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Nursing Guide
The first to speak was Virginia Fry of nursing diagnosis in an article published in 1953 in a magazine. The concept was soon to succeed mainly because it was believed that the diagnosis was a peculiar activity of the medical profession. It was the North American Nursing Diagnosis Association to give new impetus to research, making a decisive contribution to the classification of nursing diagnoses.
For nursing diagnosis, NANDA includes the clinical judgment on the answers provided at individual, family or society to the problems of health and life processes, real or potential. The nursing diagnosis provides the basis for making a choice of nursing care interventions that will lead to achieving the objectives of which is responsible for the nurses.
The nursing diagnoses are, therefore, the basis for selecting interventions to achieve the goals of care established.
Respond to a widespread need in our profession to use a standardized language, common among nurses of nations and different operational contexts. Especially in an age of increasing computerization of data about patients. All this has a positive impact on practice and documented, training and research on nursing. It also helps the communication between different health professions and the users themselves, improving performance, helping to contain health care costs. Provides an important indication of quality required by the most prestigious agencies of Accreditation of Healthcare Organizations.
That proposed by NANDA is not the only standardized classification system introduced in nursing practice. We recall, in passing, the ICNP, the proposed classification by the International Nursing Council and the NDEC (Nursing Diagnosis Extension and Classification).
And it is not even a system that fully meet the strict criteria of the scientific community, from which they come motivated criticism. The process of scientific validation and updating are still proceeding. However, a growing number of accredited research in the nursing field, relying on North American Nursing Diagnosis. Below is a list recently of such classification.
Model perception / health management:
Alteration in the maintenance of health status
Ineffective management of therapeutic regimen
Non-compliance to therapy
Alteration of protective processes
High risk of infections
High risk of injury
High risk of trauma
High risk of poisoning
High risk of suffocation
Specific behaviors aimed at maintaining health
Model nutrition / metabolism:
Alteration in nutrition: High risk of taking quantities exceeding the needs of the organism
Alteration in nutrition: Taking quantities exceeding the needs of the organism
Interruption of breastfeeding
Ineffective breastfeeding
Power of ineffective child
Breastfeeding effective
High risk of aspiration
Impairment of swallowing
Alteration of the oral mucosa
High risk of lack of fluids Lack of fluids resulting in loss of active organism
Excess liquid
Lack of fluids caused by the failure of regulatory mechanisms
High risk of damage to skin integrity
Damage to skin integrity
Damage to the integrity of tissues
High risk of impairment of body temperature
Ineffective thermoregulation
Hyperthermia
Hypothermia
Model Elimination:
Constipation
Feeling of constipation
Constipation of the colon
Diarrhea
Bowel Incontinence
Alteration of the urinary elimination cycle
Functional Incontinence
Reflex incontinence
Stress incontinence
Urgency incontinence
Total incontinence
Urinary retention
Model exercise / physical activity:
Alteration of growth and development
Fatigue
Lack of self care about personal hygiene
Lack of self-care with regard to appearance
Lack of self-care including food
Lack of self-care about the physiological functions
Lack of recreational
Inability to manage your home
High risk of activity intolerance
Motor deficit
High risk of disuse syndrome
Dysreflexia
Ineffective airway clearance
Ineffective respiratory activity
Alteration of gas exchange
Inability to sustain spontaneous breathing
Non-functional response to weaning from the respirator
Reduction of cardiac output
High risk for peripheral neurovascular dysfunction
Alteration of tissue perfusion: renal, cerebral, cardiopulmonary, gastrointestinal, peripheral
Model rest / sleep:
Sleep disorders
Model cognition / perception:
Pain
Chronic Pain
Alterations in sensory perception (visual, auditory, kinesthetic, gustatory, tactile, olfactory)
Unilateral Neglect
Alteration of cognitive processes
Decisional conflict
Lack of knowledge
Model perception / conception of himself:
Fear
Anxiety
Despair
Impotence
Altered body image
Alteration of personal identity
Alteration of self-esteem
Chronic low self-esteem
Low self-esteem, situational
High risk of self harm
Model role / relationship:
Impaired verbal communication
Social isolation
Difficulties in social interaction
Syndrome of stress transfer from
Alteration of the representation of roles
Affliction preventive
Affliction dysfunctional
High risk of violence against oneself or others
Altered family processes
High risk of altering the relationship between parents and children
Conflict in the role of parent
Difficulties in the role of caregiver for a sick family member
High risk of difficulties in the role of caregiver for a sick family member
Model sexuality / reproduction:
Sexual dysfunction
Altered patterns of sexual
Rape trauma syndrome secondary to
Rape trauma syndrome secondary reactions with composite
Rape trauma syndrome secondary reaction with silence
Model insult / stress tolerance:
Individual strategies of facing ineffective
Defensive snub
Denying ineffective
Inability to adapt
Response post-traumatic
Strategies of facing family characterized by growth potential
Strategies of dealing with severe ineffective family adaptation to health problems
Invalidation strategies of dealing with family adaptation to health problems
Model values / beliefs:
Spiritual Distress (Distress of the human spirit)
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