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NCP Angina Pectoris 2007-11-05 03:17:00 Angina Pectoris- Nursing Diagnoses/Collaborative ProblemsAngina pectoris is transient chest pain or discomfort that is caused by an imbalance between myocardial oxygen supply and demand. The discomfort typically occurs in the retrosternal area; may or may not radiate; and is described as a tight, heavy, squeezing, burning, or choking sensation. The most common cause of angina pectoris is decreased coronary blood supply due to atherosclerosis of a major coronary artery. The atherosclerosis causes narrowing of the vessel lumen and an inability of the vessel to dilate and supply sufficient blood to the myocardium at times when myocardial oxygen needs are increased. Other conditions that can compromise coronary blood flow (e.g., spasm and/or thrombosis of a coronary artery, hypovolemia) and conditions that reduce oxygen availability and/or increase myocardial workload and oxygen demands (e.g., anemia, smoking, exercise, heavy meals, increased altitude, exposure to cold, stress) may precipi
NCP Premenstrual Dysphoric Disorder Premenstrual Syndrome 2007-05-14 03:36:00 DSM-IV Premenstrual dysphoric disorder (provided for further study) Recommended for further systematic clinical study and research, Premenstrual Dysphoric Disorder (popularly called PMS) is characterized by multiple symptom clusters occurring during the menstrual cycle, becoming progressively disabling. Some research suggests these symptoms may be a delayed effect of hormonal changes earlier in the menstrual cycle, or the result of an independent cyclical mood disorder that is synchronized with the menstrual cycle. Although the physical symptoms produce discomfort, the mood change or premenstrual negative affect symptoms are often more distressing, interfering with familial, social, and work-related activities. The condition usually improves after the onset of menses; however, for some women, symptoms persist through and after menses. The symptoms cannot result solely from cyclic or environmental stress but may be enhanced by these stressors. This diagnosis is not used when the perso Read more:Syndrome
NCP Psychological Factors Affecting Medical Condition 2007-05-14 03:35:00 DSM-IV 316 (Psychological factors) affecting medical condition Choose name based on nature of/most prominent factor: Mental disorder affecting medical condition Psychological symptoms affecting medical condition Personality traits or coping style affecting medical condition Maladaptive health behaviors affecting medical condition Stress-related physiological response affecting medical condition Unspecified psychological factors affecting medical condition (Refer to DSM-IV listing for specific definitions.) These disorders represent a group of ailments in which emotional stress is a contributing factor to physical problems (coded on Axis III) involving an organ system under involuntary control. Any organ system may be affected, depending on the individual’s susceptibility. The result is the development or exacerbation of, interference with therapy for, and/or delayed recovery from a medical condition. Lists of related medical conditions are subject to change as Read more:Condition
NCP Passive Aggressive Personality Disorder 2007-05-14 03:32:00 DSM-IV 301.9 Personality
disorder NOS Passive
-Aggressive
personality disorder (negativistic personality disorder)—provided for further study. This disorder is characterized by a pervasive pattern of passive resistance, expressed indirectly rather than directly, to demands for adequate social/occupational performance, with the individual viewing the future as negatively as they view the present. ETIOLOGICAL THEORIES Psychodynamics These clients are unaware that ongoing difficulties are the result of their own behaviors. They experience conscious hostility toward authority figures but do not connect their ownpassive-resistant behaviors with hostility or resentment. They do not trust others, are not assertive, are intentionally inefficient, and try to “get back” at others through aggravation. Anger and hostility are released through others, who become angry and may suffer because of the client’s inefficiencies. This disorder can lead to more serious psychological dysfunction
NCP Anti Social Personality Disorder 2007-05-14 03:31:00 DSM-IV 301.7 Antisocial personality disorder “Sociopath” and “psychopath” are terms often used to describe the individual with antisocial personality. As deceit and manipulation are central features of the disorder, it is extremely difficult to treat. Imprisonment has been society’s major method for controlling the most dangerous behaviors. ETIOLOGICAL THEORIES Psychodynamics Psychodynamically, this individual remains fixed in an earlier level of development. Because of parental rejection or indifference, needs for satisfaction and security remain unmet, and the ego is underdeveloped. Because of a lack of ego strength, behavior is id directed and results in the need for immediate gratification. An immature supergo allows this individual to pursue gratification, regardless of means and without experiencing feelings of guilt. Biological Genetic involvement has been implicated in studies that showed that individuals with antisocial personality, and their parents, showed e Read more:Personality
, Social
NCP Anorexia Nervosa Bulimia Nervosa 2007-05-14 03:28:00 DSM-IV 307.1 Anoxexia nervosa 307.51 Bulimia
nervosa 307.50 Eating disorders NOS Binge-eating disorder (proposed, requiring further study) Anorexia
nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating, followed by self-induced vomiting. It may include abuse of laxatives and diuretics. Binge-eating is defined as recurrent episodes of overeating associated with subjective and behavioral indicators of impaired control over and significant distress about the eating behavior but without the use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise). ETIOLOGICAL THEORIES Psychodynamics The individual reflects a developmental arrest in the very early childhood years. The tasks of trust, autonomy, and separation-individuation are unfulfilled, and the individual remains in the dependent position. Ego
NCP Post Traumatic Stress Disorder 2007-05-14 03:23:00 DSM-IV 309.81 Posttraumatic stress disorder (specify acute, chronic, or delayed onset) 308.3 Acute stress disorder An anxiety disorder resulting from exposure to a traumatic event in which the individual has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death/serious injury or a threat to the physical integrity of the self or others. The individual’s response involved intense fear, helplessness, or horror. (A thorough physical examination should be done to rule out neurological organic problems.) Additionally, a newly recognized phenomenon is the development of PTSD-like symptoms in some individuals who have been involved over a long period of time in the treatment of (or living with) clients with PTSD. ETIOLOGICAL THEORIES Psychodynamics The client’s ego has experienced a severe trauma, often perceived as a threat to physical integrity or self-concept. This results in severe anxiety, which is not controlled adequately by
NCP Generalized Anxiety Disorder 2007-05-14 03:20:00 DSM-IV 300.02 Generalized anxiety disorder Although some degree of anxiety is normal in life’s stresses, anxiety can be adaptive or maladaptive. Problems arise when the client has coping mechanisms that are inadequate to deal with the danger, which may be recognized or unrecognized. The essential feature of this inadequacy is unrealistic or excessive anxiety and worries about life circumstances. Anxiety disorders are the most common of all major groups of mental disorders in the United States, sharing comorbidity with major depression and substance abuse, increasing the client’s risk of suicide. ETIOLOGICAL THEORIES Psychodynamics The Freudian view involves conflict between demands of the id and superego, with the ego serving as mediator. Anxiety occurs when the ego is not strong enough to resolve the conflict. Sullivanian theory states that fear of disapproval from the mothering figure is the basis for anxiety. Conditional love results in a fragile ego and lack of self-confid
NCP Bipolar Disorders 2007-05-14 03:16:00 DSM-IV 296.xx Bipolar
I disorder 296.0x Single manic episode 296.40 Most recent episode hypomanic 296.4x Most recent episode manic 296.6x Most recent episode mixed 296.7 Most recent episode unspecified 296.5x Most recent episode depressed 296.89 Bipolar II disorder (recurrent major depressive episodes with hypomania) 301.13 Cyclothymic disorder 296.80 Bipolar disorder NOS Bipolar disorders are characterized by recurrent mood swings of varying degree from depression to elation with intervening periods of normalcy. Milder mood swings such as cyclothymia may be manifested or viewed as everyday creativity rather than an illness requiring treatment. Hypomania can actually enhance artistic creativity and creative thinking/ problem-solving. This plan of care focuses on treatment of the manic phase. (Note: Bipolar II disorder is characterized by periods of depression and hypomania, but without manic episodes.) Refer to CP: Depressive Disorders for care of depressive episode. ETIOL
NCP Delusional Disorder 2007-05-14 03:13:00 DSM-IV 297.1 Delusional disorder Specific type: Erotomanic (delusions that another person of higher status is in love with the individual) Grandiose (delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person) Jealous (delusions that one’s sexual partner is unfaithful) Persecutory (delusions that one, or someone to whom one is close, is being malevolently treated in some way) Somatic (delusions that one has some physical defect or general medical condition) Mixed (delusions characteristic of more than one of the above types, but no one theme predominates) ETIOLOGICAL THEORIES Psychodynamics Emotional development is delayed because of a lack of maternal stimulation/attention. The infant is deprived of a sense of security and fails to establish basic trust. A fragile ego results in severely impaired self-esteem, a sense of loss of control, fear, and severe anxiety. A suspicious attitude toward others is manifested and may con
NCP Schizoaffective Disorder 2007-05-14 03:11:00 DSM-IV 295.70 Schizoaffective disorder This disorder emphasizes the temporal relationship of schizophrenic and mood symptoms and is used for conditions that meet the criteria for both schizophrenia and a mood disorder with psychotic symptoms lasting a minimum of 1 month. The clinical features must occur within a single uninterrupted period of illness (for some, this may be years or even decades) that is judged to last until the individual is completely recovered for a significant period of time, free of any significant symptoms of the disorder. In comparison with schizophrenia, schizoaffective disorder occurs more commonly in women than in men. ETIOLOGICAL THEORIES Psychodynamics Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder. Biological Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder. Recent studies suggest that schizoaffective disorder is a distinct syndrome resulting from a high genetic liability to both mood disorders and schizophren
NCP Substance Dependence Abuse Rehabilitation 2007-05-14 02:59:00 DSM-IV Alcohol Use Disorders 303.90 Alcohol dependence 305.00 Alcohol abuse AMPHETAMINE (OR AMPHETAMINE-LIKE) USE DISORDERS 304.40 Amphetamine dependence 305.70 Amphetamine abuse CANNABIS USE DISORDERS 304.30 Cannabis dependence 305.20 Cannabis abuse COCAINE USE DISORDERS 304.20 Cocaine dependence 305.60 Cocaine abuse HALLUCINOGEN USE DISORDERS 304.60 Hallucinogen dependence 305.30 Hallucinogen abuse INHALANT USE DISORDERS 304.60 Inhalant dependence 305.90 Inhalant abuse NICOTINE USE DISORDERS 305.10 Nicotine dependence OPIOID USE DISORDERS 304.00 Opioid dependence 305.50 Opioid abuse PHENCYCLIDINE USE DISORDERS 304.90 Phencyclidine dependence 305.90 Phencyclidine abuse SEDATIVE, HYPNOTIC, OR ANXIOLYTIC SUBSTANCE USE DISORDERS 304.10 Sedative, hypnotic, or anxiolytic dependence 305.40 Sedative, hypnotic, or anxiolytic abuse POLYSUBSTANCE USE DISORDER 304.80 Polysubstance dependence (For other listings, consult DSM-IV manual.) Many drugs and volatile sub Read more:Dependence
, Rehabilitation
, Substance
NCP Hallucinogen Phencyclidine and Cannabis Related Disorders 2007-05-14 02:58:00 DSM-IV HALLUCINOGEN-RELATED/induced DISORDERS 292.89 Hallucinogen intoxication 292.81 Intoxication delirium 292.89 Hallucinogen persisting perception disorder (flashbacks) 292.89 Hallucinogen-induced anxiety disorder 292.84 Hallucinogen-induced mood disorder PHENCYCLIDINE (OR PHENCYCLIDINE-LIKE)/induced DISORDERS 292.89 Phencyclidine intoxication 292.81 Intoxication delirium 292.11 Induced psychotic disorder with delusions 292.12 Induced psychotic disorder with hallucinations CANNABIS-RELATED/induced DISORDERS 292.89 Cannabis
intoxication 292.81 Intoxication delirium 292.89 Cannabis-induced anxiety disorder Hallucinogenic substances can distort an individual’s perception of reality, altering sensory perception, and inducing hallucinations. For this reason, these substances are referred to as “mind expanding.” They are highly unpredictable in the effects they may induce each time they are used, and adverse reactions, including “flashbacks,” can recur at any tim
NCP Depressants Barbiturates, Nonbarbiturates, Hypnotics and Anxiolytics, Opioids 2007-05-14 02:56:00 DSM-IV SEDATIVE-, HYPNOTIC-, OR ANXIOLYTIC-INDUCED DISORDERS 292,89 Sedative, hypnotic, or anxiolytic intoxication 292.0 Sedative, hypnotic, or anxiolytic withdrawal 292.81 Intoxication delirium 292. 84 Induced mood disorder OPIOID-RELATED DISORDERS 292.89 Opioid intoxication 292.81 Intoxication delirium 292.0 Opioid withdrawal (For further listings, consult DSM-IV.) CNS depressants are drugs that slow down the central nervous system. They are usually divided into four types: barbiturates, antianxiety agents, sedative-hypnotics, and narcotics (opioids such as morphine, heroin). CNS depressants prescribed for symptoms of anxiety, depression, and sleep disturbances are among the most widely used and abused drugs. These drugs are very likely to be abused when the underlying conditions remain untreated. Sometimes these drugs are used in conjunction with stimulants, with the user developing a pattern of taking a stimulant to be “up,” then needing the depressant drug to “co
NCP Stimulants Amphetamines, cocaine, caffeine, and nicotine and Inhalant Related Disorders 2007-05-14 02:53:00 DSM-IV AMPHETAMINE-INDUCED DISORDERS 292.81 Intoxication delirium 292.89 Amphetamine intoxication 292.0 Amphetamine withdrawal 292.11 Psychotic disorders with delusions 292.12 Psychotic disorders with hallucinations CAFFEINE-INDUCED DISORDERS 305.90 Caffeine intoxication 292.89 Caffeine-induced anxiety disorder 292.89 Caffeine-induced sleep disorder COCAINE-INDUCED DISORDERS 292.89 Cocaine intoxication 292.0 Cocaine withdrawal 292.81 Intoxication delirium INHALANT-INDUCED DISORDERS 292.89 Inhalant intoxication 292.81 Inhalant intoxication delirium 292.84 Inhalant-induced mood disorder 292.89 Inhalant-induced anxiety disorder NICOTINE-INDUCED DISORDER 292.0 Nicotine withdrawal (For additional listings, consult DSM-IV.) Stimulants are natural and manufactured drugs that speed up the nervous system. They can be swallowed, injected, inhaled, or smoked. These substances are identified by the behavioral stimulation and psychomotor agitation that they induce. They diffe Read more:nicotine
NCP Dementia due to HIV Disease 2007-05-14 02:50:00 DSM-IV DEMENTIAS DUE TO OTHER MEDICAL CONDITIONS 294.1 Dementia due to HIV disease (Code 042 On Axis III) Dementia is impairment of short- and long-term memory, abstract thinking, and judgment with personality changes, severe enough to interfere with work, normal social activities, and relationships. Human immunodeficiency virus (HIV) has been shown to affect the brain directly by crossing the blood-brain barrier on two types of immune cells—monocytes and macrophages. Cells within the central nervous system (CNS) have been found to have express CD4 receptor sites for HIV entry into cells. Although several hypotheses have been proposed, it is not known exactly by what mechanism neurological dysfunction occurs. Neuropsychiatric symptoms may range from barely perceptible changes in a person’s normal psychological presentation to acute delirium to profound dementia. Because of the associated immune dysfunction, secondary brain infections may cause further damage. Studies have show
NCP Parenting Growth Promoting Relationship 2007-05-14 02:42:00 DSM-IV V61.20 Parent-child relational problem Many parents are concerned about how to raise responsible children who have high self-esteem, demonstrate self-control, and display skills of cooperation and consideration of others. Most people believe that we somehow know how to “parent” instinctively. Usually, this attitude results in parenting the same way we were parented. However, it is clear that the traditional authoritarian or permissive methods of parenting create inner conflict for most parents, and praise, punishment, and rewards do not have the desired effects of positive relationships with children. Conflicts in the parent/child relationship can lead to dysfunctional/abusive relationship patterns. In addition, when children are experiencing mental health crises requiring therapeutic intervention, learning different ways of parenting becomes essential to developing positive relationships between parent and child. It is generally accepted that primary prevention activities Read more:Growth
, Parenting
, Relationship
NCP Elimination Disorders Enuresis / Encopresis 2007-05-14 02:41:00 DSM-IV 307.6 Enuresis (not due to a general medical condition) 307.7 Encopresis without constipation and overflow incontinence 787.6 Encopresis with constipation and overflow incontinence The DSM-IV defines enuresis/encopresis as repeated involuntary (or, much more rarely, intentional) voiding/passage of feces into places not appropriate for that purpose, after attaining the developmental level at which continence is expected. If continence has not been achieved, the condition can be termed “functional” or “primary.” The period of continence necessary to differentiate between primary and secondary enuresis/encopresis is now considered to be 1 year. There does seem to be a significant relationship between enuresis and encopresis, although neither condition can be the direct effect of a general medical condition (e.g., diabetes, spina bifida, seizure activity) to be included in this category. ETIOLOGICAL FACTORS Psychodynamics Numerous psychological interpretations exist s Read more:Elimination
NCP Oppositional Defiant Disorder 2007-05-14 02:40:00 DSM-IV 313.81 Oppositional defiant disorder 312.9 Disruptive behavior disorder NOS A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, in which the child loses temper, argues with adults, often actively defies or refuses adult requests or rules, blames others, deliberately does annoying things, and swears or uses obscene language. This behavior creates significant impairment in academic/social functioning but does not meet the criteria for conduct disorder. (Disruptive behavior disorder NOS reflects clinical features that constitute the subthreshold for both oppositional defiant and conduct disorders.) ETIOLOGICAL THEORIES Psychodynamics The oppositional youth is fixed in the separation-individuation stage of development. The youth insists on autonomy by negative adaptive maneuvers in which he or she continually provokes adults or peers. As the youth develops internal controls, he or she will eventually grow out of these behaviors. Genetic/Biolog
NCP Conduct Disorder 2007-05-14 02:38:00 DSM-IV 312.XX Conduct
disorder 312.81 Childhood-onset type 312.82 Adolescent-onset type Conduct disorder is most distinguishable by the degree of repetitive and persistent violation of the basic rights of others. Common antisocial behaviors acted out in the home and school setting include physical aggression toward people and animals, destruction of property, lying, and theft. There is a total disregard for age-appropriate social norms as the child purposely engages in criminals acts, truancy from school, and breaking curfew. The DSM-IV criteria rates the level of severity as mild, moderate, to severe. The greater the level of delinquency and frequency in early childhood, the greater the risk for chronic offending into adulthood. Other prognostic factors leading to the continuation of the disorder include age of onset and the variation in problem behaviors displayed in multiple settings. Co-morbid diagnoses often associated with this condition are hyperactivity, depression, and che
NCP Attention Deficit / Hyperactivity Disorder ADHD 2007-05-14 02:36:00 DSM-IV 314.00 ADHD predominantly inattentive type 314.01 ADHD predominantly hyperactive-impulsive type 314.01 ADHD combined type 314.9 ADHD NOS This disorder is associated with inattentive, impulsive, and hyperactive behavior that is maladaptive and inconsistent with developmental level. This behavior creates clinically significant impairment in social/academic functioning. Accurate diagnosis is difficult, as symptoms resemble depression, learning disabilities, or emotional problems. The diagnosis is made through extensive observation of the child’s behavior; however, contact with health professionals is limited and the child’s activity may be misleading during short office visits. Reports from parents and teachers are often used to make the diagnosis, and their observations may be distorted, as they assume a problem exists and often predetermine the diagnosis themselves. ETIOLOGICAL THEORIES Psychodynamics The child with this disorder has impaired ego development. Ego dev
NCP Ventilatory Assistance (Mechanical) 2007-02-21 02:56:00 Many patients on ventilators are now being transferred from the intensive care unit (ICU) to medical-surgical units with problems including (1) neuromuscular deficits, such as quadriplegia with phrenic nerve injury or high C-spine injuries, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS); (2) COPD with respiratory muscle atrophy and malnutrition (inability to wean); and (3) restrictive conditions of chest or lungs, such as kyphoscoliosis and interstitial fibrosis.The expectation is that the majority of patients will be weaned before discharge. That is the focus of this plan of care. However, some patients are either unsuccessful at weaning or are not candidates for weaning. For those patients, portions of this plan of care would need to be modified for the discharge care setting, that is, an extended care facility or home.Types of VentilatorsVolume-cycled ventilators are the primary choice for long-term ventilation of patients whose permanent changes in lung complianc
Nursing Care Plans NCP 2008-04-09 12:30:00 Abusive verbal attacks on staff and others.Name:---------------------------------------------------------------------------Problem / Need / StrengthAbusive verbal attacks on staff and others.---------------------------------------------------------------------------Goal(s)will converse with others without swearing by ____.---------------------------------------------------------------------------Intervention(s)Administer medications as ordered and monitor for side effects, effectiveness.Approach resident in low, calm voice.Document behavior as to type, duration, and precipitating causes.Inform physician of resident's behavior.Praise all appropriate behavior and interactions with others.Remind resident that verbal abuse is unacceptable and redirect.Talk with resident in calm voice when beha Read more:Nursing
Nursing Care Plan NCP 2008-04-11 12:42:00 Behavior problem related to Dx. SDAT as evidenced by: Combative behavior toward family Name:---------------------------------------------------------------------------Problem / Need / StrengthBehavior problem related to Dx. SDAT as evidenced by: Combative behavior toward family---------------------------------------------------------------------------Goal(s)Will have fewer episodes of _________ behavior daily/weekly by review date.Will have no evidence of behavior problems by review date.---------------------------------------------------------------------------Intervention(s)Administer medications as ordered and monitor for side effects, effectiveness.Anticipate and meet needs.Assist in developing more appropriate methods of coping and interacting.Encourage to express feelings appropriate Read more:Nursing
Nursing Care Plan NCP 2008-04-11 12:28:00 Chronic constipation related to [ SPECIFY ]Name:---------------------------------------------------------------------------Problem / Need / StrengthChronic constipation related to [ SPECIFY ]---------------------------------------------------------------------------Goal(s)Will have no fecal impaction x 90 days.---------------------------------------------------------------------------Intervention(s)Assist patient/resident by toileting routinely [frequency].DOC elimination pattern.Evaluate knowledge of fluids and fiber in prevention of constipation.Monitor for signs/symptoms of GI distress.Monitor meals and encourage to eat foods high in bulk and fiber.Natural laxative as ordered.Stool softeners as ordered to avoid straining or constipation.Chronic diarrhea related to [ SPECIFY ]Name:------ Read more:Nursing
Nursing Care Plan Congesitive Heat Failure NCP 2008-04-11 12:14:00 CHF (Congestive Heart Failure), Fluid Volume ExcessName:---------------------------------------------------------------------------Problem / Need / StrengthCHF (Congestive Heart Failure), Fluid Volume Excess---------------------------------------------------------------------------Goal(s)Body weight will remain within normal limitsElectrolyte levels will be within normal limitsWill demonstrate adequate knowledge concerning medical condition.Will maintain optimal fluid balanceWill verbalize less dyspnea and be more comfortable.---------------------------------------------------------------------------Intervention(s)Administer Oxygen as orderedAsess for symptoms such as dizziness, weaknes/fatigue, nausea/vomiting, confusion, sweatiness, cyanosis. Notify physician as appropriate.Assess for pr Read more:Nursing
Discharge Planning Building a Trust Relationship 2008-04-30 20:51:00 Impaired Home MaintenanceInability to independently maintain a safe growth-promoting immediate environment.Assessment Data• Lack of skills with which to function independently outside the hospital• Lack of confidence• Dependence on hospital• Perceived helplessness• Nonexistent or unrealistic goals and plans• Lack of knowledge• Inadequate support system• Inadequate financial resources• Disorganized or dysfunctional living environmentExpected OutcomesImmediateThe client will:• Verbalize concrete realistic plans regarding:• Meeting essential physical needs (housing, employment, financial resources, necessary transportation, and physical care, if needed)• Meeting emotional needs through significant relationships, social activities, a general support system, and so forth Read more:Building
, Relationship
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