NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00228 |
|---|---|
| Label | Risk for ineffective peripheral tissue perfusion |
| Spanish label | Riesgo de perfusión tisular periférica ineficaz |
| Domain | 4. Activity / rest |
| Class | 4. Cardiovascular / pulmonary responses |
| Type | Risk |
| Status | Current |
What it means
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.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Patients with diabetes, especially smokers or those who have had the disease for many years.
- Hypertension or high cholesterol combined with smoking or a sedentary lifestyle.
- After cardiac catheterization or an endovascular procedure through the femoral artery.
- Older adults with several cardiovascular risk factors.
- Patients with chronic kidney disease.
What to assess
- Dorsalis pedis and posterior tibial pulses on both feet: presence, strength and symmetry.
- Capillary refill in the toes: normal is under 2-3 seconds.
- Color, temperature and hair growth on the legs and feet; thickened or slow-growing nails.
- Calf pain with walking that eases with rest (intermittent claudication).
- Ankle-brachial index if equipment is available: below 0.9 suggests arterial disease; above 1.3 points to stiff arteries and an unreliable result, common in diabetes.
- Smoking: how many cigarettes a day and for how long.
- Blood pressure, blood glucose and the most recent lipid results.
- Weekly physical activity and what the patient knows about what damages circulation.
Risk factors
What makes the problem more likely, and what nursing can monitor or modify.
- Smoking or secondhand smoke exposure.
- Sedentary lifestyle.
- Diet high in salt and saturated fat.
- Insufficient knowledge of factors that worsen circulation.
- Insufficient knowledge of foot care and warning signs.
- Excess weight.
- Sitting for many hours with legs crossed or without moving.
At-risk populations
- Current smokers and recent former smokers.
- Adults over 65.
- People with long-standing diabetes.
- People with desk jobs or reduced mobility.
Associated conditions
- Diabetes.
- Hypertension.
- Dyslipidemia.
- Chronic kidney disease.
- Endovascular procedures or vascular surgery.
- Trauma to the extremities.
Risk factors are the ones nursing can work on: tobacco, activity, diet, knowledge. Diabetes, hypertension or a cardiac catheterization are associated conditions: they raise the risk, but they are not treated with independent nursing interventions.
How to write it (PES)
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).
There is no "as evidenced by." If the patient already has diminished pulses, claudication, cool skin or nonhealing wounds, the problem is present and the diagnosis is Ineffective peripheral tissue perfusion (00204).
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Pedal pulses remain present and symmetrical, with capillary refill under 3 seconds, at every visit.
- Patient cuts down on cigarettes per day and sets a quit date within the first month.
- By 4 weeks, walks at least 30 minutes, 5 days a week.
- At the first visit, names three warning signs: pain with walking, a cold or pale foot, a wound that will not heal.
- Blood pressure and blood glucose stay within the targets set by the provider at follow-up visits.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Assess pulses, capillary refill, color and temperature of both feet at every visit, and record the ankle-brachial index when possible. | Comparing findings over time catches deterioration before symptoms appear. |
| Give brief smoking cessation advice at every contact and refer to a cessation program. | Tobacco is the modifiable factor that does the most damage to the leg arteries. |
| Agree on a progressive walking plan, starting with what the patient can tolerate. | Regular walking improves collateral circulation and helps control weight, glucose and blood pressure. |
| Review how the patient takes their blood pressure, glucose and cholesterol medications. | Keeping those numbers controlled slows arterial damage. |
| Teach the patient not to cross their legs for long periods and to move every hour if they sit at work. | Compression and immobility reduce blood flow to the legs. |
| Teach the patient not to use hot water bottles or heating pads on the feet. | With reduced circulation and sensation, direct heat can cause burns the patient does not notice. |
| Teach daily foot care and the use of comfortable, closed-toe shoes. | A small wound on a poorly perfused foot can take a long time to heal. |
| Explain the warning signs and that a foot that suddenly becomes cold, pale and painful needs emergency care. | Acute arterial occlusion needs immediate treatment to save the limb. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0407Tissue Perfusion: Peripheral
NIC interventions
- 4066Circulatory Care: Venous Insufficiency
- 4062Circulatory Care: Arterial Insufficiency
- 3590Skin Surveillance
- 4070Circulatory Precautions
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Diabetes, hypertension and smoking
Patient. Guadalupe, 59, an office assistant, has had type 2 diabetes for 12 years and hypertension. She has smoked since age 20. She comes to her primary care follow-up with no leg complaints.
Assessment
- Smokes 12 cigarettes a day.
- Dorsalis pedis and posterior tibial pulses present and symmetrical; capillary refill of 2 seconds.
- Feet warm and pink, no wounds.
- Ankle-brachial index of 0.98 in both legs.
- Blood pressure 148/92 mmHg; HbA1c 7.8%.
- Sits for 8 hours a day and does not exercise.
- Believes smoking only damages the lungs.
Nursing diagnosis
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).
Goal
Within 3 months, Guadalupe smokes fewer than 5 cigarettes a day or has quit, walks 30 minutes at least 5 days a week and keeps pedal pulses present and symmetrical.
Interventions
- Explanation, with a simple drawing, of how tobacco narrows the leg arteries.
- Brief cessation advice and referral to a smoking cessation clinic.
- Walking plan: 15 minutes a day the first week, increasing gradually.
- Movement breaks every hour at work.
- Review of how she takes her medications and home blood pressure log.
- Teaching on warning signs and foot care.
Evaluation
At 3 months she smokes 4 cigarettes a day and has a quit date. She walks 30 minutes 5 days a week. Pulses remain present and symmetrical, and her blood pressure is down to 134/84 mmHg. The risk diagnosis is kept and smoking cessation is reinforced.
How it differs from similar diagnoses
- Ineffective peripheral tissue perfusion (00204): Ineffective peripheral tissue perfusion: there is already evidence of poor circulation (weak pulses, claudication, cool skin, nonhealing wounds).
- Risk for impaired peripheral neurovascular function (00425): Risk for impaired peripheral neurovascular function: used when the risk comes from local compression or injury, such as a cast, a tight dressing or a fracture.
- Risk for impaired skin integrity (00047): Risk for impaired skin integrity: focuses on the skin. In diabetes the two often go together when there are circulation and sensation problems.
Common mistakes
- Keeping the risk diagnosis when claudication or diminished pulses are already present.
- Assessing only one foot or not comparing with the previous assessment.
- Writing "related to diabetes" with no factors nursing can change.
- Trusting a high ankle-brachial index in a patient with diabetes: it can be falsely elevated by stiff arteries.
- Skipping tobacco counseling because you assume the patient already knows.
Used in these conditions
Other diagnoses in the Cardiovascular / pulmonary responses class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for risk for ineffective peripheral tissue perfusion?
00228, in Domain 4 (Activity/rest), Class 4 (Cardiovascular/pulmonary responses). It remains current in the 2024-2026 edition.
What's the difference between this and ineffective peripheral tissue perfusion?
00204 is a problem-focused diagnosis: signs of poor circulation are already present. 00228 is used when circulation is still normal but there are factors threatening it.
Can I use it for venous insufficiency?
It is used mainly for arterial circulation. In venous insufficiency the focus is usually the skin and edema, so consider risk for impaired skin integrity.
Which pulses should I check?
Dorsalis pedis (top of the foot) and posterior tibial (behind the inner ankle), on both feet, comparing sides. If you cannot find them, check the popliteal and femoral pulses.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Risk for ineffective peripheral tissue perfusion (00228) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2, source 3. Reviewed November 2, 2026.