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 Shock, Septic: Distributive Shock; Sepsis; Bacteremia;
Endotoxic Shock; Disseminated Intravascular Coagulation
(DIC); Multiple Organ Failure

Thrombosis, Deep Vein: Venous Thromboembolic Disease;

Phlebitis; Phlebothrombosis

Venous Insufficiency, Chronic: Postphlebitic Syndrome;

Peripheral Venous Hypertension; Venous Stasis Ulcer

Chapter 6 Pulmonary Care Plans

Acute Respiratory Distress Syndrome (ARDS): Acute Lung

Injury; Noncardiogenic Pulmonary Edema; Stiff Lung; Wet Lung

Asthma: Bronchial Asthma; Status Asthmaticus

Chest Trauma: Pneumothorax; Tension Pneumothorax; Flail

Chest; Fractured Ribs; Pulmonary Contusion; Hemothorax;
Myocardial Contusion; Cardiac Tamponade

Chronic Obstructive Pulmonary Disease: Chronic Bronchitis;

Emphysema

Cystic Fibrosis

Drowning

Head and Neck Cancer: Surgical Approaches: Radical Neck

Surgery; Laryngectomy

Lung Cancer: Squamous Cell Carcinoma; Small Cell Carcinoma;

Non–Small Cell Carcinoma; Adenocarcinoma; Large Cell
Tumors

Mechanical Ventilation: Ventilator; Endotracheal Tube;

Intubation; Ventilator-Associated Pneumonia
 Obstructive Sleep Apnea: Sleep-Disordered Breathing

Pneumonia: Pneumonitis; Community-Acquired Pneumonia

(CAP); Hospital-Acquired Pneumonia (HAP); Aspiration
Pneumonia

Pneumothorax With Chest Tube: Collapsed Lung; Tension

Pneumothorax

Pulmonary Embolism: Thromboembolism (VTE); Deep Vein

Thrombosis (DVT)

Pulmonary Tuberculosis: TB; Mycobacterium Tuberculosis

Respiratory Failure, Acute: Ventilatory Failure; Oxygenation

Failure

Thoracotomy: Chest Surgery; Thoracic Surgery; Lobectomy;

Segmental Resection; Wedge Resection; Thoracostomy;
Pneumonectomy

Tracheostomy: Artificial Airway; Tracheotomy; Stoma

Chapter 7 Neurological Care Plans

Alzheimer's Disease/Dementia: Multi-Infarct Dementia (MID);

Dementia of the Alzheimer Type (DAT)

Amyotrophic Lateral Sclerosis: Lou Gehrig's Disease; Motor

Neuron Disease; Progressive Bulbar Palsy; Progressive
Muscular Atrophy

Carpal Tunnel Syndrome: Repetitive Stress Injury; Median

Nerve Compression

Craniotomy: Craniectomy; Burr Hole; Cranioplasty; Cranial

Surgery; Stereotactic Surgery
 Headache: Migraine, Cluster, Tension

Intracranial Infection: Meningitis; Encephalitis; Brain Abscess

Intervertebral Disk Disease: Low Back Pain, Herniated Disk;

Slipped Disk; Ruptured Disk; Sciatica; Laminectomy

Lyme Disease

Multiple Sclerosis: Disseminated Sclerosis; Demyelinating

Disease

Myasthenia Gravis: Myasthenic Crisis; Cholinergic Crisis

Parkinson's Disease: Parkinsonism

Seizure Activity: Epilepsy; Seizure Disorder; Convulsion

Spinal Cord Injury: Tetraplegia; Quadriplegia; Paraplegia;

Neurogenic Shock; Spinal Shock

Stroke: Brain Attack; Cerebrovascular Accident (CVA); Ischemic

Stroke; Thrombotic Stroke; Embolic Stroke; Hemorrhagic Stroke

Transient Ischemic Attack: Transient Ischemic Attack (TIA);

Carotid Endarterectomy; Carotid Artery Stent

Traumatic Brain Injury: Head Trauma; Closed Head Trauma;

Skull Fracture; Subdural Hematoma; Concussion

West Nile Virus

Chapter 8 Gastrointestinal and Digestive Care Plans

Bariatric Surgery: Overweight; Obesity; Gastric Banding;

Gastric Bypass
 Bowel Diversion Surgery: Colostomy, Ileostomy: Fecal
Diversion; Stoma

Cholecystectomy: Laparoscopic/Open, Postoperative Care

Cirrhosis: Laënnec's Cirrhosis; Hepatic Encephalopathy;

Ascites; Liver Failure

Colorectal Cancer: Colon Cancer; Rectal Cancer; Bowel

Resection; Hemicolectomy; Colectomy

Gastroenteritis: Food Poisoning; Stomach Flu; Traveler's

Diarrhea

Gastrointestinal Bleeding: Lower Gastrointestinal Bleed; Upper

Gastrointestinal Bleed; Esophageal Varices; Ulcers

Hemorrhoids/Hemorrhoidectomy: Rectal Polyps; Piles

Hepatitis: Serum Hepatitis; Infectious Hepatitis; Viral Hepatitis

Inflammatory Bowel Disease: Crohn's Disease; Ulcerative

Colitis; Diverticulitis

Pancreatitis, Acute

Peptic Ulcer Disease: Duodenal Ulcers; Gastric Ulcers; Stress-

Induced Ulcers

Chapter 9 Musculoskeletal Care Plans

Amputation, Lower Extremity

Arthritis, Rheumatoid

Arthroscopy

Fibromyalgia: Fibromyalgia Syndrome; Fibromyositis; Fibrositis

 Fractures: Extremity and Pelvic: Closed Reduction; Open
Reduction; Internal Fixation; External Fixation

Joint Arthroplasty/Replacement: Total Hip, Knee, Shoulder

Osteoarthritis

Osteomyelitis: Bone Infection

Osteoporosis: Brittle Bone

Traction: Skeletal Traction; Skin Traction

Chapter 10 Hematolymphatic, Immunological, and Oncological

Care Plans

Anemia: Iron Deficiency; Cobalamin (Vitamin B12) Deficiency;

Pernicious Anemia; Aplastic Anemia

Cancer Chemotherapy

Cancer Radiation Therapy: External Beam; Brachytherapy;

Teletherapy; Radiotherapy

Disseminated Intravascular Coagulation: Coagulopathy;

Defibrination Syndrome; DIC

Hematopoietic Stem Cell Collection: Bone Marrow Donor; Bone

Marrow Transplantation; Apheresis; Peripheral Blood Stem Cell
Donor; Autologous; Allogenic; Syngeneic

Hematopoietic Stem Cell Transplantation: Bone Marrow

Transplant; Peripheral Blood Stem Cell Transplant

Hemophilia: Clotting Abnormality; Factor VIII Deficiency; Factor

IX Deficiency; Hemophilia A; Hemophilia B
 Human Immunodeficiency Virus (HIV) Disease: Acquired
Immunodeficiency Syndrome (AIDS)

Leukemia, Adult: Acute Lymphocytic Leukemia; Acute

Myelocytic Leukemia; Chronic Lymphocytic Leukemia;
Lymphocytic Leukemia; Chronic Myelocytic Leukemia;
Nonlymphocytic Leukemia; Myelogenous Leukemia;
Granulocytic Leukemia

Lymphoma: Hodgkin's Lymphoma; Non-Hodgkin's Lymphoma

Multiple Myeloma: Plasma Cell Myeloma; Monoclonal

Gammopathy of Undetermined Significance (MGUS)

Neutropenia: Granulocytopenia

Organ Transplantation, Solid: Heart Transplantation; Lung

Transplantation; Liver Transplantation; Kidney Transplantation;
Living Kidney Donors

Sickle Cell Disease: Vasoocclusive Event; Sickle Cell Pain Crisis;

Sickle Cell Anemia

Systemic Lupus Erythematosus: SLE; Lupus

Chapter 11 Renal and Urinary Tract Care Plans

Acute Kidney Injury: Acute Tubular Necrosis (ATN); Renal

Insufficiency; Acute Renal Failure

Chronic Kidney Disease (CKD): Uremia; Renal Failure;

Chronic/End-Stage Renal Disease

Glomerulonephritis: Acute Poststreptococcal

Glomerulonephritis; Acute Glomerulonephritis; Rapidly
Progressive Glomerulonephritis; Chronic Glomerulonephritis
 Hemodialysis: Internal Arteriovenous Fistula; Graft; Central
Venous Catheter; Renal Replacement Therapy

Peritoneal Dialysis: Intermittent Peritoneal Dialysis; Continuous

Ambulatory Peritoneal Dialysis; Continuous Cyclic Peritoneal
Dialysis; Renal Replacement Therapy

Renal Calculi: Kidney Stones; Urolithiasis; Nephrolithiasis;

Staghorn Calculi

Urinary Diversion: Bladder Cancer; Ileal Conduit; Koch Pouch;

Nephrostomy; Sigmoidostomy; Ureterostomy; Vesicostomy

Urinary Tract Infection: UTI; Pyelonephritis; Cystitis; Urethritis;

Nephritis

Chapter 12 Men's and Women's Health Care Plans

Gender Dysphoria: Gender Identity; Transgender; Transsexual;

Transman; Transwoman; Sex Reassignment Surgery

Sexually Transmitted Diseases

Benign Prostatic Hyperplasia

Erectile Dysfunction: Impotence

Prostate Cancer: Radical Prostatectomy; Localized Prostate

Cancer

Testicular Cancer

Breast Cancer/Surgical Management With Breast

Reconstruction Option

Cervical Cancer
 Hysterectomy: Salpingectomy; Oophorectomy; Total Abdominal
Hysterectomy; Cervical Cancer

Menopause: Perimenopause; Hormone Therapy

Ovarian Cancer

Pelvic Inflammatory Disease: Sexually Transmitted Infection

(STI); Salpingitis; Oophoritis

Pelvic Relaxation Disorder: Pelvic Floor Disorders; Uterine

Prolapse; Enterocele; Cystocele; Rectocele

Premenstrual Syndrome: Premenstrual Dysphoric Disorder

(PMDD)

Chapter 13 Endocrine and Metabolic Care Plans

Adrenal Insufficiency (Addison's Disease): Addisonian Crisis

Cushing's Disease: Hypercortisolism; Cushing's Syndrome;

Adrenocortical Hyperfunction

Diabetes Insipidus

Diabetes Mellitus: Type 1; Type 2

Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar

Nonketotic Syndrome

Hyperthyroidism: Graves' Disease

Hypothyroidism: Myxedema; Goiter

Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

Dilutional Hyponatremia

Thyroidectomy: Hyperthyroidism; Thyrotoxicosis; Thyroid Storm

Chapter 14 Integumentary Care Plans

Burns: Partial Thickness Skin Loss; Full Thickness Skin Loss

Contact Dermatitis: Allergic Contact Dermatitis; Irritant Contact

Dermatitis

Plastic Surgery for Wound Closure: Skin Grafts; Flap Closure;

Myocutaneous Flap

Pressure Ulcers (Impaired Skin Integrity): Pressure Sores;

Decubitus Ulcers; Bedsores

Psoriasis

Shingles: Herpes Zoster

Skin Cancer: Basal Cell Carcinoma; Squamous Cell Carcinoma;

Malignant Melanoma

Index

Quick Care Plan Locator

Copyright

1600 John F. Kennedy Blvd.

St. Louis, Missouri 63043

NURSING CARE PLANS, NINTH EDITION ISBN: 978-0-

323-42818-7
Copyright © 2017 by Elsevier, Inc. All rights reserved.

Nursing Diagnoses: Definitions and Classification 2015-2017

©2015, 2012, 2009, 2007, 2005, 2003, 2001, 1998, 1996, 1994
NANDA International. Used by arrangement with Blackwell
Publishing Limited, a company of John Wiley and Sons, Inc. In
order to make safe and effective judgments using NANDA-I
nursing diagnoses it is essential that nurses refer to the
definitions and defining characteristics of the diagnoses listed in
the work.

No part of this publication may be reproduced or transmitted in

any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and
retrieval system, without permission in writing from the
publisher. Details on how to seek permission, further information
about the Publisher's permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and
the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.

This book and the individual contributions contained in it are

protected under copyright by the Publisher (other than as may be
noted herein).

Notices
Knowledge and best practice in this field are constantly
changing. As new research and experience broaden our
understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described
herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified,
readers are advised to check the most current information
provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners,
relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the
authors, contributors, or editors, assume any liability for any
injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas
contained in the material herein.

Previous editions copyrighted 2014, 2011, 2007, 2003, 1998,

1994, 1990, and 1986.

Library of Congress Cataloging-in-Publication Data

Names: Gulanick, Meg, editor. | Myers, Judith L., editor.
Title: Nursing care plans : diagnoses interventions, & outcomes /
[edited by] Meg Gulanick, Judith L. Myers.
Description: 9th edition. | St. Louis, Missouri : Mosby, an imprint
of Elsevier Inc., [2017] | Includes bibliographical references and
index.
Identifiers: LCCN 2016038099 | ISBN 9780323428187 (pbk. :
alk. paper)
Subjects: | MESH: Patient Care Planning | Nursing Diagnosis |
Nursing Care | Outcome Assessment (Health Care) | Handbooks
Classification: LCC RT49 | NLM WY 49 | DDC 610.73–dc23
LC record available at https://lccn.loc.gov/2016038099

Executive Content Strategist: Lee Henderson

Content Development Manager: Lisa Newton
Senior Content Development Specialist: Danielle M. Frasier
Publishing Services Manager: Jeff Patterson
Book Production Specialist: Carol O'Connell
Design Direction: Ashley Miner
Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributors

We wish to express our ongoing gratitude to those who

contributed to previous editions of this book, especially the
following:
Virginia B. Bowman
Judy Lau Carino
Debra L. Cason
Pamela Cianci
Marianne T. Cosentino
Sandra Coslet
Paula Cox-North
Jennifer L. Crosby
Gail DeLuca
Lisa C. Dobogai
Amy Dolce
Linda Flemm
Patricia J. Friend
Katrina Gallagher
Nadia Goraczkowski-Jones
Rebecca Hagensee
Mary Ellen Hand
Margo S. Henderson
Connie Huberty
Judi Jennrich
Linda Kamenjarin
Tamara M. Kear
Catherine A. Kefer
Vicki A. Keough
Lucina Kimpel
Katherine T. Leslie
MariJo Letizia
Mary Jo Mikottis
Shelby J. Neel
Linda Denise Oakley
Linda Ohler
Kelly Oney
Judy K. Orth
Sue Penckofer
Joanne Pfeiffer
Dottie Roberts
Kathy G. Supple
Terry D. Takemoto
Geraldine Tansey
Stacy VandenBranden
Carol White
Jeffrey Zurlinden
We also want to acknowledge the prior editors of this classic
book: Deidra Gradishar, Susan Galanes, Audrey Klopp, and
Michele Knoll Puzas, who provided the foundation for Nursing
Care Plans: Diagnoses, Interventions, & Outcomes as it is
known today.
Reviewers

Sophia Beydoun RN, MSN

Diane Daddario MSN, ANP-C, ACNS-BC, RN-BC, CMSRN
Jennifer Duhon RN, MS
Nancy W. Ebersole RN, PhD
Arline El-Ashkar MSN, RN, CAN
Linda P. Grimsley DSN, RN
LaWanda Herron PhD, MSN, FNP-BC
Jamie Lynn Jones MSN, RN, CNE
Mary Lou Roark MSN, RN
Denise Sevigny MSN, RN, CNE
Preface

Nursing Care Plans: Diagnoses, Interventions, & Outcomes is a

well-established and premier resource book used by nurses to
plan care for an increasingly diverse population of patients. This
book continues to be the most comprehensive care planning
book on the market, with a total of 220 care plans between the
printed book and the Evolve website. These care plans cover the
most common nursing diagnoses and clinical problems nurses
encounter in patients requiring medical-surgical nursing care.
The care plans focus on patients with both acute and chronic
health problems in the acute care, ambulatory, and home care
settings.
One of our primary goals for this 9th edition has been to
incorporate QSEN (Quality and Safety Education for Nurses)
language throughout the text. The QSEN competencies relating
to nursing diagnoses and interventions include Patient-Centered
Care; Teamwork and Collaboration; Evidence-based Practice;
and Safety. These competencies can be found highlighted in the
rationales throughout the chapters. Because of the profession's
emphasis on teamwork and collaboration, the term collaborative
intervention previously used in our book has been updated to
interprofessional collaboration. This change is consistent with
the move in health care from multidisciplinary teams to
interprofessional education and collaboration.
 Nursing Care Plans: Diagnoses, Interventions & Outcomes
continues to offer “several books in one.” The book and its
accompanying Evolve website contain 70 of the most commonly
used nursing diagnoses (Chapter 2), in tandem with an
introductory chapter on how to use care plans to provide safe,
individualized, and quality care (Chapter 1). Chapter 3 provides
8 of the most common health promotion and risk factor
management care plans needed to help a patient adopt new health
behaviors. This chapter uses multifaceted, evidence-based
strategies known to facilitate successful behavior change.
Realizing that many patient conditions require attention to
specialized yet commonly used interventions, Chapter 4 provides
10 of these overarching plans, including preoperative and
postoperative care, central venous access, enteral nutrition, and
parenteral nutrition. Other care plans that can relate to a variety
of patients include hearing loss, visual impairment, death and
dying, and substance abuse disorder. This book also includes
132 of the most commonly used medical-surgical adult health
care plans. New to this part of the book (Chapters 4–14) is an
expanded table of contents that lists every nursing diagnosis
presented within each medical diagnosis. Listing every nursing
diagnosis can assist students in making comparisons between
how some NANDA diagnoses can be developed and used for
various related factors and etiologies. This book provides
detailed introductions to each care plan to serve as a foundation
for understanding care for a specific nursing diagnosis or
medical disorder. These introductions are a strength of this book.
Content on patient safety and preventable complications using
nursing bundles addresses national initiatives and discusses the
nursing responsibility in preventing complications such as falls,
pressure ulcers, infection, and the like. For example, key
measures from the OSHA (Occupational Safety and Health
Administration's) Safe Patient Handling initiatives are now
incorporated into relevant care plans.
In Chapter 2, new care plans have been added for the NANDA
International (NANDA-I) diagnoses of frail elderly syndrome
and readiness for enhanced decision making. Frail elderly
syndrome is a progressive condition that has both biological and
psychosocial contributing factors. When the deficits associated
with frail elderly syndrome are combined with the normal
physiological processes of aging, the older adult has an increased
risk for disability and mortality. Nurses have a key role in
helping patients reverse this condition. Decisions related to our
health warrant careful consideration and thoughtful reflection.
Readiness for enhanced decision making assists health care
professionals when working with patients deciding whether to
reduce their risk factors such as smoking or overweight.
However, this care plan can also be used to address more
complex decision-making issues, such as determination of cancer
therapy, genetic testing, refusal of blood products or surgical
procedures, writing of advanced directives, organ donation, and
end-of-life issues.
The previous chapters on men's health and women's health
have now been combined into one chapter (Chapter 12).
Included in this chapter is a new and timely care plan on gender
dysphoria, a condition where a person experiences clinically
significant discomfort or distress due to the discrepancy that
exists between a person's gender identity and that person's sex
assigned at birth. This is not a lifestyle, personal choice, or
political decision, but a very real biological phenomenon. This
care plan aims to educate nurses on how to work with patients
seeking to cope with their gender incongruity distress, as well as
to assist the person to find a gender role that is comfortable for
them.
The essential format for the book and for the individual care
plans has not changed from the 8th edition. These care plans
include assessments and therapeutic interventions across the
continuum of care. Chapter 2 also contains a section on patient
education and continuity of care for each nursing diagnosis.
Ongoing Assessments throughout this book contain the latest
information on methods of assessment and for laboratory and
diagnostic tests. Revised and expanded outcomes include new
measurable and specific terms for each nursing diagnosis.
Therapeutic Interventions include up-to-date information on
independent and collaborative clinical management and on drug
therapy related to nursing diagnoses and medical disorders. The
rationales for the Ongoing Assessments and Therapeutic
Interventions include current care and patient safety standards
and clinical practice guidelines in nursing and other health care
disciplines. Related care plans are referenced where applicable,
making it easy to cross-reference content throughout the book.
We continue to include the latest editions of Nursing
Interventions Classification (NIC) and Nursing Outcomes
Classification (NOC) labels at the beginning of each care plan.
The index includes entries for all nursing diagnoses, all medical
diagnoses, and all synonyms for the medical diagnoses,
providing an easy-to-use, practical tool for accessing the book's
content.
We continue to use the Evolve website as an adjunct to the
printed book. The expanded website now includes 54 additional
care plans on a wide range of disorders (see the inside back
cover of this book for a full list).
 We are grateful to the many contributors to previous editions
of this book. Their work continues to be the foundation for the
nurses who have contributed to the revisions for this edition.
Meg Gulanick PhD, APRN, FAAN
Judith L. Myers MSN, RN
CHAPTER 1

Using Nursing Care Plans to

Individualize and Improve Care

Introduction
According to the American Nurses Association (ANA), nursing
is the diagnosis and treatment of human responses to actual and
potential problems. A broad foundation of scientific knowledge,
including the biological and behavioral sciences, combined with
the ability to assist patients, families, and other caregivers in
managing their own health needs, defines the scope of nursing
practice. Nursing care in this context transcends settings, crosses
the age continuum, and supports a wellness philosophy focused
on self-care. In many ways, the roles of nurses are enhanced by
opportunities to provide nursing care in the more natural, less
institutional paradigms that are demanded by restructured health
care financing. Studies continue to document that society places
its highest trust in nurses. To deserve this trust, nurses will need
to continuously strive to improve health care quality. The current
challenges in seizing these opportunities include the following:
(1) recognition of the growing chasm between what currently
“exists” in health care and what “should be” to achieve the safe,
high-quality, effective, and patient-centered care that every
patient deserves; (2) the importance of working effectively in
interprofessional teams to deliver patient-centered care; (3) the
need for more effective professional communication; (4) the
need to help patients better navigate through difficult acute and
chronic care issues; (5) the ability of the nursing educational
system to increasingly prepare nurses for settings outside the
hospital environment as well as within the complex hospital
setting; (6) the ability of nurses themselves to be comfortable
with the responsibility of their roles; (7) the need to increase the
recruitment and retention of nurses from diverse backgrounds to
meet the needs of an increasingly diverse population; and (8) the
availability of tools to assist nurses in assessing, planning, and
providing care. Nursing Care Plans: Diagnoses, Interventions,
and Outcomes is such a tool.

Components of These Nursing Care Plans

Each care plan in this book begins with an expanded definition
of the title problem or diagnosis (Fig. 1-1). These definitions
include enough information to guide the user in understanding
what the problem or diagnosis is, information regarding the
incidence or prevalence of the problem or diagnosis, a brief
overview of the typical management and/or the focus of nursing
care, and a description of the setting in which care for the
particular problem or diagnosis can be expected to occur.
 FIGURE 1-1 Expanded definition and cross-
references of a care plan.

Each problem or diagnosis is accompanied by one or more

cross-references, some of which may be synonyms (see Fig. 1-
1). These cross-references assist the user in locating other
information that may be helpful in deciding whether this
particular care plan is indeed the one the user needs.
For each care plan, appropriate nursing diagnoses are
developed, which include the following components:
• Common related factors (those etiologies associated with a
diagnosis for an actual problem) (Fig. 1-2)

FIGURE 1-2 Common related factors and

defining characteristics of the nursing diagnosis.
• Defining characteristics (assessment data that support the
nursing diagnosis) (see Fig. 1-2)
• Common risk factors (those situations or conditions that
contribute to the patient's potential to develop a problem or
diagnosis) (Fig. 1-3)

FIGURE 1-3 Common risk factors, common

expected outcomes, and ongoing assessment of
the nursing diagnosis.

• Common expected outcomes (see Fig. 1-3)

• Ongoing assessment (see Fig. 1-3)
• Therapeutic interventions (both independent and
interprofessional) (Fig. 1-4)
 FIGURE 1-4 Therapeutic interventions of the
nursing diagnosis.

Each nursing diagnosis developed is based on the NANDA

International (NANDA-I) label unless otherwise stated.
Wherever possible, expanded rationales assist the user in
understanding the information presented; this allows for use of
Nursing Care Plans: Diagnoses, Interventions, and Outcomes as
a singular reference tool. The interventions and supporting
rationales for each care plan represent current research-based
knowledge and evidence-based clinical practice guidelines for
nursing and other health care professionals. Many care plans also
refer the user to additional diagnoses that may be pertinent and
would assist the user in further developing a care plan. Each
diagnosis developed in these care plans also identifies the
Nursing Interventions Classification (NIC) interventions and the
Nursing Outcomes Classification (NOC) outcomes.

Nursing Diagnoses Taxonomy, and

Interventions and Outcomes Classifications
As Nursing Care Plans: Diagnoses, Interventions, and
Outcomes continues to mature and reflect the changing times and
needs of its readers, as well as the needs of those for whom care
is provided, nursing diagnoses continue to evolve. The body of
research to support diagnoses, their definitions, related and risk
factors, and defining characteristics is ever increasing and
gaining momentum. Nurses continue to study both independent
and interprofessional interventions for effectiveness and
desirable outcomes.
The taxonomy of nursing diagnoses as a whole continues to be
refined; its use as an international tool for practice, education,
and research is testament to its importance as an organizing
framework for the body of knowledge that is uniquely nursing.
As a taxonomy, nursing diagnosis and all its components are
standardized. This standardized language for nursing diagnoses,
outcomes, and interventions is being incorporated into many
computer programs for nursing documentation in an electronic
medical record. Nurses must remember that care plans developed
for each diagnosis or cluster of diagnoses for particular patients
must be individualized. The patient-centered tailoring of the care
plan is the hallmark of nursing practice.
NIC presents an additional opportunity for clarifying and
organizing what nurses do. With NIC, nursing interventions
have been systematically organized to help nurses identify and
select interventions. In this ninth edition, NIC information
continues to be presented along with each nursing diagnosis
within each care plan, giving the user added ability to use NIC
taxonomy in planning for individualized patient care. According
to the developers of NIC, nursing interventions are “any
treatment, based upon clinical judgment and knowledge, that a
nurse performs to enhance patient/client outcomes” (Bulechek
et al., 2013). These interventions may include direct or indirect
care and may be initiated by a nurse, a physician, or another care
provider. Student nurses, practicing nurses, advanced practice
nurses, and nurse executives can use nursing diagnoses and NIC
as tools for learning, organizing, and delivering care; managing
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