Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span

1081 Pages·2019·7.666 MB·English

by  Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr

DOENGES MOORHOUSE MURR
Guidelines for Individualizing
Client Care Across the Life Span
lOTH EDITION
INDEX OF DISEASES/DISORDERS
Acid- base imbalances DavisPlus Gastrectomy/gastroplasty (see DavisPlus)
Acquired immunodefi ciency syndrome (AIDS), 800 Gastric bypass, 442
Acute coronary syndrome (ACS), 54 Glaucoma DavisPlus
Acute kidney injury (acute renal failure), 595 Graves’ disease, 471
Adult leukemias, 569
Alcohol: acute withdrawal, 919 Heart failure: chronic, 38
Alzheimer’s disease, 851 Hemodialysis, 641
Amputation, 718 Hemolytic anemia, 541
Anemia— iron defi ciency, anemia of chronic disease, pernicious, Hemothorax, 169
aplastic, hemolytic, 541 Hepatitis, 482
Angina: chronic/stable, 64 Herniated nucleus pulposus (see DavisPlus)
Anorexia nervosa, 413 HIV- positive client, 785
Aplastic anemia, 541 Hospice, 970
Appendectomy, 382 Hypercalcemia (calcium excess) (see DavisPlus)
Asthma, 132 Hyperkalemia (potassium excess) (see DavisPlus)
Hypermagnesemia (magnesium excess) (see DavisPlus)
Bariatric surgery, 442 Hypernatremia (sodium excess) (see DavisPlus)
Benign prostatic hyperplasia (BPH), 686 Hypertension: severe, 26
Brain infections: meningitis and encephalitis, 267 Hyperthyroidism (Graves’ disease, thyrotoxicosis, thyroid storm), 471
Bulimia nervosa, 413 Hypervolemia (extracellular fl uid volume excess) (see DavisPlus)
Burns: thermal, chemical, and electrical— acute and convalescent Hypocalcemia (calcium defi cit) (see DavisPlus)
phases, 740 Hypokalemia (potassium defi cit) (see DavisPlus)
Hypomagnesemia (magnesium defi cit) (see DavisPlus)
Cancer, general considerations, 945 Hyponatremia (sodium defi cit) (see DavisPlus)
Cardiac dysrhythmias, 85, 86 Hypovolemia (extracellular fl uid volume defi cit) (see DavisPlus)
Cardiac surgery: postoperative care, 98 Hysterectomy, 666
Cardiomyoplasty, 46
Cerebrovascular accident/stroke, 247 Ileostomy, 368
Chemical burns, 741 Infl ammatory bowel disease: ulcerative colitis, Crohn’s disease, 352
Cholecystectomy DavisPlus Iron- defi ciency anemia, 541
Cholecystitis with cholelithiasis, 399
Cholelithiasis, 399 Laminectomy (see Spinal Surgery), 276
Chronic obstructive pulmonary disease (COPD) and asthma, 132 Laryngectomy (see DavisPlus)
Cirrhosis of the liver, 494 Lewy body disease, 851
Colostomy, 368 Leukemias, 569
Coronary artery bypass graft (CABG), 98 Lung cancer: postoperative care, 159
Cranioce re bral trauma— acute rehabilitative phase, 226 Lymphomas, 582
Crohn’s disease, 352
Mastectomy, 675
Dementia: Alzheimer’s type/vascular dementia/, Lewy body disease, Meningitis, 267
frontotemporal dementia, 851 Metabolic acid- base imbalances (see DavisPlus)
Deep vein thrombosis (DVT), 120 Metabolic acidosis— primary base bicarbonate defi ciency
Diabetes mellitus, 454 (see DavisPlus)
Diabetic ketoacidosis, 454 Metabolic alkalosis— primary base bicarbonate excess
Dialysis: hemodialysis (HD), 641 (see DavisPlus)
Dialysis: peritoneal (PD), 635 Minimally invasive direct coronary artery bypass (MIDCAB), 98
Disaster considerations, 980 Multiple sclerosis, 311
Disc surgery (now called Spinal Surgery), 276 Myo car dial infarction, 72
Dysrhythmias, 85, 86
Obesity, 430
Eating disorders: anorexia nervosa/bulimia nervosa, 413
Electrolyte imbalances DavisPlus Bariatric surgery, 442
Electrical burns, 740
Encephalitis, 267 Pancreatitis, 511
End- stage renal disease, 607 Parkinson’s disease, 330
Enteral feeding, 525 Parenteral feeding, 525
Esophageal bleeding, 347 Pediatric considerations, 993
Extended care, 896 Peritoneal dialysis, 635
Peritonitis, 389
Fecal diversions: postoperative care of ileostomy and colostomy, 368 Pernicious anemia, 541
Fluid and electrolyte imbalances, DavisPlus Pneumonia, 147
Fractures, 702 Pneumothorax, 169
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Primary base bicarbonate defi ciency (see DavisPlus) Stroke, 247
Primary base bicarbonate excess (see DavisPlus) Substance use disorders (SUDs), 929
Primary carbonic acid defi cit (see DavisPlus) Surgical interventions, 873
Primary carbonic acid excess (see DavisPlus)
Prostatectomy, 694 Thermal burns, 740
Psychosocial aspects of care, 835 Thrombophlebitis: venous thromboembolism, 120
Pulmonary emboli (PE), 120 Thyroidectomy (see DavisPlus)
Pulmonary tuberculosis (TB), 204 Thyrotoxicosis, 471
Total joint replacement, 729
Radical neck surgery (see DavisPlus) Total nutritional support: parenteral/enteral feeding, 525
Renal calculi, 656 Tuberculosis (TB), pulmonary, 204
Renal dialysis— general considerations, 623
Renal failure: acute, 595 Ulcerative colitis, 352
Renal failure: chronic, 607 Upper gastrointestinal bleeding, 340
Respiratory acid- base imbalances (see DavisPlus) Urinary diversions/urostomy (postoperative care)
Respiratory acidosis (see DavisPlus) Urinary stones (calculi), 656
Respiratory alkalosis (see DavisPlus) Urostomy, 645
Rheumatoid arthritis (RA), 824
Respiratory failure/ventilatory assistance, 187 Valve replacement, 98
Ruptured intervertebral disc (see DavisPlus) Vascular dementia, 851
Venous thromboembolism (VTE) disease, 120
Seizure disorders, 216 Ventilatory assistance (mechanical), 187
Sepsis/Septic Shock, 772
Sickle cell crisis, 552 Wound care: complicated or chronic, 762
Spinal cord injury (acute rehabilitative phase), 288
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KEY TO ESSENTIAL TERMINOLOGY
CLIENT ASSESSMENT DATABASE When a risk diagnosis is used, the identifi ed risk
Provides an overview of the more commonly occurring eti- f actors serve as the “evidenced by” segment of the nursing
ology and coexisting f actors associated with a specifi c med- diagnosis statement, and interventions are provided to pre-
ical and/or surgical diagnosis or health condition as well as vent progression to a problem- focused diagnosis. Further-
the signs and symptoms and corresponding diagnostic fi nd- more, health- promotion diagnoses (readiness for enhanced)
ings. The Database contains the information used to iden- do not contain related factors but do have defi ning charac-
tify Nursing Diagnoses for planning client care. teristics for the “evidenced by” segment of the client diag-
nostic statement.
NURSING PRIORITIES
DESIRED OUTCOMES/EVALUATION
Establishes a general ranking of needs and concerns on which
the Nursing Diagnoses are ordered in constructing the plan of CRITERIA— CLIENT WILL
care. This ranking would be altered according to the individ- These give direction to client care as they identify what the
ual client situation. client or nurse hopes to achieve. They are stated in general
terms to permit the practitioner to modify or individualize
DISCHARGE GOALS them by adding timelines and specifi c client criteria so they
Identifi es generalized statements that could be developed into become “meas ura ble.” For example, “Client w ill appear re-
short-t erm and intermediate goals to be achieved by the client laxed and report anxiety is reduced to a manageable level
before being “discharged” from nursing care. They may also within 24 hours.”
provide guidance for creating long- term goals for the client to Nursing Outcomes Classifi cation (NOC) labels are
work on after discharge. also included. The outcome label is selected from a stan-
dardized nursing language and serves as a general header
NURSING DIAGNOSIS for the outcome indicators that follow.
The general need or probl em diagnosis is stated without the
distinct cause and signs and symptoms, which would be added ACTIONS/INTERVENTIONS
to create a client diagnostic statement when specifi c client in- Nursing Interventions Classifi cation (NIC) labels are drawn
formation is available. For example, when a client displays in- from a third standardized nursing language and serve as a
creased tension, apprehension, quivering voice, and focus on general header for the nursing actions that follow.
self, the nursing diagnosis of Anxiety might be stated: se- Nursing actions are divided into independent—t hose
vere Anxiety related to value confl ict, threat to current sta- actions that the nurse performs autonomously—a nd
tus as evidenced by increase in tension, apprehensiveness; collaborative—t hose actions that the nurse performs in con-
voice quivering, self- focused. junction with o thers, such as implementing physician o rders.
In addition, diagnoses identifi ed within t hese guides The interventions in this book are generally ranked from
for planning care as a ctual, risk, health promotion, or syn- most to least common. When creating the individual plan of
drome can be changed or deleted and new diagnoses added, care, interventions would normally be ranked to refl ect the
depending entirely on the specifi c client situation or avail- client’s specifi c needs and situation. In addition, the division
able information. of ind ep end ent and collaborative is arbitrary and is actually
dependent on the individual nurse’s capabilities, agency pro-
MAY BE RELATED TO/POSSIBLY tocols, and professional standards.
EVIDENCED BY
RATIONALE
T hese lists provide the usual or common reasons (etiology)
why a par tic u lar need or prob lem may occur with probable Although not commonly appearing in client plans of care,
signs and symptoms, which would be used to create the “re- rationale has been included h ere to provide a pathophysiolog-
lated to” and “evidenced by” portions of the client diagnos- ical basis to assist the nurse in deciding about the relevance
tic statement when the specifi c situation is known. of a specifi c intervention for an individual client situation.
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NURSING DIAGNOSES ACCEPTED FOR USE AND RESEARCH FOR 2018–2020
Activity Intolerance [specify level] Diversional Activity Engagement, defi cient
Activity Intolerance, risk for Dry Eye, risk for
Activity Planning, in effec tive Dry Mouth, risk for
Activity Planning, risk for in effec tive Eating Dynamics, in effec tive adolescent
Acute Substance Withdrawal Syndrome Eating Dynamics, in effec tive child
Acute Substance Withdrawal Syndrome, risk for Eating Dynamics, in effec tive infant
Adaptive Capacity, decreased intracranial Electrolyte Imbalance, risk for
Adverse Reaction to Iodinated Contrast Media, risk for Elimination, impaired urinary
Airway Clearance, in effec tive Emancipated Decision- Making, impaired
Allergy Reaction, risk for Emancipated Decision- Making, readiness for enhanced
Anxiety Emancipated Decision- Making, risk for impaired
Aspiration, risk for Emotional Control, labile
Attachment, risk for impaired Energy Field, imbalanced
Autonomic Dysrefl exia Falls, risk for
Autonomic Dysrefl exia, risk for Family Pro cesses, dysfunctional
Be hav ior, disor ga nized infant Family Pro cesses, interrupted
Be hav ior, risk for disor ga nized infant Family Pro cesses, readiness for enhanced
Be hav ior, readiness for enhanced or ga nized infant Fatigue
Bleeding, risk for Fear
Blood Glucose Level, risk for unstable Feeding Pattern, in effec tive infant
Blood Pressure, risk for unstable Female Genital Mutilation, risk for
Body Image, disturbed Fluid Balance, readiness for enhanced
Breast Milk Production, insuffi cient [Fluid Volume, defi cient hyper/hypotonic]
Breastfeeding, in effec tive Fluid Volume, defi cient [isotonic]
Breastfeeding, interrupted Fluid Volume, excess
Breastfeeding, readiness for enhanced Fluid Volume, risk for defi cient
Breathing Pattern, in effec tive Fluid Volume, risk for imbalanced
Cardiac Output, decreased Frail El derly Syndrome
Cardiac Output, decreased, risk for Frail El derly Syndrome, risk for
Childbearing Pro cess, in effec tive Gas Exchange, impaired
Childbearing Pro cess, readiness for enhanced Gastrointestinal Motility, dysfunctional
Childbearing Pro cess, risk for in effec tive Gastrointestinal Motility, risk for dysfunctional
Chronic Pain Syndrome Grieving
Comfort, impaired Grieving, complicated
Comfort, readiness for enhanced Grieving, risk for complicated
Communication, impaired verbal [Growth, risk for disproportionate] (retired 2018)
Communication, readiness for enhanced Health, defi cient community
Confusion, acute Health Be hav ior, risk- prone
Confusion, risk for acute Health Literacy, readiness for enhanced
Confusion, chronic Health Maintenance, in effec tive
Constipation Health Management, in effec tive
Constipation, chronic functional Health Management, in effec tive family
Constipation, perceived Health Management, readiness for enhanced
Constipation, risk for Home Maintenance, impaired
Constipation, risk for chronic functional Hope, readiness for enhanced
Contamination Hopelessness
Contamination, risk for Human Dignity, risk for compromised
Coping, compromised family Hyperthermia
Coping, defensive Hyperbilirubinemia, neonatal
Coping, disabled family Hyperbilirubinemia, risk for neonatal
Coping, in effec tive Hypothermia
Coping, in effec tive community Hypothermia, risk for
Coping, readiness for enhanced Hypothermia, risk for perioperative
Coping, readiness for enhanced community Immigration Transition, risk for complicated
Coping, readiness for enhanced family Impulse Control, in effec tive
Death Anxiety Incontinence, bowel
Decision-M aking, readiness for enhanced Incontinence, functional urinary
Decisional Confl ict Incontinence, overfl ow urinary
Denial, in effec tive Incontinence, refl ex urinary
Dentition, impaired Incontinence, risk for urge urinary
Development, risk for delayed Incontinence, stress urinary
Diarrhea Incontinence, urge urinary
Disuse Syndrome, risk for Infection, risk for
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Injury, risk for Role Strain, caregiver
Injury, risk for corneal Role Strain, risk for caregiver
Injury, risk for urinary tract Self-C are, readiness for enhanced
Insomnia Self- Care defi cit, Bathing
Knowledge, defi cient Self- Care defi cit, Dressing
Knowledge, readiness for enhanced Self- Care defi cit, Feeding
Latex Allergy Reaction Self- Care defi cit, Toileting
Latex Allergy Reaction, risk for Self- Concept, readiness for enhanced
Lifestyle, sedentary Self- Esteem, chronic low
Liver Function, risk for impaired Self- Esteem, risk for chronic low
Loneliness, risk for Self- Esteem, risk for situational low
Maternal- Fetal Dyad, risk for disturbed Self- Esteem, situational low
Memory, impaired Self- Mutilation
Mobility, impaired bed Self- Mutilation, risk for
Mobility, impaired physical Self- Neglect
Mobility, impaired wheelchair [Sensory Perception, disturbed (specify: visual, auditory, kinesthetic,
Mood Regulation, impaired gustatory, tactile, olfactory)] (retired 2012)
Moral Distress Sexual Dysfunction
Mucous Membrane Integrity, impaired oral Sexuality Pattern, in effec tive
Mucous Membrane Integrity, risk for impaired oral Shock, risk for
Nausea Sitting, impaired
Neonatal Abstinence Syndrome Skin Integrity, impaired
Neurovascular Dysfunction, risk for peripheral Skin Integrity, risk for impaired
Nutrition: less than body requirements, imbalanced Sleep, readiness for enhanced
Nutrition, readiness for enhanced Sleep Deprivation
Obesity Sleep Pattern, disturbed
Occupational Injury, risk for Social Interaction, impaired
Overweight Social Isolation
Overweight, risk for Sorrow, chronic
Pain, acute Spiritual Distress
Pain, chronic Spiritual Distress, risk for
Pain, labor Spiritual Well- Being, readiness for enhanced
Palliative/end- of- life care— hospice, Standing, impaired
Parenting, impaired Stress Overload
Parenting, readiness for enhanced Substance Withdrawal Syndrome, acute
Parenting, risk for impaired Substance Withdrawal Syndrome, risk for acute
Perioperative Positioning Injury, risk for Sudden infant Death, risk for
Personal Identity, disturbed Suffocation, risk for
Personal Identity, risk for disturbed Suicide, risk for
Physical Trauma, risk for Surgical Recovery, delayed
Poisoning, risk for Surgical Recovery, risk for delayed
Post- Trauma Syndrome Surgical Site Infection, risk for
Post- Trauma Syndrome, risk for Swallowing, impaired
Power, readiness for enhanced Thermal Injury, risk for
Powerlessness Thermoregulation, in effec tive
Powerlessness, risk for Thermoregulation, risk for in effec tive
Pressure Ulcer, risk for Thromboembolism, risk for venous
Protection, in effec tive Tissue Integrity, impaired
Rape- Trauma Syndrome Tissue Integrity, risk for impaired
Relationship, in effec tive Tissue Perfusion, in effec tive peripheral
Relationship, readiness for enhanced Tissue Perfusion, risk for decreased cardiac
Relationship, risk for in effec tive Tissue Perfusion, risk for in effec tive ce re bral
Religiosity, impaired Tissue Perfusion, risk for in effec tive peripheral
Religiosity, readiness for enhanced Transfer Ability, impaired
Religiosity, risk for impaired Trauma, risk for vascular
Relocation Stress Syndrome Unilateral Neglect
Relocation Stress Syndrome, risk for Ventilation, impaired spontaneous
Resilience, impaired Ventilatory Weaning Response, dysfunctional
Resilience, readiness for enhanced Vio lence, risk for other- directed
Resilience, risk for impaired Vio lence, risk for self- directed
Retention, urinary Walking, impaired
Role Confl ict, parental Wandering [specify sporadic or continual]
Role Per for mance, in effec tive [ ] author recommendations
Herdman, TH, and Kamitsuru, S (eds): Nursing Diagnoses— Defi nitions and Classifi cation 2018–2020. Copyright © 2018, 1994–2018 NANDA
International. Used by arrangement with Thieme. In order to make safe and effective judgments using NANDA- I nursing diagnoses, it is essential
that nurses refer to the defi nitions and defi ning characteristics of the diagnoses listed in this work.
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NURSING
CARE
PLANS
Guidelines for Individualizing
Client Care Across the Life Span
10th EDITION
Marilynn E. Doenges, APRN, BC- Retired
Clinical Specialist, Adult Psychiatric/Mental Health Nursing, Retired
Retired Adjunct Faculty
Beth- El College of Nursing and Health Sciences, UCCS
Colorado Springs, Colorado
Mary Frances Moor house, RN, MSN, CRRN
Adjunct Faculty/Clinical Instructor
Pikes Peak Community College
Nurse Consultant/TNT- RN Enterprises
Colorado Springs, Colorado
Alice C. Murr, BSN, RN- Retired
Retired Legal Nurse Consultant, certified Rehabilitation Case
Manager, and certified practitioner in Critical Care Nursing
Parkville, Missouri
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Acquisitions Editor: Jacalyn Sharp
Se nior Content Proj ect Man ag er: Amy M. Romano
Art and Design Man ag er: Carolyn O’Brien
As new scientifi c information becomes available through basic and clinical
research, recommended treatments and drug therapies undergo changes. The
authors and publisher have done every thing pos si ble to make this book accu-
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warranty, expressed or implied, in regard to the contents of the book. Any
practice described in this book should be applied by the reader in accordance
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cially urged when using new or infrequently ordered drugs.
Library of Congress Cataloging- in- Publication Data
Names: Doenges, Marilynn E., 1922– author. | Moorhouse, Mary Frances, 1947–
author. | Murr, Alice C., 1946– author.
Title: Nursing care plans : guidelines for individualizing client care across the
life span / Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr.
Description: Edition 10. | Philadelphia : F.A. Davis Company, [2019] |
Includes bibliographical references and index.
Identifi ers: LCCN 2018041708 (print) | LCCN 2018042523 (ebook) |
ISBN 9780803694958 | ISBN 9780803660861 (pbk. : alk. paper)
Subjects: | MESH: Patient Care Planning | Nursing Process | Handbooks
Classifi cation: LCC RT49 (ebook) | LCC RT49 (print) | NLM WY 49 |
DDC 610.73—dc23
LC record available at https://lccn.loc.gov/2018041708
Authorization to photocopy items for internal or personal use, or the internal
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To our families, friends, and colleagues, who much of the time have had to manage without us while we work, as well as
having to cope with our strug gles and frustrations.
The Doenges families: the late Dean, whose support and encouragement is sorely missed; Jim; Barbara and Bob Lanza;
David, Monita, and Tyler; Matthew, Trish, Sara, and Natilia; John, Holly, Nicole, and Kelsey; and the Daigle families:
Nancy, Jim; Jennifer, Brandon, Annabelle, Will, and Henry Smith- Daigle, and Jonathan, Kim, and Mandalyn JoAn
(MED).
The Moor house family: the late and ever pres ent Jan; Paul Moor house and Jessica Kantorski; Jason and Thenderlyn
Moor house; Alexa, Tanner, and Quinton Plant; and Mary Isabella Moor house and Richard Ortiz Vega (MFM).
To the memory of my long- time dear friend Peggy French, who lost her battle with heart failure last year. I miss her
laughter and jokes that carried me through many a day in my “writing cave” over the last 32 years (ACM).
To our F. A. Davis family, especially Robert Allen whose support is so vital to the completion of a proj ect of this magnitude.
We are happy to welcome Jacalyn Sharp, who is the Acquisitions Editor for this proj ect. And last but not least, Amy Romano,
who supports us on a daily basis and keeps track of all the pieces. Thank you for your support and understanding. We are
fortunate to have you working with us.
To the nurses we are writing for, who daily face the challenge of caring for the acutely ill client and are looking for a
practical way to or ga nize and document this care. We believe that nursing diagnosis and these guides will help.
To NANDA- I and to the international nurses who are developing and using nursing diagnoses— here we come!
Fi nally, to the late Mary Lisk Jeffries, who initiated the original proj ect. The memory of our early friendship and strug gles
remains with us. We miss her and wish she were here to see the growth of the profession and how nursing diagnosis has
contributed to the pro cess.
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