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PSYCHIATRIC NURSING MAJOR PLAN OF CARE ASSIGNMENT Guidelines: 1.

This assignment is much like a Case Study and is intended to be a comprehensive learning experience that synthesizes essential psychiatric and medical/surgical nursing theory. Your finished product will demonstrate mastery of principles needed for nurses working with mentally impaired patients. It is similar to other Major Plans of Care with face sheet, lab sheets, TACTIS, assessment forms, and etc., but will be different in that it will incorporate elements of care plans you have already done, along with content you will develop using Nurse Squared, our new Electronic Medical Record software that you will be using. After having worked with this software over the summer, I think you will find it easier to use, in that it will prompt you to fill in every important section, and it will give you many choices to select when developing your nursing problems and interventions, so you wont have to come up with them all on your own. You will, however, have to come up with rationales for each intervention and cite them, as you have in the past. A sample care plan will be provided for you to refer to. It must address the needs of one MENTAL HEALTH patient that you select to work with. The patient should be on at least 2 psych meds. (Remember that you must establish rapport, gain trust, and initiate with the patient before you can move in to the working phase of the nurse-patient relationship. Use your verbal and non-verbal therapeutic communication skills). Select a patient that is not working with another student for this assignment. Try to select a patient that is likely to be hospitalized for several more days or weeks. Check with staff to ensure that there are no imminent discharge plans. Spend some time interacting with your prospective patient before you spend a lot of time gather data from the chart. Some students have made the mistake of selecting a patient who they have not talked to and gathered pages of data, only to find that the patient was not willing to interact. Finding a patient who is more willing to interact will make the whole process much easier. Make a confidential note of the patients identification numbers for medical records review. You must ACTIVELY INTERACT with the patient frequently over a period of two or more days. You are expected to select your nursing goals/expected outcomes for the patient and attempt to achieve them. (Remember that the patient does not have to be exceptionally welcoming or talkative to do this assignment. Identify appropriate nursing interventions for each of your patients NANDA diagnoses. Try to implement as many interventions as possible during your clinical time with the patient. WHAT DIAGNOSES SHOULD YOU LOOK FOR? Schizophrenia and related psychoses Schizoaffective disorder Psychotic Depression; post-partum psychosis Bipolar disorder, either manic or depressed Psychosis related to Dementia/Organic Pathology Psychosis related to Substance Use Disorders Major depression and substance abuse are acceptable as long as your patient is on at least 2 psych meds (If questions, ask instructor.) Most parts of the assignment are to be typed. (You may highlight and write directly on forms provided and assessment tools). Your instructor is expecting to see college level work that is neatly and comprehensively done. Use black ink only in areas not typed. Handwriting needs to be easily read. Use APA format. Submit the completed paper in a very small (1/2 inch or less) lightweight three-ring binder. (Second copies are not required unless specifically requested by instructor). It is due at the time specified by your clinical instructor. Note: Do not submit partial or incomplete papers. Sequence Of Pages: (Assemble your paper in this order) Title Page

2.

3.

4. 5. 6.

7. 8.

9. 10.

Format Of The Plan of Care: 1.

2. 3. 4. 5.

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Face Sheet (Nurse Squared) Process Recording (see example in the lab manual) DSM IV TR Criteria Psychiatric History (Nurse Squared) Psychosocial History

Treatment Plan/Prescribed Treatments (focus on groups and psych treatments) Mental Status Assessment Forms (Nurse Squared and check off sheet included in Lab Manual) Prescribed Medications (Nurse Squared) Lab Sheet - (Nurse Squared, Identify abnormals, cite theory and source/page #) Psychiatric Concept Map - (Include side effects of medications) List of NANDA Diagnoses (Mark all that pertain to patient) Nursing Care Plan (Nurse Squared). Problems 1 - 3 with defining characteristics, expected outcomes, nursing interventions, evaluations of interventions and evaluation of overall goal attainment. (Met, not met, partial/Continue plan/revise). Be sure to use the AAMT format for each problem: A = Assess/ Monitor for problem; A = Actions/Nursing Interventions for problem; M = Medications for problem/why useful/source/See TACTIS; T = Teach what to the patient/family about the problem?/Why? Source. Reference Sheet Internet or Professional Article Research and how the info in the article applies to your patient.

Nursing Diagnoses to consider: 1. On an acute inpatient psych unit, such as Riverside ETS (MHITF), most patients are there on involuntary holds. This means that they are considered dangerous to self, dangerous to others, or gravely disabled (as a result of a mental disorder). Therefore, the most important nursing diagnoses to prioritize would be High Risk for Violence, (self-directed), or High risk for Violence, (other directed), or Thought process, (alteration in). Other diagnoses mentioned in Nurse Squared that address these problems include Aggressive Behavior, Delusions, Hallucinations, Manic Behavior, and Suicidal Behavior. 2. At Patton, and other longer-term settings, with many of the patients, these problems may still apply, and if present, should be prioritized. Other clients will be more stable and will have different issues to address. For these patients, diagnoses (listed in Nurse Squared) to consider might include Anger, Antisocial behavior, Anxiety, Coping, (ineffective individual), Depression, Knowledge Deficit, Noncompliance, Obsessive Thoughts/Compulsive Behavior, Self-care Deficit, Self-concept, (disturbance in), Self-esteem, (disturbance in, low), Sleep Pattern (disturbance in), Social Interaction (impaired), Social Isolation, etc. 3. For Substance abuse patients you should consider Injury (risk for) during acute withdrawal, Coping (ineffective individual), Substance Abuse _____(list substance), Denial (ineffective), etc. What Else? 1. 2. 3. The top three of the five NANDA diagnoses/problems are to be fully developed. (See diagnosis box on Concept Map sheet). Be sure to measure your overall goal at the completion of the problem. Note: MEDICAL DIAGNOSES AND MEDICAL NANDA DIAGNOSES ARE NOT ACCEPTED AND/OR APPROPRIATE FOR THE FIRST THREE DEVELOPED PROBLEMS. You will also need to select two other pertinent diagnoses for your patient (to be listed on the Concept Map but not developed). These can be medical problems if they are currently priority problems for your patient. Consider those listed in your textbook and psychiatric care plan books.

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THERAPEUTIC COMMUNICATION PROCESS RECORDING Directions: Engage in a therapeutic communication session(s) with your patient and record what each of you said. This can most easily be done by setting up a 2-column table. After each comment in your column, you should analyze whether your communication was therapeutic or non-therapeutic. Use the handout on therapeutic communication to guide you. If your responses are therapeutic, list the technique that you used; if non-therapeutic, state, I should have said Pay special attention to your patients nonverbal communication. State your observations after the patients responses. Your process recording should be about 3 pages long. Not all patients will be able to tolerate a conversation that long all at once, so you may come back several times and try to pick up the thread each time. At the end of the session, try to summarize the theme of what the patient was trying to say (anger, sadness, blame-shifting, etc.). Therapeutic communication is a new language that is not easy to learn. I wont expect each of your responses to be therapeutic, nor will I mark you off if they arent, so long as you recognize what you could have done better. Therapeutic Communication Example Student Nurse Hi, my name is Cheri, and Im a nursing student. Is it OK if I sit down and talk with you for a few minutes? (T, broad opening, offers self) How are you feeling today? (T broad opening) Surely things cant be that badthere are many people in the world who have it much worse than you. (NT, false reassurance, rejected patients message) Could have said, It sounds like youre really upset. Tell me about it. (T, reflected patients conversation, general lead.) Theme: Hopelessness. Patient Yes, I guess so. (looks down at the floor)

I feel terrible! I hate it here. Id rather be dead! (looks at scar on wrist) What do you know about how bad I have it? Youre just a student nurse you dont know my life!

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THERAPEUTIC AND NON-THERAPEUTIC TECHNIQUES

I.

THERAPEUTIC TECHNIQUES: A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. Use silence: utilize the absence of verbal communication to allow patient to reflect and gather thoughts. Acceptance: give indication of reception. Yes, I follow what you said. Nodding. Give recognition: acknowledge, indicate awareness. Good morning, Mr. S. I noticed that you combed your hair. Give broad openings: allow the patient to take the lead in conversation. Is there something you would like to talk about? Where would you like to begin? Offer self: make ones self available. Ill sit with you awhile. Im interested in your comfort. Offer general leads: give encouragement to continue. Go on, tell me about it. Place the event in time or sequence: clarify the relationship of events in time. What seemed to lead up to? Was this before or after? Make observations: verbalize what is perceived. You appear tense. Are you uncomfortable when you? Encourage description of perceptions: ask a patient to verbalize what he perceives. Tell me when you feel anxious. What does the voice seem to be saying? Encourage comparisons: ask what similarities and differences are noted. Was this something like? Have you had similar experiences? Restate: repeat the main idea expressed. Patient: I cant sleep, I stay awake all night. Nurse: You have difficulty sleeping? Reflect: direct back to the patient questions, feelings, and ideas. Patient: Do you think I should tell the doctor? Nurse: What do you think you should do? Focus: concentrate on a single point. This point seems worth looking at more closely. Explore: delving further into a subject or idea. Tell me about that. Would you describe more fully? Clarify: seek to make clear that which is not meaningful or which is vague. Im not sure that I follow. What is the main point of what you have said? Validate: search for the mutual understanding, for accord in the meaning of words. Are you using this room. Your mother is not here; I am a nurse. Verbalize the implied: voice what the patient has hinted or suggested. Patient: I cant talk to anyone, its a waste of time. Nurse: Is it your feeling that no one understands? Encourage evaluation: ask the patient to appraise the quality of his experience. What are your feelings in regard to? Does this contribute to your discomfort? Collaborate: offer to share, to strive, to work together with the patient for his benefit. Perhaps you and I can discuss and discover what produces your anxiety.

R. S.

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T. U.

Summarize: organize and sum up that which has gone before. Have I got this straight? During the past hour you and I have discussed Encourage information of a plan of action: ask the patient to consider kinds of behavior likely to be appropriate in future situations. What could you do to let out your anger harmlessly? Next time this comes up, what might you do to handle it? False reassurance: indicate that there is no cause for anxiety. Everything is going to be all right. I wouldnt worry about that. Give approval: sanction the patients ideas or behavior. Thats good, I am glad that you Reject: refuse to consider or shows contempt for the patients ideas or behavior. Lets not discuss that. I dont want to hear about it. Disapprove: denounce the patients behavior or ideas. Thats bad. Id rather you wouldnt. Agree: indicate accord with the patient. Thats right. I believe that. Disagree: oppose the patients ideas. Thats wrong. I dont believe that. Advise: tell the patient what to do. I think you should Why dont you Probe: persistent questions to the patient. Now tell me about Tell me your life history Challenge: demand proof from the patient. If you are dead, why is your heart still beating? How can you be President of the United States? Test: appraise the patients degree of insight. What day is this? Do you still have the idea that Defend: attempt to protect someone or something from verbal attach. Dr. B. is a very good psychiatrist. This hospital has a fine reputation. Request an explanation: ask the patient to provide the reasons for thoughts, feelings, and behavior to others or to outside influences. Why do you think this way? Why did you do that? Belittle feelings expressed: misjudges that degree of the patients discomfort. Patient: I have nothing to live forI wish I was dead. Nurse: Everyone gets down in the dumps. Ive felt that way myself sometimes. Stereotyped comments: offers meaningless clichs, trite expressions. Its for your own good. Just listen to your doctor and take part in activities and youll be home in no time. Giving literal responses: responds to figurative comment as though it were a statement of fact. Patient: Im an Easter egg. Nurse: What color? Uses denial: refuses to admit that a problem exists. Patient: Im nothing Nurse: Of course you are something. Everybody is somebody. Introducing an unrelated topic: changes the subject. Patient: Id like to die. Nurse: Did you have any visitors this weekend?

II.

NON-THERAPEUTIC TECHNIQUES A. B. C. D. E. F. G. H. I. J. K. L.

M.

N.

O. P. Q.

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DSM IV TR Criteria
For each axis 1 or 2 diagnosis on your client, look up the criteria in your textbook or in the DSM IV TR. List the criteria for that diagnosis, and state whether your client meets each symptom. Then make a final judgment: in your judgment, does the client meet the criteria for this disorder? In many cases, clients will seem fine when you talk to them. You made need to go back and look at the record of the behavior when first admitted. In this case you might say, Client does not currently appear to be meeting the criteria for schizophrenia at this time. He is currently receiving Risperdal 2 mg. po bid and responding well. But at time of admission client was acutely psychotic, hearing voices and talking to unseen people. Example Table: Criteria for Schizophrenia: A: Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): B: Social /Occupational Dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset C: Duration: some s/s of the disturbance persist for at least 6 months D: Not due to another psychiatric disorder, or substance abuse. DSM Criteria Client s/s 1. Delusions On admission client believed the CIA was following him 2. Hallucinations Client continues to hear voices telling him hes no good 3. Disorganized speech Not observed 4. Grossly disorganized or catatonic behavior Not observed 5. Negative symptoms: affective flattening, Grooming and hygiene are poor, patient must be alogia, or avolition prompted to perform ADLs. B: Social occupational dysfunction Has not worked in 6 years, receives SSI C: Duration Family reports that this all started 6 years ago D: Not due to drugs or other psych illness Client denies use of drugs, but UDS on admission revealed amphetamines Analysis: Based on my assessment of the client, I believe that he does meet the criteria for schizophrenia. He exhibits 3 of the 5 symptoms for criteria A, has not worked, and has had problems for 6 years. Even though amphetamines were found on the drug screen, client has been inpatient for 3 weeks, and still has some of the same symptoms, including hearing voices.

Blank Tables to Use for Other Common Diagnoses:

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DSM IV TR Criteria for Antisocial Personality Disorder There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following: DSM Criteria Client s/s Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure Impulsivity or failure to plan ahead

Irritability and aggressiveness, as indicated by repeated physical fights or assaults Reckless disregard for safety or self or others

Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another The individual must be at least 18 years old and must have evidence of a conduct disorder occurring before the age of 15. Analyisis:

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Polysubstance Dependence (Substance Dependence)


A maladaptive pattern of substance use as manifested by three or more of the following: DSM Criteria Client s/s Tolerance

Withdrawal

A need for more of the substance than was intended Inability to stop using even when wanting to do so A great deal of time is spent in acquiring the substance or in recovering from its effects Substance use causes social, occupational, or recreational problems Continued substance use despite knowledge that the substance is causing physical or psychological problems

Analysis:

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Major Depression
At least a two week period of maladaptive functioning is present that is a clear change from previous levels of functioning. At least five of the following symptoms must be present during a two week period: DSM Criteria Client s/s Depressed Mood Diminished interests in activities Significant weight loss or gain Insomnia or Hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or guilt Decreased ability to think or make decisions Recurrent thoughts of death, suicide

Analysis:

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Bipolar I Disorder, Manic


A distinct period of abnormal elevation or irritability of mood for at least one week with at least three signs and symptoms: DSM Criteria Client s/s Inflated self-esteem or grandiosity Decreased need for sleep Very talkative Flight of ideas or appearance of racing thoughts Easily distracted Increase in goal directed behavior and agitation Excessively involved in pleasurable activities that have a high potential for personal problems

Analysis:

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Paranoid Schizophrenia (first do the criteria for Schizophrenia, then these criteria, if your patient has Paranoid Schiz).
A type of schizophrenia in which the following criteria are met: DSM Criteria Client s/s A: Preoccupation with one or more delusions or frequent auditory hallucinations B: None of the following is present: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

Analysis:

For Patients with Schizoaffective Disorder, Bipolar Type (or unspecified), use the criteria for Schizophrenia, then the criteria for Manic Episode. For Patients with Schizoaffective Disorder, Depressed Type, use the criteria for schizophrenia, and the criteria for Major Depression. For Patients with Psychosis, Not Otherwise Specified (NOS) or any other NOS diagnosis, talk to your instructor. You will want to pick a real diagnosis, such as schizophrenia to focus on that most closely fits your client.

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PSYCHOSOCIAL HISTORY Include a two-page NARRATIVE summary of the patient that addresses the following: a. b. c. d. e. f. Psychiatric diagnoses, age, sex, ethnicity, religion, work history, financial support, etc. Past psychiatric and medical histories Family constellation/friends/support systems/cultural impact Events that led up to this hospitalization Any other pertinent data that helps to assess patient Multidisciplinary team input from chart and/or treatment team

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MENTAL STATUS/ASSESSMENT OF PSYCHIATRIC SYMPTOMS


INSTRUCTIONS: Check box where applicable. If NORMAL is checked, go to next section. X
GENERAL APPEARANCE NORMAL for Age/Culture Facial Expressions: Sad Expressionless Hostile Worried Avoids Gaze Dress: Meticulous Clothing, Hygiene Poor Eccentric Seductive MOTOR ACTIVITY NORMAL for Age/Culture Increased Amount Decreased Amount Agitation Tics Tremor Peculiar Posturing Unusual Gait Repetitive Acts SPEECH NORMAL for Age/Culture Excessive Amount Poverty of Pressure of Slowed Loud Soft Mute Slurred Stuttering INTERVIEW BEHAVIOR NORMAL for Age/Culture Expansive Suspicious Withdrawn Angry Outbursts Irritable Impulsive Hostile Silly Sensitive Apathetic Evasive Passive Aggressive Naive Overly Dramatic Manipulative Dependent Uncooperative Demanding Negative Callous ADDITIONAL COMMENTS: FLOW OF THOUGHT NORMAL for Age/Culture Blocking Circumstantial Tangential Perseveration Flight of Ideas Loose Associations Indecisive Incoherence Neologisms AFFECT NORMAL for Age/Culture Inappropriate Labile Range: Restricted Blunted Flat MOOD NORMAL for Age/Culture Elevated Euphoric Expansive Dysphoric: Depressed Anxious Irritable SENSORIUM NORMAL for Age/Culture Orientation Impaired: Time Place Person Memory: Clouding of Consciousness Inability to Concentrate Amnesia Poor Recent Memory Poor Remote Memory Confabulation INTELLECT NORMAL for Age/Culture Above Normal Below Normal Paucity of Knowledge Vocabulary Poor Serial Sevens Done Poorly Poor Abstraction CONTENT OF THOUGHT NORMAL for Age/Culture Suicidal Thoughts Suicidal Plans Assaultive Ideas Homicidal Thoughts Homicidal Plans Antisocial Attitudes Suspiciousness Poverty of Content Phobias Obsessions/Compulsions Feelings of Unreality Feels Persecuted Thoughts of Running Away Somatic Complaints Ideas of Guilt Ideas of Hopelessness Ideas of Worthlessness Excessive Religiosity Sexual Preoccupation Blames Others Ideas of Reference Magical Thinking Illogical Thinking Hallucinations: Present Mood-Incongruent Auditory Visual Gustatory Olfactory Somatic Tactile Delusions: Mood-Congruent Mood-Incongruent of Persecution of Grandeur of Reference Somatic Systematized of Being Controlled Bizarre Nihilistic of Poverty Jealousy INSIGHT AND JUDGMENT NORMAL for Age/Culture Poor Insight Poor Judgment Unrealistic Regarding Degree of Illness Doesnt Know Why He is Here Unmotivated for Treatment

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PSYCHIATRIC CONCEPT MAP


Developmental Stage of Life Cycle

Task: Health-Illness Continuum: Maximum Health Oxygen Needs/Circulation Health Elimination Illness Death Nutrition/Hydration

Psychiatric Diagnoses: Axis I: Axis II: Axis III: Axis IV: Axis V:
Problem List/Nursing Diagnosis

Prioritize according to Maslows Hierarchy 1. _________________________________ 2. _________________________________ 3. 4. 5. Neurological/Neurovascular Anxiety Concerns/Fear Knowledge Needs Safety/Security

Love/Belonging/Culture Coping/Body Image

Rest/Activity

Comfort/Sexuality

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(Highlight or underline problems you have chosen. Asterisk all that may pertain to your patient.)
NURSING DIAGNOSES (NANDA, 2009-20011) GROUPED ACCORDING TO CONCEPTUAL FRAMEWORK
Oxygen Needs/Circulation Breathing Airway Clearance, Ineffective Aspiration, Risk for Breathing Pattern, Ineffective Gas Exchange, Impaired Infection, Risk for Sudden Infant Death Syndrome, Risk for Suffocation, Risk for Ventilation, Impaired, Spontaneous Ventilatory Weaning Response, Dysfunctional Circulation Bleeding, Risk for Cardiac Output, Decreased Cardiac Perfusion, Decreased, Risk for Cardiac Tissue Perfusion, Ineffective, Risk for Fluid Balance, Readiness for Enhanced Fluid Volume Deficient Fluid Volume Excess Fluid Volume, Risk for Deficient Fluid Volume, Risk for Imbalanced Vascular Trauma, Risk for Neurological/Neurovascular Neurological Cerebral Tissue Perfusion, Ineffective, Risk for Confusion, Acute Confusion, Acute, Risk for Confusion, Chronic Environmental Interpretation Syndrome, Impaired Infant Behavior, Disorganized Infant Behavior, Readiness for Enhanced Organized Infant Behavior, Risk for Disorganized Intracranial, Decreased Adaptive Capacity Memory, Impaired Neurovascular Dysreflexia, Autonomic Dysreflexia, Risk for Autonomic Peripheral Neurovascular Dysfunction, Risk for Nutrition/Hydration Breastfeeding, Effective Breastfeeding, Ineffective Breastfeeding, Interrupted Dentition, Impaired Electrolyte Imbalance, Risk for Failure to Thrive, Adult Fluid Volume, Deficient Fluid Volume, Deficient, Risk for Gastrointestinal Motility, Dysfunctional Gastrointestinal Motility, Dysfunctional, Risk for Glucose Level, Unstable, Risk for Infant Feeding Pattern, Ineffective Nausea Nutrition: Imbalanced, Risk for More Than Body Requirements Nutrition: Imbalanced, Less Than Body Requirements Nutrition: Imbalanced, More Than Body Requirements Nutrition: Readiness for Enhanced Oral Mucous Membranes, Impaired Self-Care Deficit, Feeding Swallowing, Impaired Elimination Bowel Constipation Constipation, Perceived Constipation, Risk for Diarrhea Incontinence, Bowel Nausea Tissue Perfusion, Ineffective Gastrointestinal, Risk for Urinary Fluid Volume, Risk for Imbalanced Infection, Risk for Incontinence, Functional Urinary Incontinence, Overflow Urinary Incontinence, Reflex Urinary Incontinence, Risk for Urge Urinary Incontinence, Stress Urinary Incontinence, Urge Urinary Tissue Perfusion, Ineffective Renal Tissue Perfusion, Ineffective Renal, Risk for Urinary Elimination, Impaired Urinary Elimination, Readiness for Enhanced Urinary Retention Rest/Activity Activity Intolerance Activity Intolerance, Risk for Activity Planning, Ineffective Disuse Syndrome, Risk for Diversional Activity Deficient Fatigue Insomnia Mobility, Impaired Bed Mobility, Impaired Physical Mobility, Impaired Wheelchair Perioperative Positioning Injury, Risk for Sedentary Lifestyle Sleep Deprivation Sleep Pattern, Disturbed Sleep, Readiness for Enhanced Transfer Ability, Impaired Walking, Impaired Comfort/Sexuality Comfort Comfort, Impaired Comfort, Readiness for Enhanced Pain, Acute Pain, Chronic Sexuality Sexuality Pattern, Ineffective Sexual Dysfunction Safety/Skins/Wounds/Infections/Sensory Temperature Hyperthermia Hypothermia Temperature, Risk for Imbalanced Body Thermoregulation, Ineffective Skin Jaundice, Neonatal Infection, Risk for Injury, Risk for Latex Allergy Response Latex Allergy Response, Risk for Protection, Ineffective Skin Integrity, Impaired Skin Integrity, Impaired, Risk for Tissue Integrity, Impaired Tissue Perfusion, Ineffective Peripheral Physical Falls, Risk for Growth, Risk for Disproportional Liver Function, Impaired, Risk for Mobility, Impaired Physical Perioperative Positioning Injury, Risk for Trauma, Risk for Self-Care, Readiness for Enhanced Self-Care Deficit, Bathing/Hygiene Self-Care Deficit, Dressing/Grooming Self-Care Deficit, Toileting Shock, Risk for Surgical Recovery, Delayed Wandering Perception Contamination Contamination, Risk for Energy Field, Disturbed Environmental Interpretation Syndrome, Impaired Infant Behavior, Disorganized Infant Behavior, Disorganized, Risk for Infant Behavior, Readiness for Enhanced Organized Poisoning, Risk for Self-Mutilation Self-Mutilation, Risk for Sensory/Perception, Disturbed (specify): Visual, Kinesthetic, Auditory, Gustatory, Tactile, Olfactory Suicide, Risk for Unilateral Neglect Violence, Risk for Other-Directed Violence, Risk for Self-Directed Love/Belonging/Culture/Coping/Body Image Caregiver Role Strain Caregiver Role Strain, Risk for Childbearing Process, Readiness for Enhanced Communication, Impaired Verbal Communication, Readiness for Enhanced Community Coping, Ineffective Community Coping, Readiness for Enhanced Delayed Development, Risk for Family Coping: Compromised, Ineffective Family Coping: Disabled Family Coping: Readiness for Enhanced Family Processes, Dysfunctional: Alcoholism Family Processes, Interrupted Family Processes, Readiness for Enhanced Growth and Development, Delayed Loneliness, Risk for Maternal/Fetal Dyad, Risk for Disturbed Parental Role Conflict Parent/Infant/Child Attachment, Impaired, Risk for Parenting, Impaired Parenting, Impaired, Risk for Parenting, Readiness for Enhanced Relationship, Readiness for Enhanced Resilience, Compromised, Risk for Resilience, Impaired Individual Resilience, Readiness for Enhanced Role Performance, Ineffective Social Isolation Anxiety Concerns/Fear/Knowledge Needs Self-Esteem Anxiety Body Image Disturbed Coping, Defensive Coping, Ineffective Coping, Readiness for Enhanced Death Anxiety Decisional Conflict (Specify) Decision Making, Readiness for Enhanced Denial, Ineffective Dignity, Compromised Human, Risk for Fear Grieving, Anticipatory Grieving, Dysfunctional Grieving, Dysfunctional, Risk for Hope, Readiness for Enhanced Hopelessness Identity, Disturbed Personal Moral Distress Neglect, Self Personal Identity, Disturbed Post-Trauma Syndrome Post-Trauma Syndrome, Risk for Power, Readiness for Enhanced Powerlessness Powerlessness, Risk for Rape-Trauma Syndrome Religiosity, Impaired Religiosity, Readiness for Enhanced Religiosity, Risk for Impaired Relocation Stress Syndrome Relocation Stress Syndrome, Risk for Self-Concept, Readiness for Enhanced Self-Esteem, Chronic Low Self-Esteem, Situational Low Self-Esteem, Situational Low, Risk for Self-Mutilation Self-Mutilation, Risk for Stress Overload Sorrow, Chronic Spiritual Distress Spiritual Distress, Risk for Spiritual Well-Being, Readiness for Enhanced Self-Actualization Health Maintenance, Ineffective Health Management, Effective Self Health Management, Ineffective Self Health Management, Self, Readiness for Enhanced Health Seeking Behaviors (Specify) Home Maintenance, Impaired Immunization Status, Readiness for Enhanced Knowledge, Deficient (Specify) Knowledge, Readiness for Enhanced (Specify) Noncompliance Prone Health Behavior, Risk Therapeutic Regimen: Family, Ineffective Management of

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