Nursing Diagnoses: The Complete NANDA-I 2024-2026 List

The person takes little or no part in leisure, play or recreational activities, whether because of a lack of opportunities, energy or interest. They often express boredom, spend long stretches doing nothing and their mood suffers.

When to use it: Used in prolonged hospitalizations, isolation, long-term care facilities, bed rest or hospitalized children without play areas.

Example: Decreased diversional activity engagement related to a hospital environment with no leisure options as evidenced by reports of boredom and spending the day lying in bed staring at the ceiling.

Domain 1, class 1 (Health awareness) · Problem-focused · Write it · Care plan

The person spends much of their waking day sitting or lying down, with very little movement. It goes beyond not exercising: it includes long hours in front of screens, in the car or at a desk without movement breaks.

When to use it: Used in office workers, teens with heavy screen use, older adults with limited mobility or people in prolonged recovery.

Example: Excessive sedentary behaviors related to lack of interest in physical activity as evidenced by sitting more than ten hours a day and taking no movement breaks.

Domain 1, class 1 (Health awareness) · Problem-focused · Write it · Care plan

It comes from a holistic approach that views the person as having a flow of vital energy, and describes that flow as disrupted, blocked or out of harmony. It is assessed with techniques such as therapeutic touch and is often accompanied by discomfort, tension or a feeling of disconnection.

When to use it: Used in settings that offer complementary therapies such as therapeutic touch, with people experiencing pain, anxiety, grief or chronic illness.

Example: Imbalanced energy field related to anxiety about the illness process as evidenced by reports feeling blocked and temperature changes perceived in the field during assessment.

Domain 1, class 1 (Health awareness) · Problem-focused · Write it · Care plan

The person takes part in leisure activities today, but certain situations could cause them to stop or lose access to them. This can lead to boredom, isolation and a worse mood.

When to use it: Used with prolonged hospitalization, prescribed bed rest, admission to a long-term care facility, retirement or a new full-time caregiver role.

Example: Risk for decreased diversional activity engagement related to isolation in a private room and lack of entertainment options.

Domain 1, class 1 (Health awareness) · Risk · Write it · Care plan

The person still gets an acceptable amount of movement, but certain situations could lead them to spend most of the day sitting or lying down. It is worth catching early, before the habit settles into their routine.

When to use it: Used when starting a desk job or working from home, after an injury or surgery, at retirement or in teens with more screen time.

Example: Risk for excessive sedentary behaviors related to starting to work from home and insufficient knowledge of the effects of a sedentary lifestyle.

Domain 1, class 1 (Health awareness) · Risk · Write it · Care plan

The older adult shows decline in several areas at once, such as strength, mobility, nutrition, mood and memory, which leaves them with little reserve. Any illness or small change can lead to falls, loss of independence or hospitalization.

When to use it: Used in older adults with unintentional weight loss, weakness, repeated falls, slow gait or multiple chronic conditions.

Example: Elder frailty syndrome related to insufficient intake and physical inactivity as evidenced by unintentional weight loss, slow gait and needing help to bathe.

Domain 1, class 2 (Health management) · Syndrome · Write it · Care plan

The person has trouble finding, understanding, evaluating or using the health information they receive. As a result, they mix up instructions, don't understand their results or make decisions about their care without the information they need.

When to use it: Used in people with limited formal education, language barriers, older adults on many treatments or those receiving a complex diagnosis.

Example: Inadequate health literacy related to written instructions in technical language as evidenced by inability to explain what each of his medications is for.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

A community or group can't organize itself or use its resources to address a health problem that affects it. There are high rates of certain diseases or risks, and programs that are insufficient or underused by the population.

When to use it: Used in neighborhoods with dengue outbreaks, schools with rising childhood obesity, rural communities with poor access or populations after a disaster.

Example: Ineffective community health management related to insufficient prevention programs as evidenced by rising dengue cases and mosquito breeding sites in most backyards in the neighborhood.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with dry eye doesn't consistently use the measures that relieve discomfort and protect the surface of the eye. Burning, a gritty feeling or blurred vision persist, and the problem interferes with reading, screen use or sleep.

When to use it: Used in older adults, contact lens wearers, people with heavy screen use and patients after eye surgery.

Example: Ineffective dry eye self-management related to insufficient knowledge of eye care measures as evidenced by using artificial tears only during flare-ups and reporting daily burning at the computer.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with dry mouth doesn't consistently use the measures that relieve the discomfort and protect the teeth and gums. The sticky-mouth feeling and difficulty speaking or swallowing persist, and the risk of cavities and infections increases.

When to use it: Used in older adults on many medications, people treated with head and neck radiation, or with Sjögren's syndrome or diabetes.

Example: Ineffective dry mouth self-management related to insufficient knowledge of oral hydration measures as evidenced by drinking little water during the day and reporting difficulty swallowing dry foods.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The family can't fit the care that a member's illness or health risk requires into its daily routine. Treatments get missed, appointments are skipped, symptoms get worse and tension builds among family members over who does what.

When to use it: Used with families caring for a member with a chronic illness, disability or dependence, especially after hospital discharge or a recent diagnosis.

Example: Ineffective family health management related to care demands that exceed family resources as evidenced by the daughter forgetting to give her father his medications and two missed follow-up appointments.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with persistent tiredness can't use strategies that help manage it, such as pacing their energy, planning rest breaks or prioritizing tasks. Fatigue keeps limiting their daily activities and quality of life.

When to use it: Used in people undergoing cancer treatment, with multiple sclerosis, heart failure, chronic kidney disease or after a prolonged infection.

Example: Ineffective fatigue self-management related to insufficient knowledge of energy conservation strategies as evidenced by doing all the housework in the morning and spending the afternoon in bed.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person doesn't take the basic actions that protect their health, such as regular checkups, vaccines, a healthy diet or physical activity. It isn't about a specific disease but about habits and preventive care missing from their daily life.

When to use it: Used in adults who skip preventive checkups, people with financial or access barriers, or with risk habits such as smoking.

Example: Ineffective health maintenance behaviors related to perceiving himself as not at risk as evidenced by no checkups in five years and incomplete immunizations.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person lives with a chronic illness and cannot fit the medications, diet, self-monitoring and appointments they need into their routine, with visible effects: worsening symptoms, numbers out of target range or readmissions. It is not always a lack of information; sometimes they know what to do and still cannot do it.

Example: Ineffective health self-management related to complex treatment regimen and insufficient knowledge of sodium restriction and weight monitoring as evidenced by skipping the diuretic on workdays, not weighing self at home, 3 kg weight gain in 5 days, and second admission for decompensated heart failure in 6 months.

Domain 1, class 2 (Health management) · Problem-focused

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The person or family can't keep their home clean, tidy and safe. Trash or dirt piles up, there are fall or fire hazards, and the environment can affect the health of the people who live there.

When to use it: Used in older adults who live alone, people with physical or cognitive decline, overburdened caregivers or families with limited resources.

Example: Ineffective home maintenance behaviors related to physical limitations for heavy chores as evidenced by dirty dishes piled up in the kitchen and loose cords in the hallway.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with lymphedema can't keep up the care that controls swelling and prevents complications, such as compression, skin care and prescribed exercise. As a result, limb volume increases, discomfort appears and the risk of infection grows.

When to use it: Used in people treated for breast cancer with lymph node removal, with primary lymphedema or after pelvic surgery or radiation therapy.

Example: Ineffective lymphedema self-management related to difficulty putting on the compression garment as evidenced by not wearing it most days and reporting increasing heaviness in the arm.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The patient has nausea and cannot control it with what they know or do: they cannot pinpoint what triggers it, do not use the prescribed medications correctly, or do not apply measures that would help. The focus is not only the discomfort but their ability to manage it.

Example: Ineffective Nausea Self-Management related to inadequate knowledge of relief measures and fear of becoming dependent on antiemetics as evidenced by nausea rated 6/10 three times a day, intake of 25% of meals, refusal of the prescribed antiemetic, and stating they do not know what to do when it starts.

Domain 1, class 2 (Health management) · Problem-focused

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The person with overweight or obesity can't sustain the changes in diet, activity and habits that would let them manage their weight. There are usually repeated attempts that get abandoned, and weight stays the same or goes up.

When to use it: Used in adults with overweight and related conditions, teens with obesity or people who have abandoned several meal plans.

Example: Ineffective overweight self-management related to unrealistic goals as evidenced by abandoning meal plans after two weeks and weight gain over the past six months.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with pain, especially chronic pain, can't effectively use the strategies that help control it, such as pacing, relaxation techniques or taking their treatment correctly. Pain keeps limiting their activity, sleep and mood.

When to use it: Used in people with chronic low back pain, arthritis, fibromyalgia, cancer pain or a prolonged recovery after surgery.

Example: Ineffective pain self-management related to insufficient knowledge of nonpharmacological strategies as evidenced by taking analgesics only when the pain is severe and avoiding leaving the house.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person with underweight can't sustain the actions that would let them reach or maintain a healthy weight, such as eating regularly or increasing their energy intake. Their weight stays low or keeps dropping, and they may feel weak or tired.

When to use it: Used in older adults with poor appetite, people undergoing cancer treatment, with a chronic illness that increases energy expenditure or with limited resources for food.

Example: Ineffective underweight self-management related to insufficient knowledge of energy-dense foods as evidenced by frequently skipping dinner and weight loss over the past month.

Domain 1, class 2 (Health management) · Problem-focused · Write it · Care plan

The person already gets some physical activity and wants to make it more regular, varied or intense. They are motivated, look for guidance and are willing to adjust their routine to fit more exercise into their week.

When to use it: Used in adults getting back to activity after rehabilitation, people with overweight starting to make changes, active older adults or healthy pregnant women.

Example: Readiness for enhanced exercise engagement as evidenced by expressed desire to walk five days a week and a request for guidance on starting to swim.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The person already understands and uses health information reasonably well and wants to get better at finding, understanding and applying it to their decisions. They show interest in asking questions, clearing up doubts and communicating better with the health care team.

When to use it: Used in patients with a recently diagnosed chronic illness, caregivers, first-time parents or people preparing for scheduled surgery who ask for more information.

Example: Readiness for enhanced health literacy as evidenced by expressed desire to better understand nutrition labels and her lab results.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The person with a health condition already manages their treatment and symptoms reasonably well and wants to do even better. They want to fit care into daily life, make informed decisions and feel more confident.

When to use it: Used in people with diabetes, hypertension, asthma or another stable chronic condition who ask for tools to improve their control.

Example: Readiness for enhanced health self-management as evidenced by expressed desire to keep a blood glucose log and adjust her diet to her goals.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The older person, or someone approaching that stage, takes care of themselves and wants to strengthen the habits that let them age with independence and well-being. They show interest in staying active, connected with other people and up to date on preventive care.

When to use it: Used in independent older adults, people about to retire or those who attend community groups and health programs.

Example: Readiness for enhanced healthy aging as evidenced by expressed desire to join a walking group and improve her diet.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The person or family keeps their home in good condition and wants to improve cleanliness, organization or safety. They show interest in learning practical measures, such as preventing falls or storing hazardous products safely.

When to use it: Used in families expecting a baby, older adults adapting their home or people who will be caring for a dependent family member at home.

Example: Readiness for enhanced home maintenance behaviors as evidenced by expressed desire to rearrange her home to prevent her mother from falling.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The person wants to improve how they manage their weight and already shows habits or efforts in that direction. They are looking for information, realistic goals and support to sustain changes in diet and physical activity.

When to use it: Used in people with overweight who are starting to make changes, adults who want to maintain a weight they have reached or people who want to regain weight in a healthy way.

Example: Readiness for enhanced weight self-management as evidenced by expressed desire to plan her weekly meals and track her physical activity.

Domain 1, class 2 (Health management) · Health promotion · Write it · Care plan

The older adult isn't frail yet but is accumulating factors that could lead to a quick loss of strength, weight and independence. Catching it early makes it possible to intervene on nutrition, physical activity and social support.

When to use it: Used in older adults who live alone, with a poor diet, little physical activity, a recent hospitalization or multiple chronic conditions.

Example: Risk for elder frailty syndrome related to insufficient protein intake, physical inactivity and social isolation.

Domain 1, class 2 (Health management) · Syndrome · Write it · Care plan

The person understands basic information about their health today, but certain factors could make it hard for them to understand or use it in new situations. This can happen with more complex treatments, very technical information or language barriers.

When to use it: Used when receiving a complex diagnosis, in older adults with vision or hearing changes, people with limited formal education or speakers of another language.

Example: Risk for inadequate health literacy related to a language barrier and educational materials available only in a language the patient doesn't read.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

It is the possibility that a person with a glucose disorder will not be able to manage their own treatment, food, activity and glucose checks, so that their blood glucose ends up outside the target range. The problem has not appeared yet: nursing acts before it does.

Example: Risk for Ineffective Blood Glucose Pattern Self-Management related to inadequate knowledge of matching food intake to insulin, irregular meal times, and irregular self-monitoring, in a patient with type 2 diabetes starting basal insulin (associated condition).

Domain 1, class 2 (Health management) · Risk

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A community or group is meeting its health needs today, but certain factors could weaken that capacity. If that happens, a health problem could spread through the population without enough programs or resources to address it.

When to use it: Used in communities facing service cuts, rapid population growth, a rainy season with outbreak risk or after a disaster.

Example: Risk for ineffective community health management related to insufficient community resources and low participation in prevention programs.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person may start to have dry mouth, or not manage it well, because of factors such as medications, treatments or low fluid intake. If they don't learn to prevent and manage it, discomfort when speaking and eating and the risk of dental problems increase.

When to use it: Used in older adults on several medications, people starting head and neck radiation, on oxygen therapy or with low fluid intake.

Example: Risk for ineffective dry mouth self-management related to insufficient fluid intake and insufficient knowledge of oral care.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The family is meeting its members' health needs today, but certain factors could throw that care into disarray. If that happens, treatments could be forgotten, appointments missed or the entire care burden could fall on one member.

When to use it: Used when a family member receives a new diagnosis, a dependent member is discharged, finances change or a baby with special needs is born.

Example: Risk for ineffective family health management related to growing care demands and conflict over how tasks are divided.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person keeps up with basic preventive care today, but certain factors could cause them to stop. Lack of time, resources or information can lead them to neglect checkups, vaccines or healthy habits.

When to use it: Used in overburdened caregivers, people with job or financial changes, recent immigrants or adults with limited access to health services.

Example: Risk for ineffective health maintenance behaviors related to long working hours and difficulty getting to the health center.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person with a health condition is managing their treatment well today, but certain factors could cause them to drop it or follow it inconsistently. If that happens, their symptoms could worsen or preventable complications could appear.

When to use it: Used with a recent chronic diagnosis, treatment changes, financial difficulties or complex regimens with many medications.

Example: Risk for ineffective health self-management related to a complex treatment regimen and limited social support.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The home is in acceptable condition today, but certain factors could cause the person or family to stop looking after it. If that happens, dirt, clutter and the risk of accidents in the home would increase.

When to use it: Used in older adults with declining strength, when returning home after a hospitalization, when taking on a new caregiver role or after a financial loss.

Example: Risk for ineffective home maintenance behaviors related to fatigue when doing household chores and a limited support network.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person with lymphedema, or at high risk of developing it, may not keep up the care that keeps it from progressing. Control is adequate today, but certain factors threaten consistency, such as lack of information, cost or little support.

When to use it: Used after cancer surgery with lymph node removal, when starting compression therapy or in people with few resources or limited support.

Example: Risk for ineffective lymphedema self-management related to insufficient knowledge of prevention measures and the high cost of compression garments.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person with overweight or obesity is following a plan to manage their weight today, but certain factors could cause them to abandon it. If that happens, they could regain the weight they lost and increase their risk of complications.

When to use it: Used after recent weight loss, with work stress, changes in routine, the holiday season or when follow-up with the health care team ends.

Example: Risk for ineffective overweight self-management related to work stress and irregular mealtimes.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

The person is managing their weight acceptably today but could have trouble maintaining it, or regaining it if it drops. Factors such as poor appetite, limited resources or demanding treatments can disrupt their eating and lead to weight loss.

When to use it: Used when starting chemotherapy, in older adults who live alone, after digestive surgery or in people with food insecurity.

Example: Risk for ineffective underweight self-management related to decreased appetite and difficulty preparing meals.

Domain 1, class 2 (Health management) · Risk · Write it · Care plan

Exclusive breastfeeding is stopped or supplemented with other foods earlier than planned. The baby receives formula, water or other liquids for reasons that can often be resolved with support, practical information and follow-up.

When to use it: In mothers returning to work, hospitalized babies, families who offer formula because they believe the milk isn't enough, or because of pain when breastfeeding.

Example: Disrupted exclusive chestfeeding related to returning to work without a space to pump as evidenced by the 3-month-old receiving formula in the afternoons.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

The person has difficulty swallowing. The problem can be in the mouth (forming and pushing the bolus), in the throat (closing off the airway while the bolus passes) or in the esophagus. The main concerns are food going into the lungs and the person not eating enough.

Example: Impaired swallowing related to improper positioning during meals and unmodified liquid consistency as evidenced by coughing and wet voice with 10 mL of water, SpO2 drop from 96% to 92%, food pocketed on the paralyzed side of the mouth, and drooling.

Domain 2, class 1 (Ingestion) · Problem-focused

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The lactating person produces less milk than their baby needs. It shows up as very long or very frequent feedings, a fussy baby after feeding, few wet diapers or poor weight gain.

When to use it: Postpartum with infrequent breastfeeding, separation of parent and baby, early formula use or marked fatigue and stress.

Example: Inadequate human milk production related to feedings spaced every four hours as evidenced by the baby having four wet diapers a day and poor weight gain.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

The patient does not eat enough to cover what their body uses and needs to maintain itself, heal or grow. It shows in what they leave on the plate, in the weight they lose and, over time, in their strength and wound healing.

Example: Inadequate nutritional intake related to uncontrolled nausea and pain with eating and lack of knowledge of the prescribed diet as evidenced by intake of less than 50% of meals for 4 days and weight loss of 4 kg (6%) in 3 weeks.

Domain 2, class 1 (Ingestion) · Problem-focused

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The person doesn't eat enough calories or protein to cover what their body uses. Over time they lose weight and muscle mass, tire easily and heal more poorly, especially if they are ill or recovering.

When to use it: In older adults with poor appetite, hospitalized patients with prolonged NPO status, people with chewing difficulties or limited resources to buy food.

Example: Inadequate protein energy nutritional intake related to poor appetite and ill-fitting dentures as evidenced by eating less than half of each meal.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

The teen has disorganized eating habits that don't meet their body's needs. They may skip meals, eat out or alone a lot, or choose highly processed foods, which affects their weight, energy and mood.

When to use it: In teens with irregular schedules, frequent fast food, family conflict at mealtimes or marked concern about body image.

Example: Ineffective adolescent eating dynamics related to irregular school schedules and eating alone as evidenced by skipping breakfast five days a week.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

Breastfeeding isn't working as it should for the lactating person or the baby. There may be a poor latch, pain, cracked nipples, very short feedings or a baby who isn't satisfied and isn't gaining the expected weight.

When to use it: In first-time mothers, preterm babies or babies with tongue-tie, postpartum nipple pain or little guidance on positioning and latch.

Example: Ineffective chestfeeding related to incorrect latch technique as evidenced by cracked nipples on both sides and feedings lasting less than five minutes.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

The way the child eats at home and at school doesn't support healthy nutrition. Common patterns include meals in front of screens, sweets used as rewards, food refusal or little adult involvement, which affects growth and food preferences.

When to use it: In preschool or school-age children with selective food refusal, overweight, meals in front of the TV or caregivers with little time.

Example: Ineffective child eating dynamics related to using sweets as rewards and meals in front of screens as evidenced by refusing vegetables at every meal.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

The interaction between the infant and the person feeding them doesn't result in an adequate, calm feeding. The baby may eat little, refuse the breast or bottle, or be given foods at times or in ways that aren't right for their age.

When to use it: In infants with reflux, preterm infants, with very early introduction of solids, or with caregivers who are unsure or poorly informed about hunger cues.

Example: Ineffective infant feeding dynamics related to lack of knowledge of hunger and satiety cues as evidenced by forced feedings and crying during feeding.

Domain 2, class 1 (Ingestion) · Problem-focused · Write it · Care plan

Breastfeeding is already going well and the person wants to make it even better. They want to resolve questions, improve positioning, maintain milk supply or continue breastfeeding longer with more confidence and comfort.

When to use it: In mothers with established breastfeeding who plan to return to work, want to breastfeed longer or want answers at follow-up visits.

Example: Readiness for enhanced chestfeeding as evidenced by expressed desire to continue exclusive breastfeeding until the baby is six months old.

Domain 2, class 1 (Ingestion) · Health promotion · Write it · Care plan

The person eats reasonably well and wants to improve the quality of their diet. They are looking for information and concrete changes, such as eating more vegetables and fruit, cutting back on sugar, drinking more water or planning their weekly meals better.

When to use it: In people who want to take care of their health, pregnant women, families planning changes at home or patients starting a physical activity program.

Example: Readiness for enhanced nutritional intake as evidenced by expressed desire to include more vegetables and cut back on sugary drinks in her daily diet.

Domain 2, class 1 (Ingestion) · Health promotion · Write it · Care plan

There is a chance that exclusive breastfeeding will be stopped or supplemented too early. Certain situations push toward formula or other liquids, and timely support for the family can prevent it.

When to use it: In mothers about to return to work, babies admitted to the hospital, families suggesting formula or people unsure whether their milk is enough.

Example: Risk for disrupted exclusive chestfeeding related to returning to work in two weeks and lack of knowledge about pumping and storing breast milk.

Domain 2, class 1 (Ingestion) · Risk · Write it · Care plan

The lactating person has conditions that could reduce milk production even though there are no clear signs yet. Catching it early allows feeding frequency, latch and support to be adjusted before the baby stops gaining weight.

When to use it: Immediate postpartum with separation from the baby, cesarean birth, early bottle use, an upcoming return to work or little support at home.

Example: Risk for inadequate human milk production related to separation from the baby due to nursery admission and infrequent milk expression.

Domain 2, class 1 (Ingestion) · Risk · Write it · Care plan

The person has factors that could lead them to take in fewer nutrients than they need. For now their diet is adequate, but that could change unless their intake and weight are monitored.

When to use it: In older adults who live alone, people with nausea or pain when eating, patients on restricted diets or families with limited access to food.

Example: Risk for inadequate nutritional intake related to difficulty preparing meals due to living alone and limited mobility.

Domain 2, class 1 (Ingestion) · Risk · Write it · Care plan

The person is at risk of not eating enough calories and protein for their needs. They are still maintaining their weight and strength, but certain circumstances could reduce their intake if what they eat and how they are doing aren't monitored in time.

When to use it: In patients kept NPO for tests, older adults who live alone, people with persistent nausea or with increased needs due to surgery or wounds.

Example: Risk for inadequate protein energy nutritional intake related to repeated NPO periods for tests and a liquid diet for three days.

Domain 2, class 1 (Ingestion) · Risk · Write it · Care plan

Certain conditions could keep breastfeeding from going well, even though there are no problems for now. Anticipating it makes it possible to teach positioning, latch and hunger cues before pain or poor weight gain appear.

When to use it: In first-time mothers, after a cesarean birth, with preterm babies or a weak suck, and in people with no previous experience or support with breastfeeding.

Example: Risk for ineffective chestfeeding related to first baby and lack of guidance on positioning and latch during the hospital stay.

Domain 2, class 1 (Ingestion) · Risk · Write it · Care plan

The newborn builds up more bilirubin in the blood than expected for their age in hours. It shows up as yellow skin and eyes, sometimes with sleepiness or a poor suck, and calls for close monitoring to prevent neurological complications.

When to use it: In newborns with visible jaundice in the first days of life, preterm infants, babies with ineffective breastfeeding or marked weight loss.

Example: Neonatal hyperbilirubinemia related to insufficient milk intake in the first 72 hours as evidenced by yellow skin extending to the abdomen and a weak suck.

Domain 2, class 4 (Metabolism) · Problem-focused · Write it · Care plan

The newborn is more likely to have bilirubin rise to high levels in the first days of life. There is no significant jaundice yet, but certain conditions favor it, so skin color, feeding and stools should be monitored.

When to use it: In preterm newborns, with delayed initiation of feeding, greater-than-expected weight loss or very early hospital discharge.

Example: Risk for neonatal hyperbilirubinemia related to delayed passage of meconium and infrequent feedings during the first day.

Domain 2, class 4 (Metabolism) · Risk · Write it · Care plan

The body accumulates more fluid than it needs, both inside the blood vessels and in the tissues. It shows up as rapid weight gain, edema, distended neck veins and, in severe cases, pulmonary congestion. It usually develops when the heart, kidneys or liver can't handle water and sodium properly.

Example: Excessive fluid volume related to sodium intake above the prescribed limit and skipped diuretic doses as evidenced by 3.5 kg weight gain in 6 days, 2+ pitting edema to the knees, JVD at 45°, bilateral basilar crackles and a positive fluid balance of 900 mL in 24 hours.

Domain 2, class 5 (Hydration) · Problem-focused

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The patient has less circulating fluid than their body needs to maintain blood pressure, perfusion and organ function. It develops when losses (vomiting, diarrhea, fever, drains, third spacing) exceed intake, or when intake is poor.

Example: Inadequate Fluid Volume related to unreplaced losses from vomiting and no oral intake for 24 hours as evidenced by HR 118 bpm, BP 96/60 mmHg, urine output of 0.25 mL/kg/h over the last 4 hours, dry oral mucosa, and capillary refill of 3 seconds.

Domain 2, class 5 (Hydration) · Problem-focused

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The person may retain more fluid than their body can handle. There is no edema or shortness of breath yet, but certain factors favor fluid buildup, so weight, intake and output, and signs of overload should be monitored.

When to use it: In patients on continuous IV fluids, a high-sodium diet, a poorly followed fluid restriction or with compromised heart or kidney function.

Example: Risk for excessive fluid volume related to continuous IV infusion and intake of high-sodium foods.

Domain 2, class 5 (Hydration) · Risk · Write it · Care plan

The person may lose or build up too much fluid, inside or outside the blood vessels. There are no signs of dehydration or overload yet, but certain processes could disrupt their balance quickly.

When to use it: In extensive surgery, burns, patients with drains, active bleeding, continuous IV fluids or fluid balance that is hard to control.

Example: Risk for impaired fluid volume balance related to abdominal drain losses and prolonged post-op NPO status.

Domain 2, class 5 (Hydration) · Risk · Write it · Care plan

The person may develop disturbances in body water and in salts such as sodium or potassium. There are no signs of imbalance yet, but certain losses or intake could alter them and affect the heart, the muscles or alertness.

When to use it: In patients with vomiting or diarrhea, on diuretics, with prolonged NPO status, high-output drains or kidney disease.

Example: Risk for impaired water-electrolyte balance related to three days of diarrhea and low oral fluid intake.

Domain 2, class 5 (Hydration) · Risk · Write it · Care plan

The patient has no signs of dehydration yet but is losing more fluid than they replace, or is in a situation that could lead to it. Without intervention, circulating blood volume drops and tachycardia, hypotension and decreased urine output follow.

Example: Risk for Inadequate Fluid Volume related to losses from an NG tube to suction, fever, and NPO status, in a patient with acute pancreatitis (associated condition).

Domain 2, class 5 (Hydration) · Risk

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The person leaks urine because a physical, cognitive or environmental limitation keeps them from reaching or using the bathroom in time, even though their bladder works fine. The problem is access to the toilet or the ability to get there, not urinary control.

When to use it: In older adults with reduced mobility, people with cognitive impairment, and patients facing barriers at home or in the hospital to reaching the bathroom.

Example: Disability-associated urinary incontinence related to difficulty walking and a bathroom far from the room as evidenced by urine leakage before reaching the toilet.

Domain 3, class 1 (Urinary function) · Problem-focused · Write it · Care plan

The person has trouble urinating normally. They may void very often, with urgency, with pain or in small amounts, get up several times at night or have leakage, which affects their rest and daily life.

When to use it: In older adults, patients whose urinary catheter was recently removed, people with a urinary tract infection or with changes in mobility or fluid intake.

Example: Impaired urinary elimination related to low fluid intake and recent catheter removal as evidenced by frequent low-volume voids and burning on urination.

Domain 3, class 1 (Urinary function) · Problem-focused · Write it · Care plan

The person has two types of urine leakage at once: with exertion such as coughing or laughing, and also with a sudden, intense urge to urinate. Each component calls for different strategies, so it helps to identify which one predominates.

When to use it: In menopausal women or those with previous births, older adults and people with pelvic floor weakness who also have an irritable bladder.

Example: Mixed urinary incontinence related to pelvic floor weakness and high coffee intake as evidenced by leakage when coughing and urgency with leakage before reaching the bathroom.

Domain 3, class 1 (Urinary function) · Problem-focused · Write it · Care plan

The person has factors that could trigger a sudden urge to urinate with leakage before reaching the bathroom. They aren't leaking urine yet, but their habits or condition make uncontrolled bladder contractions more likely.

When to use it: In older adults, people with high intake of coffee, alcohol or soda, frequent constipation or limited mobility that makes it hard to reach the bathroom in time.

Example: Risk for urge urinary incontinence related to high intake of coffee and soda and frequent constipation.

Domain 3, class 1 (Urinary function) · Risk · Write it · Care plan

The person may have trouble fully emptying the bladder and may retain urine. They are still voiding, but certain factors could prevent adequate emptying and cause pain, distension or infection if not monitored.

When to use it: Post-op, after spinal anesthesia, postpartum, and in patients on opioids, immobile patients or those with significant constipation.

Example: Risk for urinary retention related to the effects of spinal anesthesia and bed rest in the immediate post-op period.

Domain 3, class 1 (Urinary function) · Risk · Write it · Care plan

The person leaks small amounts of urine with exertion such as coughing, sneezing, laughing, lifting or exercising. This happens because the muscles that support the bladder and close the urethra can't withstand the increase in abdominal pressure.

When to use it: In women after vaginal births, during menopause, people with overweight, high-impact athletes and men after prostate surgery.

Example: Stress urinary incontinence related to pelvic floor weakness after two vaginal births as evidenced by urine leakage when coughing and running.

Domain 3, class 1 (Urinary function) · Problem-focused · Write it · Care plan

The person suddenly feels an intense need to urinate and leaks urine before reaching the bathroom. They usually go many times during the day and at night, and may avoid leaving home for fear of an accident.

When to use it: In older adults, people with overactive bladder, high coffee or alcohol intake, frequent constipation or neurological aftereffects.

Example: Urge urinary incontinence related to drinking five cups of coffee a day as evidenced by urine leakage before reaching the bathroom and ten voids a day.

Domain 3, class 1 (Urinary function) · Problem-focused · Write it · Care plan

The person has difficult, infrequent or incomplete bowel movements for months, with no organic cause to explain it. There are usually hard stools, a need to strain a lot, a feeling of incomplete emptying and abdominal discomfort.

When to use it: In older adults, people with a low-fiber diet, little physical activity, low water intake or who tend to hold in the urge to have a bowel movement.

Example: Chronic functional constipation related to a low-fiber diet and sedentary lifestyle as evidenced by two hard bowel movements per week over the past six months.

Domain 3, class 2 (Gastrointestinal function) · Problem-focused · Write it · Care plan

The person loses stool or gas without being able to control it. It may be due to lack of warning, not reaching the bathroom in time or weakness of the muscles that support the rectum, and it takes a heavy toll on their skin and social life.

When to use it: In older adults, people with cognitive impairment or reduced mobility, women with tears during childbirth and patients with persistent diarrhea.

Example: Impaired fecal continence related to limited mobility to reach the bathroom as evidenced by stool soiling of underwear twice a day.

Domain 3, class 2 (Gastrointestinal function) · Problem-focused · Write it · Care plan

The person's digestive tract moves slower or faster than normal. Depending on the direction of the change, it may show up as abdominal distension, absent or hyperactive bowel sounds, nausea, vomiting, cramping, inability to pass gas or diarrhea.

When to use it: After abdominal surgery, in patients on prolonged bed rest, on opioids, receiving enteral feeding or under intense anxiety and stress.

Example: Impaired gastrointestinal motility related to post-op immobility as evidenced by abdominal distension, hypoactive bowel sounds and no flatus for 48 hours.

Domain 3, class 2 (Gastrointestinal function) · Problem-focused · Write it · Care plan

The person has changes in how they have bowel movements: in frequency, stool consistency or the effort needed. It is a new diagnosis in 2024-2026; this edition retired the standalone labels Constipation (00011) and Diarrhea (00013).

When to use it: In hospitalized patients with diet changes, prolonged bed rest, medications that affect the bowel or changes in their bowel routine.

Example: Impaired intestinal elimination related to a change in diet and bed rest as evidenced by irregular bowel movements with straining and a feeling of incomplete emptying.

Domain 3, class 2 (Gastrointestinal function) · Problem-focused · Write it · Care plan

The person has habits or conditions that could lead to constipation lasting months. They still have reasonably regular bowel movements, but their diet, activity or routine make it likely the problem will appear and persist.

When to use it: In older adults, sedentary or bedbound people, those with a low-fiber diet or low water intake, or who put off bowel movements because of a lack of privacy.

Example: Risk for chronic functional constipation related to water intake under 1 liter a day and prolonged bed rest.

Domain 3, class 2 (Gastrointestinal function) · Risk · Write it · Care plan

The person has factors that could cause them to lose stool without control. They are still continent, but their mobility, pelvic floor strength or stool consistency put them at risk of accidents.

When to use it: In older adults, women after births with perineal tears, patients with frequent diarrhea, limited mobility or cognitive impairment.

Example: Risk for impaired fecal continence related to frequent loose stools and difficulty reaching the bathroom in time.

Domain 3, class 2 (Gastrointestinal function) · Risk · Write it · Care plan

The person may develop changes in the movement of the digestive tract, which may become too slow or too fast. There are no symptoms yet, but certain factors could cause distension, nausea, inability to pass gas or diarrhea.

When to use it: After abdominal surgery, in immobile patients, people on opioids, with intense anxiety or abrupt diet changes.

Example: Risk for impaired gastrointestinal motility related to post-op immobility and delayed start of oral intake.

Domain 3, class 2 (Gastrointestinal function) · Risk · Write it · Care plan

The person's bowel pattern could change in frequency, consistency or ease. Their bowel movements are still normal, but changes in diet, activity or treatment could affect their bowels.

When to use it: In hospitalized patients, people on prolonged bed rest, with changes in diet or routine, or starting medications that alter bowel transit.

Example: Risk for impaired intestinal elimination related to bed rest and a switch to a low-fiber soft diet.

Domain 3, class 2 (Gastrointestinal function) · Risk · Write it · Care plan

Oxygen doesn't move well from the alveoli into the blood, or CO₂ doesn't move well from the blood into the alveoli. The result is low blood oxygen, CO₂ retention or both, even when the patient's respiratory rate and effort look acceptable.

Example: Impaired gas exchange related to shallow breathing from pleuritic pain and prolonged supine positioning as evidenced by SpO2 of 86% on room air, drowsiness and PaCO₂ of 55 mmHg on ABG.

Domain 3, class 4 (Respiratory function) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person keeps habits that get in the way of good rest, such as irregular bedtimes, screen use before sleep or afternoon caffeine. These behaviors affect how much and how well they sleep.

When to use it: Used in students, shift workers, teens who use their phones at night and people who have caffeine or alcohol in the evening.

Example: Ineffective sleep hygiene behaviors related to insufficient knowledge of sleep habits as evidenced by using her phone in bed until the early morning hours and drinking coffee at 7 p.m.

Domain 4, class 1 (Sleep / rest) · Problem-focused · Write it · Care plan

The person doesn't get enough sleep, or restful enough sleep, for their needs. They may take a long time to fall asleep or wake up several times or very early, and during the day they feel tired, sleepy, irritable or have trouble concentrating.

When to use it: Used in hospitalized people and those with stress or anxiety, pain, work schedule changes or noisy surroundings.

Example: Ineffective sleep pattern related to nighttime noise and light on the unit as evidenced by reports waking up four times a night and feeling tired on getting up.

Domain 4, class 1 (Sleep / rest) · Problem-focused · Write it · Care plan

The person sleeps reasonably well and wants better-quality rest. They show interest in adjusting their schedule, environment or bedtime habits to sleep through the night and wake up with more energy for the day.

When to use it: Used in healthy adults, pregnant women, parents of newborns and people recovering from a stressful period who want to rest better.

Example: Readiness for enhanced sleep pattern as evidenced by expressed desire to set a regular sleep schedule and wake up rested.

Domain 4, class 1 (Sleep / rest) · Health promotion · Write it · Care plan

The person could pick up habits that make it hard to sleep well, such as irregular bedtimes, screen use before bed or evening caffeine. The risk comes from changes in their routine, even though their sleep habits are adequate for now.

When to use it: Used in students during exam periods, people starting shift work, teens and people with recent changes in routine.

Example: Risk for ineffective sleep hygiene behaviors related to insufficient knowledge of sleep habits and an upcoming start of night work.

Domain 4, class 1 (Sleep / rest) · Risk · Write it · Care plan

The person could stop getting enough sleep or restful sleep. Factors such as stress, pain, schedule changes or a noisy environment could disrupt their rest, although there are no sleep problems yet.

When to use it: Used in people being admitted to the hospital, caregivers of ill family members, workers starting night shifts or people who are recently bereaved.

Example: Risk for ineffective sleep pattern related to a switch to night shift and a noisy home environment during the day.

Domain 4, class 1 (Sleep / rest) · Risk · Write it · Care plan

The person can't change position in bed on their own, such as turning, sitting up or moving up toward the head of the bed. This increases the risk of pressure injuries, joint stiffness and dependence on staff or family.

When to use it: Used after hip or abdominal surgery and in people with severe pain, muscle weakness, obesity or sedation.

Example: Impaired bed mobility related to surgical incision pain as evidenced by inability to turn onto his side without assistance.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person cannot move their body or a limb with the freedom, strength or coordination they need, so they rely on another person or a device to change position, transfer or walk. It is not about a medical order restricting movement, but about what the person can actually do.

Example: Impaired physical mobility related to pain and decreased muscle strength in the right lower extremity as evidenced by needing one-person assist to transfer from bed to chair, slow gait with a walker, and difficulty turning in bed.

Domain 4, class 2 (Activity / exercise) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person has trouble getting into or staying in a sitting position on their own. They struggle to balance their trunk, hold up their head or stay seated long enough to eat, transfer or take part in activities.

When to use it: Used in people with trunk weakness, neurological aftereffects, prolonged bed rest, low back pain or pelvic fractures.

Example: Impaired sitting ability related to trunk muscle weakness as evidenced by leaning to one side after two minutes of sitting.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person can't stand up or stay upright steadily. They may lose their balance, need to support themselves with their hands or be unable to bear weight on their legs, which increases the risk of falls.

When to use it: Used in people with lower extremity weakness, prolonged bed rest, recent amputation, dizziness on standing or pain in weight-bearing joints.

Example: Impaired standing ability related to lower extremity weakness as evidenced by being unable to stand for more than 30 seconds without support.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person can't move on their own from one surface to another, such as from bed to chair, chair to toilet or into a car. These transfers are unsafe for them and require help or equipment, with a risk of falls.

When to use it: Used in people with hemiplegia, spinal cord injury, amputation, generalized weakness or after orthopedic surgery.

Example: Impaired transferring ability related to lower extremity weakness as evidenced by inability to transfer from bed to chair without two-person assistance.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person has trouble getting around on foot on their own. They may walk slowly, with short or unsteady steps, be unable to cover the distances they need or climb stairs, and often need a walker, cane or another person's help.

When to use it: Used after hip or knee surgery, in older adults afraid of falling and in people with joint pain or neurological aftereffects.

Example: Impaired walking ability related to right knee pain and decreased muscle strength as evidenced by walking less than 10 meters (about 33 feet) with a walker.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person who uses a wheelchair has trouble operating it on their own in different settings. They struggle to propel it, turn, go up ramps or get around obstacles, which limits their independence inside and outside the home.

When to use it: Used in people with spinal cord injury, lower limb amputation, arm weakness or who are new to using a wheelchair.

Example: Impaired wheelchair mobility related to insufficient upper extremity strength as evidenced by inability to go up a ramp without assistance.

Domain 4, class 2 (Activity / exercise) · Problem-focused · Write it · Care plan

The person could lose the ability to move freely and purposefully. Weakness, stiffness or limited walking and repositioning could develop if they don't stay active or if the factors holding them back aren't addressed.

When to use it: Used in prolonged hospitalizations, post-op patients, frail older adults and people with joint pain or fear of falling.

Example: Risk for impaired physical mobility related to prolonged bed rest and fear of moving because of pain.

Domain 4, class 2 (Activity / exercise) · Risk · Write it · Care plan

The patient cannot handle the effort their daily activities require. When they move, the heart and lungs cannot keep up with what the body demands, and dyspnea, tachycardia or exhaustion force them to stop before finishing.

Example: Decreased activity tolerance related to prolonged bed rest and inadequate oxygenation during exertion as evidenced by HR increase of 32 bpm when walking 10 meters, SpO2 of 87% while ambulating, and Borg dyspnea score of 6/10.

Domain 4, class 3 (Energy balance) · Problem-focused

See the full page: defining characteristics, care plan and case study

It is lasting physical and mental exhaustion that does not improve with sleep or rest and is more intense than the person's activity would explain. It drains the energy they need to work, care for themselves or spend time with others.

Example: Excessive Fatigue Burden related to fragmented sleep and insufficient protein and iron intake as evidenced by tiredness rated 8/10 that does not improve with sleep, 2-hour naps without regaining energy, and giving up household tasks for the past 3 weeks.

Domain 4, class 3 (Energy balance) · Problem-focused

See the full page: defining characteristics, care plan and case study

The surgical patient is recovering more slowly than expected. They still have pain, fatigue, limited mobility or wound problems, and can't resume self-care or usual activities within the time frame expected for their type of surgery.

When to use it: Used in post-op patients with wound infection, poorly controlled pain, delayed mobilization, malnutrition or complications that extend the hospital stay.

Example: Impaired surgical recovery related to poorly controlled pain and delayed mobilization as evidenced by not ambulating on post-op day 5 and needing help with hygiene.

Domain 4, class 3 (Energy balance) · Problem-focused · Write it · Care plan

The person may not have the physical or mental energy to carry out daily activities. Fatigue, shortness of breath or heart rate changes could develop with exertion they used to tolerate.

When to use it: Used in people on prolonged bed rest, with deconditioning, anemia, heart or lung disease, and in inactive older adults.

Example: Risk for decreased activity tolerance related to 10 days of bed rest and a sedentary lifestyle.

Domain 4, class 3 (Energy balance) · Risk · Write it · Care plan

The surgical patient could take longer than expected to recover and get back to their activities. Factors such as advanced age, obesity, smoking or poor nutrition could complicate wound healing, pain control or mobilization.

When to use it: Used pre-op and post-op in older adults, people with diabetes, smokers and people with malnutrition or obesity.

Example: Risk for impaired surgical recovery related to current smoking and insufficient protein intake.

Domain 4, class 3 (Energy balance) · Risk · Write it · Care plan

The adult on mechanical ventilation doesn't tolerate a reduction in ventilatory support. During the weaning attempt, rapid breathing, accessory muscle use, agitation or a drop in oxygen saturation appear, and support has to be increased again.

When to use it: Used in adults on prolonged mechanical ventilation, with respiratory muscle weakness, anxiety during the spontaneous breathing trial or poor nutritional status.

Example: Impaired adult ventilatory weaning response related to anxiety and respiratory muscle fatigue as evidenced by a respiratory rate of 36 and agitation 20 minutes into the trial.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Problem-focused · Write it · Care plan

The child or infant on mechanical ventilation doesn't tolerate a decrease in ventilatory support. During weaning, nasal flaring, retractions, rapid breathing, irritability or a drop in oxygen saturation appear, and the previous level of support has to be resumed.

When to use it: Used in preterm infants, infants on prolonged ventilation, children with respiratory muscle weakness or with poorly adjusted sedation during weaning.

Example: Impaired child ventilatory weaning response related to respiratory muscle fatigue as evidenced by intercostal retractions, nasal flaring and SpO2 of 88% when support is reduced.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Problem-focused · Write it · Care plan

The person can't breathe on their own well enough to maintain oxygenation and clear carbon dioxide. Respiratory muscle fatigue, rapid or shallow breathing and abnormal arterial blood gases develop, so ventilatory support is usually needed.

When to use it: Used in critically ill patients with respiratory exhaustion, neuromuscular injury, deep sedation or severe exacerbations of lung disease.

Example: Impaired spontaneous ventilation related to respiratory muscle fatigue as evidenced by accessory muscle use, a respiratory rate of 34 and SpO2 of 86%.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Problem-focused · Write it · Care plan

It describes a way of breathing that doesn't move air well: too fast, too slow, too shallow or with too much effort. The problem is how air moves in and out, not what happens inside the lung, and it can often be corrected by treating pain, positioning or anxiety.

Example: Ineffective breathing pattern related to pain on inspiration after thoracotomy and respiratory muscle fatigue as evidenced by respiratory rate of 28 breaths/min, shallow breathing and accessory muscle use.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Problem-focused

See the full page: defining characteristics, care plan and case study

Circulation to the arms or, more often, to the legs and feet isn't enough to keep the tissues healthy. The skin gets less oxygen and heals poorly, and pain with walking, coolness and color changes appear.

Example: Ineffective peripheral tissue perfusion related to active smoking and lack of knowledge about foot care as evidenced by weak dorsalis pedis pulses, capillary refill of 4 seconds, a cool right foot, and calf pain after walking 100 meters that eases with rest.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Problem-focused

See the full page: defining characteristics, care plan and case study

The heart may not pump enough blood to meet the body's needs. If this happens, blood pressure and organ perfusion drop, causing fatigue, dizziness, cool skin or decreased urine output.

When to use it: Used in people with a recent MI, arrhythmias, heart failure, fluid imbalances or after cardiac surgery.

Example: Risk for decreased cardiac output related to negative fluid balance from repeated vomiting in a patient with heart failure.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Risk · Write it · Care plan

Blood pressure could rise or fall outside the person's safe range. These swings can cause dizziness, falls, headache or damage to organs such as the heart, brain and kidneys.

When to use it: Used in people starting a new antihypertensive, with poor treatment adherence, dehydration, severe pain or sudden position changes.

Example: Risk for imbalanced blood pressure related to irregular adherence to antihypertensive therapy and high sodium intake.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Risk · Write it · Care plan

The function of the heart and blood vessels could deteriorate and affect circulation to the organs. The risk usually comes from habits and factors built up over years, such as smoking, inactivity, overweight, stress or poorly controlled blood pressure.

When to use it: Used in people with cardiovascular risk factors, a family history of heart disease, diabetes or hypertension with poor treatment adherence.

Example: Risk for impaired cardiovascular function related to current smoking, a sedentary lifestyle and a high-sodium diet.

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Risk · Write it · Care plan

The person may experience a drop in the blood reaching the brain and, with it, in the oxygen and glucose that neurons need. There are no new signs of damage yet, but the situation makes them likely if it isn't monitored and corrected in time.

Example: Risk for ineffective cerebral tissue perfusion related to blood pressure fluctuations, uncontrolled hyperglycemia and hyperthermia, in a patient with ischemic stroke treated with thrombolysis (associated condition).

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Risk

See the full page: defining characteristics, care plan and case study

It is the possibility that blood flow to the tissues of the extremities drops below what they need, which can cause leg pain with walking, wounds that will not heal or, in severe cases, tissue loss. On assessment, pulses and skin are still normal.

Example: Risk for ineffective peripheral tissue perfusion related to smoking, sedentary lifestyle and insufficient knowledge of factors that worsen circulation, in a patient with type 2 diabetes and hypertension (associated conditions).

Domain 4, class 4 (Cardiovascular / pulmonary responses) · Risk

See the full page: defining characteristics, care plan and case study

The person can't bathe completely without help. They may have trouble getting in and out of the shower, reaching parts of the body, adjusting the water or drying off, which affects their hygiene and independence.

When to use it: Used in older adults, people with the aftereffects of a stroke, after hip surgery or with cognitive impairment.

Example: Decreased bathing abilities related to right-sided weakness as evidenced by inability to wash his back and feet.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

The person has trouble putting on or taking off clothes on their own. They struggle to choose appropriate clothing, button, zip or put on shoes, and need partial or full help getting dressed, which reduces their day-to-day independence.

When to use it: Used in people with arthritis in the hands, hemiplegia, cognitive impairment, shoulder pain or limitations after surgery.

Example: Decreased dressing abilities related to hand stiffness as evidenced by inability to button her clothes and tie her shoelaces.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

The person can't fully feed themselves. They may have trouble cutting food, bringing it to the mouth, holding utensils or finishing a meal, with a risk of eating less than they need.

When to use it: Used in people with tremor, upper extremity paralysis, cognitive impairment, severe fatigue or vision problems.

Example: Decreased feeding abilities related to tremor in both hands as evidenced by spilling food when bringing the spoon to his mouth.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

The person has trouble with personal grooming, such as combing their hair, shaving, trimming their nails, washing their face or putting on makeup. They depend on others for these tasks, which affects their appearance, comfort and, often, their self-esteem.

When to use it: Used in people with hand weakness or tremor, hemiplegia, cognitive impairment, poor vision or depression.

Example: Decreased grooming abilities related to hand tremor as evidenced by inability to shave and trim his nails without assistance.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

It describes a patient who needs help with several personal care activities at once, from a common cause. Instead of writing one diagnosis per activity, they are grouped into one, and the care plan is organized around what they have in common.

Example: Decreased self-care ability syndrome related to right-sided weakness, fatigue on exertion and lack of assistive devices as evidenced by need for assistance with bathing, lower-body dressing, cutting food and transferring to the toilet, with a Barthel Index of 30/100.

Domain 4, class 5 (Self-care) · Syndrome

See the full page: defining characteristics, care plan and case study

The person has trouble using the toilet without help. They struggle to get to the bathroom in time, sit down and get up, manage their clothing or clean themselves afterward, which can lead to accidents, skin irritation and embarrassment.

When to use it: Used in people with reduced mobility, cognitive impairment, after hip or knee surgery and in frail older adults.

Example: Decreased toileting abilities related to pain when bending the knee as evidenced by inability to sit on and get up from the toilet without assistance.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

The person doesn't take proper care of their mouth, teeth or dentures. They may brush too little or poorly, not floss or skip dental checkups, leading to plaque buildup, bad breath or bleeding gums.

When to use it: Used in teens, older adults with dentures, people with insufficient knowledge of oral hygiene or with limited access to dental care.

Example: Ineffective oral hygiene behaviors related to insufficient knowledge of brushing technique as evidenced by brushing once a day and bleeding gums.

Domain 4, class 5 (Self-care) · Problem-focused · Write it · Care plan

The person carries out their own self-care and wants to do it more independently or more effectively. They show interest in learning techniques, using assistive devices or adjusting their routine to bathe, dress, eat or groom with less help.

When to use it: Used in people in rehabilitation, active older adults, patients being discharged from the hospital and people with stable chronic illness.

Example: Readiness for enhanced self-care abilities as evidenced by expressed desire to learn to dress herself using assistive devices.

Domain 4, class 5 (Self-care) · Health promotion · Write it · Care plan

The person could lose the ability to carry out several self-care activities at once, such as bathing, dressing, eating, grooming or toileting. The risk appears when there are factors affecting their energy, mobility or ability to organize themselves.

When to use it: Used in frail older adults, people with advanced chronic illness, early cognitive impairment or after a prolonged hospitalization.

Example: Risk for decreased self-care ability syndrome related to persistent fatigue and muscle weakness after a three-week hospitalization.

Domain 4, class 5 (Self-care) · Syndrome · Write it · Care plan

The person could stop taking proper care of their mouth, teeth or dentures. Certain factors make that routine harder, such as reduced hand dexterity, lack of information or limited access to hygiene supplies.

When to use it: Used in older adults with arthritis, hospitalized or bedbound people, people with orthodontic appliances and people with limited resources.

Example: Risk for ineffective oral hygiene behaviors related to decreased manual dexterity and insufficient knowledge of denture cleaning.

Domain 4, class 5 (Self-care) · Risk · Write it · Care plan

The person has sudden changes in attention, awareness and thinking that develop over hours or days and fluctuate throughout the day. They may be disoriented, agitated or drowsy, and can't follow a conversation or understand what is happening around them.

When to use it: Hospitalized older adults, post-op patients, ICU patients and people with infection, dehydration or alcohol withdrawal.

Example: Acute confusion related to sleep deprivation and dehydration as evidenced by disorientation to time, inattention and nighttime agitation.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

There is a progressive, persistent decline in memory, judgment and the ability to interpret the environment that lasts for months or years. The person stays alert but relies more and more on others to organize their day.

When to use it: People with dementia or the aftereffects of stroke or traumatic brain injury, especially in long-term care or receiving care at home.

Example: Chronic confusion related to an unstructured environment and frequent changes in routine as evidenced by forgetting recent events and difficulty recognizing family members.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The person has difficulty organizing ideas, reasoning, solving problems or interpreting information logically. Their thinking may be slow, disorganized or incoherent, and that interferes with their decisions and daily activities.

When to use it: People with psychiatric disorders, cognitive impairment, substance effects, intense stress or sleep deprivation.

Example: Disrupted thought processes related to sleep deprivation and high stress as evidenced by difficulty planning simple tasks and incoherent responses.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The person has trouble choosing between health-related options: they hesitate, put off the decision or choose without considering the consequences. They often feel distressed or torn, especially when the alternatives carry risks or clash with their values.

When to use it: Patients facing surgery or treatments with significant adverse effects, family members deciding for someone else and people receiving conflicting information.

Example: Impaired decision-making related to conflicting information about treatment options as evidenced by delaying signing the consent form and expressing distress about deciding.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The person has trouble making their own health decisions because they rely too heavily on the opinions of family members, health care professionals or other authority figures. Their choices don't fully reflect their own values and preferences.

When to use it: Women or older adults in hierarchical family settings, people with limited health information and patients facing complex treatment decisions.

Example: Impaired emancipated decision-making related to insufficient information about treatment options as evidenced by asking her son to decide for her and hesitating to state her preference.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The person forgets recent information or skills they used to have down, such as taking their medications, keeping appointments or following the steps of an everyday task. The forgetfulness is persistent and affects their safety or independence, even without generalized confusion.

When to use it: Older adults, people with mild cognitive impairment, neurological aftereffects or depression, and patients on complex treatment regimens.

Example: Impaired memory related to information overload and lack of external memory aids as evidenced by missed medication doses and scheduled appointments.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The patient does not know enough about their illness, their treatment or how to care for themselves, or holds misconceptions that put them at risk. It is not a lack of ability: it is information they are missing, did not understand or do not know how to apply.

Example: Inadequate Health Knowledge regarding insulin management related to information given in technical terms without supervised practice as evidenced by incorrect injection technique on return demonstration, inability to identify symptoms of hypoglycemia, and stating that they skip the dose when they do not eat.

Domain 5, class 4 (Cognition) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person acts quickly and without weighing the consequences in response to internal or external triggers, even if they regret it later. They may overspend, react aggressively, gamble or use substances without being able to stop themselves in time.

When to use it: People with ADHD, mood or personality disorders, brain injury, substance use or addictive behaviors.

Example: Ineffective impulse control related to ineffective frustration management and hopelessness as evidenced by compulsive spending and constantly interrupting when others speak.

Domain 5, class 4 (Cognition) · Problem-focused · Write it · Care plan

The person already makes reasonable decisions about their health and wants to do it better. They are looking for more information, want to weigh their options calmly, and want their choices to reflect their values and personal goals.

When to use it: People weighing treatment options, family planning, lifestyle changes or end-of-life care decisions.

Example: Readiness for enhanced decision-making as evidenced by expressed desire to compare the risks and benefits of treatment options for her knee.

Domain 5, class 4 (Cognition) · Health promotion · Write it · Care plan

The person wants to take a bigger, more independent part in decisions about their health. They want to understand their options, say what they prefer and decide in line with their values, even while having support from others.

When to use it: People with chronic illness, pregnant women planning their birth, patients facing scheduled surgery and older adults who want to keep their independence.

Example: Readiness for enhanced emancipated decision-making as evidenced by expressed desire to decide for herself how to feed her baby after learning about all the options.

Domain 5, class 4 (Cognition) · Health promotion · Write it · Care plan

The person already has information about their health and wants to expand or deepen it. They ask questions, look for reliable sources and want to better understand their illness, their treatment or how to care for themselves at home and prevent complications.

When to use it: People recently diagnosed with a chronic illness, pregnant women, caregivers and patients preparing for discharge or surgery.

Example: Readiness for enhanced health knowledge as evidenced by expressed desire to learn how to interpret her fingerstick blood glucose readings.

Domain 5, class 4 (Cognition) · Health promotion · Write it · Care plan

Over hours or days, the person may develop a state of confusion: they lose attention, become disoriented, and their level of alertness changes throughout the day. It hasn't happened yet, but the illness, the treatment or the hospital environment make it likely. Many cases can be prevented.

Example: Risk for acute confusion related to sleep deprivation, dehydration, uncontrolled pain, and sensory deprivation from missing glasses and hearing aid, in an 82-year-old patient with urosepsis (associated condition).

Domain 5, class 4 (Cognition) · Risk

See the full page: defining characteristics, care plan and case study

The person is exposed to factors that could lead them to leave health decisions they could make themselves in others' hands. They still decide independently, but their ability to voice and stand by their preferences could weaken.

When to use it: People with little information about their diagnosis, very protective families, fear of contradicting health care staff or intense stress.

Example: Risk for impaired emancipated decision-making related to insufficient knowledge of treatment alternatives and fear of contradicting the health care team.

Domain 5, class 4 (Cognition) · Risk · Write it · Care plan

The person has trouble expressing what they think or understanding what is said to them in words. It can stem from damage to the language areas of the brain, trouble articulating, a device that prevents speech, or not sharing a language with the care team.

Example: Impaired verbal communication related to lack of an alternative communication system and a noisy, distracting environment as evidenced by inability to name 4 of 5 common objects, one- to two-word phrases, use of gestures to ask for water, and crying when not understood.

Domain 5, class 5 (Communication) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person communicates adequately and wants to express themselves more clearly or understand others better. They want to improve how they get their ideas, needs and feelings across in personal relationships or with the health care team.

When to use it: Patients in speech-language rehabilitation, people learning another language, caregivers and adults who want to communicate better with their family.

Example: Readiness for enhanced verbal communication as evidenced by expressed desire to describe his symptoms more clearly during appointments.

Domain 5, class 5 (Communication) · Health promotion · Write it · Care plan

The person is exposed to factors that could interfere with their ability to speak, understand or use language when interacting with others. For now they can communicate, but some conditions could reduce that ability if they aren't prevented.

When to use it: Patients with a language barrier, uncorrected hearing loss, planned intubation or tracheostomy, or prolonged social isolation.

Example: Risk for impaired verbal communication related to a language barrier and no interpreter available.

Domain 5, class 5 (Communication) · Risk · Write it · Care plan

The family loses its shared sense of who they are as a group, and this shows up as several problems at once: tense communication, unclear roles and difficulty making decisions together. It usually appears after crises or changes that upset family dynamics.

When to use it: Families facing a member's serious illness or disability, divorce, migration, grief or long-running conflicts among members.

Example: Disrupted family identity syndrome related to role changes due to the father's illness and ineffective family communication as evidenced by frequent conflicts and disagreement about family goals.

Domain 6, class 1 (Self-concept) · Syndrome · Write it · Care plan

The person can't hold on to a clear, stable sense of who they are. They may feel that their values, tastes or goals shift aimlessly, or that they no longer recognize themselves after a major life change.

When to use it: People with psychiatric disorders, teens in crisis and people after serious losses, migration or drastic role changes.

Example: Disrupted personal identity related to an abrupt role change after retirement as evidenced by stating he doesn't know who he is anymore and expressing contradictory personal goals.

Domain 6, class 1 (Self-concept) · Problem-focused · Write it · Care plan

The person has a stable view of themselves and wants to strengthen it. They want to better recognize their abilities, accept their limitations without blaming themselves, and act more in line with what they think, feel and value in daily life.

When to use it: People in rehabilitation, teens and adults going through life transitions, patients with stable chronic illness and support group participants.

Example: Readiness for enhanced self-concept as evidenced by expressed desire to feel more confident in his abilities when returning to work.

Domain 6, class 1 (Self-concept) · Health promotion · Write it · Care plan

The transgender person wants their gender identity to be recognized and lived more fully in their relationships and social settings. They are looking for support, information or networks to express themselves safely with family, at work or in health care settings.

When to use it: Transgender people at any stage of social transition, in primary care, mental health or gender-affirming care follow-up.

Example: Readiness for enhanced transgender social identity as evidenced by expressed desire for clinic staff to use their chosen name and to join a support group.

Domain 6, class 1 (Self-concept) · Health promotion · Write it · Care plan

The family is facing factors that could break down its shared view of itself as a group. It still functions with some cohesion, but a crisis or major change could throw its roles, communication and goals into disarray.

When to use it: Families with a member recently diagnosed with a serious illness, going through a separation, migrating or with overburdened caregivers.

Example: Risk for disrupted family identity syndrome related to primary caregiver strain and little communication about the son's diagnosis.

Domain 6, class 1 (Self-concept) · Syndrome · Write it · Care plan

The person is exposed to care situations that could make them feel humiliated, treated like an object or without control over their body and decisions. The risk increases when their body is exposed or their privacy is not respected.

When to use it: Dependent hospitalized patients, people in palliative care, older adults in long-term care facilities and patients who need intimate procedures.

Example: Risk for impaired human dignity related to body exposure during bed baths and limited involvement in care decisions.

Domain 6, class 1 (Self-concept) · Risk · Write it · Care plan

The person has viewed themselves negatively for a long time, with self-criticism that repeats across different situations. They tend to downplay their achievements, seek others' approval and avoid challenges for fear of failing.

When to use it: People with persistent depression, a history of prolonged rejection, chronic illness or long-standing disability.

Example: Chronic inadequate self-esteem related to repeated experiences of failure and limited social support as evidenced by rejecting praise and reporting feeling inferior to others.

Domain 6, class 2 (Self-esteem) · Problem-focused · Write it · Care plan

The person doubts their ability to do what their health requires, such as following a treatment plan, changing habits or managing symptoms. That lack of confidence can lead them not to try at all or to give up early.

When to use it: People with chronic illness, previous failed attempts to change habits, little social support or new self-care tasks after discharge.

Example: Inadequate health self-efficacy related to previous failed attempts to quit smoking as evidenced by stating he doesn't believe he can stay smoke-free.

Domain 6, class 2 (Self-esteem) · Problem-focused · Write it · Care plan

The person is exposed to factors that, over time, could lead them to see themselves in a persistently negative way. They don't show that pattern yet, but repeated experiences of rejection or failure make it likely.

When to use it: Children and teens who are bullied at school, people with chronic illness or disabilities and people with prolonged social isolation.

Example: Risk for chronic inadequate self-esteem related to repeated criticism at home and social isolation.

Domain 6, class 2 (Self-esteem) · Risk · Write it · Care plan

The person is going through a change or loss that could affect how they value themselves. Their self-esteem is still healthy, but the current situation puts them at risk of seeing themselves negatively.

When to use it: People facing a new diagnosis, prolonged hospitalization, job loss, a breakup or visible physical changes.

Example: Risk for situational inadequate self-esteem related to a change in work role due to temporary disability and lack of recognition from family.

Domain 6, class 2 (Self-esteem) · Risk · Write it · Care plan

The person starts to see themselves negatively because of a specific event, such as a loss, an illness or a role change. They used to value themselves appropriately, and the distress is tied to that situation.

When to use it: People after a layoff, divorce, amputation, recent diagnosis, retirement or a visible change in appearance.

Example: Situational inadequate self-esteem related to recent job loss as evidenced by stating he is good for nothing and avoiding contact with friends.

Domain 6, class 2 (Self-esteem) · Problem-focused · Write it · Care plan

The person feels uncomfortable or distressed about the shape, appearance or function of their body. They may avoid looking at themselves, hide certain body parts or stop doing activities because of how they feel about their appearance.

When to use it: People with an amputation, ostomy, mastectomy, burns, significant weight changes or visible treatment effects.

Example: Disrupted body image related to incomplete adjustment to the stoma as evidenced by avoiding looking at it and refusing to take part in its care.

Domain 6, class 3 (Body image) · Problem-focused · Write it · Care plan

The parent or caregiver feels intense tension between what they believe they should do for their child and what the situation allows them to do. They feel confused, guilty or pushed aside in their caregiving role.

When to use it: A child in intensive care, a child with a chronic illness or disability, parental separation or complex home care.

Example: Excessive parental role conflict related to the child's NICU admission as evidenced by expressed guilt and feeling excluded from care.

Domain 7, class 1 (Caregiving roles) · Problem-focused · Write it · Care plan

The caregiver can't give the child the care, protection and stimulation they need to grow well. There may be inattention, insensitive responses, inappropriate discipline or difficulty building an affectionate bond.

When to use it: Teen parents, caregivers with high stress or substance use, lack of a support network or children with special needs.

Example: Impaired parenting behaviors related to insufficient knowledge of child development as evidenced by yelling in response to crying and missing well-child visits.

Domain 7, class 1 (Caregiving roles) · Problem-focused · Write it · Care plan

The caregiver already provides adequate care and wants to do it better. They are looking for information and strategies to support the child's development, set limits respectfully, understand their needs at each stage and strengthen their emotional bond.

When to use it: Well-child visits, first-time parents, parenting classes and times of change such as the arrival of a sibling or adolescence.

Example: Readiness for enhanced parenting behaviors as evidenced by expressed desire to learn ways to set limits without physical punishment.

Domain 7, class 1 (Caregiving roles) · Health promotion · Write it · Care plan

The caregiver has factors that could make it hard to give the child adequate care, protection and affection. There are no obvious parenting problems yet, but without timely support the relationship and daily care could suffer.

When to use it: First-time parents without support, teen pregnancy, financial stress, sleep deprivation or a preterm newborn.

Example: Risk for impaired parenting behaviors related to sleep deprivation and a limited support network.

Domain 7, class 1 (Caregiving roles) · Risk · Write it · Care plan

A change or crisis disrupts the usual way family members communicate, support each other and share tasks. The family loses its previous dynamic and struggles to adapt to the new situation.

When to use it: Hospitalization or illness of a family member, a birth, divorce, a member migrating or a change in who supports the household financially.

Example: Disrupted family interaction patterns related to role changes due to the mother's hospitalization as evidenced by disorganized sharing of tasks and less communication between siblings.

Domain 7, class 2 (Family relationships) · Problem-focused · Write it · Care plan

The family can't consistently carry out its functions of support, communication and organization. There are frequent conflicts, unclear roles, denial of problems or difficulty solving them, and this affects the well-being of its members.

When to use it: Families affected by problematic alcohol or other substance use, chronic conflict, violence or prolonged financial crisis.

Example: Impaired family processes related to the father's problematic alcohol use as evidenced by closed communication, frequent conflicts and denial of the problem.

Domain 7, class 2 (Family relationships) · Problem-focused · Write it · Care plan

The family functions well and wants to strengthen how it communicates, supports each other and gets organized. They are looking to improve how they get along, how household tasks are shared or how they face upcoming changes together.

When to use it: Families with a new member, adjusting to a member's illness, with teenage children or reorganizing after a move.

Example: Readiness for enhanced family processes as evidenced by expressed desire to improve communication between parents and their teenage children.

Domain 7, class 2 (Family relationships) · Health promotion · Write it · Care plan

There are factors that could make it hard for the baby or child and their primary caregiver to form a secure emotional bond. Without intervention, closeness, physical contact and mutual responsiveness between them could be affected.

When to use it: Preterm newborns or those in intensive care, early mother-infant separation, adoption, postpartum depression or a caregiver with substance use.

Example: Risk for disrupted attachment behaviors related to physical separation due to the newborn's NICU stay.

Domain 7, class 2 (Family relationships) · Risk · Write it · Care plan

The family is facing a change or stressful situation that could disrupt its usual way of communicating, supporting each other and getting organized. For now the family dynamic is holding, but it is vulnerable if the change drags on or the family gets no support.

When to use it: Serious illness or hospitalization of a family member, a birth, a move, job loss or a member leaving the household.

Example: Risk for disrupted family interaction patterns related to role changes during the father's prolonged hospitalization.

Domain 7, class 2 (Family relationships) · Risk · Write it · Care plan

The person takes little part in social exchange, or experiences it in a way that is unsatisfying for them or for others. They may avoid contact, feel uncomfortable around other people or have trouble starting and keeping up a conversation or a close relationship.

When to use it: People isolated by prolonged hospitalization, with autism spectrum disorder, cognitive impairment or language and communication barriers.

Example: Impaired social interaction related to limited skills for starting conversations as evidenced by avoiding time with other residents and reporting discomfort in groups.

Domain 7, class 3 (Role performance) · Problem-focused · Write it · Care plan

The person can't prepare for or maintain a healthy pregnancy, birth or postpartum period, or the baby's early care. They may miss prenatal visits, neglect nutrition and rest, or have trouble establishing breastfeeding and bonding with the newborn.

When to use it: Unplanned or teen pregnancy, limited prenatal care, lack of a support network, substance use or domestic violence.

Example: Ineffective childbearing process related to insufficient knowledge and a limited support network as evidenced by irregular attendance at prenatal visits and poor nutrition.

Domain 7, class 3 (Role performance) · Problem-focused · Write it · Care plan

The partners can't support each other or respond to each other's needs in a satisfying way. There is poor communication, little cooperation with tasks or a sense of distance, and one or both feel dissatisfied with the relationship.

When to use it: Couples where one partner has a chronic illness, with parenting or caregiving stress, financial problems or substance use.

Example: Ineffective intimate partner relationship related to limited communication skills as evidenced by reports of frequent arguments and lack of support in caring for the children.

Domain 7, class 3 (Role performance) · Problem-focused · Write it · Care plan

The person can't carry out the tasks of a role, such as worker, student, partner or parent, the way they expect to or the way others expect them to. There are changes in how they perform the role, conflict with others or a sense of not measuring up.

When to use it: Chronic illness or recent disability, unemployment, retirement, prolonged hospitalization or family changes such as a divorce.

Example: Ineffective role performance related to fatigue and lack of support to reorganize tasks as evidenced by reports being unable to keep up at work and conflicts with his boss.

Domain 7, class 3 (Role performance) · Problem-focused · Write it · Care plan

The pregnant or postpartum person is going through the process in a healthy way and wants to be better prepared for birth, breastfeeding or caring for the baby. They show interest in learning and in looking after their own health and the newborn's.

When to use it: Prenatal care, childbirth education classes, birth planning and the first weeks postpartum with breastfeeding underway.

Example: Readiness for enhanced childbearing process as evidenced by expressed desire to learn breastfeeding techniques and newborn care.

Domain 7, class 3 (Role performance) · Health promotion · Write it · Care plan

The couple has a functional relationship and wants to strengthen it. They want to communicate better, support each other more in day-to-day decisions, and protect trust, respect and emotional closeness over time.

When to use it: Couples expecting a child, adjusting to one partner's illness, raising children or after getting through a crisis.

Example: Readiness for enhanced intimate partner relationship as evidenced by expressed desire to improve communication and share parenting decisions.

Domain 7, class 3 (Role performance) · Health promotion · Write it · Care plan

The pregnant or postpartum person has factors that could keep them from going through the process in a healthy way. Without intervention, they could neglect their checkups, self-care or preparation to bring the baby home and care for them.

When to use it: Unplanned pregnancy, first-time mother without a support network, low income, substance use or a history of pregnancy loss.

Example: Risk for ineffective childbearing process related to late entry into prenatal care and insufficient social support.

Domain 7, class 3 (Role performance) · Risk · Write it · Care plan

The couple has factors that could weaken how they communicate, support each other and respond to each other's needs. The relationship still works, but it is vulnerable to becoming distant or unsatisfying for one or both partners.

When to use it: Birth of a child, chronic illness in one partner, financial stress, separation due to work or unrealistic expectations.

Example: Risk for ineffective intimate partner relationship related to the stress of caring for a newborn and limited communication skills.

Domain 7, class 3 (Role performance) · Risk · Write it · Care plan

The person notices changes in some phase of their sexual response, such as desire, arousal or orgasm, and finds them unsatisfying. They may feel pain, frustration or distance from their partner, which affects their well-being and their relationship.

When to use it: Used after pelvic or breast surgery, during menopause, with medication side effects or with chronic conditions such as diabetes.

Example: Impaired sexual function related to insufficient knowledge about changes after hysterectomy as evidenced by reported decreased desire and fear of pain.

Domain 8, class 2 (Sexual function) · Problem-focused · Write it · Care plan

The health of the pregnant woman and the fetus can be affected by pregnancy-related conditions, habits or insufficient care. The risk covers both at once, because whatever disrupts the mother's well-being affects the baby's growth and oxygenation.

When to use it: Used in pregnancies with limited prenatal care, tobacco or substance use, gestational hypertension or poorly controlled gestational diabetes.

Example: Risk for impaired maternal-fetal dyad related to insufficient prenatal care and daily tobacco use.

Domain 8, class 3 (Reproduction) · Risk · Write it · Care plan

After a traumatic event, the person continues to react intensely and persistently. They may relive what happened, have nightmares, avoid reminders, stay constantly on alert or feel emotionally numb, and this affects their daily life.

When to use it: Survivors of accidents, natural disasters, assault, sexual violence, armed conflict or critical ICU stays.

Example: Post-trauma syndrome related to involvement in a fatal motor vehicle crash as evidenced by recurring nightmares, avoidance of driving and hypervigilance.

Domain 9, class 1 (Post-trauma responses) · Syndrome · Write it · Care plan

A person who moves to live in another country has factors that could make it hard to adapt to the new culture, language and environment. They could experience isolation, ongoing stress or problems accessing health care and support services.

When to use it: Recent immigrants, refugees, families separated by migration or people who don't speak the language of the host country.

Example: Risk for disrupted immigration transition related to a language barrier and an insufficient social support network.

Domain 9, class 1 (Post-trauma responses) · Risk · Write it · Care plan

The person went through or is exposed to a traumatic event and has factors that could lead to a prolonged fear response, intrusive memories or avoidance. They don't show that picture yet, but they are vulnerable to developing it.

When to use it: Emergency personnel, victims of assault or disasters, patients discharged from the ICU or people with little social support.

Example: Risk for post-trauma syndrome related to recent exposure to a natural disaster and an insufficient support network.

Domain 9, class 1 (Post-trauma responses) · Syndrome · Write it · Care plan

It is intense worry about something the person cannot pin down, stronger than the situation warrants. It shows in what they say, in their body (racing heart, tension, insomnia), and in trouble thinking, sleeping or following instructions.

Example: Excessive Anxiety related to a major stressor (scheduled surgery) and inadequate knowledge of the procedure as evidenced by verbalized constant worry about the outcome, insomnia for two nights, and a resting heart rate of 110 bpm.

Domain 9, class 2 (Coping responses) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person caring for a family member or a dependent person feels the demands of caregiving are more than they can handle. They show fatigue, stress, neglect of their own health and difficulty continuing to provide care the way they used to.

When to use it: Caregivers of people with dementia, severe disability, terminal illness or children with special needs, especially when no one can relieve them.

Example: Excessive caregiving burden related to round-the-clock care without respite and lack of family support as evidenced by fatigue, irritability and skipping her own medical appointments.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The person feels intense distress when thinking about death or the process of dying, their own or that of someone close. That worry takes away their peace, disrupts their rest and creeps into daily life.

When to use it: People with serious or terminal illness, older adults, patients in palliative care or after the recent death of someone close.

Example: Excessive death anxiety related to uncertainty about prognosis as evidenced by constant worry about dying, insomnia and fear of pain at the end of life.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The person feels intense fear of a clearly identified threat, such as surgery, a procedure or pain. The reaction is greater than expected and affects their behavior, rest or cooperation with care.

When to use it: Patients before surgery or an invasive procedure, hospitalized children, people in critical care units or after a bad experience with health care.

Example: Excessive fear related to lack of knowledge about the surgical procedure as evidenced by tachycardia, crying and repeated requests to cancel the surgery.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The person has difficulty bouncing back and adapting after an adverse situation or a major change. They feel overwhelmed, have little self-confidence and lack enough personal or social resources to get through it.

When to use it: People with multiple losses, chronic illness, violence, poverty, recent migration or piling-up family crises.

Example: Impaired resilience related to an accumulation of recent losses and a limited support network as evidenced by stating she can't move forward and low self-esteem.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The person is harsh with themselves about their mistakes, limitations or suffering. Instead of understanding, they show intense self-criticism, judge themselves severely and struggle to accept that difficulties are part of everyone's experience.

When to use it: People with chronic illness or changes in body image, exhausted caregivers, health care staff under high demands or after a mistake or failure.

Example: Inadequate self-compassion related to high self-imposed standards as evidenced by constant self-criticism and difficulty accepting her limitations after discharge.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

A community can't respond effectively to its problems or to a crisis. There is disorganization, conflict, few resources or a lack of member participation to meet everyone's needs.

When to use it: Communities after disasters, with high crime or unemployment, disease outbreaks or inadequate health services.

Example: Maladaptive community coping related to insufficient community resources after a flood as evidenced by conflicts between neighbors and low participation in prevention measures.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The person can't effectively handle the stress or problems they are facing. They use strategies that don't help, such as avoidance, denial or substance use, and have trouble resolving situations or asking for support.

When to use it: Serious health news, losses, financial crises, prolonged hospitalizations or people with a weak support network.

Example: Maladaptive coping related to perceived lack of control and a limited support network as evidenced by increased alcohol use and difficulty solving problems.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

The primary support person can't give the patient the presence and help they need to manage their health situation. They may be exhausted, preoccupied with other matters or have little information about what is going on.

When to use it: Prolonged hospitalization, chronic or terminal illness, simultaneous family crises or family caregivers with insufficient information about the condition.

Example: Maladaptive family coping related to insufficient information and family member exhaustion as evidenced by the patient reporting feeling alone and the family member limiting visits.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

After the death of someone significant, the person remains in intense suffering that doesn't ease over time. They struggle to accept the loss and get on with life, with persistent yearning, guilt, anger or isolation.

When to use it: Sudden or violent deaths, loss of a child, a highly dependent relationship with the person who died or grief without a support network.

Example: Maladaptive grieving related to insufficient social support after her husband's sudden death as evidenced by persistent yearning, isolation and giving up activities.

Domain 9, class 2 (Coping responses) · Problem-focused · Write it · Care plan

A community responds adequately to its problems and wants to strengthen its capacity to cope with stress. It is looking to get better organized, pool resources, improve communication between neighbors and institutions, and plan actions for future situations.

When to use it: Neighborhoods or schools after a natural disaster, disease outbreaks, safety problems or community health programs.

Example: Readiness for enhanced community coping as evidenced by expressed desire to form neighborhood flood-response teams.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The person is handling the demands and stress of their situation adequately and wants to do even better. They are looking for new strategies, information or support to feel more in control and solve the problems that come up.

When to use it: People well adjusted to a chronic illness, caregivers, students or workers under stress and patients in rehabilitation.

Example: Readiness for enhanced coping as evidenced by expressed desire to learn stress management techniques for coping with long-term treatment.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The family is handling a member's health situation well and wants to keep growing from it. They want to learn, better support the person who is ill and also look after their own well-being and that of the household.

When to use it: Families supporting a member with chronic illness, recovering from surgery, living with a disability or receiving palliative care.

Example: Readiness for enhanced family coping as evidenced by expressed desire to learn home care and set up shifts to support the patient.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The person is experiencing the loss in a healthy way and wants to integrate it better into their life. They want to express what they feel, remember the person they lost with less pain and gradually return to their activities and relationships.

When to use it: Family members after the death of a loved one, people with an amputation or perinatal loss and participants in grief support groups.

Example: Readiness for enhanced grieving as evidenced by expressed desire to talk about her loss and return to her social activities.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The person holds positive expectations about their future and wants to reinforce them. They want to set achievable goals, find meaning in what they are going through and rely more on their own abilities and support network to keep going.

When to use it: Patients with chronic or serious illness, people in rehabilitation, in palliative care or after a major loss.

Example: Readiness for enhanced hope as evidenced by expressed desire to set short-term goals during rehabilitation.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The person adapts well to difficulties and wants to strengthen that capacity. They want to widen their support network, build problem-solving skills and make better use of their personal resources for whatever comes next.

When to use it: Patients in rehabilitation, caregivers, people who have come through a crisis and participants in support groups or community programs.

Example: Readiness for enhanced resilience as evidenced by expressed desire to widen her support network and learn to solve problems.

Domain 9, class 2 (Coping responses) · Health promotion · Write it · Care plan

The person caring for a dependent person has factors that could make the demands of caregiving exceed their strength. For now they are managing, but they could become physically and emotionally exhausted and neglect their own health.

When to use it: Sole caregivers, older adults caring for their spouse, long-term caregiving or people who provide care while working.

Example: Risk for excessive caregiving burden related to long-term caregiving without respite and caregiver social isolation.

Domain 9, class 2 (Coping responses) · Risk · Write it · Care plan

The person is facing hardships or changes that could exceed their ability to adapt and recover. They still have resources to get through it, but personal, family or social factors could weaken them if they don't get support.

When to use it: Recent chronic illness, job loss, caregivers with a heavy load, teens in adverse environments or situations of violence.

Example: Risk for impaired resilience related to recent job loss and social isolation.

Domain 9, class 2 (Coping responses) · Risk · Write it · Care plan

After the death of someone significant, the person has factors that could make their grief drag on and become very painful. For now they are adjusting, but they could get stuck in the loss and pull away from their usual life.

When to use it: Unexpected or violent death, perinatal loss or loss of a child, social isolation or a highly dependent relationship with the person who died.

Example: Risk for maladaptive grieving related to the unexpected death of her son and social isolation.

Domain 9, class 2 (Coping responses) · Risk · Write it · Care plan

After abruptly stopping or cutting back on alcohol, drugs or certain medications, the person develops intense physical and emotional symptoms. They may have tremors, sweating, anxiety, agitation, nausea or sleep disturbances, and in severe cases dangerous complications.

When to use it: People with long-term use of alcohol, opioids or benzodiazepines who are hospitalized, in detox or stop using without supervision.

Example: Acute substance withdrawal syndrome related to abrupt cessation of daily alcohol use as evidenced by tremors, diaphoresis, agitation and anxiety.

Domain 9, class 3 (Neurobehavioral responses) · Syndrome · Write it · Care plan

The person has mood changes that affect daily life, such as persistent sadness, irritability or euphoria, along with changes in sleep, appetite or concentration. They struggle to get back to a stable emotional state on their own.

When to use it: People with chronic pain, social isolation, recent losses, chronic illness or mood disorders.

Example: Impaired mood regulation related to social isolation and persistent pain as evidenced by sadness, irritability and insomnia.

Domain 9, class 3 (Neurobehavioral responses) · Problem-focused · Write it · Care plan

The person has trouble managing the intensity and expression of their emotions. They may cry or laugh uncontrollably, react out of proportion to what is happening or feel embarrassed about not being able to hold it in.

When to use it: People with acquired brain injury, intense stress, fatigue, mood disorders or substance use.

Example: Ineffective emotion regulation related to intense stress and fatigue as evidenced by uncontrollable crying and disproportionate angry outbursts.

Domain 9, class 3 (Neurobehavioral responses) · Problem-focused · Write it · Care plan

The person is dependent on a substance and could develop intense physical and emotional symptoms if they stop or cut back abruptly. The risk is higher when use is daily, long-term or heavy, or when there have been previous withdrawals.

When to use it: People with daily use of alcohol, opioids or sedatives who are hospitalized, having surgery or decide to stop using on their own.

Example: Risk for acute substance withdrawal syndrome related to daily alcohol use and expected interruption due to hospitalization.

Domain 9, class 3 (Neurobehavioral responses) · Syndrome · Write it · Care plan

A person with a spinal cord injury at T6 or above can have an uncontrolled nervous system response to a noxious stimulus below the level of injury. It shows up as a sudden, severe rise in blood pressure, a pounding headache, sweating and flushing, and requires immediate action.

When to use it: People with high spinal cord injuries, especially with bladder distension, constipation, pressure injuries or tight clothing and shoes.

Example: Risk for autonomic dysreflexia related to bladder distension from a kinked urinary catheter and constipation.

Domain 9, class 3 (Neurobehavioral responses) · Risk · Write it · Care plan

The person can't live out their faith the way they want to: they have trouble taking part in rituals, prayer or religious practices that matter to them. They may feel cut off from their community or distressed about not keeping their beliefs.

When to use it: Hospitalized patients or those with limited mobility, older adults in long-term care facilities, and people going through a personal crisis or grief.

Example: Impaired religiosity related to prolonged hospitalization and lack of access to religious services as evidenced by reported distress over being unable to attend Mass or receive Communion.

Domain 10, class 3 (Value / belief / action congruence) · Problem-focused · Write it · Care plan

The person loses a sense of meaning or peace in life and feels disconnected from themselves, from others or from what they see as transcendent. They may ask why this is happening to them, feel angry at God or describe an inner emptiness.

When to use it: People with serious or terminal illness, those who are grieving, after a major loss or in the face of prolonged suffering.

Example: Impaired spiritual well-being related to recent loss of spouse and social isolation as evidenced by stating that life has lost its meaning and expressing anger at God.

Domain 10, class 3 (Value / belief / action congruence) · Problem-focused · Write it · Care plan

The person knows what they believe is right in an ethical situation but can't act on it because of pressure, hierarchy or outside constraints. This causes distress, guilt, frustration or a sense of powerlessness that may linger after the fact.

When to use it: Health care professionals facing end-of-life decisions, family members making decisions for a patient, and people whose values clash with institutional rules.

Example: Moral distress related to conflict between the patient's wishes and the family's decision about life support as evidenced by expressed powerlessness and guilt.

Domain 10, class 3 (Value / belief / action congruence) · Problem-focused · Write it · Care plan

The person wants to strengthen their religious life and live their faith more deeply. They are looking to resume or expand practices such as prayer, reading sacred texts or taking part in their faith community.

When to use it: People with chronic illness, in recovery, grieving or going through life transitions who want to lean more on their faith.

Example: Readiness for enhanced religiosity as evidenced by expressed desire for a visit from her spiritual leader during hospitalization.

Domain 10, class 3 (Value / belief / action congruence) · Health promotion · Write it · Care plan

The person finds meaning and peace in life and wants to deepen that experience. They are looking to strengthen their connection with themselves, with other people, with nature or with what they hold sacred, for example through reflection, prayer or service.

When to use it: People with chronic illness or in palliative care, caregivers, people who have worked through grief, and anyone seeking personal growth.

Example: Readiness for enhanced spiritual well-being as evidenced by expressed desire to set aside time each day for meditation and to reconcile with his brother.

Domain 10, class 3 (Value / belief / action congruence) · Health promotion · Write it · Care plan

The person is facing circumstances that could keep them from their usual religious practices, such as praying, attending their place of worship or following their rituals. They still keep these practices, but a hospital stay, a change of setting or a personal crisis could pull them away.

When to use it: Patients with long hospital admissions, people who are relocating, older adults losing mobility and people who are recently bereaved.

Example: Risk for impaired religiosity related to prolonged hospital admission and no private space to pray.

Domain 10, class 3 (Value / belief / action congruence) · Risk · Write it · Care plan

The person is living through circumstances that could break their sense of purpose or their connection with what gives them peace. Their spiritual well-being is still intact, but a loss, an illness or isolation could affect it.

When to use it: People recently diagnosed with a serious illness, overburdened caregivers, isolated people and anyone facing a major loss.

Example: Risk for impaired spiritual well-being related to social isolation and difficulty accessing spiritual practices.

Domain 10, class 3 (Value / belief / action congruence) · Risk · Write it · Care plan

The body's defenses don't respond adequately to microorganisms or other external or internal agents. This can make the person more vulnerable to repeated infections, slower to recover or less responsive to vaccination.

When to use it: Used in people with malnutrition, prolonged stress, lack of sleep, frail older adults or incomplete immunizations.

Example: Impaired immune response related to insufficient protein intake and less than 5 hours of sleep as evidenced by repeated respiratory infections over 3 months.

Domain 11, class 1 (Infection) · Problem-focused · Write it · Care plan

It describes a patient with no infection right now, but with open portals of entry or weakened defenses that make it easier for microorganisms to invade. The nurse's job is to close those portals and catch the earliest sign that an infection has started.

Example: Risk for infection related to malnutrition, inadequate care of the insertion site and insufficient knowledge of catheter care, in a patient with a central venous catheter (associated condition).

Domain 11, class 1 (Infection) · Risk

See the full page: defining characteristics, care plan and case study

A surgical wound can become infected by microorganisms that enter it during or after the procedure. The risk increases with poor wound hygiene, handling without hand hygiene, smoking, obesity, malnutrition or inadequate blood glucose control.

When to use it: Used in post-op patients, people with diabetes or obesity, smokers, contaminated surgeries or patients with drains.

Example: Risk for surgical wound infection related to current smoking and handling the dressing without hand hygiene.

Domain 11, class 1 (Infection) · Risk · Write it · Care plan

An adult has a localized injury to the skin or underlying tissue from sustained pressure or shear, almost always over a bony prominence or under a device. It can range from nonblanchable redness to deep tissue loss.

When to use it: Used in bedbound adults, wheelchair users, and those with prolonged sedation, incontinence or devices that exert pressure.

Example: Adult pressure injury related to insufficient repositioning as evidenced by nonblanchable erythema on the right heel.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

A child has a localized injury to the skin or underlying tissue caused by sustained pressure, often from casts, tubes, splints or masks. The injury can be superficial, such as persistent redness, or deep, with tissue loss.

When to use it: Used in children in intensive care, with reduced mobility, sedation, medical devices or impaired sensation.

Example: Child pressure injury related to pressure from the edge of the cast as evidenced by a 1 cm blister on the ankle and crying when the foot is moved.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

The nipple or areola has lesions such as cracks, blisters, redness, inflammation or bleeding. It usually happens during breastfeeding, causes pain when nursing or pumping, and can lead the mother to cut back on feedings or stop breastfeeding.

When to use it: Used in breastfeeding mothers with a poor latch, incorrect breast pump use, a baby with tongue-tie or in the first weeks of breastfeeding.

Example: Impaired nipple-areolar complex integrity related to a shallow latch as evidenced by a crack in the right nipple and pain when breastfeeding.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

The mouth has lesions on the lips, gums, tongue or mucosa, such as ulcers, cracks, bleeding, inflammation or white patches. This causes pain, makes it hard to eat, drink or speak, and increases the risk of local infection and of the person eating less.

When to use it: Used in patients on chemotherapy, people who are NPO for long periods or have a feeding tube, dependent older adults or those with poor oral hygiene.

Example: Impaired oral mucous membrane integrity related to insufficient oral hygiene and mouth breathing as evidenced by ulcers on the buccal mucosa and pain on swallowing.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

The skin shows a visible change in the epidermis or dermis, such as persistent redness, abrasion, maceration, blisters or an open wound. The skin's protective barrier is weakened, increasing the risk of infection, pain and progression of the injury.

When to use it: Used in people with incontinence, immobility, edema, the fragile skin of older adults or prolonged contact with moisture or adhesives.

Example: Impaired skin integrity related to moisture from urinary incontinence as evidenced by erythema and maceration in the perineal area.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

There is damage to body tissues beyond the superficial skin, such as mucous membranes, cornea, muscle, tendon, bone or joint capsule. The injury involves deep structures, takes longer to heal and can compromise function of the affected area.

When to use it: Used in complicated surgical wounds, deep ulcers, extensive burns or traumatic injuries that expose subcutaneous or muscle tissue.

Example: Impaired tissue integrity related to prolonged pressure over the sacral prominence as evidenced by a 4 cm wound with exposed subcutaneous tissue.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

The patient can't keep the airway open because they can't expel secretions or whatever is blocking it. The cough is too weak or absent, mucus builds up and air moves with difficulty.

Example: Ineffective airway clearance related to thick secretions and incisional pain with coughing as evidenced by a weak cough that does not clear secretions, bilateral basilar rhonchi and SpO2 of 91%.

Domain 11, class 2 (Physical injury) · Problem-focused

See the full page: defining characteristics, care plan and case study

The newborn has a localized injury to the skin or underlying tissue from pressure or friction, often caused by cannulas, sensors or tubes. Their skin is thin and immature, so it is easily damaged and slow to recover.

When to use it: Used in NICU neonates, preterm infants, with nasal CPAP, sensors, cannulas or prolonged immobility.

Example: Neonatal pressure injury related to continuous pressure from nasal CPAP prongs as evidenced by nonblanchable erythema and erosion of the nasal septum.

Domain 11, class 2 (Physical injury) · Problem-focused · Write it · Care plan

The person could accidentally be deprived of air because something blocks the airway or the environment keeps them from breathing. It is more common in infants who sleep with soft objects, in young children and in people with limited mobility or swallowing.

When to use it: Used in infants who sleep with soft objects or bed-share, young children with access to plastic bags or small parts, and people with impaired swallowing.

Example: Risk for accidental suffocation related to bed-sharing in an adult bed with pillows and thick blankets.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

An adult who has not fallen yet, or who has fallen before, has personal or environmental characteristics that make it likely they will end up on the floor unintentionally and get hurt. The diagnosis is meant for acting before the fall, not after.

Example: Risk for adult falls related to dizziness on rising, inappropriate footwear and nighttime urinary urgency, in a 78-year-old patient on diuretics and antihypertensives (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

An adult could develop an injury to the skin or underlying tissue from sustained pressure or shear, almost always over bony prominences such as the sacrum or heels. The risk rises with immobility, moisture, friction, poor nutrition and medical devices.

When to use it: Used in bedbound adults, wheelchair users, and those with sedation, incontinence, malnutrition or a high-risk Braden Scale score.

Example: Risk for adult pressure injury related to immobility in bed, urinary incontinence and a Braden Scale score of 12.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The patient is at risk for material from the mouth, pharynx or stomach passing into the trachea and lungs. That can cause choking, pneumonia or hypoxia. It hasn't happened yet: the goal is for the patient to eat, drink and breathe safely.

Example: Risk for aspiration related to oral feeding without a swallow screen, unmodified fluid consistency and poor oral hygiene, in a patient with ischemic stroke (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

The person could suffer burns from heat, hot liquids, fire, electricity, chemicals or radiation. The risk increases with unsafe environments, little supervision, reduced heat sensation, cognitive impairment or using hot packs and hot water bottles without protection or time limits.

When to use it: Used in young children at home, older adults, people with neuropathy, with cognitive disabilities or who use hot packs.

Example: Risk for burn injury related to decreased sensation in the feet and using a hot water bottle in bed.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

A child could fall and get hurt because of their developmental stage, health status or an unsafe environment. The risk increases with beds without side rails, sedation, slippery floors, medications that cause dizziness or insufficient supervision by caregivers.

When to use it: Used in hospitalized children, infants on changing tables or in beds without side rails, sedated children or children who are just starting to walk.

Example: Risk for child falls related to a crib with a low side rail and a caregiver who leaves the room.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

A child could develop an injury to the skin or underlying tissue from sustained pressure or friction, often caused by medical devices. The risk increases if the child moves little, is sedated, has moist skin or eats poorly.

When to use it: Used in children hospitalized in intensive care, with sedation, casts, splints, tubes, masks or reduced mobility.

Example: Risk for child pressure injury related to continuous use of a noninvasive ventilation mask and infrequent repositioning.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The person could suffer damage to the skin and tissues from cold exposure, such as frostbite or injuries from applying ice. The risk increases with inadequate clothing, damp skin, poor sensation, poor circulation or prolonged exposure to low temperatures.

When to use it: Used in people experiencing homelessness, outdoor workers in cold weather, mountain athletes or patients receiving local cryotherapy.

Example: Risk for cold injury related to applying ice directly to the skin for more than 20 minutes and decreased sensation.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The cornea can develop an abrasion, ulcer or infection because the eye is left exposed, dries out or isn't well protected. This happens mainly when the person doesn't blink or fully close their eyelids, and without proper care it can permanently affect vision.

When to use it: Used in sedated or unconscious patients, with reduced blinking, incomplete eyelid closure, mechanical ventilation or prone positioning.

Example: Risk for corneal injury related to blinking fewer than 5 times per minute and exposure of the eyeball in a sedated patient.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The eyes can dry out because they produce too few tears or because tears evaporate too quickly. This causes discomfort, burning, a gritty feeling and blurred vision, and if it persists it can damage the surface of the eye and lead to infections or corneal ulcers.

When to use it: Used in patients on mechanical ventilation or sedation, contact lens wearers, older adults or people with prolonged screen use.

Example: Risk for dry eye related to incomplete eyelid closure due to sedation and constant airflow in the ICU.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The person could try to leave the place where they are receiving care without authorization or supervision, which puts them at risk of getting lost, falling or having accidents. It is usually linked to confusion, aimless wandering, anxiety or a strong wish to go home.

When to use it: Used in people with dementia or delirium, psychiatric patients, long-term care residents or minors who refuse hospitalization.

Example: Risk for elopement attempt related to disorientation to time and place and repeatedly looking for the unit exit.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

This diagnosis describes a patient who is not bleeding abnormally yet, but whose treatment, illness or habits could lead to more blood loss than expected after a wound, a procedure or a bump. The nurse monitors, prevents injury and teaches the patient to recognize warning signs.

Example: Risk for Excessive Bleeding related to inadequate knowledge of anticoagulant therapy precautions, in a patient with atrial fibrillation on oral anticoagulants (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

The nipple or areola could be injured, especially during the first weeks of breastfeeding. The risk increases with a poor latch, pumping with excessive suction, constant moisture in the area or a baby who has trouble sucking well.

When to use it: Used in first-time mothers, in the first days postpartum, with breast pump use or with babies who have trouble sucking.

Example: Risk for impaired nipple-areolar complex integrity related to lack of knowledge of latch technique and using a breast pump on high suction.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The mouth can develop lesions on the lips, gums, tongue or mucosa if certain conditions don't change. The risk increases with dry mouth, poor hygiene, NPO status, oxygen therapy or treatments that damage the mucosa, such as chemotherapy and head and neck radiation.

When to use it: Used in patients receiving chemotherapy or head and neck radiation, people who are NPO, on oxygen therapy or dependent on others for oral hygiene.

Example: Risk for impaired oral mucous membrane integrity related to prolonged NPO status and oxygen therapy without humidification.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

Circulation, sensation or movement in an arm or leg could become impaired. It is usually due to compression from casts, bandages or immobilizers, or to swelling after an injury or surgery, and is detected by pain, pallor, coolness or tingling.

When to use it: Used in people with fractures, casts or splints, orthopedic surgery, burns on the extremities or compression bandages.

Example: Risk for impaired peripheral neurovascular function related to a circumferential forearm cast and edema after fracture reduction.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

It describes the chance that the outer layers of the skin (epidermis and dermis) will be injured: a crack, a blister, irritation or an erosion. The skin is healthy at the time of the assessment, and the diagnosis is there to protect what has not been damaged yet.

Example: Risk for impaired skin integrity related to inadequate foot care, inappropriate footwear and dry skin from insufficient moisturizing, in a patient with type 2 diabetes and peripheral neuropathy (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

Tissues such as mucous membranes, cornea, muscle, tendon or joint capsule could be damaged if certain factors persist. The person doesn't have the injury yet, but their situation makes it likely because of device pressure, immobility, edema, poor nutrition or contact with irritating substances.

When to use it: Used in immobilized people, with edema, malnutrition, invasive medical devices or exposure to irritating substances.

Example: Risk for impaired tissue integrity related to sustained pressure from a nasogastric tube on the nasal ala.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The newborn could develop an injury to the skin or underlying tissue from pressure, mainly from medical devices such as nasal cannulas, sensors or tubes. Immature skin, limited mobility and a long stay in an incubator increase this risk.

When to use it: Used in preterm infants, neonates on CPAP, with catheters, pulse oximetry sensors, sedation or a long stay in an incubator.

Example: Risk for neonatal pressure injury related to a gestational age of 29 weeks and a pulse oximetry sensor without site rotation.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The person could be injured by the position they remain in, without moving, during surgery or a long procedure. The risk includes pressure injuries, nerve damage, muscle pain or joint injury from sustained pressure, stretching or poor body alignment.

When to use it: Used in long surgeries, positions such as prone or lithotomy, people with obesity or who are very thin, or older adults with limited joint mobility.

Example: Risk for perioperative positioning injury related to prone positioning for more than 4 hours and a low body mass index.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The patient is exposed to bodily harm, such as bumps, wounds, burns or tongue bites, because their condition or environment keeps them from protecting themselves. Use it when the risk is general and does not fit a more specific diagnosis, such as falls.

Example: Risk for physical injury related to inadequate adherence to antiseizure medication, sleep deprivation and unadapted environment, in a patient with epilepsy (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

The patient is at risk of blood flow to the tissues dropping below what the organs need, with organ damage that can become life-threatening. Shock is not present yet: the goal is close monitoring and correcting whatever could trigger it before it happens.

Example: Risk for shock related to poor fluid intake over the previous three days and uncontrolled hyperthermia, in a patient with urosepsis (associated condition).

Domain 11, class 2 (Physical injury) · Risk

See the full page: defining characteristics, care plan and case study

A baby under one year of age could die suddenly and unexpectedly during sleep, with no cause to explain it. The risk increases with unsafe sleep practices, such as sleeping prone or on soft surfaces, and with exposure to tobacco smoke.

When to use it: Used in teaching parents of newborns and infants, preterm infants, babies who sleep prone or in homes with smokers.

Example: Risk for sudden infant death related to placing the baby prone to sleep and a soft mattress with pillows.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The person could form a clot that blocks a vein or artery, especially in the legs. The risk increases with immobility, dehydration, recent surgery, pregnancy, venous catheters or lack of prevention measures such as early mobilization and compression stockings.

When to use it: Used in post-op patients, bedbound patients, pregnant or postpartum women, people taking long trips or with venous catheters.

Example: Risk for thrombosis related to bed rest after hip surgery and low fluid intake.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The urinary tract could be injured by catheters or other instruments. The risk includes injury or tearing of the urethra, bleeding, later strictures or trauma from poor securement, accidental pulling on the catheter or improper insertion technique.

When to use it: Used in people with an indwelling urinary catheter, repeated catheterizations, confused patients who may pull on the catheter or large-bore catheters.

Example: Risk for urinary tract injury related to an unsecured indwelling urinary catheter and confusion with attempts to remove it.

Domain 11, class 2 (Physical injury) · Risk · Write it · Care plan

The person intentionally causes themselves physical harm, such as cutting, hitting or burning, without the intent to die. They usually do it to relieve tension, calm difficult emotions or feel in control, and often hide it out of shame or fear of how others will react.

When to use it: Used in teens and young adults, people who have trouble regulating emotions, those with a history of trauma or in mental health units.

Example: Non-suicidal self-injurious behavior related to difficulty managing anxiety as evidenced by recent superficial cuts on the forearm and stating she does it to calm down.

Domain 11, class 3 (Violence) · Problem-focused · Write it · Care plan

A girl or woman could be subjected to total or partial removal of, or other injury to, her external genitalia for cultural, non-medical reasons. The risk comes from the customs of her family or her community of origin.

When to use it: Used with girls from families from countries where it is practiced, before trips to the country of origin or if other women in the family have undergone it.

Example: Risk for female genital mutilation related to mother and older sister having undergone it and a planned family trip to the country of origin.

Domain 11, class 3 (Violence) · Risk · Write it · Care plan

The person could deliberately harm themselves physically, without the intent to die, as a way to handle intense emotions or tension. There are signs or factors, such as impulsivity, trauma, isolation or contact with peers who self-harm, that make this behavior likely.

When to use it: Used in teens under intense stress, people with impulsivity, a history of self-harm, bullying or who spend time with peers who self-harm.

Example: Risk for non-suicidal self-injurious behavior related to impulsivity, bullying at school and close friends who self-harm.

Domain 11, class 3 (Violence) · Risk · Write it · Care plan

The person could physically, verbally or sexually assault others, including health care staff or family. There are signs of agitation, threats or a history suggesting they could harm those around them if no one intervenes in time.

When to use it: Used in mental health units, the emergency department, and in people with intoxication, psychomotor agitation or a history of aggressive behavior.

Example: Risk for other-directed violence related to psychomotor agitation, raised voice and verbal threats toward staff.

Domain 11, class 3 (Violence) · Risk · Write it · Care plan

The person could harm themselves with the intent to end their life. Personal, emotional, family or environmental factors increase this possibility and call for careful assessment, close observation and a safe environment with no means of self-harm.

When to use it: Used in people with depression, hopelessness, previous attempts, recent losses, substance use or social isolation.

Example: Risk for suicidal self-injurious behavior related to expressions of hopelessness, social isolation and a recent breakup.

Domain 11, class 3 (Violence) · Risk · Write it · Care plan

The person has already been exposed to environmental contaminants, such as chemicals, biological agents or radiation, at levels that affect their health. They have symptoms or physical effects related to that exposure and need to be removed from the source and have their condition monitored.

When to use it: Used after exposure to pesticides, smoke, chemical spills, contaminated water or in environmental disasters.

Example: Contamination related to pesticide use without protective equipment as evidenced by skin irritation on the hands and headache after spraying.

Domain 11, class 4 (Environmental hazards) · Problem-focused · Write it · Care plan

The person could unintentionally swallow, inhale or come into contact with toxic substances or medications in harmful amounts. The risk increases with unsafe storage, unlabeled containers, confusion in managing medications or young children with free access to hazardous products.

When to use it: Used in homes with young children, older adults on multiple medications, people with cognitive impairment or with cleaning products within reach.

Example: Risk for accidental poisoning related to medications and cleaning products stored without safety locks within reach of a 2-year-old.

Domain 11, class 4 (Environmental hazards) · Risk · Write it · Care plan

The person could be exposed to chemical, biological or radioactive agents in the environment in amounts large enough to harm their health. The risk depends on where they live or work and on the protective measures in place.

When to use it: Used in agricultural or industrial workers, communities near contaminated areas, environmental disasters or homes with sources of lead or gas.

Example: Risk for contamination related to handling pesticides without gloves or a mask while doing farm work.

Domain 11, class 4 (Environmental hazards) · Risk · Write it · Care plan

The person could become ill because of their working conditions, through repeated exposure to chemicals, dust, noise, biological agents or ongoing stress. The damage usually develops gradually and can go unnoticed until it is advanced.

When to use it: Used in workers exposed to chemicals, dust, noise or biological agents, health care staff or people who work long hours.

Example: Risk for occupational illness related to daily exposure to solvents without adequate ventilation or respiratory protection.

Domain 11, class 4 (Environmental hazards) · Risk · Write it · Care plan

The person could be physically injured at work through accidents, falls, cuts, overexertion, awkward postures or exposure to machinery. The risk depends on working conditions, accumulated fatigue, and the training and protective equipment available.

When to use it: Used in construction workers, health care staff who move patients, workers on long shifts or without safety training.

Example: Risk for occupational physical injury related to moving patients without mechanical lift equipment and 12-hour shifts.

Domain 11, class 4 (Environmental hazards) · Risk · Write it · Care plan

The person could have an exaggerated immune response to a substance such as food, medications, insect stings, pollen or chemicals. The reaction can be mild, with hives or itching, or life-threatening if it affects breathing or circulation.

When to use it: Used in people with a history of allergies, atopy, exposure to new medications or contrast media, or in children starting allergenic foods.

Example: Risk for allergic reaction related to a history of hives from insect stings and frequent outdoor activities.

Domain 11, class 5 (Defensive processes) · Risk · Write it · Care plan

The person is likely to have a hypersensitivity reaction on contact with gloves, catheters, balloons or other latex products. The reaction can range from itching and hives to difficulty breathing or a severe generalized response.

When to use it: Used in people with multiple previous surgeries, health care workers, patients with repeated catheterizations or with allergies to fruits such as banana or kiwi.

Example: Risk for latex allergy reaction related to repeated exposure to latex gloves and catheters during frequent urinary catheterizations.

Domain 11, class 5 (Defensive processes) · Risk · Write it · Care plan

Body temperature is below normal because the body is losing more heat than it produces. It can cause shivering, cool pale skin and sluggishness and, if it progresses, changes in alertness, heart rhythm and breathing.

When to use it: Used in older adults, people exposed to cold or water, patients with malnutrition or after procedures in cold environments.

Example: Decreased body temperature related to wet clothing and exposure to a cold environment as evidenced by a temperature of 35.2 °C (95.4 °F), cool skin and shivering.

Domain 11, class 6 (Thermoregulation) · Problem-focused · Write it · Care plan

The newborn's body temperature is below normal. Newborns lose heat easily because of their thin skin, large body surface area and small fat reserves, and this can lead to feeding difficulties, low blood glucose or breathing problems.

When to use it: Used in preterm infants, low-birth-weight newborns, and babies bathed or left exposed soon after birth or during transport.

Example: Decreased neonatal body temperature related to an early bath and delayed skin-to-skin contact as evidenced by an axillary temperature of 35.9 °C (96.6 °F) and cool extremities.

Domain 11, class 6 (Thermoregulation) · Problem-focused · Write it · Care plan

Body temperature rises above its normal range because the body produces or absorbs more heat than it can get rid of. Causes include infection, environmental heat, exertion or not drinking enough, and nursing targets whatever is keeping the patient from losing heat.

Example: Hyperthermia related to dehydration and exposure to a hot environment as evidenced by axillary temperature of 39.2 °C (102.6 °F), hot flushed skin and heart rate of 118 bpm.

Domain 11, class 6 (Thermoregulation) · Problem-focused

See the full page: defining characteristics, care plan and case study

The person can't keep their body temperature stable and swings between high and low values within a short time. Their mechanisms for producing, conserving or losing heat don't respond well to changes in the environment or in their own body, so they need frequent temperature monitoring.

When to use it: Used in preterm newborns, frail older adults, people with neurological injury or critically ill patients with temperature fluctuations.

Example: Ineffective thermoregulation related to fluctuating ambient temperature in the incubator as evidenced by axillary temperature alternating between 35.8 °C (96.4 °F) and 37.9 °C (100.2 °F) over 12 hours.

Domain 11, class 6 (Thermoregulation) · Problem-focused · Write it · Care plan

Body temperature could drop below normal if the body loses more heat than it generates. The risk increases with cold environments, scant or wet clothing, malnutrition, advanced age, sedation or little physical activity to help produce heat.

When to use it: Used in older adults, people experiencing homelessness, sedated patients or those exposed to cold environments during tests or transport.

Example: Risk for decreased body temperature related to an unheated home and low body weight in an older adult.

Domain 11, class 6 (Thermoregulation) · Risk · Write it · Care plan

The newborn could lose heat and their body temperature could drop below normal. The risk increases with cold environments, incomplete drying at birth, an early bath, separation from the mother, low birth weight or procedures and transport without thermal protection.

When to use it: Used in newborns in the delivery room, preterm infants, low-birth-weight babies or during procedures and transport.

Example: Risk for decreased neonatal body temperature related to a delivery room at 20 °C (68 °F) and incomplete drying at birth.

Domain 11, class 6 (Thermoregulation) · Risk · Write it · Care plan

The person could have a drop in body temperature before, during or after surgery. Contributing factors include anesthesia, a cold OR, body exposure, room-temperature fluids and the length of the procedure, among others.

When to use it: Used in long surgeries, older adults, children, open abdominal or thoracic surgery and patients with low body weight.

Example: Risk for decreased perioperative body temperature related to an OR at 18 °C (64.4 °F) and prolonged abdominal exposure without active warming.

Domain 11, class 6 (Thermoregulation) · Risk · Write it · Care plan

Body temperature could rise above normal because the body gains or produces more heat than it can get rid of. The risk increases with hot weather, dehydration, excessive clothing, intense exercise or a limited ability to sweat and cool down.

When to use it: Used in older adults and infants during heat waves, athletes, people who work in the sun or those with insufficient fluid intake.

Example: Risk for hyperthermia related to sun exposure during the workday and low fluid intake.

Domain 11, class 6 (Thermoregulation) · Risk · Write it · Care plan

The person may not be able to keep their body temperature within normal limits and may have rises or drops. Their mechanisms for producing, conserving or losing heat could fail with changes in the environment, activity level or health status.

When to use it: Used in newborns, preterm infants, older adults, people with neurological impairment or those exposed to extreme ambient temperatures.

Example: Risk for ineffective thermoregulation related to little subcutaneous fat and temperature changes during handling of the newborn.

Domain 11, class 6 (Thermoregulation) · Risk · Write it · Care plan

It is pain that comes from a recent cause, such as surgery, trauma or inflammation, and that has an end in sight: it improves as the tissue heals. Nursing measures it with a scale, treats it and checks that the treatment is working.

Example: Acute pain related to physical injury agent (12-hour-old abdominal surgical incision) as evidenced by pain rated 7/10 on the numeric scale, facial grimacing, and guarding of the incision when coughing and moving.

Domain 12, class 1 (Physical comfort) · Problem-focused

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The person has pain that lasts longer than three months or keeps coming back. Over time it changes their sleep, mood, work and daily life, and they learn to live with it without it ever fully going away.

When to use it: Used in people with osteoarthritis, persistent low back pain, fibromyalgia, diabetic neuropathy or long-standing cancer pain.

Example: Chronic pain related to prolonged posture at work and physical deconditioning as evidenced by reported low back pain of 7/10 for the past 8 months and limiting walks.

Domain 12, class 1 (Physical comfort) · Problem-focused · Write it · Care plan

The persistent pain no longer comes alone: it is accompanied by other problems that feed it, such as poor sleep, fatigue, low mood, fear of movement or isolation. Each one makes the others worse and the person gets caught in that cycle.

When to use it: Used in people with months of pain who also have insomnia, anxiety, inactivity or social withdrawal, for example in fibromyalgia or chronic low back pain.

Example: Chronic pain syndrome related to avoiding movement out of fear of pain as evidenced by insomnia, daily fatigue, withdrawal from social activities and pain of 8/10.

Domain 12, class 1 (Physical comfort) · Syndrome · Write it · Care plan

At the end of life, the person has several discomforts at once that take away their peace and well-being: pain, shortness of breath, fatigue, distress or worry about their family. These discomforts add up and affect how they live their last days.

When to use it: Used in people receiving palliative care, in the terminal phase of cancer or advanced organ failure, at home or in the hospital.

Example: Impaired end-of-life comfort syndrome related to inadequate symptom control and a noisy environment as evidenced by reported dyspnea, pain, restlessness and difficulty resting.

Domain 12, class 1 (Physical comfort) · Syndrome · Write it · Care plan

The person isn't comfortable in their body because of things like cold, heat, itching, nausea, poor positioning or noise from their surroundings. These sensations keep them from relaxing and resting, even when pain isn't the issue.

When to use it: Used in bedbound patients, patients with pruritus, nausea, tubes or splints, or in rooms with inadequate temperature, lighting or noise levels.

Example: Impaired physical comfort related to damp bed linens and low room temperature as evidenced by shivering, restlessness and reports being unable to rest.

Domain 12, class 1 (Physical comfort) · Problem-focused · Write it · Care plan

The woman feels pain from contractions and cervical dilation during labor and the pushing stage. Its intensity and how she experiences it change with the stage of labor, fatigue, fear and the support she receives.

When to use it: Used in women in active labor, first-time mothers who are afraid of giving birth, or laboring women without a support person or prior childbirth preparation.

Example: Labor pain related to uterine contractions and fear of childbirth as evidenced by moaning, muscle tension and reported pain of 9/10 with each contraction.

Domain 12, class 1 (Physical comfort) · Problem-focused · Write it · Care plan

The person generally feels well physically and wants to be even more comfortable in their body. They are interested in relieving minor discomforts, resting better, or adjusting their posture, clothing or surroundings to feel at ease.

When to use it: Used in pregnant women looking to relieve discomforts, older adults who want to rest better, or people improving their posture at work.

Example: Readiness for enhanced physical comfort as evidenced by expressed desire to learn sleeping positions to be more comfortable during the third trimester.

Domain 12, class 1 (Physical comfort) · Health promotion · Write it · Care plan

The person feels intensely and persistently lonely, with a sense of emptiness or of not mattering to anyone. Even if there are people around, they feel their relationships don't give them the companionship or affection they need.

When to use it: Used in older adults who live alone, grieving people, immigrants far from their families or patients with long hospital stays.

Example: Excessive loneliness related to loss of her spouse and little contact with her children as evidenced by reports feeling lonely every day and crying when talking about it.

Domain 12, class 3 (Social comfort) · Problem-focused · Write it · Care plan

The person has less contact and fewer relationships than they need, or their relationships hold little meaning for them. They go long stretches without interacting with others and feel left out of their family, friendships or community.

When to use it: Used in homebound older adults, people with disabilities or serious mental illness, long hospital stays or people facing social stigma.

Example: Inadequate social connectedness related to reduced mobility and lack of transportation as evidenced by reports not seeing anyone outside the home for weeks and not taking part in activities.

Domain 12, class 3 (Social comfort) · Problem-focused · Write it · Care plan

The person doesn't have enough people or resources to turn to when they need practical, emotional or informational help. Their network is small, far away or unresponsive, which leaves them with less backup when health problems come up.

When to use it: Used in newly arrived immigrants, caregivers with no one to relieve them, older adults without close family, or people with chronic illness who live alone.

Example: Inadequate social support network related to a recent move to a new city and lack of contacts as evidenced by stating she has no one to ask for help getting to her appointments.

Domain 12, class 3 (Social comfort) · Problem-focused · Write it · Care plan

The person feels reasonably at ease in their relationships and social environment and wants to feel even more comfortable and connected. They are looking to improve how they get along with others, their involvement in groups or the support they give and receive.

When to use it: Used in people joining a new group, older adults looking for community activities, or patients getting back to their social life after an illness.

Example: Readiness for enhanced social comfort as evidenced by expressed desire to join a walking group in her neighborhood and spend more time with her neighbors.

Domain 12, class 3 (Social comfort) · Health promotion · Write it · Care plan

The person may come to feel intensely and persistently lonely, beyond a passing low mood. Certain circumstances are pulling them away from others or keeping their relationships from giving them the closeness they need.

When to use it: Used in older adults who live alone, people with long hospital stays, the recently widowed, or people whose limited mobility keeps them homebound.

Example: Risk for excessive loneliness related to recent widowhood, living alone and difficulty leaving home because of knee pain.

Domain 12, class 3 (Social comfort) · Risk · Write it · Care plan

The person doesn't feel calm inside: they experience restlessness, tension, worry or emotional distress that takes away their peace of mind. It doesn't always reach the level of a disorder, but it keeps them from resting, concentrating or feeling safe.

When to use it: Used in hospitalized patients far from their family, people waiting on test results, patients in isolation or those facing a recent diagnosis.

Example: Impaired psychological comfort related to insufficient information about her surgery and separation from her family as evidenced by reported nervousness, crying and difficulty sleeping.

Domain 12, class 4 (Psychological comfort) · Problem-focused · Write it · Care plan

The person has a degree of inner calm and security and wants to build on it. They show interest in handling their worries better, feeling calmer and finding practical ways to be at peace with themselves and their current situation.

When to use it: Used in people looking for relaxation techniques, patients preparing for surgery or caregivers who want to manage their stress better.

Example: Readiness for enhanced psychological comfort as evidenced by expressed desire to learn breathing exercises to feel calmer before bed.

Domain 12, class 4 (Psychological comfort) · Health promotion · Write it · Care plan

The child isn't gaining weight or height as expected for their age and sex and falls below their growth curve. This may be due to inadequate nutrition, feeding problems or conditions in their environment.

When to use it: Used in children with inadequate or limited diets, feeding difficulties, repeated infections or families facing food insecurity.

Example: Delayed child growth related to insufficient intake and irregular mealtimes as evidenced by weight and height below the 3rd percentile for age.

Domain 13, class 1 (Growth) · Problem-focused · Write it · Care plan

The child may fall below the weight or height expected for their age. Factors in their diet, their health or their family environment put their growth at risk.

When to use it: Used in children with limited diets, early weaning, frequent infections or families with limited resources to buy food.

Example: Risk for delayed child growth related to inadequate complementary feeding and repeated bouts of diarrhea in recent months.

Domain 13, class 1 (Growth) · Risk · Write it · Care plan

The child already shows a delay in one or more areas of development, such as talking, moving, playing or relating to others. They can't yet do what most children their age already do.

When to use it: Used in children with a history of prematurity, chronic malnutrition, prolonged hospitalizations or environments with little stimulation and play.

Example: Delayed child development related to insufficient stimulation and excessive screen time as evidenced by saying fewer than 10 words at 24 months and not combining two words.

Domain 13, class 2 (Development) · Problem-focused · Write it · Care plan

The baby is taking longer than expected to reach motor skills such as holding up the head, sitting, crawling or grasping objects. Body control and movement aren't progressing at the pace expected for their age.

When to use it: Used in preterm infants, infants with hypotonia, those with prolonged hospitalization, or babies who spend a lot of time in a crib, carrier or stroller.

Example: Delayed infant motor development related to little tummy time and prolonged time in a baby carrier as evidenced by lack of steady head control at 5 months.

Domain 13, class 2 (Development) · Problem-focused · Write it · Care plan

The baby can't regulate their responses to stimuli well: they startle, cry inconsolably, change color, have tremors or struggle to sleep and feed. Their still-immature nervous system gets overwhelmed easily.

When to use it: Used in preterm infants in the NICU, newborns with neonatal abstinence syndrome or babies exposed to frequent noise, light and handling.

Example: Impaired infant neurodevelopmental organization related to excessive light, noise and handling as evidenced by startles, hiccups, crying that is hard to soothe and short sleep periods.

Domain 13, class 2 (Development) · Problem-focused · Write it · Care plan

The baby can't coordinate sucking, swallowing and breathing well while feeding. They tire quickly, choke, cough or lose milk from the mouth, and don't take in enough at each feeding.

When to use it: Used in preterm infants, low-birth-weight newborns, infants with hypotonia or babies who spent time on tube feedings.

Example: Ineffective infant suck-swallow response related to prematurity and fatigue during feeding as evidenced by coughing, brief desaturation and a weak suck that stops after a few minutes.

Domain 13, class 2 (Development) · Problem-focused · Write it · Care plan

The baby already regulates their sleep, movements and responses to the environment reasonably well, and the parents or caregivers want to help them do even better. They want to learn to read the baby's cues and adjust their care.

When to use it: Used with parents of stable preterm infants, families preparing for NICU discharge or caregivers who want to learn containment techniques.

Example: Readiness for enhanced infant neurodevelopmental organization as evidenced by the mother expressing a desire to learn to recognize her baby's stress cues.

Domain 13, class 2 (Development) · Health promotion · Write it · Care plan

The child may not reach the milestones expected for their age in movement, language, learning or relating to others on time. Conditions in their environment, health or care threaten healthy development.

When to use it: Used in children born preterm, children with malnutrition, in environments with little stimulation, with teen parents, or exposed to violence or poverty.

Example: Risk for delayed child development related to insufficient stimulation at home and irregular attendance at well-child visits.

Domain 13, class 2 (Development) · Risk · Write it · Care plan

The baby may fall behind in motor skills such as head control, rolling over, sitting or crawling. Factors related to their health, their birth or how they are cared for and stimulated put them in this situation.

When to use it: Used in preterm infants, low-birth-weight newborns, infants with long hospital stays or babies who get little floor play.

Example: Risk for delayed infant motor development related to birth at 32 weeks and little tummy time at home.

Domain 13, class 2 (Development) · Risk · Write it · Care plan

The baby may lose the ability to regulate their sleep, movements and reactions to their surroundings. Factors within the baby or in the environment could overwhelm their still-developing nervous system.

When to use it: Used in preterm infants, newborns undergoing repeated painful procedures or babies in units with a lot of noise and light.

Example: Risk for impaired infant neurodevelopmental organization related to birth at 30 weeks and repeated procedures without clustering care.

Domain 13, class 2 (Development) · Risk · Write it · Care plan