Dermatitis, seborrheic

• Impaired skin integrity

Candidiasis

• Impaired skin or tissue integrity
• Acute pain or discomfort
• Risk for sexual s\dysfunction

Eczema (dermatitis)

• Pain or discomfort
• Risk for infection
• Social isolation

Frostbite

• Impaired tissue integrity
• Acute pain
• Risk for infection

Pressure ulcer or sore

• Ineffective peripheral tissue perfusion
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Fractures

• Risk for trauma
• Acute pain
• Risk for peripheral neurovascular dysfunction
• Risk for impaired gas exchange
• Impaired physical mobility
• Risk for impaired skin or tissue integrity
• Risk for infection
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

View Sample Nursing Care Plan for Fracture

Amputation

• Low self-esteem
• Acute pain
• Risk for ineffective peripheral tissue perfusion
• Risk for infection
• Impaired physical mobility
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Total Joint Replacement

• Risk for infection
• Impaired physical mobility
• Risk for peripheral neurovascular dysfunction
• Acute pain
• Risk for constipation
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Rheumatoid Arthritis

• Acute or chronic pain
• Impaired mobility
• Impaired physical or walking
• Ineffective body image
• Disturbed role performance
• Self-care deficit
• Risk for impaired home maintenance
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs

View Sample Nursing Care Plan for Rheumatoid Arthritis

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3. Nursing Diagnosis for Neurological/Sensory Disorders

Anemia’s (Iron Deficiency, Pernicious, Aplastic, Hemolytic)

• Activity intolerance
• Imbalanced nutrition less than body requirements
• Constipation or diarrhea
• Risk for infection
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

View Sample Nursing Care Plan for Anemia

Sickle Cell Crisis

• Impaired gas exchange
• Acute or chronic pain
• Ineffective tissue perfusion (specify)
• Risk for deficient fluid volume
• Impaired physical mobility
• Risk for impaired skin integrity
• Risk for infection
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Leukemias

• Risk for infection
• Risk for deficient fluid volume
• Acute pain
• Activity intolerance
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

View sample Nursing Care Plan for Leukemia

Lymphomas

• Risk for impaired gas exchange
• Sexual dysfunction
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Sepsis/ Septicemia

• Risk for infection (progression of sepsis to septic shock, development of opportunistic infections)
• Hyperthermia
• Risk for ineffective tissue perfusion
• Risk for deficient fluid volume
• Risk for impaired gas exchange
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

View Sample Nursing Care Plan for Sepsis

HIV-Positive Patient

• Impaired adjustment
• Fatigue
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.
• Risk for social isolation
• Ineffective therapeutic regimen management (individual/family)

AIDS (Acquired Immune Deficiency Syndrome)

• Risk for infection (progression to sepsis or onset of new opportunistic infection)
• Risk for deficient fluid volume
• Risk for impaired breathing pattern
• Ineffective gas exchange
• Risk for injury (hemorrhage)
• Imbalanced nutrition less than body requirements
• Acute or chronic pain
• Risk for impaired skin integrity
• Impaired oral mucous membrane
• Fatigue
• Disturbed thought process
• Anxiety or fear
• Social Isolation
• Powerlessness
• Deficient knowledge (learning need) regarding condition, prognosis, treatment, self-care, and discharge needs.

Related posts:

1. Nursing Diagnosis for Integumentary and Skeletal System Diseases/Disorders
2. Nursing Diagnosis for Gastrointestinal Diseases/Disorders
3. Nursing Diagnosis for Metabolic and Endocrine Disorders

Top 10 jobs in the UK, Canada, Australia and Singapore today and/or over the next five years

UK 1

1. Data communications analyst
2. Marketing officer
3. Software engineer
4. Medical administrator
5. Community nurse
6. Advertising executive
7. Customer service assistant
8. Information officer
9. Administrator
10. Engineer

CANADA 2

1. Financial manager
2. Skilled tradesperson 5
3. Community college or vocational school teacher
4. Dentist or dental hygienist
5. Computer and information systems managers
6. University professor
7. Human resource specialist
8. Pharmacist
9. Registered nurse
10. Retail manager

AUSTRALIA 3

1. Organic farming specialist 6
2. Investment banker, securities broker
3. Mining worker 7
4. Online information service
5. Child care manager
6. Veterinarian
7. Financial planner, investment advisor
8. Accountant
9. Medical/hospital professional 8
10. Biotechnologist

SINGAPORE 4

1. Computer & information systems manager
2. Editor (newspaper & periodicals)
3. Business management consultant
4. Legal professional 9
5. Research & development manager
6. Futures trader, broker
7. Advertising creative director
8. Physicians, surgeons
9. Commercial airline pilot, flight inspector
10. Fund manager

1 Source: Alec.co.Uk
2 Source: canadianliving. com
3 Source: IBISWorld
4 Source: HubPages
5 Includes chef, electrician, carpenter, plumber, aviation technician, auto technician, industrial mechanic, etc.
6 Includes ecologist, biodynamic farming specialist, researcher, etc.
7 Includes chemical and material engineer, geologist, surveyor, cartographer, electrician, welder, safety inspector, etc.
8 Includes surgeon, anaesthetist, pediatrician, nurse, occupational therapist, medical technician, radiologist, ambulance officer, etc.
9 Includes lawyer, advocate, solicitor, etc.

Source: Inquirer.net

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• Is a systematic disease characterized by inflammatory lesions of connective tissue and endothelial tissue, primarily affecting the heart and joints.
• The pathogenesis is thought to be an autoimmune response to group A beta-hemolytic streptococcus.
• There is cross-reactivity between cardiac tissue antigens and streptococcal cell wall components.
• The unique pathologic lesions of rheumatic fever is the Aschoff body, a collection of reticuloendothelial cells surrounding a necrotic center on some structure of the heart.
• Acute Rheumatic Fever is commonly seen in children ages 5 to 15 but may occur in adults.
• There is a high recurrence rate, and 75% of those with ARF progresses to acute rheumatic heart disease in adulthood.
• Complications include significant heart failure, pericarditis, pericardial effusions, aortic or mitral valve insufficiency, and permanent cardiac damage.

Assessment

1. History of streptococcal pharyngitis or upper respiratory infection 2 to 6 weeks before onset of illness.
2. Jones criteria, presence of two major manifestations, or one major and two minor manifestations, plus evidence of preceding streptococcal infection, are required to establish diagnosis.
3. Major manifestations:
   • Carditis
   • Polyarthritis
   • Chorea
   • Erythema marginatum
   • Subcutaneous nodules
4. Minor manifestations:
   • History of previous rheumatic fever or evidence of pre-existing rheumatic disease.
   • Arthralgia: pain in one or more joints without evidence of inflammation, tenderness to touch, or limitation of motion.
   • Fever: temperature in excess of 100.4 degree Fahrenheit (38 degree Celsius).
   • Erythrocyte sedimentation rate (ESR) – elevated.
   • C – reactive protein – positive.
   • Electrocardiogram (ECG) changes – mainly pulse rate interval prolongation.
   • White blood cell count – elevated (leukocytosis).

Diagnostic Evaluation

1. Throat culture for group A beta-hemolytic streptococci and blood sample for titter of streptococcal antibodies ( antistreptolysin O, or ASO titer) to support evidence of recent streptococcal infection.
2. Complete blood count, ESR, and C-reactive protein for changes described above.
3. Baseline ECG and echocardiogram may be done to evaluate valve function.
4. Chest x-ray for cardiomegaly or heart failure.

Pharmacologic Interventions

1. Antibiotics to treat streptococcal infection – generally I.M. penicillin or erythromycin in penicillin allergy.
2. Corticosteroids for patients with carditis complicated by heart failure to prevent permanent cardiac damage.
3. Salicylates or nonsteroidals for patients with arthritis (but not while on high-dose corticosteroids because of risk of GI bleeding) and antipyretics to control fever, after diagnosis has been established.
4. Phenobarbital, diazepam if chorea is present.
5. Prophylactic antibiotics for at least 5 years after ARF.

Nursing Interventions

1. Monitor temperature frequently, and patient’s response to antipyretics.
2. Monitor the patient’s pulse frequently, especially after activity to determine degree of cardiac compensation.
3. Auscultate the hear periodically for development of new heart murmur or pericardial or pleural friction rub.
4. Observe for adverse effects of salicylate or nonsteroidal anti-inflammatory drug (NSAID) therapy, such as stomach upset, tinnitus, headache, GI bleeding, and altered mental status.
5. Monitor the patient’s response to long-term activity restriction.
6. Restrict sodium and fluids and obtain daily weights as indicated.
7. Administer medications punctually and at regular intervals to achieve constant therapeutic blood levels.
8. Explain the need to rest (usually prescribed for 4 to 12 weeks, depending on the severity of the disease and health care provider’s preference) and assure the patient that bed rest will be imposed no longer than necessary.
9. Assist the patient to resume activity very gradually once asymptomatic at rest and indicators of acute inflammation have become normal.
10. Provide comfort measures.
11. Provide safe, supportive environment for the child with chorea.
12. Observe for the disappearance or any major or minor manifestations of the disease and report signs of increased rheumatic activity as salicylates or steroids are being tampered.
13. Encourage continuous prophylactic antimicrobial therapy to prevent recurrence.

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• Is a protrusion of part of the stomach through the hiatus of the diaphragm and into the thoracic cavity.
• Two types of hiatal hernias:
  • Sliding hernia – the upper stomach and gastroesophageal junction move upward into the chest and slide in and out of the thorax (most common).
  • Paraesophageal hernia – or rolling hernia, part of the greater curvature of the stomach rolls through the diaphragmatic defect next to the gastroesophageal junction.
• Hiatal hernia results from muscle weakening caused by aging or other conditions such as esophageal carcinoma, trauma, or after certain surgical procedures.
• Treatment can prevent incarceration of the involved portion of the stomach in the thorax, which constricts gastric blood supply.

Assessment

1. Maybe asymptomatic.
2. Patient may report feeling of fullness or chest pain resembling angina.
3. Sliding hernia may cause dysphagia, heartburn (with or without regurgitation of gastric contents into the mouth), or restrosternal or substernal chest pain from gastric reflux.
4. Severe pain or shock may result from incarceration of stomach in thoracic cavity with paraesophageal hernia.

Diagnostic Evaluation

1. Upper gastric intestinal series with barium contrast shows outline of hernia in esophagus.
2. Endoscopy visualizes defect and rules out other disorders, such as tumors or esophagitis.

Therapeutic Intervention

1. Elevate head of the bed 6 to 8 inches (15 to 20) to reduce nighttime reflux.

Pharmacologic Interventions

1. Antacids neutralize gastric acid and reduce pain.
2. If patient has esophagitis, give histamine-2 receptor antagonist (such as cimetidine or ranitidine) or proton pump inhibitor (such as omeprazole) to decrease acid secretion.

Surgical Interventions

1. Gastropexy to fix the stomach in position is indicated if symptoms are severe.

Nursing Interventions

1. Advise the patient about preventing reflux of gastric contents into esophagus by:
   • Eating smaller meals to reduce stomach bulk.
   • Avoiding stimulation of gastric secretions by omitting caffeine and alcohol, which may intensify symptoms.
   • Refraining from smoking, which stimulates gastric acid secretions.
   • Avoiding fatty foods, which promote reflux and delay gastric emptying.
   • Refraining from lying down for at least 1 hour after meals.
   • Losing weight, if obese.
   • Avoiding bending from the waist or wearing tight-fitting clothes.
2. Advise the patient to report health care facility immediately at onset of acute chest pain – may indicate incarceration of paraesophageal hernia.
3. Reassure patient that he or she is not having a heart attack, but all instances of chest pain should be taken seriously and reported to the patient’s health care provider.

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Eating Disorders: Anorexia Nervosa/ Bulimia Nervosa

• Imbalanced nutrition, less than body requirements
• Actual or risk for deficient fluid volume
• Disturbed thought process
• Disturbed body image
• Low self-esteem
• Impaired parenting
• Risk for impaired tissue integrity
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Eating Disorders: Obesity

• Imbalanced nutrition, less than body requirements
• Actual or risk for deficient fluid volume
• Disturbed thought process
• Disturbed body image
• Chronic low self-esteem
• Impaired parenting
• Risk for impaired skin integrity
• Disturbed thought process
• Disturbed body image

Obesity: Surgical Interventions (Gastric Partitioning/Gastroplasty, Gastric Bypass)

• Ineffective breathing pattern
• Risk for ineffective tissue perfusion
• Risk for deficient fluid volume
• Imbalanced nutrition less than body requirements
• Risk for impaired tissue integrity
• Risk for infection
• Diarrhea
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Diabetes Mellitus/ Diabetic Ketoacidosis

• Deficient fluid volume (specify)
• Imbalanced nutrition less than body requirements
• Risk for infection (sepsis)
• Risk for disturbed sensory perception (specify)
• Fatigue
• Powerlessness
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

View Sample Nursing Care Plan for Diabetes Mellitus type 1

View Sample Nursing Care Plan for Diabetes Mellitus type 2

Hyperthyroidism (Thyrotoxicosis, Grave’s Disease)

• Risk for decreased cardiac output
• Fatigue
• Risk for imbalanced nutrition, less than body requirements
• Anxiety (specify level)
• Risk for disturbed thought process
• Risk for impaired tissue integrity
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Thyroidectomy

• Risk for ineffective airway clearance
• Impaired verbal communication
• Risk for injury (tetany)
• Acute pain
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Hepatitis

• Fatigue
• Imbalanced nutrition less than body requirements
• Risk for deficient fluid volume
• Low self-esteem
• Risk for infection
• Risk for impaired skin or tissue integrity
• Imbalanced nutrition less than body requirements

View Sample Nursing Care Plan for Hepatitis A

Cirrhosis of the liver

• Imbalanced nutrition less than body requirements
• Excess fluid volume
• Risk for impaired tissue integrity
• Risk for ineffective breathing pattern
• Risk for injury (hemorrhage)
• Risk for acute confusion
• Disturbed self-esteem
• Disturbed body image
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

View Sample Nursing Care Plan for Liver Cirrhosis

Pancreatitis

• Acute pain
• Risk for deficient fluid volume
• Imbalanced nutrition less than body requirements
• Risk for infection
• Risk for ineffective breathing pattern
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Total Nutritional Support: Parenteral/ Enteral Feeding

• Imbalanced nutrition less than body requirements
• Risk for infection
• Risk for injury (multifactor)
• Risk for aspiration
• Risk for imbalance fluid volume
• Fatigue
• Knowledge deficient (learning need) regarding condition, prognosis, treatment regimen, self-care, and discharge needs

Related posts:

1. Nursing Diagnosis for Gastrointestinal Diseases/Disorders
2. Nursing Diagnosis for Hematologic and Immune System Diseases/Disorders
3. Nursing Diagnosis for Neurological/Sensory Disorders