NURSING DIAGNOSIS ACTIVITY INTOLERANCE

RELATED FACTORS
y y y y y Bedrest complete exhaustion imbalance between oxygen supply and demand immobility Lifestyle

ACTIVITY INTOLERANCE; RISK FOR ACTIVITY PLANNING, INEFFECTIVE AUTONOMIC DYSREFLEXIA

AUTONOMIC DYSREFLEXIA, RISK FOR

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

Head Injury Subarachnoid Hemorrhage Guillain-Barre Syndrome Medication side effects Threat or perceived threat to physical and emotional integrity Changes in role function Intrusive diagnostic and surgical tests and procedures Changes in environment and routines Threat or perceived threat to self-concept Threat to (or change in) socioeconomic status Situational and maturational crises Interpersonal conflicts Environmental Smoking smoke inhalation second-hand smoke Obstructed Airway Airway spasm retained secretions excessive mucus presence of artificial airway foreign body in airway secretions in bronchi exudates in alveoli Physiological Neuromuscular dysfunction hyperplasia of bronchial walls; chronic obstructive pulmonary disease; infection; asthma; allergic airways Impaired gag reflex Poor Dentition Alteration In Consciousness Impaired Airway Defense Mechanisms Poor oral hygiene

ANXIETY

ANXIETY, DEATH

AIRWAY CLEARANCE, INEFFECTIVE

ASPIRATION, RISK FOR

ALLERGY RESPONSE, LATEX ALLERGY RESPONSE, RISK FOR LATEX

No immune mechanism response Inability of parents to meet personal needs Anxiety associated with the parent role Substance abuse Premature infant; ill infant/child who is unable to effectively initiate parental contact due to altered behavioral organization Separation; physical barriers Lack of privacy

ATTACHMENT, RISK FOR IMPAIRED

y y

BLEEDING, RISK FOR

y y y y y Inadequate comprehension Low self-efficacy; Multiple stressors; Inadequate social support Low socioeconomic status Negative attitudes toward health care

BEHAVIOR, RISK-PRONE HEALTH

BODY IMAGE, DISTURBED

y y y y y y y y y y y y

Psychosocial biophysical cognitive/perceptual cultural spiritual, or developmental changes illness trauma or injury surgery illness treatment Change in stool consistency (diarrhea, constipation, fecal impaction) abnormal motility (metabolic disorders, inflammatory bowel disease, infectious disease, drug induced motility disorders, food intolerance) defects in rectal vault function (low rectal compliance from ischemia, fibrosis, radiation, infectious proctitis, Hirschprung's disease, local or infiltrating neoplasm, severe rectocele) sphincter dysfunction (obstetric or traumatic induced incompetence, fistula or abscess, prolapse, third degree hemorrhoids, pseudodyssynergia of the pelvic muscles) neurological disorders impacting gastrointestinal motility, rectal vault function and sphincter function (cerebro vascular accident, spinal injury, traumatic brain injury, central nervous system tumor, advanced stage dementia, encephalopathy, profound mental retardation, multiple sclerosis, myelodysplasia and related neural tube defects, gastroparesis of diabetes mellitus, heavy metal poisoning, chronic alcoholism, infectious or autoimmune neurological disorders, myasthenia gravis) Normal breast structure Normal infant oral structure Gestational age >34* weeks Infant eagerness to breastfeed s/s MER Adequate infant output (for day of PP age) Maternal knowledge/confidence/support Verbalization of satisfaction BF process Infant anomaly infant receiving supplemental feedings with artificial nipple interruption in breastfeeding knowledge deficit maternal ambivalence maternal anxiety maternal breast anomaly nonsupportive family; nonsupportive partner poor infant reflex prematurity; previous breast surgery previous history of breastfeeding failure Maternal-infant separation RT illness of either, prematurity/immaturity, etc. Short-term contraindications to breastfeeding Need to wean abruptly Maternal employment Inflammatory process: viral or bacterial Hypoxia Neuromuscular impairment Pain Musculoskeletal impairment Tracheobronchial obstruction Perception or cognitive impairment Anxiety Decreased energy and fatigue Decreased lung expansion Extremes of weight or age

BOWEL INCONTINENCE

BREASTFEEDING, EFFECTIVE

BREASTFEEDING, INEFFECTIVE

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

BREASTFEEDING, INTERRUPTED

BREATHING PATTERN, INEFFECTIVE

y y

BODY TEMPERATURE, RISK FOR IMBALANCED

y y y y y y y y y y y y y y y y y y y y y

Dehydration Illness and/or trauma, especially affecting temperature regulation center Drugs Environment: exposure to hot or cold temperatures Inappropriate clothing Inactivity or vigorous activity Increased or decreased ventricular filling (preload) Alteration in afterload Impaired contractility Alteration in heart rate, rhythm, and conduction Decreased oxygenation Cardiac muscle disease Unclear personal values/beliefs Perceived threat to value system Lack of experience/interference with decision making Lack of relevant information Multiple/divergent sources of information Moral obligations require performing/not performing actions Moral principles/rules/values support mutually inconsistent courses of action Support system deficit [Age, developmental state] [Family system; Sociocultural factors] [Cognitive/ emotional/behavioral level of functioning] Change in or loss of body part Diagnosis of serious illness Recent change in health status Unsatisfactory support system Inadequate psychological resources (poor self-esteem, lack of motivation) Personal vulnerability Inadequate coping method Situational crises Maturational crises Inadequate fiber intake Immobility/inadequate physical activity Inadequate fluid intake Pain on defecation Change in routine (diet intake) Abuse of laxatives Delaying defecation when urge is present Use of prescribed constipating medications (narcotic analgesic, iron, antacid and anticholinergic)

CARDIAC OUTPUT, DECREASED

CONFLICT, DECISIONAL (SPECIFY)

COPING, DEFENSIVE
y y y y y

COPING, INEFFECTIVE
y y y y y y y y y y y y

CONSTIPATION

CONSTIPATION, PERCEIVED

y y y

Altered thought process Family health beliefs Knowledge deficit about normal processes diminished defecation reflex associated with: o suppression of urge to defecate because of lack of privacy and reluctance to use bedpan o decreased gravity filling of lower rectum resulting from horizontal positioning; weakened abdominal muscles associated with generalized loss of muscle tone resulting from prolonged immobility; decreased gastrointestinal motility associated with decreased activity and the increased sympathetic nervous system activity that occurs with anxiety.

CONSTIPATION, RISK FOR

y y

CONFUSION, ACUTE

CONFUSION, RISK FOR ACUTE

CONFUSION, CHRONIC

y y y y y y y y y y y y y y y y

60 years of age Dementia alcohol abuse abuse; delirium uncontrolled pain multiple morbidities and medications Alzheimer s disease (dementia of the Alzheimer s type) Multiinfarct dementia Cerebrovascular accident (CVA) Acquired immune deficiency disease Chronic hepatic encephalopathy Chronic drug intoxication Chronic subdural hematoma Parkinson s disease Huntington s chorea Creutzfeldt-Jakob disease

y y y y y

COMFORT, IMPAIRED

Sternotomy (mediastinal incision) or donor site (leg or arm incision) Myocardial ischemia (acute MI, angina) Tissue inflammation, edema formation Intraoperative nerve trauma

COMFORT, READINESS FOR ENHANCED CONTAMINATION CONTAMINATION, RISK FOR

y y y Caregiver expresses difficulty in performing patient care Caregiver verbalizes anger with responsibility of patient care Caregiver worries that own health will suffer because of caregiving Caregiver states that formal and informal support systems are inadequate Caregiver regrets that caregiving responsibility does not allow time for other activities Caregiver expresses problems in coping with patient s behavior Caregiver expresses negative feeling about patient or relationship Caregiver neglects patient care Caregiver abuses patient Brain injury that adversely affects the transmission, reception or interpretation of language or other forms of communication Structural problem (e.g., cleft palate, laryngectomy, tracheostomy, intubation, or wired jaws) Cultural difference (e.g., speaks different language) Dyspnea Fatigue Sensory challenge involving hearing or vision Change in marital status home care of a child with special needs interruptions of family life due to home care regimen (e.g., treatments, caregivers, lack of respite) intimidation with invasive modalities (e.g., intubation) intimidation with restrictive modalities (e.g., isolation) separation from child due to chronic illness specialized care center Change in or loss of body part Diagnosis of serious illness Recent change in health status Unsatisfactory support system Inadequate psychological resources (poor self-esteem, lack of

CAREGIVER ROLE STRAIN

y y y y y y y y

CAREGIVER ROLE STRAIN, RISK FOR

COMMUNICATION, IMPAIRED VERBAL

y y y y

COMMUNICATION, READINESS FOR ENHANCED

y y y y y y y y y y y y y

CONFLICT, PARENTAL ROLE

COPING, INEFFECTIVE COMMUNITY

COPING, READINESS FOR ENHANCED COMMUNITY

COPING, COMPROMISED FAMILY

y y y y y y y y y y y y y y y y y y y y y y y y

COPING, DISABLED FAMILY

y y y y y y

COPING, READINESS FOR ENHANCED FAMILY

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

DISUSE SYNDROME, RISK FOR

DIVERSIONAL ACTIVITY, DEFICIENT DECISION MAKING, READINESS FOR ENHANCED

motivation) Personal vulnerability Inadequate coping method Situational crises Maturational crises Social supports available Resources available for problem solving Community has a sense of power to manage stressors Coexisting situations affecting the significant person developmental crises the significant person may be facing exhaustion of supportive capacity of significant people inadequate information by a primary person inadequate understanding of information by a primary person incorrect information by a primary person lack of reciprocal support little support provided by client, in turn, for primary person prolonged disease that exhausts supportive capacity of significant people situational crises the significant person may be facing temporary family disorganization temporary family role changes temporary preoccupation by a significant person Situational crisis temporary family disorganization and role changes Highly ambivalent family relationship Prolonged disease and disability progression that exhausts the supportive capacity of SO Client providing little support in turn for SO SO with chronically unexpressed feelings of guilt Anxiety Hostility despair Needs sufficiently gratified to enable goals of self-actualization to surface Adaptive tasks effectively addressed to enable goals of selfactualization to surface [Developmental stage, situational crises/supports] Unconciousness Neuromuscular Impairment Musculoskeletal condition Immobility Traction/casts/splints Monotonous environment Long-term hospitalization Lack of motivation with signs of depression Skeletal-muscular impairments Overwhelming stress Threat of unpleasant reality Fear of deaths Fear of separation Fear of loss of autonomy Anxiety Lack of competency in using effective coping mechanisms Lack of control of life situation Lack of emotional support from others Multiple negative factors Dietary alteration Stress/anxiety Inflammation/irritation of the bowel drug side effects spoiled food tube feeding

DENIAL, INEFFECTIVE

DIGNITY, RISK FOR COMPROMISED HUMAN DISTRESS, MORAL

DIARRHEA

allergy Ineffective oral hygeine Inadequate prenatal care Placental abnormalities Low weight gain during pregnancy Their first pregnancy at younger than 20 years of age Anemia History of sexually transmitted diseases or urinary tract infections

DENTITION, IMPAIRED

DEATH SYNDROME, RISK FOR SUDDEN INFANT

y y y y y y y

DEVELOPMENT, RISK FOR DELAYED

y y y

ENERGY FIELD, DISTURBED

Slowing or blocking of energy flows secondary to: maturational factors: age-related developmental crisis or difficulties pathophysiologic factors: illness, injury, pregnancy; situational factors: anxiety, fear, grieving, pain; treatment-related factors: chemotherapy, immobility, labor and delivery, perioperative experience Dementia (Alzheimer's disease) multiinfarct dementia Innate origin (e.g., sudden noise, height, pain, loss of physical support) Innate releasers (neurotransmitters) Phobic stimulus Learned response (e.g., conditioning, modeling from or identification with others); Unfamiliarity with environmental experience(s) Separation from support system in potentially stressful situation (e.g., hospitalization, hospital procedures [/treatments]) Language barrier Sensory impairment Depression Apathy Fatigue Prematurity Neurological impairment/delay Oral hypersensitivity Prolonged NPO Anatomic abnormality Hypertonic dehydration: uncontrolled diabetes mellitus/insipidus, HHNC, increased intake of hypertonic fluids/IV therapy, inability to respond to thirst reflex/inadequate free water supplementation (high-osmolarity enteral feeding formulas), renal insufficiency/failure]; [Hypotonic dehydration: chronic illness/malnutrition, excessive use of hypotonic IV solutions Active fluid volume loss [e.g., hemorrhage, gastric intubation, diarrhea, wounds abdominal cancer burns fistulas ascites (third spacing) use of hyperosmotic radiopaque contrast agents] Failure of regulatory mechanisms [e.g., fever/thermoregulatory response, renal tubule damage] [Impaired access/intake/absorption of fluids] Abuse of alcohol [/addictive substances]

ELECTROLYTE IMBALANCE, RISK FOR ENVIRONMENTAL INTERPRETATION SYNDROME, IMPAIRED FATIGUE

y y y y y y y y

FEAR

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

FAILURE TO THRIVE, ADULT

FEEDING PATTERN, INEFFECTIVE INFANT FLUID BALANCE, READINESS FOR ENHANCED

[FLUID VOLUME, DEFICIENT HYPER/HYPOTONIC]

FLUID VOLUME, DEFICIENT [ISOTONIC]

FAMILY PROCESSES, DYSFUNCTIONAL

y y y y y y y y y y y y y

FAMILY PROCESSES, INTERRUPTED

Family history of alcoholism/resistance to treatment Inadequate coping skills Addictive personality Lack of problem-solving skills Biochemical influences Genetic predisposition Situational transition/crises Developmental transition/crises [e.g., loss or gain of a family member, adolescence, leaving home for college] Shift in health status of a family member Family roles shift Power shift of family members Modification in family finances/social status Interaction with community

FAMILY PROCESSES, READINESS FOR ENHANCED FALLS, RISK FOR

y y y y y y y y y y y y y y y y y Extremes of age/weight Loss of fluid through abnormal routes (e.g., indwelling tubes) Knowledge deficiency Factors influencing fluid needs (e.g., hypermetabolic states) Medications (e.g., diuretics) Excessive losses through normal routes (e.g., diarrhea) Deviations affecting access/intake/absorption of fluids Anticipatory loss of significant other/significant object (e.g., possessions, job, status, home, parts and processes of body) Death of significant other Loss of significant object Death/sudden death of a significant other Emotional instability Lack of social support [Loss of significant object (e.g., possessions, job, status, home, ideals, parts and processes of the body amputation, paralysis, chronic/terminal illness] Death of a significant other Emotional instability Lack of social support [Loss of significant object (e.g., possessions, job, status, home, parts and processes of body)] Lack of acceptance of diagnosis Deficient knowledge of diabetes management (e.g., action plan) Lack of diabetes management/adherence to diabetes management (e.g., action plan) Inadequate blood glucose monitoring Medication management Dietary intake Weight gain/loss; Rapid growth periods Pregnancy Physical health status/activity level Stress; Mental health status Developmental level Ventilation-perfusion imbalance [as in altered blood flow (e.g., pulmonary embolus, increased vascular resistance), vasospasm, heart failure, hypovolemic shock] Alveolar-capillary membrane changes (e.g., acute adult respiratory distress syndrome) chronic conditions such as: restrictive/obstructive lung disease, pneumoconiosis, respiratory depressant drugs, brain injury, asbestosis/silicosis] [Altered oxygen supply (e.g., altitude sickness)] [Altered oxygen-carrying capacity of blood (e.g., sickle cell/other anemia, carbon monoxide poisoning)] Inadequate caretaking

FLUID VOLUME RISK FOR IMBALANCE

+FLUID VOLUME, RISK FOR IMBALANCED GRIEVING

GRIEVING, COMPLICATED

GRIEVING, RISK FOR COMPLICATED

y y y y y y y y y y y y y y y y

GLUCOSE, RISK FOR UNSTABLE BLOOD

GAS EXCHANGE, IMPAIRED

y y

GROWTH, RISK FOR DISPROPORTIONATE

y y

GROWTH AND DEVELOPMENT, DELAYED

y y y y y y y y y

y y

[Physical/emotional neglect or abuse] Indifference Inconsistent responsiveness Multiple caretakers Separation from significant others Environmental/stimulation deficiencies Effects of physical disability [handicapping condition] Prescribed dependence [insufficient expectations for self-care] [Physical/emotional illness (chronic, traumatic), e.g., chronic inflammatory disease, pituitary tumors, impaired nutrition/metabolism, greater-than-normal energy requirements; prolonged/painful treatments; prolonged/repeated hospitalizations] [Sexual abuse] [Substance use/abuse] Prolonged activity restriction, creating isolation Failing or deteriorating physiologic condition Long-term stress Abandonment Lost belief in transcendent values [/God] Deficient communication skills [written, verbal, gestural] Unachieved developmental tasks Inability to make appropriate judgments Perceptual/cognitive impairment Diminished/lack of gross motor skills Diminished/lack of fine motor skills Ineffective individual/family coping Complicated grieving Spiritual distress Insufficient resource (e.g., equipment, finances) [Lack of psychosocial supports] Disease Injury Insufficient family organization/planning Insufficient finances Impaired functioning Lack of role modelling Unfamiliarity with neighborhood resources Deficient knowledge Inadequate support systems Exposure to hot environment Inappropriate clothing Vigorous activity Dehydration Decreased perspiration Medications Anesthesia Increased metabolic rate Illness Trauma Exposure to cool or cold environment [prolonged exposure, e.g., homeless, immersion in cold water/near-drowning; induced hypothermia/cardiopulmonary bypass] Inadequate clothing Evaporation from skin in cool environment Decreased ability to shiver Aging [or very young] [Debilitating] illness Trauma Damage to hypothalamus Malnutrition Decreased metabolic rate Inactivity

HOPE, READINESS FOR ENHANCED HOPELESSNESS

HEALTH MAINTENANCE, INEFFECTIVE

HOME MAINTENANCE, IMPAIRED

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

HYPERTHERMIA

HYPOTHERMIA

y y y y y y y y y y

y y

Consumption of alcohol Medications[Drug overdose]

+HEALTH BEHAVIOR, RISK-PRONE +HEALTH MANAGEMENT, INEFFECTIVE SELF

y To be developed y [Organic brain syndrome] y [Poor ego differentiation, as in schizophrenia] y [Panic/dissociative states] y [Biochemical body change] y Prenatal Congenital/genetic disorders; Teratogenic exposure; [Exposure to drugs/substances] Postnatal Prematurity; Oral/motor problems; Feeding intolerance; Malnutrition; Invasive procedures; Pain Individual Gestational/postconceptual age; Immature neurological system; Illness; [Infection]; [Hypoxia/birth asphyxia] Environmental Physical environment inappropriateness; Sensory inappropriateness/overstimulation/deprivation; Lack of containment within environment Caregiver Cue misreading; Cue knowledge deficit; Environmental stimulation contribution y Prematurity y Pain y y y y y y y y y y y Pain Oral/motor problems Environmental overstimulation Lack of containment/boundaries Invasive/painful procedures Prematurity [Immaturity of the central nervous system generic problems that alter neurologic and/or physiologic functioning conditions resulting in hypoxia and/or birth asphyxia] [Malnutrition; infection drug addiction] [Environmental events or conditions such as separation from parent, exposure to loud noise, excessive handling, bright lights] Prematurity Neurological impairment/delay Oral hypersensitivity Prolonged NPO Anatomic abnormality Inadequate primary defenses (broken skin, traumatized tissue, decrease in ciliary action, stasis of body fluids, change in pH secretions, altered peristalsis) Inadequate secondary defenses (e.g., decreased hemoglobin, leukopenia, suppressed inflammatory response) Inadequate acquired immunity; Immunosuppression Tissue destruction Increased environmental exposure Invasive procedures Chronic disease Malnutrition Trauma Pharmaceutical agents (e.g., immunosuppressants, [antibiotic therapy])

IDENTITY, DISTURBED PERSONAL IMMUNIZATION STATUS, READINESS FOR ENHANCED INFANT BEHAVIOR, DISORGANIZED

INFANT BEHAVIOR, READINESS FOR ENHANCED ORGANIZED INFANT BEHAVIOR, RISK FOR DISORGANIZED

INFANT FEEDING PATTERN, INEFFECTIVE

INFECTION, RISK FOR

y y y y y y

y y y y y y y y y y

y y y

INJURY, RISK FOR

y

INJURY, RISK FOR PERIOPERATIVE POSITIONING

INSOMNIA

y y y y y y y y y y y y y y y y y y y y y

INTRACRANIAL ADAPTIVE CAPACITY, DECREASED

KNOWLEDGE, DEFICIENT [LEARNING NEED] (SPECIFY)

y y y y y y y y y y y y y y y y

Rupture of amniotic membranes Insufficient knowledge to avoid exposure to pathogens Internal Physical (e.g., broken skin, altered mobility); Tissue hypoxia; Malnutrition; Abnormal blood profile (e.g., leukocytosis/leukopenia, altered clotting factors, thrombocytopenia, sickle cell, thalassemia, decreased hemoglobin); Biochemical dysfunction; Sensory dysfunction; Integrative/effector dysfunction; Immune/autoimmune dysfunction; Developmental age (physiological, psychosocial); Psychological (affective, orientation) External Biological (e.g., immunization level of community, microorganism); Chemical (e.g., pollutants, poisons, drugs, pharmaceutical agents, alcohol, nicotine, preservatives, cosmetics, dyes); Nutritional (e.g., vitamins, food types); Physical (e.g., design, structure, and arrangement of community, building, and/or equipment), mode of transport or transportation; Human (e.g., nosocomial agents, staffing patterns; cognitive, affective, and psychomotor factors) Disorientation sensory/perceptual disturbances due to anesthesia Immobilization Muscle weakness [Pre-existing musculoskeletal conditions] Obesity Emaciation Edema [Elderly] Intake of stimulants/alcohol Medications Gender-related hormonal shifts Stress (e.g., ruminative presleep pattern) Depression Fear Anxiety Grief Impairment of normal sleep pattern (e.g., travel, shift work, parental responsibilities, interruptions for interventions) Inadequate sleep hygiene (current) Activity pattern (e.g., timing, amount) Physical discomfort (e.g., body temperature, pain, shortness of breath, cough, gastroesophageal reflux, nausea, incontinence/urgency) Environmental factors (e.g., ambient noise, daylight/darkness exposure, ambient temperature/humidity, unfamiliar setting) Brain injuries Sustained increase in ICP equal to 10 to 15 mm Hg Decreased cerebral perfusion pressure 50 to 60 mm Hg Systemic hypotension with intracranial hypertension Lack of exposure Information misinterpretation Unfamiliarity with information resources Lack of recall Cognitive limitation Lack of interest in learning [Request for no information] [Inaccurate/incomplete information presented] Lack of interest/motivation/resources (time, money, companionship, facilities) Lack of training for accomplishment of physical exercise Deficient knowledge of health benefits of physical exercise Viral infection (e.g., hepatitis A, hepatitis B, hepatitis C, EpsteinBarr)

KNOWLEDGE (SPECIFY), READINESS FOR ENHANCED LIFESTYLE, SEDENTARY

LIVER FUNCTION, RISK FOR IMPAIRED

LONELINESS, RISK FOR

MEMORY, IMPAIRED

MOBILITY, IMPAIRED BED

y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y y

MOBILITY, IMPAIRED PHYSICAL

MOBILITY, IMPAIRED WHEELCHAIR

HIV co-infection Hepatotoxic medications (e.g., acetaminophen, statins) Substance abuse (e.g., alcohol, cocaine) Affectional deprivation Physical isolation Cathectic deprivation Social isolation [Problems of attachment for children] [Chaotic family relationships] Hypoxi Anemia Fluid and electrolyte imbalance Decreased cardiac output Neurological disturbances [e.g., brain injury/concussion] Excessive environmental disturbances [Manic state, fugue, traumatic event] [Substance use/abuse] [Effects of medications]; [Age] Neuromuscular/musculosketal impairment Insufficient muscle strength Deconditioning Obesity Environmental constraints (i.e., bed size/type, treatment equipment, restraints) Pain Sedating medications Deficient knowledge Cognitive impairment Sedentary lifestyle Activity intolerance Disuse Deconditioning Decreased endurance Limited cardiovascular endurance Decreased muscle strength/control/mass Joint stiffness Contracture Loss of integrity of bone structures Pain/discomfort Neuromuscular/musculoskeletal impairment Sensoriperceptual/cognitive impairment Developmental delay Depressive mood state Anxiety Malnutrition Altered cellular metabolism Body mass index above 75th age-appropriate percentile Deficient knowledge regarding value of physical activity Cultural beliefs regarding age-appropriate activity Lack of environmental supports (e.g., physical or social) Prescribed movement restrictions; Medications Reluctance to initiate movement Neuromuscular/musculosketal impairments (e.g., contractures) Insufficient muscle strength Limited endurance Deconditioning Obesity Impaired vision Pain Depressed mood Cognitive impairment Deficient knowledge Environmental constraints (e.g., stairs, inclines, uneven surfaces, unsafe obstacles, distances, lack of assistive devices or persons, wheelchair type)

Treatment Gastric irritation; Gastric distention; Pharmaceuticals [e.g., analgesics aspirin/nonsterodial anti-inflammatory drugs/opioids, anesthesia, antivirals for HIV, steroids, antibiotics, chemotherapeutic agents]; [Radiation therapy/exposure] Biophysical Biochemical disorders (e.g., uremia, diabetic ketoacidosis, pregnancy); Localized tumors (e.g., acoustic neuroma, primary or secondary brain tumors, bone metastases at base of skull); Intraabdominal tumors; Toxins (e.g., tumor-produced peptides, abnormal metabolites due to cancer); Esophageal/pancreatic disease; Liver/splenetic capsule stretch; Gastric distention [e.g., delayed gastric emptying, pyloric intestinal obstruction, external compression of the stomach, other organ enlargement that slows stomach functioning (squashed stomach syndrome)]; Gastric irritation [e.g., pharyngeal and/or peritoneal inflammation]; Motion sickness; Mnire s disease; Labyrinthitis; Increased intracranial pressure; Meningitis

NAUSEA

NEGLECT, UNILATERAL

NONCOMPLIANCE [ADHERENCE, INEFFECTIVE] (SPECIFY)

Situational Noxious odors/taste; Unpleasant visual stimulation; Pain; Psychological factors; Anxiety; Fear Brain injury from: y Cerebrovascular problems y Neurological illness y Trauma y Tumor y Left hemiplegia from cerebrovascular accident of the right hemisphere y Hemianopsia y Health Care Plan Duration; Cost; Intensity; Complexity; Financial flexibility of plan y y Individual factors Personal/developmental abilities; Knowledge/skill relevant to the regimen behavior; Motivational forces; Individual s value system; Health beliefs; Cultural influences; Spiritual values; Significant others; [Altered thought processes such as depression, paranoia]; [Difficulty changing behavior, as in addictions]; [Denial]; [Issues of secondary gain] Health System Individual health coverage; Credibility of provider; Client-provider relationships; Provider continuity/regular follow-up; Provider reimbursement; Communication/teaching skills of the provider; Access/ convenience of care; Satisfaction with care Network Involvement of members in health plan; Social value regarding plan; Perceived beliefs of significant others Inability to ingest/digest food Inability to absorb nutrients Biological/psychological/economic factors [Increased metabolic demands, e.g., burns] [Lack of information, misinformation, misconceptions] Excessive intake in relationship to metabolic need Underlying cause is often complex and may be difficult to diagnose/treat Dysfunctional eating patterns Pairing food with other activities Eating in response to external cues other than hunger (e.g., time of day, social situation) Eating in response to internal cues other than hunger (such as anxiety)

NUTRITION: LESS THAN BODY REQUIREMENTS, IMBALANCED

NUTRITION: MORE THAN BODY REQUIREMENTS, IMBALANCED NUTRITION: READINESS FOR ENHANCED NUTRITION: RISK FOR MORE THAN BODY REQUIREMENTS, IMBALANCED

y y y y y y y y y y y y

y y y y y y y y y y

Concentrating food intake at end of day Parental obesity Rapid transition across growth percentiles in children Reported use of solid food as major food source before 5 months of age Higher baseline weight at beginning of each pregnancy Observed use of food as reward/comfort measure [Frequent/repeated dieting] [Alteration in usual activity patterns/sedentary lifestyle] [Majority of foods consumed are concentrated, high-calorie/fat sources] [Lower socioeconomic status]

ORAL MUCOUS MEMBRANE, IMPAIRED

y y y y y y y y y

y y y y

y y y y y y y y

Dehydration NPO for more than 24 hours Malnutrition Decreased salivation Medication side effects Diminished hormone levels (women) Mouth breathing Deficient knowledge of appropriate oral hygiene Ineffective oral hygiene; Barriers to oral selfcare/professional care; Mechanical factors (e.g., ill-fitting dentures; braces; tubes [endotrachial, nasogastric], surgery in oral cavity) Loss of supportive structures Trauma Cleft lip or palate Chemical irritants (e.g., alcohol, tobacco, acidic foods, regular use of inhalers or other noxious agents) Chemotherapy Immunosuppression Immunocompromised Decreased platelets Infection Radiation therapy Stress Depression