate environmental supportive positioning
- Inadequate environmental sensory stimulation
- Inadequate physical environment
- Malnutrition
- Sensory deprivation
- Sensory overstimulation
- Unaddressed pain
- Unaddressed poor sleep quality
Risk for impaired infant neurodevelopmental organization (00452)
Level of Evidence: 2.1
Risk Factors
- Environmental overstimulation
- Excessive stress
- Feeding intolerance
- Inadequate caregiver knowledge of behavioral cues
- Inadequate caregiver recognition of infant behavioral cues
- Inadequate caregiver responsiveness to infant
- Inadequate containment within environment
- Inadequate environmental supportive positioning
- Inadequate environmental sensory stimulation
- Inadequate physical environment
- Malnutrition
- Sensory deprivation
- Sensory overstimulation
- Unaddressed pain
- Unaddressed poor sleep quality
Readiness for enhanced infant neurodevelopmental organization (00453)
Level of Evidence: 2.1
No related factors listed for this diagnosis.
Ineffective infant suck-swallow response (00295)
Level of Evidence: 2.1
Related Factors
- Hypothermia
- Inappropriate positioning
- Muscle hypotonia
- Unaddressed hypoglycemia
- Unsatisfactory sucking behavior
This list is intended as a quick reference. For complete definitions, defining characteristics, and clinical application, please consult the official NANDA-I publication.
A Guide to Creating Effective Nursing Care Plans
Core Principles of Nursing Care Planning
A nursing care plan is a formal process that correctly identifies a patient's needs and goals, sets a clear plan of action, and provides a framework for evaluation. Adhering to the following principles ensures the plan is comprehensive, effective, and patient-centered.
-
1. Follow the Nursing Process (ADPIE): The care plan is the written manifestation of the five-step nursing process.
- Assessment: Gather comprehensive subjective and objective data.
- Diagnosis: Analyze data to identify the patient's health problems using an approved NANDA-I diagnosis.
- Planning: Set clear, measurable, patient-centered goals (outcomes).
- Implementation: Carry out the nursing interventions designed to meet the goals.
- Evaluation: Determine if the goals were met and revise the plan as needed.
- Specific: Clearly state what is to be achieved.
- Measurable: Include criteria to measure success (e.g., "respiratory rate between 16-20 breaths/min").
- Achievable: The goal must be realistic for the patient.
- Relevant: The goal must relate directly to the nursing diagnosis.
- Time-bound: Set a specific timeframe for achieving the goal (e.g., "by the end of the shift," "within 48 hours").
Sample Nursing Care Plan
This example demonstrates how the principles are applied in a clinical scenario, following the logical flow of the nursing process.
| Assessment Data (Subjective & Objective) | Nursing Diagnosis (PES Format) | Goals / Outcomes (SMART) | Nursing Interventions | Rationale | Evaluation |
|---|---|---|---|---|---|
Subjective:
|
Ineffective Airway Clearance related to excessive mucus and retained secretions as evidenced by adventitious breath sounds (rhonchi), ineffective cough, and dyspnea. |
Short-Term Goal:
|
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Goal Met: At the end of the shift, patient's respiratory rate is 18/min, O2 saturation is 95% on room air, and lung sounds are clearer. Continue plan.
Goal Not Met: Patient continues to have labored breathing and rhonchi persist. Re-evaluate and revise plan: consider need for suctioning and notify provider. |
Breakdown of Each Section (Process-Oriented)
1. Assessment Data
This is the foundation of your entire care plan. It's where you list the specific, relevant evidence gathered from the patient. By separating it into subjective data (what the patient tells you) and objective data (what you observe, measure, or test), you create a comprehensive picture that justifies your clinical reasoning.
2. Nursing Diagnosis
After analyzing the assessment data, you formulate the nursing diagnosis. This is your clinical judgment about the patient's health problem. The three-part PES format is standard: the Problem (the NANDA-I label), the Etiology (the "related to" cause), and the Signs/Symptoms (the "as evidenced by" data from your assessment column).
3. Goals / Outcomes
Once the problem is identified, you decide on the desired outcome. What do you want to achieve for the patient? These goals must be patient-centered and written using the SMART format (Specific, Measurable, Achievable, Relevant, Time-bound) to provide a clear target for your care.
4. Nursing Interventions
These are the specific actions you will take to achieve the goals. Interventions should be evidence-based and aimed at addressing the etiology (the "related to" factor) of the diagnosis. Each intervention should be a clear, actionable command.
5. Rationale
The rationale provides the scientific, evidence-based reason for each intervention. It explains *why* a specific action is expected to work. This section is crucial as it demonstrates your understanding of the underlying principles of nursing care.
6. Evaluation
This is the final step, where you assess the patient's response to your interventions and determine if the goals were met. The evaluation should be concrete, referencing the measurable criteria you set in your goal. Based on this evaluation, the care plan is either continued, revised, or resolved.
Nursing Care Plans: Ugandan Hospital Scenarios
Condition: Hyperglycemia
Scenario: Mr. Okello, a 48-year-old boda-boda driver from Gulu, is admitted to the medical ward at St. Mary's Hospital Lacor. He presents with complaints of excessive thirst, frequent urination, and unexplained weight loss over the past two months. He mentions his diet consists mainly of posho (maize meal) and beans. His random blood sugar (RBS) on admission was 22.5 mmol/L. He appears fatigued and has dry mucous membranes.
| Assessment Data | Nursing Diagnosis | Goals / Outcomes | Nursing Interventions | Rationale | Evaluation |
|---|---|---|---|---|---|
| S: "I am always thirsty and passing urine all the time." "I feel tired and have lost weight." O: RBS 22.5 mmol/L, dry mucous membranes, poor skin turgor, reported polyuria and polydipsia. |
Unstable Blood Glucose Level related to insufficient insulin secretion/resistance as evidenced by RBS of 22.5 mmol/L and reported symptoms of hyperglycemia. | Patient's blood glucose will stabilize within the target range of 6-10 mmol/L within 48 hours. | 1. Monitor blood glucose levels q4h and as needed. 2. Administer insulin as per sliding scale/physician's orders. 3. Administer IV fluids as prescribed to rehydrate. 4. Monitor for signs of hypoglycemia (sweating, tremors, confusion). |
1. Frequent monitoring tracks response to treatment and detects fluctuations. 2. Insulin is necessary to facilitate glucose uptake into cells. 3. Rehydration is critical to correct fluid loss from osmotic diuresis. 4. Insulin therapy can lead to hypoglycemia, which requires immediate intervention. |
Goal Met. After 48 hours, patient's RBS has consistently remained between 7.2 and 9.8 mmol/L. |
| S: "I drink a lot of water but still feel dry." O: Dry mucous membranes, poor skin turgor, increased heart rate (98 bpm), hypotension (100/60 mmHg). |
Deficient Fluid Volume related to osmotic diuresis from hyperglycemia as evidenced by dry mucous membranes and poor skin turgor. | Patient will demonstrate adequate hydration, evidenced by moist mucous membranes, good skin turgor, and stable vital signs within 24 hours. | 1. Administer isotonic IV fluids (e.g., Normal Saline) as prescribed. 2. Monitor intake and output accurately. 3. Encourage oral fluid intake as tolerated. 4. Assess vital signs and skin turgor every 4 hours. |
1. IV fluids rapidly restore intravascular volume. 2. Monitoring I&O provides a clear indicator of fluid balance. 3. Oral fluids supplement IV rehydration and promote patient participation. 4. These are key indicators of hydration status. |
Goal Met. Within 24 hours, patient's mucous membranes are moist, skin turgor has improved, and vital signs are within normal limits. |
| S: "I don't know what I am supposed to eat. I mostly eat posho." O: Newly diagnosed with diabetes mellitus, verbalizes lack of knowledge about diet and medication. |
Deficient Knowledge related to new diagnosis of diabetes mellitus as evidenced by patient's questions about diet and disease management. | Patient will verbalize a basic understanding of diabetes, including diet, medication, and signs of hypo/hyperglycemia before discharge. | 1. Assess patient's readiness to learn. 2. Provide simple, clear education on diabetes using locally available food examples (e.g., portion control of matoke, posho; increasing intake of greens). 3. Teach the "teach-back" method for insulin administration technique. 4. Provide written materials in a simple language (Luo/English). |
1. Learning is more effective when the patient is ready and receptive. 2. Tailoring education to the patient's context improves comprehension and adherence. 3. This confirms the patient's understanding and ability to perform the skill correctly. 4. Written materials reinforce learning. |
Goal Met. Before discharge, patient correctly explained his dietary needs, demonstrated proper insulin injection technique, and listed three signs of both high and low blood sugar. |
Condition: Otitis Media
Scenario: A 3-year-old girl, Aisha, is brought to the outpatient clinic at Kawempe National Referral Hospital by her mother. The mother reports Aisha has been crying inconsolably for two days, pulling at her right ear, and has had a fever. The mother admits she first tried putting some warm oil in the ear as her grandmother advised. On examination, the child is febrile (38.8°C), irritable, and the right tympanic membrane is red and bulging.
| Assessment Data | Nursing Diagnosis | Goals / Outcomes | Nursing Interventions | Rationale | Evaluation |
|---|---|---|---|---|---|
| S: Mother reports, "She has been crying and pulling her ear." O: Child is irritable, crying, pulling at right ear. Pain score of 8/10 on FLACC scale. Right tympanic membrane is red and bulging. |
Acute Pain related to inflammation and pressure in the middle ear as evidenced by crying, irritability, and pulling at the affected ear. | Child will show signs of reduced pain, evidenced by a FLACC score of less than 3 and decreased irritability within 4 hours of intervention. | 1. Administer prescribed analgesics (e.g., paracetamol) promptly. 2. Apply a warm, dry compress to the affected ear. 3. Position the child with the head elevated or on the unaffected side. 4. Provide a calm, quiet environment and offer comfort measures like cuddling. |
1. Analgesics block pain pathways, providing relief. 2. Warmth can help soothe the ear and reduce discomfort. 3. This position can help reduce pressure in the middle ear. 4. Comfort measures and a calm environment help the child cope with pain and reduce anxiety. |
Goal Met. Four hours after receiving paracetamol, Aisha is resting quietly, FLACC score is 2/10. |
| S: Mother reports, "She has been very hot." O: Temperature of 38.8°C. Skin is flushed and warm to touch. Tympanic membrane is red and bulging, indicating infection. |
Hyperthermia related to the inflammatory process of infection as evidenced by a temperature of 38.8°C and flushed skin. | Child's temperature will return to the normal range (36.5-37.5°C) within 6 hours. | 1. Administer prescribed antipyretics (e.g., paracetamol) and antibiotics. 2. Remove excess clothing and blankets. 3. Encourage intake of cool fluids (water, juice). 4. Monitor temperature every 2-4 hours. |
1. Antipyretics reduce fever; antibiotics treat the underlying infection. 2. This promotes heat loss through convection. 3. Fluids prevent dehydration, which can be exacerbated by fever. 4. Monitoring tracks the effectiveness of interventions. |
Goal Met. Child's temperature reduced to 37.4°C after 6 hours. |
| S: Mother states, "My grandmother told me to use oil." "What should I do to stop this from happening again?" O: Mother used a traditional remedy before seeking care. Expresses desire for information. |
Readiness for Enhanced Health Management as evidenced by mother's questions regarding prevention and appropriate treatment for otitis media. | Mother will verbalize three preventive measures for otitis media and state the importance of completing the full course of antibiotics before leaving the clinic. | 1. Explain the cause of ear infections in simple terms. 2. Educate on the importance of completing the full antibiotic course, even if the child feels better. 3. Teach preventive measures: avoiding secondhand smoke, importance of immunizations, and avoiding bottle-propping. 4. Advise against putting oils or other substances in the ear. |
1. Understanding the cause helps the parent understand the treatment. 2. Completing antibiotics is crucial to fully eradicate the infection and prevent resistance. 3. These are key evidence-based strategies to reduce the risk of recurrence. 4. This corrects misconceptions and prevents potential harm. |
Goal Met. Mother correctly stated three preventive measures and explained why finishing the medication is important. She agreed not to use traditional remedies for ear pain again. |
Condition: Sickle Cell Anemia (Vaso-occlusive Crisis)
Scenario: David, a 16-year-old boy with a known history of sickle cell disease, is carried into the emergency unit of Mulago National Referral Hospital by his father. He is crying in pain, rating his pain as "10/10" in his back and legs. He has been unable to drink much for the past day due to the pain. He appears dehydrated, with a heart rate of 120 bpm and a respiratory rate of 28/min.
| Assessment Data | Nursing Diagnosis | Goals / Outcomes | Nursing Interventions | Rationale | Evaluation |
|---|---|---|---|---|---|
| S: "The pain is everywhere, my back, my legs... it's a 10/10!" O: Moaning, guarding painful areas, facial grimacing, tachycardia (120 bpm), tachypnea (28/min). |
Acute Pain related to tissue ischemia and vaso-occlusion from sickled red blood cells as evidenced by patient's self-report of 10/10 pain and guarding behaviors. | Patient will report a pain level of less than 4/10 on a 0-10 scale within 4 hours of initiating aggressive pain management. | 1. Administer IV opioid analgesics (e.g., morphine) as prescribed, promptly and around the clock. 2. Apply warm packs to painful joints and areas. 3. Maintain a quiet, restful environment. 4. Reassess pain level 30-60 minutes after each intervention. |
1. Opioids are the mainstay for managing severe pain in a vaso-occlusive crisis. 2. Warmth promotes vasodilation, which can improve blood flow and reduce ischemic pain. 3. Reducing external stimuli helps the patient to rest and cope with pain. 4. Frequent reassessment guides titration of analgesia. |
Goal Met. After 4 hours of IV morphine and hydration, David reports his pain is now 3/10. |
| S: Father reports, "He has not been drinking well because of the pain." O: Tachycardia (120 bpm), dry oral mucosa, decreased skin turgor, concentrated urine. |
Deficient Fluid Volume related to decreased oral intake and increased insensible loss as evidenced by tachycardia and signs of dehydration. | Patient will achieve adequate hydration as evidenced by moist mucous membranes, urine output > 0.5 mL/kg/hr, and heart rate < 100 bpm within 8 hours. | 1. Initiate IV fluid hydration at a maintenance rate or higher, as prescribed. 2. Encourage frequent sips of oral fluids (water, juice) once nausea subsides. 3. Monitor intake, output, and urine specific gravity. 4. Assess for signs of fluid overload (e.g., crackles, edema). |
1. Aggressive hydration is crucial to reduce blood viscosity and prevent further sickling. 2. Oral fluids supplement IV therapy. 3. This ensures adequate rehydration and kidney function. 4. Patients with sickle cell can be at risk for fluid overload, requiring careful monitoring. |
Goal Met. After 8 hours, patient's heart rate is 92 bpm, mucous membranes are moist, and he is producing adequate amounts of clear, yellow urine. |
| S: "I hate this disease. I am always in hospital." O: Appears withdrawn between episodes of pain, makes minimal eye contact, verbalizes frustration with chronic illness. |
Anxiety related to acute pain, hospitalization, and unpredictability of chronic illness as evidenced by verbal expressions of frustration and withdrawal. | Patient will verbalize feelings of anxiety and identify at least one coping strategy he finds helpful by the end of the shift. | 1. Acknowledge the patient's feelings and provide a safe space to talk. 2. Use therapeutic communication; listen actively to his concerns. 3. Introduce distraction techniques (e.g., listening to music on a phone, watching a movie). 4. Involve the father/family in providing emotional support. |
1. Validating feelings reduces distress and builds trust. 2. Active listening shows empathy and encourages the patient to express himself. 3. Distraction can help shift focus away from pain and anxiety. 4. Family support is a powerful coping resource. |
Goal Met. David discussed his fears about missing school with the nurse and stated that listening to music on his father's phone helped him relax. |
Condition: Corneal Ulcer
Scenario: Ms. Nanyonjo, a 35-year-old farmer from Masaka, presents to the eye clinic at Mbarara Regional Referral Hospital. She reports severe pain, redness, and blurred vision in her left eye for four days. She thinks she got some dirt in her eye while working in her shamba (garden). She is visibly distressed and fears she might go blind. Examination reveals a corneal abrasion with an underlying opaque infiltrate, consistent with a corneal ulcer.
| Assessment Data | Nursing Diagnosis | Goals / Outcomes | Nursing Interventions | Rationale | Evaluation |
|---|---|---|---|---|---|
| S: "My eye is so painful, I can't even open it properly." "It feels like sand is scratching it." O: Squinting, excessive tearing, rates pain 9/10, guarding the eye. |
Acute Pain related to corneal nerve irritation from the ulcerative process as evidenced by self-report of 9/10 pain and guarding behavior. | Patient will report a decrease in pain to a level of 3/10 or less within 24 hours of starting treatment. | 1. Administer prescribed topical antibiotic and cycloplegic eye drops as ordered. 2. Encourage the patient to rest in a dimly lit room. 3. Instruct patient not to rub the affected eye. 4. Apply a cool compress over the closed eyelid for comfort. |
1. Antibiotics treat the infection, and cycloplegics reduce painful ciliary muscle spasms. 2. Reducing light exposure minimizes photophobia, a common source of discomfort. 3. Rubbing can worsen the abrasion and increase pain. 4. Cool compresses can help reduce inflammation and soothe the eye. |
Goal Met. After 24 hours of regular eye drop instillation, the patient stated her pain was "much better, maybe a 2/10". |
| S: "I am scared I will not be able to see from this eye again." O: Patient is tearful, voice is trembling, frequently asks about the possibility of blindness. |
Anxiety related to threat to vision and uncertain prognosis as evidenced by expressions of fear and tearfulness. | Patient will verbalize a decrease in anxiety and express understanding of the treatment plan by the end of the clinic visit. | 1. Maintain a calm, reassuring demeanor. 2. Explain all procedures and treatments clearly before performing them. 3. Reinforce the ophthalmologist's explanation of the condition and the importance of adherence to treatment. 4. Answer questions honestly and provide emotional support. |
1. A calm presence can help reduce the patient's anxiety. 2. Explanations reduce fear of the unknown. 3. Understanding the plan and its purpose can empower the patient and give a sense of control. 4. Honest communication builds trust and alleviates fears. |
Goal Met. At the end of her visit, Ms. Nanyonjo was able to explain her treatment schedule and stated, "I feel better now that I know what we are doing to treat it." |
| S: "It's hard to see things clearly with my left eye." O: Corneal opacity visible on examination, patient has difficulty reading chart with affected eye, bumps into objects on her left side. |
Risk for Injury related to impaired vision in the affected eye. | Patient will remain free from injury (e.g., falls, bumps) throughout the duration of her treatment. | 1. Orient the patient to her immediate surroundings. 2. Instruct to keep pathways clear of clutter at home. 3. Advise wearing a protective eye shield, especially at night, as directed. 4. Teach the patient to turn her head to scan her environment to compensate for the visual deficit. |
1. Familiarity with the environment reduces the risk of accidents. 2. A clear pathway minimizes tripping hazards. 3. A shield protects the eye from accidental trauma during sleep. 4. Scanning helps to widen the field of vision and identify potential hazards. |
Goal Met. Patient has remained free from falls or other injuries. She reported using the scanning technique at home to navigate safely. |