Supplemental Reference List

Supplemental Reference List

Contents

Contents

Part 1 Original Literature Support

Domain 1. Health promotion 15

Class 1. Health awareness

Decreased diversional activity engagement 17
Risk for decreased diversional activity engagement 18
Excessive sedentary behaviors 19
Risk for excessive sedentary behaviors 21
Imbalanced energy field 23

Class 2. Health management

Ineffective health self-management 25
Risk for ineffective health self-management 27
Readiness for enhanced health self-management 29
Ineffective family health management 31
Risk for ineffective family health management 33
Ineffective community health management 35
Risk for ineffective community health management 36
Risk for ineffective blood glucose pattern self-management 37
Ineffective dry eye self-management 41
Ineffective dry mouth self-management 44
Risk for ineffective dry mouth self-management 45
Ineffective fatigue self-management 46
Ineffective lymphedema self-management 47
Risk for ineffective lymphedema self-management 50
Ineffective nausea self-management 53
Ineffective pain self-management 54
Readiness for enhanced weight self-management 55
Ineffective overweight self-management 57
Risk for ineffective overweight self-management 61
Ineffective underweight self-management 65
Risk for ineffective underweight self-management 67
Ineffective health maintenance behaviors 69
Risk for ineffective health maintenance behaviors 71
Ineffective home maintenance behaviors 73
Risk for ineffective home maintenance behaviors 74
Readiness for enhanced home maintenance behaviors 75
Readiness for enhanced exercise engagement 76
Inadequate health literacy 78
Risk for inadequate health literacy 83
Readiness for enhanced health literacy 88
Readiness for enhanced healthy aging 91
Elder frailty syndrome 92
Risk for elder frailty syndrome 94

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Contents

Domain 2. Nutrition 97

Class 1. Ingestion
Inadequate nutritional intake 99
Risk for inadequate nutritional intake 103
Readiness for enhanced nutritional intake 107
Inadequate protein energy nutritional intake 108
Risk for inadequate protein energy nutritional intake 112
Ineffective chestfeeding 115
Risk for ineffective chestfeeding 117
Disrupted exclusive chestfeeding 119
Risk for disrupted exclusive chestfeeding 121
Readiness for enhanced chestfeeding 123
Inadequate human milk production 124
Risk for inadequate human milk production 126
Ineffective infant feeding dynamics 128
Ineffective child eating dynamics 129
Ineffective adolescent eating dynamics 130
Impaired swallowing 131

Class 2. Digestion
This class does not currently contain any diagnoses 135

Class 3. Absorption
This class does not currently contain any diagnoses 136

Class 4. Metabolism
Neonatal hyperbilirubinemia 137
Risk for neonatal hyperbilirubinemia 138

Class 5. Hydration
Risk for impaired water-electrolyte balance 139
Risk for impaired fluid volume balance 140
Excessive fluid volume 145
Risk for excessive fluid volume 150
Inadequate fluid volume 155
Risk for inadequate fluid volume 160

Domain 3. Elimination and exchange 165

Class 1. Urinary function

Impaired urinary elimination 167
Risk for urinary retention 170
Disability-associated urinary incontinence 171
Mixed urinary incontinence 178
Stress urinary incontinence 185
Urge urinary incontinence 192
Risk for urge urinary incontinence 199

5
Contents

Class 2. Gastrointestinal function

Impaired gastrointestinal motility 206
Risk for impaired gastrointestinal motility 207
Impaired intestinal elimination 208
Risk for impaired intestinal elimination 210
Chronic functional constipation 212
Risk for chronic functional constipation 214
Impaired fecal continence 216
Risk for impaired fecal continence 217

Class 3. Integumentary function

This class does not currently contain any diagnoses 218

Class 4. Respiratory function

Impaired gas exchange 219

Domain 4. Activity / rest 221

Class 1. Sleep / rest

Ineffective sleep pattern 223
Risk for ineffective sleep pattern 231
Readiness for enhanced sleep pattern 239
Ineffective sleep hygiene behaviors 247
Risk for ineffective sleep hygiene behaviors 248

Class 2. Activity / exercise

Impaired physical mobility 249
Risk for impaired physical mobility 250
Impaired bed mobility 251
Impaired wheelchair mobility 253
Impaired sitting ability 255
Impaired standing ability 256
Impaired transferring ability 257
Impaired walking ability 258

Class 3. Energy balance

Decreased activity tolerance 259
Risk for decreased activity tolerance 261
Excessive fatigue burden 263
Impaired surgical recovery 265
Risk for impaired surgical recovery 268

Class 4. Cardiovascular / pulmonary responses

Risk for impaired cardiovascular function 271
Risk for imbalanced blood pressure 275
Risk for decreased cardiac output 277
Risk for ineffective cerebral tissue perfusion 280
Ineffective peripheral tissue perfusion 281
Risk for ineffective peripheral tissue perfusion 282

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Contents

Ineffective breathing pattern 283

Impaired spontaneous ventilation 285
Impaired child ventilatory weaning response 286
Impaired adult ventilatory weaning response 287

Class 5. Self-care
Decreased self-care ability syndrome 291
Risk for decreased self-care ability syndrome 292
Readiness for enhanced self-care abilities 293
Decreased bathing abilities 295
Decreased dressing abilities 296
Decreased feeding abilities 297
Decreased grooming abilities 298
Decreased toileting abilities 299
Ineffective oral hygiene behaviors 300
Risk for ineffective oral hygiene behaviors 301

Domain 5. Perception / cognition 303

Class 1. Attention
This class does not currently contain any diagnoses 305

Class 2. Orientation
This class does not currently contain any diagnoses 306

Class 3. Sensation / perception

This class does not currently contain any diagnoses 307

Class 4. Cognition
Acute confusion 308
Risk for acute confusion 312
Chronic confusion 316
Ineffective impulse control 317
Disrupted thought processes 319
Inadequate health knowledge 322
Readiness for enhanced health knowledge 324
Impaired memory 326
Impaired decision-making 327
Readiness for enhanced decision-making 328
Impaired emancipated decision-making 329
Risk for impaired emancipated decision-making 330
Readiness for enhanced emancipated decision-making 331

Class 5. Communication
Impaired verbal communication 332
Risk for impaired verbal communication 333
Readiness for enhanced verbal communication 334

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Contents

Domain 6. Self-perception 335

Class 1. Self-concept
Readiness for enhanced self-concept 336
Disrupted personal identity 337
Disrupted family identity syndrome 338
Risk for disrupted family identity syndrome 339
Risk for impaired human dignity 340
Readiness for enhanced transgender social identity 341

Class 2. Self-esteem
Chronic inadequate self-esteem 342
Risk for chronic inadequate self-esteem 345
Situational inadequate self-esteem 348
Risk for situational inadequate self-esteem 351
Inadequate health self-efficacy 354

Class 3. Body image

Disrupted body image 355

Domain 7. Role relationship 359

Class 1. Caregiving roles

Impaired parenting behaviors 361
Risk for impaired parenting behaviors 366
Readiness for enhanced parenting behaviors 371
Excessive parental role conflict 374

Class 2. Family relationships

Disrupted family interaction patterns 376
Risk for disrupted family interaction patterns 377
Impaired family processes 378
Readiness for enhanced family processes 379
Risk for disrupted attachment behaviors 380

Class 3. Role performance

Ineffective role performance 381
Ineffective intimate partner relationship 382
Risk for ineffective intimate partner relationship 383
Readiness for enhanced intimate partner relationship 384
Impaired social interaction 385
Ineffective childbearing process 387
Risk for ineffective childbearing process 388
Readiness for enhanced childbearing process 389

Domain 8. Sexuality 391

Class 1. Sexual identity

8
Contents

This class does not currently contain any diagnoses 392

Class 2. Sexual function

Impaired sexual function 393

Class 3. Reproduction
Risk for impaired maternal-fetal dyad 394

Domain 9. Coping / stress tolerance 395

Class 1. Post-trauma responses

Post-trauma syndrome 397
Risk for post-trauma syndrome 398
Risk for disrupted immigration transition 399

Class 2. Coping responses

Maladaptive coping 401
Readiness for enhanced coping 403
Maladaptive family coping 405
Readiness for enhanced family coping 406
Maladaptive community coping 407
Readiness for enhanced community coping 408
Excessive caregiving burden 409
Risk for excessive caregiving burden 410
Maladaptive grieving 411
Risk for maladaptive grieving 413
Readiness for enhanced grieving 415
Impaired resilience 417
Risk for impaired resilience 418
Readiness for enhanced resilience 419
Readiness for enhanced hope 421
Inadequate self-compassion 422
Excessive anxiety 429
Excessive death anxiety 432
Excessive fear 433

Class 3. Neurobehavioral responses

Risk for autonomic dysreflexia 436
Ineffective emotion regulation 437
Impaired mood regulation 439
Acute substance withdrawal syndrome 440
Risk for acute substance withdrawal syndrome 441

Domain 10. Life principles 443

Class 1. Values
This class does not currently contain any diagnoses 444

Class 2. Beliefs

9
Contents

This class does not currently contain any diagnoses 445

Class 3. Value / belief / action congruence

Moral distress 446
Impaired spiritual well-being 447
Risk for impaired spiritual well-being 449
Readiness for enhanced spiritual well-being 451
Impaired religiosity 452
Risk for impaired religiosity 454
Readiness for enhanced religiosity 456

Domain 11. Safety / protection 459

Class 1. Infection
Impaired immune response 462
Risk for infection 463
Risk for surgical wound infection 469

Class 2. Physical injury

Risk for physical injury 471
Risk for burn injury 472
Risk for cold injury 473
Risk for corneal injury 474
Risk for dry eye 478
Risk for perioperative positioning injury 480
Neonatal pressure injury 482
Risk for neonatal pressure injury 484
Child pressure injury 486
Risk for child pressure injury 488
Adult pressure injury 490
Risk for adult pressure injury 492
Risk for urinary tract injury 494
Impaired tissue integrity 495
Risk for impaired tissue integrity 498
Impaired skin integrity 501
Risk for impaired skin integrity 504
Impaired nipple-areolar complex integrity 507
Risk for impaired nipple-areolar complex integrity 511
Impaired oral mucous membrane integrity 515
Risk for impaired oral mucous membrane integrity 517
Risk for child falls 519
Risk for adult falls 520
Risk for aspiration 522
Ineffective airway clearance 524
Risk for accidental suffocation 530
Risk for excessive bleeding 531
Risk for shock 533
Risk for thrombosis 537
Risk for impaired peripheral neurovascular function 542

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Contents

Risk for sudden infant death 543

Risk for elopement attempt 545

Class 3. Violence
Risk for other-directed violence 547
Risk for female genital mutilation 548
Risk for suicidal self-injurious behavior 550
Non-suicidal self-injurious behavior 552
Risk for non-suicidal self-injurious behavior 553

Class 4. Environmental hazards

Contamination 554
Risk for contamination 556
Risk for accidental poisoning 558
Risk for occupational illness 560
Risk for occupational physical injury 563

Class 5. Defensive processes

Risk for allergic reaction 566
Risk for latex allergy reaction 567

Class 6. Thermoregulation
Ineffective thermoregulation 568
Risk for ineffective thermoregulation 569
Decreased neonatal body temperature 570
Risk for decreased neonatal body temperature 576
Decreased body temperature 582
Risk for decreased body temperature 584
Risk for decreased perioperative body temperature 586
Hyperthermia 590
Risk for hyperthermia 591

Domain 12. Comfort 593

Class 1. Physical comfort

Impaired physical comfort 595
Readiness for enhanced physical comfort 596
Impaired end-of-life comfort syndrome 597
Acute pain 598
Chronic pain syndrome 600
Chronic pain 604
Labor pain 607

Class 2. Environmental comfort

This class does not currently contain any diagnoses 610

Class 3. Social comfort

Readiness for enhanced social comfort 611
Inadequate social connectedness 612

11
Contents

Inadequate social support network 614

Excessive loneliness 617
Risk for excessive loneliness 618

Class 4. Psychological comfort

Impaired psychological comfort 619
Readiness for enhanced psychological comfort 620

Domain 13. Growth / development 621

Class 1. Growth
Delayed child growth 622
Risk for delayed child growth 630

Class 2. Development
Delayed child development 638
Risk for delayed child development 640
Delayed infant motor development 642
Risk for delayed infant motor development 644
Impaired infant neurodevelopmental organization 646
Risk for impaired infant neurodevelopmental organization 647
Readiness for enhanced infant neurodevelopmental organization 648
Ineffective infant suck-swallow response 649

Index 650

12
Part 1
Original Literature Support

Domain 1. Health promotion 15

Domain 2. Nutrition 97
Domain 3. Elimination and exchange 165
Domain 4. Activity / rest 221
Domain 5. Perception / cognition 303
Domain 6. Self-perception 335
Domain 7. Role relationship 359
Domain 8. Sexuality 391
Domain 9. Coping / stress tolerance 395
Domain 10. Life principles 443
Domain 11. Safety / protection 459
Domain 12. Comfort 593
Domain 13. Growth / development 621

NANDA International, Inc. Nursing Diagnoses: Definitions and Classification 2024–2026, 13th Edition.
Edited by T. Heather Herdman, Shigemi Kamitsuru, and Camila Takáo Lopes.
© 2024 NANDA International, Inc. Published 2024 by Thieme Medical Publishers, Inc., New York.
Companion website: www.thieme.com/nanda-i.

13
Domain 1.
Health promotion

Class 1. Health awareness

Code Diagnosis Page

00097 Decreased diversional activity engagement 17
00448 Risk for decreased diversional activity engagement 18
00355 Excessive sedentary behaviors 19
00394 Risk for excessive sedentary behaviors 21
00273 Imbalanced energy field 23

Class 2. Health management

Code Diagnosis Page

00276 Ineffective health self-management 25
00369 Risk for ineffective health self-management 27
00293 Readiness for enhanced health self-management 29
00080 Ineffective family health management 31
00410 Risk for ineffective family health management 33
00356 Ineffective community health management 35
00413 Risk for ineffective community health management 36
00489 Risk for ineffective blood glucose pattern self-management 37
00277 Ineffective dry eye self-management 41
00352 Ineffective dry mouth self-management 44
00412 Risk for ineffective dry mouth self-management 45
00397 Ineffective fatigue self-management 46
00278 Ineffective lymphedema self-management 47
00281 Risk for ineffective lymphedema self-management 50
00384 Ineffective nausea self-management 53

15
Domain 1. Health promotion

00418 Ineffective pain self-management 54

00447 Readiness for enhanced weight self-management 55
00398 Ineffective overweight self-management 57
00487 Risk for ineffective overweight self-management 61
00485 Ineffective underweight self-management 65
00486 Risk for ineffective underweight self-management 67
00292 Ineffective health maintenance behaviors 69
00395 Risk for ineffective health maintenance behaviors 71
00300 Ineffective home maintenance behaviors 73
00308 Risk for ineffective home maintenance behaviors 74
00309 Readiness for enhanced home maintenance behaviors 75
00307 Readiness for enhanced exercise engagement 76
00339 Inadequate health literacy 78
00411 Risk for inadequate health literacy 83
00262 Readiness for enhanced health literacy 88
00340 Readiness for enhanced healthy aging 91
00353 Elder frailty syndrome 92
00357 Risk for elder frailty syndrome 94

16
Domain 1. Health promotion Class 1. Health awareness

Domain 1 • Class 1 • Diagnosis Code 00097

Decreased diversional activity engagement

1. Health promotion
References
Barnett-Damewood M, Carlson-Catalano J. Physical activity deficit: a proposed nurs-
ing diagnosis. Nurs Diagn. 2000; 11(1):24–31
de Abreu Almeida M, da Silva MB, Panato BP, de Oliveira Siqueira AP, Laurent MdoC.
Nursing outcomes for Brazilian pediatric patients hospitalized with deficient diver-
sional activity. Int J Nurs Knowl. 2013; 24(2):85–92
Kim D. The effects of a combined physical activity, recreation, and art and craft pro-
gram on ADL, cognition, and depression in the elderly. J Phys Ther Sci. 2017; 29(4):
744–747
Linden M, Gehrke G, Geiselmann B. Profiles of recreational activities of daily living
(RADL) in patients with mental disorders. Psychiatr Danub. 2009; 21(4):490–496
Raffaelli Q, Mills C, Christoff K. The knowns and unknowns of boredom: a review of
the literature. Exp Brain Res. 2017:28
Zawadzki MJ, Smyth JM, Costigan HJ. Real-time associations between engaging in lei-
sure and daily health and well-being. Ann Behav Med. 2015; 49(4):605–615

17
Domain 1. Health promotion Class 1. Health awareness

Domain 1 • Class 1 • Diagnosis Code 00448

Risk for decreased diversional activity engagement

1. Health promotion

References
Barnett-Damewood M, Carlson-Catalano J. Physical activity deficit: a proposed nurs-
ing diagnosis. Nurs Diagn. 2000; 11(1):24–31
de Abreu Almeida M, da Silva MB, Panato BP, de Oliveira Siqueira AP, Laurent MdoC.
Nursing outcomes for Brazilian pediatric patients hospitalized with deficient diver-
sional activity. Int J Nurs Knowl. 2013; 24(2):85–92
Kim D. The effects of a combined physical activity, recreation, and art and craft pro-
gram on ADL, cognition, and depression in the elderly. J Phys Ther Sci. 2017; 29(4):
744–747
Linden M, Gehrke G, Geiselmann B. Profiles of recreational activities of daily living
(RADL) in patients with mental disorders. Psychiatr Danub. 2009; 21(4):490–496
Raffaelli Q, Mills C, Christoff K. The knowns and unknowns of boredom: a review of
the literature. Exp Brain Res. 2017:28
Zawadzki MJ, Smyth JM, Costigan HJ. Real-time associations between engaging in lei-
sure and daily health and well-being. Ann Behav Med. 2015; 49(4):605–615

18
Domain 1. Health promotion Class 1. Health awareness

Domain 1 • Class 1 • Diagnosis Code 00355

Excessive sedentary behaviors

1. Health promotion
References
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Phys-
ical fitness and all-cause mortality. A prospective study of healthy men and women.
JAMA. 1989;262(17):2395–2401
da Silva Costa L, de Lima Lopes J, Takáo Lopes C, Batista Santos V, Lúcia Bottura Leite
de Barros A. Prevalence and Associations Between Related Factors and Defining
Characteristics of the Nursing Diagnosis Sedentary Lifestyle in Patients with Acute
Coronary Syndrome. Int J Nurs Knowl. 2018. doi:10.1111/2047–3095.12234
de Oliveira MR, da Silva VM, Guedes NG, de Oliveira Lopes MV. Clinical Validation
of the “Sedentary Lifestyle” Nursing Diagnosis in Secondary School Students. J Sch
Nurs. 2015;32(3):186–194. doi:10.1177/1059840515588956
del Pino Casado R, Ugalde Apalategui M. Líneas de investigación en diagnóstico enfer-
mero. Enferm Clin. 1999;9(3):115–120
Dumuid D, Olds TS, Lewis LK, Maher C. Does home equipment contribute to socio-
economic gradients in Australian children’s physical activity, sedentary time and
screen time? BMC Public Health. 2016;16:736. doi:10.1186/s12889–016–3419–9
Guedes NG, Lopes MV, Cavalcante TF, Moreira RP, Araujo TL. Review of nursing di-
agnosis sedentary lifestyle in individuals with hypertension: conceptual analysis. Rev
Esc Enferm USP. 2013;47(3):742–749
Guirao-Goris JA, Duarte-Climents G. The Expert Nurse Profile and Diagnostic Con-
tent Validity of Sedentary Lifestyle: The Spanish Validation. Int J Nurs Terminol
Classif. 2007;18(3):84–92. doi:10.1111/j.1744–618x.2007.00056.x
Hesketh KR, Lakshman R, van Sluijs E. Barriers and facilitators to young children’s
physical activity and sedentary behaviour: a systematic review and synthesis of qual-
itative literature. Obes Rev. 2017;18(9):987–1017. doi:10.1111/obr.12562
Lindsay AC, Arruda C, De Andrade GP, Machado M, Greaney ML. Parenting practices
that may encourage and discourage physical activity in preschool-age children of
Brazilian immigrant families: A qualitative study. PLoS One. 2019;14(3):e0214143.
doi:10.1371/journal.pone.0214143
Lira ALBC, Tinôco JDS, Delgado MF, Araujo MGA, Costa RG, Souza AML. Diagnósti-
co de enfermería estilo de vida sedentario en escolares: la asociación con datos socio-
demográficos. Rev Mex Enferm Cardiol. 2015;23(1):6–11
Martins LCG, Lopes MV, Guedes NG, Menezes AP, Farias OO, Santos NA. Classifica-
tion tree for the assessment of sedentary lifestyle among hypertensive. Invest Educ
Enferm. 2016;34(1):113–119. doi:10.17533/udea.iee.v34n1a13
Martins LCG, Lopes MV, Guedes NG, Teixeira IX, Souza VEC, Montoril MH. Nursing
diagnosis sedentary lifestyle in individuals with hypertension: an analysis of accu-
racy. Rev Esc Enferm USP. 2014;48(5):804–810. doi:10.1590/S0080–
6234201400005000005
Martins LCG. Análise dos fatores relacionados do diagnóstico de enfermagem Estilo de
vida sedentário em pessoas com hipertensão arterial. Tese [Doutorado em Enferma-
gem]. Fortaleza, Universidade Federal do Ceará; 2020
Moreira RP, Guedes NG, Lopes MV, Cavalcante TF, Araújo TL. Nursing diagnosis of
sedentary lifestyle: expert validation. Texto Contexto Enferm. 2014;23(3):547–554

19
Domain 1. Health promotion Class 1. Health awareness

Parker KE, Salmon J, Costigan SA, Villanueva K, Brown HL, Timperio A. Activity-re-
lated behavior typologies in youth: a systematic review. Int J Behav Nutr Phys Act.
2019;16(1):44. doi:10.1186/s12966–019–0804–7
1. Health promotion

20
Domain 1. Health promotion Class 1. Health awareness

Domain 1 • Class 1 • Diagnosis Code 00394

Risk for excessive sedentary behaviors

1. Health promotion
References
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Phys-
ical fitness and all-cause mortality. A prospective study of healthy men and women.
JAMA. 1989;262(17):2395–2401
da Silva Costa L, de Lima Lopes J, Takáo Lopes C, Batista Santos V, Lúcia Bottura Leite
de Barros A. Prevalence and Associations Between Related Factors and Defining
Characteristics of the Nursing Diagnosis Sedentary Lifestyle in Patients with Acute
Coronary Syndrome. Int J Nurs Knowl. 2018. doi:10.1111/2047–3095.12234
de Oliveira MR, da Silva VM, Guedes NG, de Oliveira Lopes MV. Clinical Validation
of the “Sedentary Lifestyle” Nursing Diagnosis in Secondary School Students. J Sch
Nurs. 2015;32(3):186–194. doi:10.1177/1059840515588956
del Pino Casado R, Ugalde Apalategui M. Líneas de investigación en diagnóstico enfer-
mero. Enferm Clin. 1999;9(3):115–120
Dumuid D, Olds TS, Lewis LK, Maher C. Does home equipment contribute to socio-
economic gradients in Australian children’s physical activity, sedentary time and
screen time? BMC Public Health. 2016;16:736. doi:10.1186/s12889–016–3419–9
Guedes NG, Lopes MV, Cavalcante TF, Moreira RP, Araujo TL. Review of nursing di-
agnosis sedentary lifestyle in individuals with hypertension: conceptual analysis. Rev
Esc Enferm USP. 2013;47(3):742–749
Guirao-Goris JA, Duarte-Climents G. The Expert Nurse Profile and Diagnostic Con-
tent Validity of Sedentary Lifestyle: The Spanish Validation. Int J Nurs Terminol
Classif. 2007;18(3):84–92. doi:10.1111/j.1744–618x.2007.00056.x
Hesketh KR, Lakshman R, van Sluijs E. Barriers and facilitators to young children’s
physical activity and sedentary behaviour: a systematic review and synthesis of qual-
itative literature. Obes Rev. 2017;18(9):987–1017. doi:10.1111/obr.12562
Lindsay AC, Arruda C, De Andrade GP, Machado M, Greaney ML. Parenting practices
that may encourage and discourage physical activity in preschool-age children of
Brazilian immigrant families: A qualitative study. PLoS One. 2019;14(3):e0214143.
doi:10.1371/journal.pone.0214143
Lira ALBC, Tinôco JDS, Delgado MF, Araujo MGA, Costa RG, Souza AML. Diagnósti-
co de enfermería estilo de vida sedentario en escolares: la asociación con datos socio-
demográficos. Rev Mex Enferm Cardiol. 2015;23(1):6–11
Martins LCG, Lopes MV, Guedes NG, Menezes AP, Farias OO, Santos NA. Classifica-
tion tree for the assessment of sedentary lifestyle among hypertensive. Invest Educ
Enferm. 2016;34(1):113–119. doi:10.17533/udea.iee.v34n1a13
Martins LCG, Lopes MV, Guedes NG, Teixeira IX, Souza VEC, Montoril MH. Nursing
diagnosis sedentary lifestyle in individuals with hypertension: an analysis of accu-
racy. Rev Esc Enferm USP. 2014;48(5):804–810. doi:10.1590/S0080–
6234201400005000005
Martins LCG. Análise dos fatores relacionados do diagnóstico de enfermagem Estilo de
vida sedentário em pessoas com hipertensão arterial. Tese [Doutorado em Enferma-
gem]. Fortaleza, Universidade Federal do Ceará; 2020
Moreira RP, Guedes NG, Lopes MV, Cavalcante TF, Araújo TL. Nursing diagnosis of
sedentary lifestyle: expert validation. Texto Contexto Enferm. 2014;23(3):547–554

21
Domain 1. Health promotion Class 1. Health awareness

Parker KE, Salmon J, Costigan SA, Villanueva K, Brown HL, Timperio A. Activity-re-
lated behavior typologies in youth: a systematic review. Int J Behav Nutr Phys Act.
2019;16(1):44. doi:10.1186/s12966–019–0804–7
1. Health promotion

22
Domain 1. Health promotion Class 1. Health awareness

Domain 1 • Class 1 • Diagnosis Code 00273

Imbalanced energy field

1. Health promotion
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1. Health promotion

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24
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00276

Ineffective health self-management

1. Health promotion
References
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Ena-
blers and barriers to effective diabetes self-management: A multi-national investiga-
tion. PLOS ONE, 14(6), e0217771. doi:10.1371/journal.pone.0217771. Available
From: http://onlinelibrary.wiley.com/doi/10.1111/2047–3095.12071/full
Alvarez JS, Goldraich LA, Nunes AH, Zandavalli MCB, Zandavalli RB, Belli KC, et al.
Association between Spirituality and Adherence to Management in Outpatients with
Heart Failure. Arq Bras Cardiol [Internet]. 2016. Available from: http://www.gnre-
search.org/doi/10.5935/abc.20160076
Bodenheimer, T. (2002). Patient Self-management of Chronic Disease in Primary Care.
JAMA, 288(19), 2469. doi:10.1001/jama.288.19.2469
Carneiro CS, Oliveira APD, Lopes JL, RN, Bachion MM, Herdman TH, Moorhead SA,
Barros ALBL. Outpatient Clinic for Health Education: Contribution to Self-Manage-
ment and Self-Care for People with Heart Failure. International Journal of Nursing
Knowledge [Internet]. 2015, v.11(4);
Carneiro, C. de S., Lopes, C. T., Lopes, J. de L., Santos, V. B., Bachion, M. M., & de
Barros, A. L. B. L. (2016). Ineffective Health Management in People With Heart Fail-
ure: A Pilot Study. International Journal of Nursing Knowledge, 29(1), 11–17.
doi:10.1111/2047–3095.12142
Champion, V., Skinner, C.S. (2008). The Health Belief Model. In: Glanz K, Rimer B,
Viswanath K, editors. Health behavior and health education. 4. San Francisco, CA:
Jossey-Bass. pp. 45–65
Conceição Ana Paula da, Santos Mariana Alvina dos, Santos Bernardo dos, Cruz Diná
de Almeida Lopes Monteiro da. Self-care in heart failure patients. Rev. Latino-Am.
Enfermagem [Internet]. 2015 Aug [cited 2020 June 19]; 23(4): 578–586. doi.org/
10.1590/0104–1169.0288.2591
da Silva RC, Gondim MC, Cavalcante AMRZ, Bachion MM, da Silva VM, de Oliveira
Lopes MV. Ineffective health management: A systematic review and meta-analysis of
related factors. J Nurs Scholarsh. 2022;54:376–387. https://doi.org/10.1111/jnu.12747
Davies, N. J. (2010). Improving self-management for patients with long-term condi-
tions. Nursing Standard, 24(25), 49–56. doi:10.7748/ns2010.02.24.25.49.c7562
Dwarswaard, J., Bakker, E. J., van Staa, A., & Boeije, H. R. (2016). Self-management
support from the perspective of patients with a chronic condition: a thematic synthe-
sis of qualitative studies. Health Expectations, 19(2), 194–208
Gonzalez, J. S., Tanenbaum, M. L., & Commissariat, P. V. (2016). Psychosocial factors
in medication adherence and diabetes self-management: Implications for research
and practice. American Psychologist, 71(7), 539–551. doi:10.1037/a0040388
Hourzad, A., Pouladi, S., Ostovar, A., & Ravanipour, M. (2018). The effects of an em-
powering self-management model on self-efficacy and sense of coherence among re-
tired elderly with chronic diseases: a randomized controlled trial. Clinical Interven-
tions in Aging, Volume 13, 2215–2224. doi:10.2147/cia.s183276
Jolly, K., Majothi, S., Sitch, A. J., Heneghan, N. R., Riley, R. D., Moore, D. J., Bates, E. J.,
Turner, A. M., Bayliss, S. E., Price, M. J., Singh, S. J., Adab, P., Fitzmaurice, D. A., &
Jordan, R. E. (2016). Self-management of health care behaviors for COPD: a system-

25
Domain 1. Health promotion Class 2. Health management

atic review and meta-analysis. International journal of chronic obstructive pulmo-

nary disease, 11, 305–326. doi:10.2147/COPD.S90812
Mackey, L.M., Doody, C., Werner, E.L., Fullen, B. (2016). Self-Management Skills in
Chronic Disease Management: What Role Does Health Literacy Have? Med Decis
1. Health promotion

Making, 36(6), 741–59. Doi: 10.1177/0272989X16638330. Epub 2016 Apr 6

Morgan, H. M., Entwistle, V. A., Cribb, A., Christmas, S., Owens, J., Skea, Z. C., &
Watt, I. S. (2017). We need to talk about purpose: a critical interpretive synthesis of
health and social care professionals’ approaches to self-management support for
people with long-term conditions. Health Expectations, 20(2), 243–259
Paiva, M. das G. M. N. de, Tinôco, J. D. de S., Fernandes, M. I. da C. D., Dantas, J. R.,
Nogueira, I. L. A., Medeiros, A. B. de A., … Lira, A. L. B. de C. (2018). Ineffective
Health Management in Hemodialysis Patients: Diagnostic Accuracy Study. Clinical
Nursing Research, 105477381775402. doi:10.1177/1054773817754021
Paiva, M.G.M.N. Tinôco, J.D.S., Silva, F.B.B.L. Dantas, J.R., Lopes, M.V.O, & Lira, A.L.
B.C. (2018). Ineffective health management in hemodialysis patients: content analy-
sis. Revista Brasileira de Enfermagem, 71(4), 1825–1831. doi:10.1590/0034–7167–
2016–0682
Pender, N.J. (2011). Health Promotion Model Manual. Michigan, United State: Univer-
sity of Michigan. Available from: https://deepblue.lib.umich.edu/bitstream/handle/
2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5–2011.pdf
Sanson G, Vellone E, Takao-Lopes C, et al. Filling a gap in standardized nursing termi-
nology. Development of a new nursing diagnosis proposal on heart failure self-care.
Int J Nurs Knowl. 2022;33(1):18–28. doi:10.1111/2047–3095.12324
Silva, R.A.R., Santos, W.N., Souza, F.M.L.C., Santos, R.S.C., Oliveira, I.C., Silva, H.L.L.,
& Lima, D.M. (2020). Ineffective health control in people living with AIDS: a content
analysis. Acta Paulista de Enfermagem, 33, 1–11

26
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00369

Risk for ineffective health self-management

1. Health promotion
References
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Ena-
blers and barriers to effective diabetes self-management: A multi-national investiga-
tion. PLOS ONE, 14(6), e0217771. doi:10.1371/journal.pone.0217771. Available
From: http://onlinelibrary.wiley.com/doi/10.1111/2047–3095.12071/full
Alvarez JS, Goldraich LA, Nunes AH, Zandavalli MCB, Zandavalli RB, Belli KC, et al.
Association between Spirituality and Adherence to Management in Outpatients with
Heart Failure. Arq Bras Cardiol [Internet]. 2016. Available from: http://www.gnre-
search.org/doi/10.5935/abc.20160076
Bodenheimer, T. (2002). Patient Self-management of Chronic Disease in Primary Care.
JAMA, 288(19), 2469. doi:10.1001/jama.288.19.2469
Carneiro CS, Oliveira APD, Lopes JL, RN, Bachion MM, Herdman TH, Moorhead SA,
Barros ALBL. Outpatient Clinic for Health Education: Contribution to Self-Manage-
ment and Self-Care for People with Heart Failure. International Journal of Nursing
Knowledge [Internet]. 2015, v.11(4);
Carneiro, C. de S., Lopes, C. T., Lopes, J. de L., Santos, V. B., Bachion, M. M., & de
Barros, A. L. B. L. (2016). Ineffective Health Management in People With Heart Fail-
ure: A Pilot Study. International Journal of Nursing Knowledge, 29(1), 11–17.
doi:10.1111/2047–3095.12142
Champion, V., Skinner, C.S. (2008). The Health Belief Model. In: Glanz K, Rimer B,
Viswanath K, editors. Health behavior and health education. 4. San Francisco, CA:
Jossey-Bass. pp. 45–65
Conceição Ana Paula da, Santos Mariana Alvina dos, Santos Bernardo dos, Cruz Diná
de Almeida Lopes Monteiro da. Self-care in heart failure patients. Rev. Latino-Am.
Enfermagem [Internet]. 2015 Aug [cited 2020 June 19]; 23(4): 578–586. doi.org/
10.1590/0104–1169.0288.2591
da Silva RC, Gondim MC, Cavalcante AMRZ, Bachion MM, da Silva VM, de Oliveira
Lopes MV. Ineffective health management: A systematic review and meta-analysis of
related factors. J Nurs Scholarsh. 2022;54:376–387. https://doi.org/10.1111/jnu.12747
Davies, N. J. (2010). Improving self-management for patients with long-term condi-
tions. Nursing Standard, 24(25), 49–56. doi:10.7748/ns2010.02.24.25.49.c7562
Dwarswaard, J., Bakker, E. J., van Staa, A., & Boeije, H. R. (2016). Self-management
support from the perspective of patients with a chronic condition: a thematic synthe-
sis of qualitative studies. Health Expectations, 19(2), 194–208
Gonzalez, J. S., Tanenbaum, M. L., & Commissariat, P. V. (2016). Psychosocial factors
in medication adherence and diabetes self-management: Implications for research
and practice. American Psychologist, 71(7), 539–551. doi:10.1037/a0040388
Hourzad, A., Pouladi, S., Ostovar, A., & Ravanipour, M. (2018). The effects of an em-
powering self-management model on self-efficacy and sense of coherence among re-
tired elderly with chronic diseases: a randomized controlled trial. Clinical Interven-
tions in Aging, Volume 13, 2215–2224. doi:10.2147/cia.s183276
Jolly, K., Majothi, S., Sitch, A. J., Heneghan, N. R., Riley, R. D., Moore, D. J., Bates, E. J.,
Turner, A. M., Bayliss, S. E., Price, M. J., Singh, S. J., Adab, P., Fitzmaurice, D. A., &
Jordan, R. E. (2016). Self-management of health care behaviors for COPD: a system-

27
Domain 1. Health promotion Class 2. Health management

atic review and meta-analysis. International journal of chronic obstructive pulmo-

nary disease, 11, 305–326. doi:10.2147/COPD.S90812
Mackey, L.M., Doody, C., Werner, E.L., Fullen, B. (2016). Self-Management Skills in
Chronic Disease Management: What Role Does Health Literacy Have? Med Decis
1. Health promotion

Making, 36(6), 741–59. Doi: 10.1177/0272989X16638330. Epub 2016 Apr 6

Morgan, H. M., Entwistle, V. A., Cribb, A., Christmas, S., Owens, J., Skea, Z. C., &
Watt, I. S. (2017). We need to talk about purpose: a critical interpretive synthesis of
health and social care professionals’ approaches to self-management support for
people with long-term conditions. Health Expectations, 20(2), 243–259
Paiva, M. das G. M. N. de, Tinôco, J. D. de S., Fernandes, M. I. da C. D., Dantas, J. R.,
Nogueira, I. L. A., Medeiros, A. B. de A., … Lira, A. L. B. de C. (2018). Ineffective
Health Management in Hemodialysis Patients: Diagnostic Accuracy Study. Clinical
Nursing Research, 105477381775402. doi:10.1177/1054773817754021
Paiva, M.G.M.N. Tinôco, J.D.S., Silva, F.B.B.L. Dantas, J.R., Lopes, M.V.O, & Lira, A.L.
B.C. (2018). Ineffective health management in hemodialysis patients: content analy-
sis. Revista Brasileira de Enfermagem, 71(4), 1825–1831. doi:10.1590/0034–7167–
2016–0682
Pender, N.J. (2011). Health Promotion Model Manual. Michigan, United State: Univer-
sity of Michigan. Available from: https://deepblue.lib.umich.edu/bitstream/handle/
2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5–2011.pdf
Sanson G, Vellone E, Takao-Lopes C, et al. Filling a gap in standardized nursing termi-
nology. Development of a new nursing diagnosis proposal on heart failure self-care.
Int J Nurs Knowl. 2022;33(1):18–28. doi:10.1111/2047–3095.12324
Silva, R.A.R., Santos, W.N., Souza, F.M.L.C., Santos, R.S.C., Oliveira, I.C., Silva, H.L.L.,
& Lima, D.M. (2020). Ineffective health control in people living with AIDS: a content
analysis. Acta Paulista de Enfermagem, 33, 1–11

28
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00293

Readiness for enhanced health self-management

1. Health promotion
References
Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to
effective diabetes self-management: A multi-national investigation. PLOS ONE.
2019;14(6):e0217771. doi:10.1371/journal.pone.0217771. Available from: http://onli-
nelibrary.wiley.com/doi/10.1111/2047–3095.12071/full
Alvarez JS, Goldraich LA, Nunes AH, Zandavalli MCB, Zandavalli RB, Belli KC, et al.
Association between Spirituality and Adherence to Management in Outpatients with
Heart Failure. Arq Bras Cardiol [Internet]. 2016. Available from: http://www.gnre-
search.org/doi/10.5935/abc.20160076
Bodenheimer T. Patient Self-management of Chronic Disease in Primary Care. JAMA.
2002;288(19):2469. doi:10.1001/jama.288.19.2469
Carneiro C de S, Lopes CT, Lopes J de L, Santos VB, Bachion MM, de Barros ALBL.
Ineffective Health Management in People With Heart Failure: A Pilot Study. Inter-
national Journal of Nursing Knowledge. 2016;29(1):11–17. doi:10.1111/2047–
3095.12142
Carneiro CS, Oliveira APD, Lopes JL, RN, Bachion MM, Herdman TH, Moorhead SA,
Barros ALBL. Outpatient Clinic for Health Education: Contribution to Self-Manage-
ment and Self-Care for People with Heart Failure. International Journal of Nursing
Knowledge [Internet]. 2015, v.11(4)
Champion V, Skinner CS. The Health Belief Model. In: Glanz K, Rimer B, Viswanath
K, editors. Health behavior and health education. 4. San Francisco, CA: Jossey-Bass;
2008. pp. 45–65
Conceição AP da, Santos MA dos, Santos B dos, Cruz DALM. Self-care in heart failure
patients. Rev. Latino-Am. Enfermagem [Internet]. 2015 Aug [cited 2020 June 19];23
(4):578–586. doi.org/10.1590/0104–1169.0288.2591
da Silva RC, Gondim MC, Cavalcante AMRZ, Bachion MM, da Silva VM, de Oliveira
Lopes MV. Ineffective health management: A systematic review and meta-analysis of
related factors. J Nurs Scholarsh. 2022;54:376–387. https://doi.org/10.1111/jnu.12747
Davies NJ. Improving self-management for patients with long-term conditions. Nurs-
ing Standard. 2010;24(25):49–56. doi:10.7748/ns2010.02.24.25.49.c7562
Dwarswaard J, Bakker EJ, van Staa A, Boeije HR. Self-management support from the
perspective of patients with a chronic condition: a thematic synthesis of qualitative
studies. Health Expectations. 2016;19(2):194–208
Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication
adherence and diabetes self-management: Implications for research and practice.
American Psychologist. 2016;71(7):539–551. doi:10.1037/a0040388
Hourzad A, Pouladi S, Ostovar A, Ravanipour M. The effects of an empowering self-
management model on self-efficacy and sense of coherence among retired elderly
with chronic diseases: a randomized controlled trial. Clinical Interventions in Aging.
2018;13:2215–2224. doi:10.2147/cia.s183276
Jolly K, Majothi S, Sitch AJ, Heneghan NR, Riley RD, Moore DJ, et al. Self-manage-
ment of health care behaviors for COPD: a systematic review and meta-analysis. In-
ternational Journal of Chronic Obstructive Pulmonary Disease. 2016;11:305–326.
doi:10.2147/COPD.S90812

29
Domain 1. Health promotion Class 2. Health management

Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Dis-
ease Management: What Role Does Health Literacy Have? Med Decis Making.
2016;36(6):741–59. doi:10.1177/0272989X16638330. Epub 2016 Apr 6
Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need
1. Health promotion

to talk about purpose: a critical interpretive synthesis of health and social care pro-
fessionals’ approaches to self-management support for people with long-term condi-
tions. Health Expectations. 2017;20(2):243–259
Paiva M das G M N de, Tinôco J D S, Fernandes M I da C D, Dantas J R, Nogueira
ILA, Medeiros AB de A, et al. Ineffective Health Management in Hemodialysis Pa-
tients: Diagnostic Accuracy Study. Clinical Nursing Research. 2018. doi:10.1177/
1054773817754021
Paiva MGMN, Tinôco JDS, Silva FBBDL, Dantas JR, Lopes MVO, Lira ALBC. Ineffec-
tive health management in hemodialysis patients: content analysis. Revista Brasileira
de Enfermagem. 2018;71(4):1825–1831. doi:10.1590/0034–7167–2016–0682
Pender NJ. Health Promotion Model Manual. Michigan, United States: University of
Michigan; 2011. Available from: https://deepblue.lib.umich.edu/bitstream/handle/
2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5–2011.pdf
Sanson G, Vellone E, Takao-Lopes C, et al. Filling a gap in standardized nursing termi-
nology. Development of a new nursing diagnosis proposal on heart failure self-care.
Int J Nurs Knowl. 2022;33(1):18–28. doi:10.1111/2047–3095.12324
Silva RAR, Santos WN, Souza FMLC, Santos RSC, Oliveira IC, Silva HLL, Lima DM.
Ineffective health control in people living with AIDS: a content analysis. Acta Paulis-
ta de Enfermagem. 2020;33:1–11

30
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00080

Ineffective family health management

1. Health promotion
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32
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Domain 1 • Class 2 • Diagnosis Code 00410

Risk for ineffective family health management

1. Health promotion
References
Andrade GB, Pedroso VSM, Weykamp JM, et al. Palliative Care and the Importance of
Communication Between Nurse and Patient, Family and Caregiver. Rev Fund Care
Online. 2019. Apr./Jul.; 11(3):713–717. DOI: http://dx.doi.org/10.9789/2175–
5361.2019.v11i3.713–717
Bellato R, Araújo LFSD, Dolina JV, Musquim CA, Corrêa GHLS. The family experi-
ence of care in chronic situation. Revista da Escola de Enfermagem da USP. 2016;50
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Domain 1 • Class 2 • Diagnosis Code 00356

Ineffective community health management

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Domain 1 • Class 2 • Diagnosis Code 00413

Risk for ineffective community health management

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36
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Domain 1 • Class 2 • Diagnosis Code 00489

Risk for ineffective blood glucose pattern self-ma-

1. Health promotion
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Domain 1 • Class 2 • Diagnosis Code 00277

Ineffective dry eye self-management

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43
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00352

Ineffective dry mouth self-management

1. Health promotion

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44
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00412

Risk for ineffective dry mouth self-management

1. Health promotion
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2012;8(3):176–182. doi:10.1038/nrneph.2011.218
Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary gland hypofunction and xe-
rostomia in head and neck radiation patients. JNCI Monographs. 2019;2019(53).
doi:10.1093/jncimonographs/lgz016
Jiang N, Zhao Y, Jansson H, Chen X, Mårtensson J. Experiences of xerostomia after
radiotherapy in patients with head and neck cancer: A qualitative study. J Clin Nurs.
2017;27(1–2):e100–e108. doi:10.1111/jocn.13879
Kumar NM, Swamy RKN, Thippeswamy HM, Kamath G, Devananda D. Prevalence of
xerostomia in patients on haemodialysis: A systematic review and meta-analysis.
Gerodontology. 2021;38(3):235–241. doi:10.1111/ger.12526
Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia.
Clin Dermatol. 2017;35(5):468–476. doi:10.1016/j.clindermatol.2017.06.010
Mouly S, Salom M, Tillet Y, Coudert AC, Oberli F, Preshaw PM, Desjonquères S, Berg-
mann JF. Management of xerostomia in older patients. Drugs Aging. 2007;24
(11):957–965. doi:10.2165/00002512–200724110–00007
Nazir MA, AlGhamdi L, AlKadi M, AlBeajan N, AlRashoudi L, AlHussan M. The bur-
den of diabetes, its oral complications and their prevention and management. OA
Maced J Med Sci. 2018. doi:10.3889/oamjms.2018.294
Tanasiewicz M, Hildebrandt T, Obersztyn I. Xerostomia of various etiologies: A review
of the literature. Adv Clin Exp Med. 2016;25(1):199–206. doi:10.17219/acem/29375
Vivino FB, Carsons SE, Foulks G, Daniels TE, Parke A, Brennan MT, Forsblad-d'Elia
H, Scofield RH, Hammitt KM. New treatment guidelines for Sjögren’s disease.
Rheum Dis Clin North Am. 2016;42(3):531–551. doi:10.1016/j.rdc.2016.03.010
Vivino FB. Sjogren’s syndrome: Clinical aspects. Clin Immunol. 2017;182:48–54.
doi:10.1016/j.clim.2017.04.005

45
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00397

Ineffective fatigue self-management

1. Health promotion

References
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46
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00278

Ineffective lymphedema self-management

1. Health promotion
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Akita S, Nakamura R, Yamamoto N, Tokumoto H, Ishigaki T, Yamaji Y, Sasahara Y,
Kubota Y, Mitsukawa N, Satoh K. Early Detection of Lymphatic Disorder and Treat-
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(2):192e-202e
Armer JM, Hulett JM, Bernas M, Ostby P, Stewart BR, Cormier JN. Best Practice
Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-
Breast Cancer Lymphedema. Curr Breast Cancer Rep. 2013;5(2):134–144.
doi:10.1007/s12609–013–0105–0
Basta MN, Fox JP, Kanchwala SK, Wu LC, Serletti IJ, Kovach SJ, Fosnot J, Fischer JP.
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Choi JK, Kim HD, Jeong HJ. A Survey of the status of awareness of lymphedema in
breast cancer patients in Busan-Gyeongnam, Korea. Ann Rehabil Med. 2015;39
(4):609–615
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Demirkıran F, Balkaya NA, Memis S, Türk G, Ozvurmaz S, Tunçyurek P. How do
nurses and teachers perform breast self-examination: are they reliable sources of in-
formation? BMC Public Health. 2007;7(1):96
Demirkıran F, Ozgun H, Eskin M, Türk G, Çam R, Demirkıran AE. Cognition of breast
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Fife CE, Farrow W, Hebert A, Armer N, Stewart R, Cormier JN, Armer JM. Skin and
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Effect. Am J Phys Med Rehabil. 2015;94(6):483–98
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Kleinman R, Haber J. Proactive approach to lymphedema risk reduction: a prospec-
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z
Fu MR, Deng J, Armer JM. Putting evidence into practice: cancer-related lymphedema.
Clin J Oncol Nurs. 2014;18 Suppl:68–79

47
Domain 1. Health promotion Class 2. Health management

Jolly K, Majothi S, Sitch AJ, Heneghan NR, Riley RD, Moore DJ, Bates EJ, Turner AM,
Bayliss SE, Price MJ, Singh S, Adab P, Fitzmaurice DA, Jordan RE. Self-management
of health care behaviors for COPD: a systematic review and meta-analysis. Int J
Chron Obstruct Pulmon Dis. 2016;11:305–326. doi:10.2147/COPD.S90812
1. Health promotion

Kim DS, Sim YJ, Jeong HJ, Kim GC. Effect of Active Resistive Exercise on Breast Can-
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2010;91(12):1844–8
Kwan ML, Shen L, Munneke JR, Tam EK, Partee PN, André M, Kutner SE, Somkin
CP, Ackerson LM, Thiadens SR. Patient awareness and knowledge of breast cancer-
ralated lymphedema in a large, integrated health care delivery system. Breast Cancer
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Mak SS, Mo KF, Suen JJ, Chan SL, Ma WL, Yeo W. Lymphedema and quality of life in
Chinese women after treatment for breast cancer. Eur J Oncol Nurs. 2009;13(2):110–
5
Menezes MM, Bello MA, Millen E, Lucas FA, Carvalho FN, Andrade MF, Pereira AC,
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48
Domain 1. Health promotion Class 2. Health management

Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN. Lymphedema following
breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hem-
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1. Health promotion
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literature review for clinical practice. Int J Nurs Sci. 2016;33(2):202–207

49
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00281

Risk for ineffective lymphedema self-management

1. Health promotion

References
Akita S, Nakamura R, Yamamoto N, Tokumoto H, Ishigaki T, Yamaji Y, Sasahara Y,
Kubota Y, Mitsukawa N, Satoh K. Early Detection of Lymphatic Disorder and Treat-
ment for Lymphedema following Breast Cancer. Plast Reconstr Surg. 2016;138
(2):192e-202e
Armer JM, Hulett JM, Bernas M, Ostby P, Stewart BR, Cormier JN. Best Practice
Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-
Breast Cancer Lymphedema. Curr Breast Cancer Rep. 2013;5(2):134–144.
doi:10.1007/s12609–013–0105–0
Basta MN, Fox JP, Kanchwala SK, Wu LC, Serletti IJ, Kovach SJ, Fosnot J, Fischer JP.
Complicated breast cancer-related lymphedema: evaluating health care resource uti-
lization and associated Surgery. Am J Surg. 2016;211(1):133–41
Bodenheimer T. Patient Self-management of Chronic Disease in Primary Care. JAMA.
2002;288(19):2469. doi:10.1001/jama.288.19.2469
Champion V, Skinner CS. The Health Belief Model. In: Glanz K, Rimer B, Viswanath
K, editors. Health behavior and health education. 4th ed. San Francisco, CA: Jossey-
Bass; 2008. pp. 45–65
Cheifetz O, Haley L. Management of secondary lymphedema related to breast cancer.
Can Fam Physician. 2010;56:1277–1284
Choi JK, Kim HD, Jeong HJ. A Survey of the status of awareness of lymphedema in
breast cancer patients in Busan-Gyeongnam, Korea. Ann Rehabil Med. 2015;39
(4):609–615
Davies NJ. Improving self-management for patients with long-term conditions. Nurs
Stand. 2010;24(25):49–56. doi:10.7748/ns2010.02.24.25.49.c7562
Demirkıran F, Balkaya NA, Memis S, Türk G, Ozvurmaz S, Tunçyurek P. How do
nurses and teachers perform breast self-examination: are they reliable sources of in-
formation? BMC Public Health. 2007;7(1):96
Demirkıran F, Ozgun H, Eskin M, Türk G, Çam R, Demirkıran AE. Cognition of breast
cancer among gestational age Turkish women: a cross-sectional study. Asian Pac J
Cancer Prev. 2011;12:277–282
Dwarswaard J, Bakker EJ, van Staa A, Boeije HR. Self-management support from the
perspective of patients with a chronic condition: a thematic synthesis of qualitative
studies. Health Expect. 2016;19(2):194–208
Fife CE, Farrow W, Hebert A, Armer N, Stewart R, Cormier JN, Armer JM. Skin and
Wound Care in Lymphedema Patients: A Taxonomy, Primer, and Literature Review.
Adv Skin Wound Care. 2017;30(7):305–318
Finnane A, Janda M, Hayes SC. Review of the Evidence of Lymphedema Treatment
Effect. Am J Phys Med Rehabil. 2015;94(6):483–98
Fu MR, Axelrod D, Guth AA, Cartwright F, Qiu Z, Goldberg JD, Kim J, Scagliola J,
Kleinman R, Haber J. Proactive approach to lymphedema risk reduction: a prospec-
tive study. Ann Surg Oncol. 2014;21(11):3481–3489. doi:10.1245/s10434–014–3761-
z
Fu MR, Deng J, Armer JM. Putting evidence into practice: cancer-related lymphedema.
Clin J Oncol Nurs. 2014;18 Suppl:68–79

50
Domain 1. Health promotion Class 2. Health management

Jolly K, Majothi S, Sitch AJ, Heneghan NR, Riley RD, Moore DJ, Bates EJ, Turner AM,
Bayliss SE, Price MJ, Singh S, Adab P, Fitzmaurice DA, Jordan RE. Self-management
of health care behaviors for COPD: a systematic review and meta-analysis. Int J
Chron Obstruct Pulmon Dis. 2016;11:305–326. doi:10.2147/COPD.S90812

1. Health promotion
Kim DS, Sim YJ, Jeong HJ, Kim GC. Effect of Active Resistive Exercise on Breast Can-
cer–Related Lymphedema: A Randomized Controlled Trial. Arch Phys Med Rehabil.
2010;91(12):1844–8
Kwan ML, Shen L, Munneke JR, Tam EK, Partee PN, André M, Kutner SE, Somkin
CP, Ackerson LM, Thiadens SR. Patient awareness and knowledge of breast cancer-
ralated lymphedema in a large, integrated health care delivery system. Breast Cancer
Res Treat. 2012;135(2):591–602
Mak SS, Mo KF, Suen JJ, Chan SL, Ma WL, Yeo W. Lymphedema and quality of life in
Chinese women after treatment for breast cancer. Eur J Oncol Nurs. 2009;13(2):110–
5
Menezes MM, Bello MA, Millen E, Lucas FA, Carvalho FN, Andrade MF, Pereira AC,
Koifman RJ, Bergmann A. Breast reconstruction and risk of lymphedema after mas-
tectomy: A prospective cohort study with 10 years of follow-up. J Plast Reconstr Aes-
thet Surg. 2016;69(9):1218–26
Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need
to talk about purpose: a critical interpretive synthesis of health and social care pro-
fessionals’ approaches to self-management support for people with long-term condi-
tions. Health Expect. 2017;20(2):243–259
Oncology Nurse Advisor. Lymphedema: A challenge for caregivers, a burden to pa-
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Domain 1 • Class 2 • Diagnosis Code 00384

Ineffective nausea self-management

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Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00418

Ineffective pain self-management

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Domain 1 • Class 2 • Diagnosis Code 00447

Readiness for enhanced weight self-management

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Domain 1 • Class 2 • Diagnosis Code 00398

Ineffective overweight self-management

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Domain 1 • Class 2 • Diagnosis Code 00487

Risk for ineffective overweight self-management

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64
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00485

Ineffective underweight self-management

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Trans Int Med. 2015;3:151–154

65
Domain 1. Health promotion Class 2. Health management

Singh JK, Acharya D, Rani D, Gautam S, Bajgain KT, Bajgain BB, Park JH, Yoo SJ,
Poder TG, Lewin A, Lee K. Underweight and Associated Factors Among Teenage
Adolescent Girls in Resource-poor Settings: A Cross-sectional Study. Risk Manage-
ment and Healthcare Policy. 2021;14:9–19. https://doi.org/10.2147/RMHP.S280499
1. Health promotion

Sserwanja Q, Kawuki J. Prevalence of underweight and associated factors among lactat-

ing women in Ethiopia: a mini-review. Journal of Advances in Medicine and Medical
Research. 2020;32(8):1–9
Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, Patsche
CB. Mid-upper arm circumference as an indicator of underweight in adults: a cross-
sectional study from Nepal. BMC Public Health. 2020;20(1):1–7
Vaajoki A, Pietila¨ AM, Kankkunen P, Vehvila¨inen-Julkunen K. Effects of listening to
music on pain intensity and pain distress after surgery: an intervention. J Clin Nurs.
2012 Mar;21(5–6):708–17. doi: 10.1111/j.1365–2702.2011.03829.x
van der Meulen IC, May AM, Ros WJG, Oosterom M, Hordijk GJ, Koole L, et al. One-
Year Effect of a Nurse-Led Psychosocial Intervention on Depressive Symptoms in
Patients With Head and Neck Cancer: A Randomized Controlled Trial. Oncologist.
2013;18(3):336–44. doi: 10.1634/theoncologist.2012–0299
Wright SC, Maree JE, Sibanyoni M. Treatment of Oral Thrush in HIV/AIDS Patients
With Lemon Juice and Lemon Grass (Cymbopogon Citratus) and Gentian Violet.
Phytomedicine. 2009;16(2–3):118–24. doi: 10.1016/j.phymed.2008.07.015
Yang C, Gong G, Jin E, Han X, Zhuo Y, Yang S, et al. Topical Application of Honey in
the Management of chemo/radiotherapy-induced Oral Mucositis: A Systematic Re-
view and Network Meta-Analysis. Int J Nurs Stud. 2019;89:80–87. doi: 10.1016/j.ij-
nurstu.2018.08.007

66
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00486

Risk for ineffective underweight self-management

1. Health promotion
References
Bhutta, Z. A., Berkley, J. A., Bandsma, R., Kerac, M., Trehan, I., & Briend, A. (2017).
Severe childhood malnutrition. Nature reviews. Disease primers, 3, 17067. https://
doi.org/10.1038/nrdp.2017.67
Charalambous M, Raftopoulos V, Lambrinou E, Charalambous A. The effectiveness of
honey for the management of radiotherapy-induced oral mucositis in head and neck
cancer patients: A systematic review of clinical trials. Eur J Integr Med. 2012;5
(3):217–25. doi: 10.1016/j.eujim.2013.01.003
Charalambous M, Raftopoulos V, Paikousis L, Katodritis N, Lambrinou E, Vomvas D,
et al. The effect of the use of thyme honey in minimizing radiation-induced oral mu-
cositis in head and neck cancer patients: A randomized controlled trial. Eur J Oncol
Nurs. 2018;34:89–97. doi: 10.1016/j.ejon.2018.04.003
Chong C, van Druten J, Briars G, et al. Neonates living with enterostomy following
necrotising enterocolitis are at high risk of becoming severely underweight. Eur J Pe-
diatr. 2019;178:1875–1881. https://doi.org/10.1007/s00431–019–03440–6
Francisco PMSB, Assumpção DD, Borim FSA, Malta DC. Prevalence and factors asso-
ciated with underweight among Brazilian older adults. Ciência & Saúde Coletiva.
2019;24:2443–2452
Golubnitschaja O, Liskova A, Koklesova L, Samec M, Biringer K, Büsselberg D, ... Ku-
batka P. Caution,“normal” BMI: health risks associated with potentially masked in-
dividual underweight—EPMA Position Paper 2021. EPMA Journal. 2021;12(3):243–
264
Joventino ES, Ximenes LB, da Penha JC, Andrade LCO, de Almeida PC. The use of
educational video to promote maternal self-efficacy in preventing early childhood di-
arrhoea. Int J Nurs Pract. 2017;23:e12524. doi: 10.1111/ijn.12524
Keogh E, Williams EM. Managing malnutrition in COPD: a review. Respiratory Medi-
cine. 2021;176:106248
Khanal B, Baliga M, Uppal N. Effect of Topical Honey on Limitation of Radiation-In-
duced Oral Mucositis: An Intervention Study. Int J Oral Maxillofac Surg. 2010;39
(12):1181–5. doi: 10.1016/j.ijom.2010.05.014
Nikoletti S, Hyde S, Shaw T, Myers H, Kristjanson LJ. Comparison of plain ice and
flavoured ice for preventing oral mucositis associated with the use of 5 fluorouracil. J
Clin Nurs.2005;14(6):750–3. doi: 10.1111/j.1365–2702.2005.01156.x
Noll, M., de Mendonça, C. R., de Souza Rosa, L. P., & Silveira, E. A. (2017). Determi-
nants of eating patterns and nutrient intake among adolescent athletes: a systematic
review. Nutrition journal, 16(1), 46. https://doi.org/10.1186/s12937–017–0267–0
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tators to weight management for individuals with spinal cord injury. Spinal Cord.
2021;59:1061–1071. https://doi.org/10.1038/s41393–021–00614–8
Raheem RA, Binns CW, Chih HJ. Protective effects of breastfeeding against acute res-
piratory tract infections and diarrhoea: Findings of a cohort study. J Paediatric &
Child Care. 2017;53:271–6. doi: 10.1111/jpc.13480
Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: a review. J
Trans Int Med. 2015;3:151–154

67
Domain 1. Health promotion Class 2. Health management

Singh JK, Acharya D, Rani D, Gautam S, Bajgain KT, Bajgain BB, Park JH, Yoo SJ,
Poder TG, Lewin A, Lee K. Underweight and Associated Factors Among Teenage
Adolescent Girls in Resource-poor Settings: A Cross-sectional Study. Risk Manage-
ment and Healthcare Policy. 2021;14:9–19. https://doi.org/10.2147/RMHP.S280499
1. Health promotion

Sserwanja Q, Kawuki J. Prevalence of underweight and associated factors among lactat-

ing women in Ethiopia: a mini-review. Journal of Advances in Medicine and Medical
Research. 2020;32(8):1–9
Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, Patsche
CB. Mid-upper arm circumference as an indicator of underweight in adults: a cross-
sectional study from Nepal. BMC Public Health. 2020;20(1):1–7
Vaajoki A, Pietila¨ AM, Kankkunen P, Vehvila¨inen-Julkunen K. Effects of listening to
music on pain intensity and pain distress after surgery: an intervention. J Clin Nurs.
2012 Mar;21(5–6):708–17. doi: 10.1111/j.1365–2702.2011.03829.x
van der Meulen IC, May AM, Ros WJG, Oosterom M, Hordijk GJ, Koole L, et al. One-
Year Effect of a Nurse-Led Psychosocial Intervention on Depressive Symptoms in
Patients With Head and Neck Cancer: A Randomized Controlled Trial. Oncologist.
2013;18(3):336–44. doi: 10.1634/theoncologist.2012–0299
Wright SC, Maree JE, Sibanyoni M. Treatment of Oral Thrush in HIV/AIDS Patients
With Lemon Juice and Lemon Grass (Cymbopogon Citratus) and Gentian Violet.
Phytomedicine. 2009;16(2–3):118–24. doi: 10.1016/j.phymed.2008.07.015
Yang C, Gong G, Jin E, Han X, Zhuo Y, Yang S, et al. Topical Application of Honey in
the Management of chemo/radiotherapy-induced Oral Mucositis: A Systematic Re-
view and Network Meta-Analysis. Int J Nurs Stud. 2019;89:80–87. doi: 10.1016/j.ij-
nurstu.2018.08.007

68
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00292

Ineffective health maintenance behaviors

1. Health promotion
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Risk for ineffective home maintenance behaviors

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74
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Domain 1 • Class 2 • Diagnosis Code 00309

Readiness for enhanced home maintenance behav-

1. Health promotion
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Domain 1 • Class 2 • Diagnosis Code 00307

Readiness for enhanced exercise engagement

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tificação de eventos adversos relacionados ao uso de medicamentos e vacinas da An-
visa. 2018;7(3)
Jandorf S, Blatt B, Fraser S, Hammer M, Ruf S, David R. Low health literacy levels in
patients with chronic retinal disease. BMC Ophthalmology. 2019;19(1):1–5
Karamolahi, P. F., Khalesi, Z. B., Niknami, M. Efficacy of mobile app-based training on
health literacy among pregnant women: A randomized controlled trial study. DOI:
10.1016/j.eurox.2021.100133
Kim, S. H. (2009) Health literacy and functional health status in Korean older adults.
Journal of Clinical Nursing, 18(16), 2337–2343. DOI
Kim, S. H., & Yu, X. (2010) The mediating effect of self-efficacy on the relationship
between health literacy and health status in Korean older adults: a short report.
Aging and Mental Health 14(7), 870–873. DOI: https://doi.org/10.1080/
13607861003801011

79
Domain 1. Health promotion Class 2. Health management

Lawrence, P. R., Feinberg, I., Spratling, R. The relationship of parental health literacy to
health outcomes of children with medical complexity. DOI: 10.1016/j.
pedn.2021.02.014
Lee, H. Y., Zhou, A. Q., Lee, R. M., Dillon, A. L. Parents’ functional health literacy is
1. Health promotion

associated with children’s health outcomes: Implications for health practice, policy,
and research. DOI: 10.1016/j.childyouth.2020.104801
León-González, R., García-Esquinas, E., Paredes-Galán, E., Ferrero-Martínez, A. I.,
González-Guerrero, J. L., Hornillos-Calvo, M., Menéndez-Colino, R., Torres-Torres,
I., Galán, M. C., Torrente-Carballido, M., & Olcoz-Chiva, M. (2018) Alfabetización
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Revista Española de Cardiología, 71(3), 178–184. DOI
Liu, Y. B., Xue, L. L., Xue, H. P., & Hou, P. (2018) Health literacy, self-care agency,
health status and social support among elderly Chinese nursing home residents.
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2F0017896917739777
Loke YK, Hinz I, Wang X, Rowlands G, Scott D, Salter C, et al. Impact of health liter-
acy in patients with chronic musculoskeletal disease–systematic review. PloS one.
2012;7(7):e40210
Mayo-Gamble, T. L., & Mouton, C. (2018) Examining the Association Between Health
Literacy and Medication Adherence Among Older Adults. Health Communication
33(9), 1124–1130. DOI: https://doi.org/10.1080/10410236.2017.1331311
McKenna VB, Sixsmith J, Barry M. Facilitators and barriers to the development of
health literacy capacities over time for self-management. HLRP: Health Literacy Re-
search and Practice. 2020;4(2):e104-e118
Mõttus, R., Johnson, W., Murray, C., Wolf, M.S., Starr, J. M., & Deary, I. J. (2014) To-
wards understanding the links between health literacy and physical health. Health
Psychology, 33(2), 164–173. DOI
Nam HJ, Yoon JY. Linking Health Literacy to Self-Care in Hypertensive Patients with
Physical Disabilities: A Path Analysis Using a Multi-Mediation Model. International
Journal of Environmental Research and Public Health. 2021;18(7):3363
Poureslami I, Nimmon L, Rootman I, Fitzgerald JM. A conceptual model of functional
health literacy to improve chronic airway disease outcomes. BMC Public Health.
2021;21(1):1–16
Romero, S. S., Scortegagna, H. D. M., & Doring, M. (2019) Nível de letramento funcio-
nal em saúde e comportamento em saúde de idosos. Texto & Contexto Enfermagem,
27(4), e5230017. DOI
Romero, S. S., Scortegagna, H. M., & Doring, M. (2018) Nível de letramento funcional
em saúde e comportamento em saúde de idosos. Texto & Contexto Enfermagem 27
(4), 1–12. DOI: https://doi.org/10.1590/0104–07072018005230017
Sanders, L. M., Federico, S., Klass, P., Abrams, M. A., Dreyer, B. Literacy and Child
Health: A Systematic Review
Santos, M. I. P. O., & Portella, M. R. (2016) Condições do letramento funcional em
saúde de um grupo de idosos diabéticos. Revista Brasileira de Enfermagem 69(1),
156–164. DOI: https://doi.org/10.1590/0034–7167.2016690121i
Severo AH, Marinho A, Moura P, Vidal PM, Tavares AP, Ribas VR, et al. Comunica-
ção verbal prejudicada: revisão do diagnóstico em pacientes com Esclerose Lateral
Amiotrófica. Revista Brasileira de Enfermagem. 2018;71:3063–3073

80
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em saúde prejudicado. [Dissertação de mestrado/doutorado]. Natal: Universidade
Federal do Rio Grande do Norte; 2022
Sivakumar, H., Hanoch, Y., Barnes, A. J., & Federman A. D. (2016) Cognition, Health

1. Health promotion
Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medi-
care Beneficiaries. Journal of Health Communication 21, 155–163. DOI: https://doi.
org/10.1080/10810730.2016.1193921
Smith, C. A., Chang, E., Gallego, G., & Balneaves, L. G. (2017) An education interven-
tion to improve health literacy and decision making about supporting self-care
among older Australians: a study protocol for a randomized controlled trial. Trials
18(1), 1–8. DOI: https://doi.org/10.1186/s13063–017–2182–2
Smith, K. H. (2014) Aging and health literacy. Journal of Consumer Health on the In-
ternet 18(1), 94–100. DOI: 10.1080/15398285.2014.869447
Souza, J. G., Apolinario, D., Magaldi, R. M., Busse, A. L., Campora, F., & Jacob-Filho
W. (2014) Functional health literacy and glycaemic control in older adults with type
2 diabetes: a cross-sectional study. BMJ Open 4(2), e004180. DOI: http://dx.doi.org/
10.1136/bmjopen-2013–004180
Souza, J. G., Farfel, J. M., Jaluul, O., Queiroz, M. S., & Nery, M. (2020) Associação entre
alfabetismo em saúde e controle glicêmico em idosos com diabetes tipo 2 e efeito
modificador do suporte social. Einstein 18, 1–9. DOI: https://doi.org/10.31744/ein-
stein_journal/2020AO5572
Toci, E., Burazeri, G., Jerliu, N., Sørensen, K., Ramadani, N., Hysa, B., & Brand H.
(2015) Health literacy, self-perceived health and self-reported chronic morbidity
among older people in Kosovo. Health Promotion International, 30(3), 667–674.
DOI
Verney, S. P., Gibbons, L. E., Dmitrieva, N. O., Kueider, A. M., Williams, M. W.,
Meyer, O. L., Manly, J. J., Sisco, S. M., & Marsiske, M. (2019) Health literacy, socio-
demographic factors, and cognitive training in the active study of older adults. Inter-
national Journal of Geriatric Psychiatry 34(4), 563–570. DOI: https://doi.org/
10.1002/gps.5051
Vogt, D., Berens, E.-M., & Schaeffer, D. (2020) Gesundheitskompetenz im höheren
Lebensalter. Gesundheitswesen 82(5), 407–412. DOI: https://doi.org/10.1055/a-
0667–8382
Warren, M., De Carlo, D., & Dreer, L. E. (2016) Health literacy in older adults with
and without low vision. The American Journal of Occupational Therapy 70(3), 1–7.
DOI: https://doi.org/10.5014/ajot.2016.017400
Wayment A, Brym R, Doyle J, Hsu C-H. Beyond access block: understanding the role
of health literacy and self-efficacy in low-acuity emergency department patients.
Ochsner Journal. 2020;20(2):161–169
Wilson, F. L., Mayeta-Peart, A., Parada-Webster, L., Nordstrom, C. Using the Teach-
Back Method to Increase Maternal Immunization Literacy Among Low-Income
Pregnant Women in Jamaica: A Pilot Study. DOI: 10.1016/j.pedn.2011.05.004
Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Health Risk Behaviors
Among Older Adults. Am J Prev Med. 2007;32(1):19–24. doi:10.1016/j.
amepre.2006.08.024
World Health Organization (WHO). Optimizing health literacy: Improving health and
reducing health inequities. 2015
World Health Organization. (2021) Health promotion glossary of terms 2021. WHO

81
Domain 1. Health promotion Class 2. Health management

Zhang, F., Or, P. P.-L., & Chung, J. W.-Y. (2020) The effects of health literacy on influ-
enza vaccination competencies among community-dwelling older adults in Hong
Kong. BMC Geriatrics 20(1), 103. DOI: https://doi.org/10.1186/s12877–020–1504–5
1. Health promotion

82
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00411

Risk for inadequate health literacy

1. Health promotion
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health literacy to improve chronic airway disease outcomes. BMC Public Health.
2021;21(1):1–16
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nal em saúde e comportamento em saúde de idosos. Texto & Contexto Enfermagem,
27(4), e5230017. DOI
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em saúde e comportamento em saúde de idosos. Texto & Contexto Enfermagem 27
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Severo AH, Marinho A, Moura P, Vidal PM, Tavares AP, Ribas VR, et al. Comunica-
ção verbal prejudicada: revisão do diagnóstico em pacientes com Esclerose Lateral
Amiotrófica. Revista Brasileira de Enfermagem. 2018;71:3063–3073

85
Domain 1. Health promotion Class 2. Health management

Silva AB. Desenvolvimento de teoria de médio alcance de enfermagem para letramento

em saúde prejudicado. [Dissertação de mestrado/doutorado]. Natal: Universidade
Federal do Rio Grande do Norte; 2022
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1. Health promotion

Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medi-
care Beneficiaries. Journal of Health Communication 21, 155–163. DOI: https://doi.
org/10.1080/10810730.2016.1193921
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tion to improve health literacy and decision making about supporting self-care
among older Australians: a study protocol for a randomized controlled trial. Trials
18(1), 1–8. DOI: https://doi.org/10.1186/s13063–017–2182–2
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ternet 18(1), 94–100. DOI: 10.1080/15398285.2014.869447
Souza, J. G., Apolinario, D., Magaldi, R. M., Busse, A. L., Campora, F., & Jacob-Filho
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modificador do suporte social. Einstein 18, 1–9. DOI: https://doi.org/10.31744/ein-
stein_journal/2020AO5572
Thesis:
Toci, E., Burazeri, G., Jerliu, N., Sørensen, K., Ramadani, N., Hysa, B., & Brand H.
(2015) Health literacy, self-perceived health and self-reported chronic morbidity
among older people in Kosovo. Health Promotion International, 30(3), 667–674.
DOI
Verney, S. P., Gibbons, L. E., Dmitrieva, N. O., Kueider, A. M., Williams, M. W.,
Meyer, O. L., Manly, J. J., Sisco, S. M., & Marsiske, M. (2019) Health literacy, socio-
demographic factors, and cognitive training in the active study of older adults. Inter-
national Journal of Geriatric Psychiatry 34(4), 563–570. DOI: https://doi.org/
10.1002/gps.5051
Vogt, D., Berens, E.-M., & Schaeffer, D. (2020) Gesundheitskompetenz im höheren
Lebensalter. Gesundheitswesen 82(5), 407–412. DOI: https://doi.org/10.1055/a-
0667–8382
Warren, M., De Carlo, D., & Dreer, L. E. (2016) Health literacy in older adults with
and without low vision. The American Journal of Occupational Therapy 70(3), 1–7.
DOI: https://doi.org/10.5014/ajot.2016.017400
Wayment A, Brym R, Doyle J, Hsu C-H. Beyond access block: understanding the role
of health literacy and self-efficacy in low-acuity emergency department patients.
Ochsner Journal. 2020;20(2):161–169
Wilson, F. L., Mayeta-Peart, A., Parada-Webster, L., Nordstrom, C. Using the Teach-
Back Method to Increase Maternal Immunization Literacy Among Low-Income
Pregnant Women in Jamaica: A Pilot Study. DOI: 10.1016/j.pedn.2011.05.004
Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Health Risk Behaviors
Among Older Adults. Am J Prev Med. 2007;32(1):19–24. doi:10.1016/j.
amepre.2006.08.024
World Health Organization (WHO). Optimizing health literacy: Improving health and
reducing health inequities. 2015
World Health Organization. (2021) Health promotion glossary of terms 2021. WHO

86
Domain 1. Health promotion Class 2. Health management

Zhang, F., Or, P. P.-L., & Chung, J. W.-Y. (2020) The effects of health literacy on influ-
enza vaccination competencies among community-dwelling older adults in Hong
Kong. BMC Geriatrics 20(1), 103. DOI: https://doi.org/10.1186/s12877–020–1504–5

1. Health promotion

87
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00262

Readiness for enhanced health literacy

1. Health promotion

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90
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Domain 1 • Class 2 • Diagnosis Code 00340

Readiness for enhanced healthy aging

1. Health promotion
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91
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00353

Elder frailty syndrome

1. Health promotion

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92
Domain 1. Health promotion Class 2. Health management

Jarosz P., & Bellar, A. (2008). Sarcopenic obesity: An emerging cause of frailty in olders
adults. Geriatric Nursing, 30(1), 64–70. Landi, F., Onder, G., Carpenter, I., Cesari,
M., Soldato, M, & Bernabei, R. (2007). Physical activity prevented functional decline
among frail community-living elderly subjects in an international observational

1. Health promotion
study. Journal of Clinical Epidemiology, 60(5), 18–24
Levers, M-J., Estabrooks, C.A. & Ross Kerr, J .C. (2006). Factors contributing to frailty:
Literature review. Journal of Advanced Nursing, 56(3), 282–291
Markle-Ried, M. & Browne, G. (2003). Conceptualizations of frailty in relation to older
adults. Journal of Advanced Nursing, 44(1), 58–68
Milne, A.C., Avenell, A., & Potter, J. (2006). Improved food intake in frail older people.
British Medical Journal, 332(7551), 1165–1166
Xue, Q-L., Fried, L., Glass, T.A., Laffan, A., & Chaves, P.H.M. (2008). Life-space con-
striction, development of frailty, and the competing risk of mortality. The women´s
health and ageing study I. American Journal of Epidemiology, 167(2), 240–248

93
Domain 1. Health promotion Class 2. Health management

Domain 1 • Class 2 • Diagnosis Code 00357

Risk for elder frailty syndrome

1. Health promotion

References
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(2), 275–86
Afilalo, J., Karunananthan, S., Eisenberg, M.J., Alexander, K.P., & Bergman, H. (2009).
Role of frailty in patients with cardiovascular disease. The American Journal of Car-
diology, 103(11), 1616–1621
Ávila-Funes, J.A., Amieva, H., Barberger-Gateau, P., Le Goff, M., Raoux, N., Ritchie,
K., … Dartigues, J.F. (2009). Cognitive impairment improves the predictive validity
of the phenotype of frailty for adverse health outcomes: the three-city study. Journal
of the American Geriatrics Society, 57(3), 453–461
Bartali, B., Frongillo, E.A., Bandinelli, S., Lauretani, F., Semba, R.D. & Fried, L.P.
(2006). Low nutrient intake is an essential component of frailty in older persons.
Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 61(6),
589–593
Chen, C.Y., Wu, S.CH. Chen, L.J. & Lue, B.H. (2010).The prevalence of subjective
frailty and factors associated with frailty in Taiwan. Archives of Gerontology and
Geriatrics, 50, 543–547
Espinoza, S., & Walston, J.D. (2005). Frailty in older adults: insights and interventions.
Cleveland Clinic Journal of Medicine, 72(12), 1105–1112
Fillit, H., & Butler, R. (2009). The frailty identity crisis. Journal of the American Geriat-
rics Society, 57(2), 348–352
Fried, L.P., Ferrucci, L., Darer, J., Williamson, J.D. & Anderson, G. (2004). Untangling
the concepts of disability, frailty, and comorbidity: implications for improved target-
ing and care. Journal of Gerontology: Series A Biological Sciences and Medical Scien-
ces, 59(3), 255–63
Gallucci, M., Ongaro, F., Amici, G.P., & Regini, C. (2009). Frailty, disability and surviv-
al in the elderly over the age of seventy: Evidence from ‘‘The Treviso Longeva (TRE-
LONG) Study’’. Archives of Gerontology and Geriatrics, 48(3), 281–283
Garrido, M., Serrano, M.D., Bartolomé, R., & Martínez-Vizcaino, V. (2012). Differences
in the expression of the frailty syndrome in institutionalized elderly men and women
with no severe cognitive decline. Revista Espanola de Geriatria y Gerontologia, 47
(6), 247–253
Gill, T.M., Allore, H.G., Holford, T.R. & Guo, Z.G. (2004). Hospitalization, restricted
activity and the development of disability among older persons. Journal of the Amer-
ican Medical Association, 292(17), 2115–2124
Gobbens, R.J, Luijkx, K.G., Wijnen-Sponselee, M.T. & Schols, J.M. (2010). Toward a
conceptual definition of frail community dwelling older people. Nursing Outlook, 58
(2), 76–86
Graf, C. (2006). Functional Decline in Hospitalized Older Adults: It's often a conse-
quence of hospitalization, but it doesn't have to be. American Journal of Nursing,
106 (1), 58–67
Heppenstall, C.P., Wilkinson, T.J., Hanger, H.C. & Keeling, S. (2009). Frailty: dominos
or deliberation? Journal of the New Zealand Medical Association, 122(1299), 42–53

94
Domain 1. Health promotion Class 2. Health management

Jarosz P., & Bellar, A. (2008). Sarcopenic obesity: An emerging cause of frailty in olders
adults. Geriatric Nursing, 30(1), 64–70. Landi, F., Onder, G., Carpenter, I., Cesari,
M., Soldato, M, & Bernabei, R. (2007). Physical activity prevented functional decline
among frail community-living elderly subjects in an international observational

1. Health promotion
study. Journal of Clinical Epidemiology, 60(5), 18–24
Levers, M-J., Estabrooks, C.A. & Ross Kerr, J .C. (2006). Factors contributing to frailty:
Literature review. Journal of Advanced Nursing, 56(3), 282–291
Markle-Ried, M. & Browne, G. (2003). Conceptualizations of frailty in relation to older
adults. Journal of Advanced Nursing, 44(1), 58–68
Milne, A.C., Avenell, A., & Potter, J. (2006). Improved food intake in frail older people.
British Medical Journal, 332(7551), 1165–1166
Xue, Q-L., Fried, L., Glass, T.A., Laffan, A., & Chaves, P.H.M. (2008). Life-space con-
striction, development of frailty, and the competing risk of mortality. The women´s
health and ageing study I. American Journal of Epidemiology, 167(2), 240–248

95
Domain 2.
Nutrition

Class 1. Ingestion

Code Diagnosis Page

00343 Inadequate nutritional intake 99
00409 Risk for inadequate nutritional intake 103
00419 Readiness for enhanced nutritional intake 107
00359 Inadequate protein energy nutritional intake 108
00360 Risk for inadequate protein energy nutritional intake 112
00371 Ineffective chestfeeding 115
00406 Risk for ineffective chestfeeding 117
00347 Disrupted exclusive chestfeeding 119
00382 Risk for disrupted exclusive chestfeeding 121
00479 Readiness for enhanced chestfeeding 123
00333 Inadequate human milk production 124
00334 Risk for inadequate human milk production 126
00271 Ineffective infant feeding dynamics 128
00270 Ineffective child eating dynamics 129
00269 Ineffective adolescent eating dynamics 130
00103 Impaired swallowing 131

Class 2. Digestion

Code Diagnosis Page

This class does not currently contain any diagnoses 135

Class 3. Absorption

97
Domain 2. Nutrition

Code Diagnosis Page

This class does not currently contain any diagnoses 136

Class 4. Metabolism

Code Diagnosis Page

00194 Neonatal hyperbilirubinemia 137
00230 Risk for neonatal hyperbilirubinemia 138

Class 5. Hydration

Code Diagnosis Page

00491 Risk for impaired water-electrolyte balance 139
00492 Risk for impaired fluid volume balance 140
00026 Excessive fluid volume 145
00370 Risk for excessive fluid volume 150
00421 Inadequate fluid volume 155
00420 Risk for inadequate fluid volume 160

98
Domain 2. Nutrition Class 1. Ingestion

Domain 2 • Class 1 • Diagnosis Code 00343

Inadequate nutritional intake

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Domain 2 • Class 1 • Diagnosis Code 00419

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Domain 2 • Class 1 • Diagnosis Code 00360

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Domain 2 • Class 1 • Diagnosis Code 00371

Ineffective chestfeeding
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116
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Domain 2 • Class 1 • Diagnosis Code 00406

Risk for ineffective chestfeeding

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117
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118
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Domain 2 • Class 1 • Diagnosis Code 00347

Disrupted exclusive chestfeeding

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Domain 2 • Class 1 • Diagnosis Code 00382

Risk for disrupted exclusive chestfeeding

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Domain 2 • Class 1 • Diagnosis Code 00479

Readiness for enhanced chestfeeding

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123
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Domain 2 • Class 1 • Diagnosis Code 00333

Inadequate human milk production

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Anderson PO. Drugs that suppress lactation, part 2. Breastfeed Med. 2017;12(4):199–
201. https://doi.org/10.1089/bfm.2017.0029
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diatriArs.2020.75875
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tors Influencing Milk Production [Doctoral dissertation]. University of California,
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124
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Napierala M, Mazela J, Merritt TA, Florek E. Tobacco smoking and breastfeeding: ef-
fect on the lactation process, breast milk composition and infant development. A
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vres.2016.08.002
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negative association between maternal obesity and exclusive breastfeeding at 1 and 2
months postpartum. J Nutr. 2015;145(10):2369–2378. https://doi.org/10.3945/
jn.115.214619

2. Nutrition
O'Sullivan EJ, Perrine CG, Rasmussen KM. Early breastfeeding problems mediate the
negative association between maternal obesity and exclusive breastfeeding at 1 and 2
months postpartum. J Nutr. 2015;145(10):2369–2378. https://doi.org/10.3945/
jn.115.214619
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ception of adequacy of mother's milk among mothers giving birth at a teaching hos-
pital in Sri Lanka. J Hum Lact. 2019;35(1):171–180. https://doi.org/10.1177/
0890334418773304
Rodrigo R, Rodrigo A, Liyanage N, Hatahagoda W, Hewavitharana U. Maternal per-
ception of adequacy of mother's milk among mothers giving birth at a teaching hos-
pital in Sri Lanka. J Hum Lact. 2019;35(1):171–180. https://doi.org/10.1177/
0890334418773304
Sebastiani G, Herranz Barbero A, Borrás-Novell C, Alsina Casanova M, Aldecoa-Bilbao
V, Andreu-Fernández V, et al. The effects of vegetarian and vegan diet during preg-
nancy on the health of mothers and offspring. Nutrients. 2019;11(3):557
Sebastiani G, Herranz Barbero A, Borrás-Novell C, Alsina Casanova M, Aldecoa-Bilbao
V, Andreu-Fernández V, et al. The effects of vegetarian and vegan diet during preg-
nancy on the health of mothers and offspring. Nutrients. 2019;11(3):557
Segura‐Pérez S, Richter L, Rhodes EC, Hromi‐Fiedler A, Vilar‐Compte M, Adnew M,
et al. Risk factors for self‐reported insufficient milk during the first 6 months of life:
A systematic review. Matern Child Nutr. 2022;e13353
Witten C, Claasen N, Kruger HS, Coutsoudis A, Grobler H. Psychosocial barriers and
enablers of exclusive breastfeeding: lived experiences of mothers in low-income
townships, North West Province, South Africa. Int Breastfeed J. 2020;15(1):1–15

125
Domain 2. Nutrition Class 1. Ingestion

Domain 2 • Class 1 • Diagnosis Code 00334

Risk for inadequate human milk production

References
Anderson PO. Alcohol use during breastfeeding. Breastfeed Med. 2018;13(5):315–317.
https://doi.org/10.1089/bfm.2018.0053
2. Nutrition

Anderson PO. Drugs that suppress lactation, part 2. Breastfeed Med. 2017;12(4):199–
201. https://doi.org/10.1089/bfm.2017.0029
Cheng F, Dai S, Wang C, Zeng S, Chen J, Cen Y. Do breast implants influence breast-
feeding? A meta-analysis of comparative studies. J Hum Lact. 2018;34(3):424–432.
https://doi.org/10.1177/0890334418776654
Cruz NI, Korchin L. Breastfeeding after augmentation mammaplasty with saline im-
plants. Ann Plast Surg. 2010;64(5):530–533. https://doi.org/10.1097/SAP.0-
b013e3181c925e4
Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contra-
ceptive Use, 2016. MMWR Recomm Rep. 2016;65(3):1-
Donmez AY, Korgali EU. The relationship between the perception of breast milk of
parents with term infants and exclusive breastfeeding in the postnatal first six
months. Turk Arch Pediatr. 2021;56(2):164–172. https://doi.org/10.14744/TurkPe-
diatriArs.2020.75875
Farah E, Barger MK, Klima C, Rossman B, Hershberger P. Impaired lactation: Review
of delayed lactogenesis and insufficient lactation. J Midwifery Womens Health.
2021;66(5):631–640
Ferri RL, Rosen-Carole CB, Jackson J, Carreno-Rijo E, Greenberg KB; Academy of
Breastfeeding Medicine. ABM Clinical Protocol #33: Lactation care for lesbian, gay,
bisexual, transgender, queer, questioning plus patients. Breastfeed Med. 2020;15
(5):284–293. https://doi.org/10.1089/bfm.2020.29152.rlf
Ford E. An Investigation of Maternal Energy Demands During Lactation and the Fac-
tors Influencing Milk Production [Doctoral dissertation]. University of California,
Davis; 2022
Gokceoglu E, Kucukoglu S. The relationship between insufficient milk perception and
breastfeeding self-efficacy among Turkish mothers. Glob Health Promot. 2017;24
(4):53–61. https://doi.org/10.1177/1757975916635080
Golan Y, Assaraf YG. Genetic and physiological factors affecting human milk produc-
tion and composition. Nutrients. 2020;12(5):1500
Hurst NM. Recognizing and treating delayed or failed lactogenesis II. J Midwifery
Womens Health. 2007;52(6):588–594. https://doi.org/10.1016/j.jmwh.2007.05.005
Kent JC, Ashton E, Hardwick CM, Alethea R, Murray KM, Geddes DT. Causes of per-
ception of insufficient milk supply in Western Australian mothers. Matern Child
Nutr. 2021;17(1):e13080. https://doi.org/10.1111/mcn.13080
Menekse D, Tiryaki O, Karakaya Suzan O, Cinar N. An investigation of the relation-
ship between mother's personality traits, breastfeeding self-efficacy, and perception
of insufficient milk supply. Health Care Women Int. 2021;42:1–17. https://doi.org/
10.1080/07399332.2021.1892114
Mohebati LM, Hilpert P, Bath S, Rayman MP, Raats MM, Martinez H, et al. Perceived
insufficient milk among primiparous, fully breastfeeding women: Is infant crying im-
portant? Matern Child Nutr. 2021;17(3):e13133. https://doi.org/10.1111/mcn.13133

126
Domain 2. Nutrition Class 1. Ingestion

Napierala M, Mazela J, Merritt TA, Florek E. Tobacco smoking and breastfeeding: ef-
fect on the lactation process, breast milk composition and infant development. A
critical review. Environ Res. 2016;151:321–338. https://doi.org/10.1016/j.en-
vres.2016.08.002
O'Sullivan EJ, Perrine CG, Rasmussen KM. Early breastfeeding problems mediate the
negative association between maternal obesity and exclusive breastfeeding at 1 and 2
months postpartum. J Nutr. 2015;145(10):2369–2378. https://doi.org/10.3945/
jn.115.214619

2. Nutrition
O'Sullivan EJ, Perrine CG, Rasmussen KM. Early breastfeeding problems mediate the
negative association between maternal obesity and exclusive breastfeeding at 1 and 2
months postpartum. J Nutr. 2015;145(10):2369–2378. https://doi.org/10.3945/
jn.115.214619
Rodrigo R, Rodrigo A, Liyanage N, Hatahagoda W, Hewavitharana U. Maternal per-
ception of adequacy of mother's milk among mothers giving birth at a teaching hos-
pital in Sri Lanka. J Hum Lact. 2019;35(1):171–180. https://doi.org/10.1177/
0890334418773304
Rodrigo R, Rodrigo A, Liyanage N, Hatahagoda W, Hewavitharana U. Maternal per-
ception of adequacy of mother's milk among mothers giving birth at a teaching hos-
pital in Sri Lanka. J Hum Lact. 2019;35(1):171–180. https://doi.org/10.1177/
0890334418773304
Sebastiani G, Herranz Barbero A, Borrás-Novell C, Alsina Casanova M, Aldecoa-Bilbao
V, Andreu-Fernández V, et al. The effects of vegetarian and vegan diet during preg-
nancy on the health of mothers and offspring. Nutrients. 2019;11(3):557
Sebastiani G, Herranz Barbero A, Borrás-Novell C, Alsina Casanova M, Aldecoa-Bilbao
V, Andreu-Fernández V, et al. The effects of vegetarian and vegan diet during preg-
nancy on the health of mothers and offspring. Nutrients. 2019;11(3):557
Segura‐Pérez S, Richter L, Rhodes EC, Hromi‐Fiedler A, Vilar‐Compte M, Adnew M,
et al. Risk factors for self‐reported insufficient milk during the first 6 months of life:
A systematic review. Matern Child Nutr. 2022;e13353
Witten C, Claasen N, Kruger HS, Coutsoudis A, Grobler H. Psychosocial barriers and
enablers of exclusive breastfeeding: lived experiences of mothers in low-income
townships, North West Province, South Africa. Int Breastfeed J. 2020;15(1):1–15

127
Domain 2. Nutrition Class 1. Ingestion

Domain 2 • Class 1 • Diagnosis Code 00271

Ineffective infant feeding dynamics

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128
Domain 2. Nutrition Class 1. Ingestion

Domain 2 • Class 1 • Diagnosis Code 00270

Ineffective child eating dynamics

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2. Nutrition
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147
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ison between families of children with and without overweight. J Pediatr Psychol.
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age of 6 years. Appl Physiol Nutr Metab. 2009; 34(4):551–570
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130
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Domain 2 • Class 1 • Diagnosis Code 00103

Impaired swallowing
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134
Domain 2. Nutrition Class 2. Digestion

This class does not currently contain any diagnoses

2. Nutrition

135
Domain 2. Nutrition Class 3. Absorption

This class does not currently contain any diagnoses

2. Nutrition

136
Domain 2. Nutrition Class 4. Metabolism

Domain 2 • Class 4 • Diagnosis Code 00194

Neonatal hyperbilirubinemia
References
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2. Nutrition
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137
Domain 2. Nutrition Class 4. Metabolism

Domain 2 • Class 4 • Diagnosis Code 00230

Risk for neonatal hyperbilirubinemia

References
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2. Nutrition

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138
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00491

Risk for impaired water-electrolyte balance

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139
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00492

Risk for impaired fluid volume balance

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Biol Eng Comput. 2013;51(10):1167–75. doi:10.1007/s11517–013–1064–3
Nagayama I, Masuda T, Nakagawa S, et al. Different effects on fluid distribution be-
tween tolvaptan and furosemide in a liver cirrhosis patient with chronic kidney dis-
ease. Intern Med. 2019;58(11):1587–91. doi:10.2169/internalmedicine.2174–18
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Norberg Å, Rooyackers O, Segersvärd R, et al. Leakage of albumin in major abdominal
surgery. Crit Care. 2016;20(1):113. doi:10.1186/s13054–016–1283–8
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-

142
Domain 2. Nutrition Class 5. Hydration

dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-
dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114

2. Nutrition
Ogna A, Forni Ogna V, Mihalache A, et al. Obstructive sleep apnea severity and over-
night body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10
(6):1002–10. doi:10.2215/CJN.08760914
Ohashi Y, Joki N, Yamazaki K, et al. Changes in the fluid volume balance between in-
tra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a
cross-sectional study. Am J Physiol Renal Physiol. 2018;314(4):F614–22. doi:
10.1152/ajprenal.00477.2017
Orvieto R, Dratviman-Storobinsky O, Lantsberg D, et al. Interleukin-2 and SOCS-1
proteins involvement in the pathophysiology of severe ovarian hyperstimulation syn-
drome-a preliminary proof of concept. J Ovarian Res. 2014;7:106. doi: 10.1186/
s13048–014–0106–2
Patton KT, Thibodeau GA. Fluid and electrolyte balance. In: ___ Anatomy & Physiol-
ogy. St Louis: Mosby, 2016. p. 999–1018
Pietribiasi M, Waniewski J, Wójcik-Załuska A, et al. Model of fluid and solute shifts
during hemodialysis with active transport of sodium and potassium. PLoS ONE.
2018;13(12):e0209553. https://doi.org/10.1371/journal.pone.0209553
Pietribiasi M, Waniewski J, Załuska A, et al. Modelling transcapillary transport of fluid
and proteins in hemodialysis patients. PLoS ONE. 2016;11(8):e0159748. https://doi.
org/10.1371/journal.pone.0159748
Prakash A, Mathur R. Ovarian hyperstimulation syndrome. The Obstetrician & Gynae-
cologist. 2013;15:31–5. doi: 10.1111/j.1744–4667.2012.00153.x
Premaratna R, Ragupathy A, Miththinda JK, et al. Timing, predictors, and progress of
third space fluid accumulation during preliminary phase fluid resuscitation in adult
patients with dengue. Int J Infect Dis. 2013;17(7):e505–9. doi: 10.1016/j.
ijid.2012.12.021
Raina R, Krishnappa V, Das A, et al. Overview of monogenic or mendelian forms of
hypertension. Front Pediatr. 2019;7:263. doi:10.3389/fped.2019.00263
Riegel B, Lee S, Hill J, et al. Patterns of adherence to diuretics, dietary sodium and fluid
intake recommendations in adults with heart failure. Heart Lung. 2019;48(3):179–
185. doi:10.1016/j.hrtlng.2018.12.008
Sharma P, Newman K, Long CS, et al. Use of wavelet transform to detect compensated
and decompensated stages in the congestive heart failure patient. Biosensors (Basel).
2017;7(3):40. doi:10.3390/bios7030040
Shatat IF, Becton LJ, Woroniecki RP. Hypertension in childhood nephrotic syndrome.
Front Pediatr. 2019;7:287. doi:10.3389/fped.2019.00287
Simon DA, Taylor TL, Bayley G, et al. Four-limb compartment syndrome associated
with the systemic capillary leak syndrome. J Bone Joint Surg Br. 2010;92(12):1700–2.
doi: 10.1302/0301–620X.92B12.25225
Siparsky PN, Kirkendall DT, Garrett WE Jr. Muscle changes in aging: understanding
sarcopenia. Sports Health. 2014;6(1):36–40. doi:10.1177/1941738113502296

143
Domain 2. Nutrition Class 5. Hydration

Site UpToDate. Intraoperative fluid management. [acesso 16 jun 2020]. Disponível em:
https://www.uptodate.com/contents/intraoperative-fluid-management
Site UpToDate. Overview of postoperative fluid therapy in adults. [acesso 16 jun 2020].
Disponível em: https://www.uptodate.com/contents/overview-of-postoperative-flu-
id-therapy-in-adults
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2. Nutrition

2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tanai E, Frantz S. Pathophysiology of heart failure. Compr Physiol. 2015;6(1):187–214.
doi: 10.1002/cphy.c140055
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Fluid volume, fluid balance and patient
outcome in severe sepsis and septic shock: a systematic review. J Crit Care.
2018;48:153–9. doi: 10.1016/j.jcrc.2018.08.018
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Response to letter to the editor: Fluid
volume, fluid balance and patient outcome in severe sepsis and septic shock: A sys-
tematic review. J Crit Care. 2019;50:314–5. doi: 10.1016/j.jcrc.2018.11.011
Törnudd M, Hahn RG, Zdolsek JH. Fluid distribution kinetics during cardiopulmonary
bypass. Clinics. 2014;69(8):535–41. doi:10.6061/clinics/2014(08)06
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. Relationship between dialytic parame-
ters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring
in dialysis study. BMC Nephrol. 2019;20(1):80. doi:10.1186/s12882–019–1212–6
Van Buren PN, Zhou Y, Neyra JA, et al. Extracellular volume overload and increased
vasoconstriction in patients with recurrent intradialytic hypertension. Kidney Blood
Press Res. 2016;41(6):802–14. doi:10.1159/000450565

144
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00026

Excessive fluid volume

References
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2. Nutrition
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Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure.
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Balter P, Ficociello LH, Taylor PB, et al. A year-long quality improvement project on
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2. Nutrition
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with a rare abdominal and four-limb compartment syndrome: a case report. J Med
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10.1016/S0140–6736(11)60178–5
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and frailty: A review. Nutrients. 2019;11(8):1857. doi:10.3390/nu11081857
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therapeutic applications. Int J Eat Disord. 2011;44(3):200–2. doi: 10.1002/eat.20814
Matsuyama K, Koizumi N, Nishibe T, et al. Effects of short-term administration of tol-
vaptan after open heart surgery. Int J Cardiol. 2016;220:192–5. doi: 10.1016/j.ij-
card.2016.06.156
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ure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:449–456.
doi:10.2147/VHRM.S128608
Miller WL, Mullan BP. Understanding the heterogeneity in volume overload and fluid
distribution in decompensated heart failure is key to optimal volume management:
role for blood volume quantitation. JACC Heart Fail. 2014;2(3):298–305. doi:
10.1016/j.jchf.2014.02.007
Miller WL. Fluid volume overload and congestion in heart failure: time to reconsider
pathophysiology and how volume is assessed. Circ Heart Fail. 2016;9(8):e002922.
doi: 10.1161/CIRCHEARTFAILURE.115.002922
Montgomery LD, Gerth WA, Montgomery RW, et al. Monitoring intracellular, inter-
stitial, and intravascular volume changes during fluid management procedures. Med
Biol Eng Comput. 2013;51(10):1167–75. doi:10.1007/s11517–013–1064–3
Nagayama I, Masuda T, Nakagawa S, et al. Different effects on fluid distribution be-
tween tolvaptan and furosemide in a liver cirrhosis patient with chronic kidney dis-
ease. Intern Med. 2019;58(11):1587–91. doi:10.2169/internalmedicine.2174–18
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Norberg Å, Rooyackers O, Segersvärd R, et al. Leakage of albumin in major abdominal
surgery. Crit Care. 2016;20(1):113. doi:10.1186/s13054–016–1283–8
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-

147
Domain 2. Nutrition Class 5. Hydration

dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-
dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
2. Nutrition

Ogna A, Forni Ogna V, Mihalache A, et al. Obstructive sleep apnea severity and over-
night body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10
(6):1002–10. doi:10.2215/CJN.08760914
Ohashi Y, Joki N, Yamazaki K, et al. Changes in the fluid volume balance between in-
tra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a
cross-sectional study. Am J Physiol Renal Physiol. 2018;314(4):F614–22. doi:
10.1152/ajprenal.00477.2017
Orvieto R, Dratviman-Storobinsky O, Lantsberg D, et al. Interleukin-2 and SOCS-1
proteins involvement in the pathophysiology of severe ovarian hyperstimulation syn-
drome-a preliminary proof of concept. J Ovarian Res. 2014;7:106. doi: 10.1186/
s13048–014–0106–2
Patton KT, Thibodeau GA. Fluid and electrolyte balance. In: ___ Anatomy & Physiol-
ogy. St Louis: Mosby, 2016. p. 999–1018
Pietribiasi M, Waniewski J, Wójcik-Załuska A, et al. Model of fluid and solute shifts
during hemodialysis with active transport of sodium and potassium. PLoS ONE.
2018;13(12):e0209553. https://doi.org/10.1371/journal.pone.0209553
Pietribiasi M, Waniewski J, Załuska A, et al. Modelling transcapillary transport of fluid
and proteins in hemodialysis patients. PLoS ONE. 2016;11(8):e0159748. https://doi.
org/10.1371/journal.pone.0159748
Prakash A, Mathur R. Ovarian hyperstimulation syndrome. The Obstetrician & Gynae-
cologist. 2013;15:31–5. doi: 10.1111/j.1744–4667.2012.00153.x
Premaratna R, Ragupathy A, Miththinda JK, et al. Timing, predictors, and progress of
third space fluid accumulation during preliminary phase fluid resuscitation in adult
patients with dengue. Int J Infect Dis. 2013;17(7):e505–9. doi: 10.1016/j.
ijid.2012.12.021
Raina R, Krishnappa V, Das A, et al. Overview of monogenic or mendelian forms of
hypertension. Front Pediatr. 2019;7:263. doi:10.3389/fped.2019.00263
Riegel B, Lee S, Hill J, et al. Patterns of adherence to diuretics, dietary sodium and fluid
intake recommendations in adults with heart failure. Heart Lung. 2019;48(3):179–
185. doi:10.1016/j.hrtlng.2018.12.008
Sharma P, Newman K, Long CS, et al. Use of wavelet transform to detect compensated
and decompensated stages in the congestive heart failure patient. Biosensors (Basel).
2017;7(3):40. doi:10.3390/bios7030040
Shatat IF, Becton LJ, Woroniecki RP. Hypertension in childhood nephrotic syndrome.
Front Pediatr. 2019;7:287. doi:10.3389/fped.2019.00287
Simon DA, Taylor TL, Bayley G, et al. Four-limb compartment syndrome associated
with the systemic capillary leak syndrome. J Bone Joint Surg Br. 2010;92(12):1700–2.
doi: 10.1302/0301–620X.92B12.25225
Siparsky PN, Kirkendall DT, Garrett WE Jr. Muscle changes in aging: understanding
sarcopenia. Sports Health. 2014;6(1):36–40. doi:10.1177/1941738113502296

148
Domain 2. Nutrition Class 5. Hydration

Site UpToDate. Intraoperative fluid management. [acesso 16 jun 2020]. Disponível em:
https://www.uptodate.com/contents/intraoperative-fluid-management
Site UpToDate. Overview of postoperative fluid therapy in adults. [acesso 16 jun 2020].
Disponível em: https://www.uptodate.com/contents/overview-of-postoperative-flu-
id-therapy-in-adults
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.

2. Nutrition
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tanai E, Frantz S. Pathophysiology of heart failure. Compr Physiol. 2015;6(1):187–214.
doi: 10.1002/cphy.c140055
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Fluid volume, fluid balance and patient
outcome in severe sepsis and septic shock: a systematic review. J Crit Care.
2018;48:153–9. doi: 10.1016/j.jcrc.2018.08.018
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Response to letter to the editor: Fluid
volume, fluid balance and patient outcome in severe sepsis and septic shock: A sys-
tematic review. J Crit Care. 2019;50:314–5. doi: 10.1016/j.jcrc.2018.11.011
Törnudd M, Hahn RG, Zdolsek JH. Fluid distribution kinetics during cardiopulmonary
bypass. Clinics. 2014;69(8):535–41. doi:10.6061/clinics/2014(08)06
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. Relationship between dialytic parame-
ters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring
in dialysis study. BMC Nephrol. 2019;20(1):80. doi:10.1186/s12882–019–1212–6
Van Buren PN, Zhou Y, Neyra JA, et al. Extracellular volume overload and increased
vasoconstriction in patients with recurrent intradialytic hypertension. Kidney Blood
Press Res. 2016;41(6):802–14. doi:10.1159/000450565

149
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00370

Risk for excessive fluid volume

References
Alyeşil C, Doğan NÖ, Özturan İU, et al. Distributive shock in the emergency depart-
ment: sepsis, anaphylaxis, or capillary leak syndrome? J Emerg Med. 2017;52(6):
2. Nutrition

e229–31. doi: 10.1016/j.jemermed.2017.01.012

Antlanger M, Josten P, Kammer M, et al. Blood volume-monitored regulation of ultra-
filtration to decrease the dry weight in fluid-overloaded hemodialysis patients: a
randomized controlled trial. BMC Nephrol. 2017;18(1):238. doi:10.1186/s12882–
017–0639-x
Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure.
J Card Fail. 2011;17(6):451–8. doi: 10.1016/j.cardfail.2011.02.010
Balter P, Ficociello LH, Taylor PB, et al. A year-long quality improvement project on
fluid management using blood volume monitoring during hemodialysis. Curr Med
Res Opin. 2015;31(7):1323–31. doi: 10.1185/03007995.2015.1047746
Barbieri C, Cattinelli I, Neri L, et al. Development of an artificial intelligence model to
guide the management of blood pressure, fluid volume, and dialysis dose in end-
stage kidney disease patients: proof of concept and first clinical assessment. Kidney
Dis (Basel). 2019;5(1):28–33. doi: 10.1159/000493479
Berthelsen RE, Itenov T, Perner A, et al. Forced fluid removal versus usual care in in-
tensive care patients with high-risk acute kidney injury and severe fluid overload
(FFAKI): study protocol for a randomised controlled pilot trial. Trials. 2017;18
(1):189. doi:10.1186/s13063–017–1935–2
Bighamian R, Reisner AT, Hahn JO. A lumped-parameter subject-specific model of
blood volume response to fluid infusion. Front Physiol. 2016;7:390. doi:10.3389/
fphys.2016.00390
Cadwallader AB, Torre X, Tieri A, et al. Abuse of diuretics as performance-enhancing
drugs and masking agents in sport doping: pharmacology, toxicology and analysis.
Br J Pharmacol. 2010;161(1):1–16. doi: 10.1111/j.1476–5381.2010.00789.x
Canaud B, Chazot C, Koomans J, Collins A. Manejo hídrico e hemodinâmico em pa-
cientes em hemodiálise: desafios e oportunidades. J Bras Nefrol. 2019;41(4):550–9.
doi: 10.1590/2175–8239-jbn-2019–0135
Changwe GJ, Wenlong Z, Zhang H, et al. Heart in the ‘jaws’ of a constrictor, unusual
cause of subacute right heart failure. J Cardiothorac Surg. 2019;14:110. doi:10.1186/
s13019–019–0916–9
Chelazzi C, Villa G, Mancinelli P, et al. Glycocalyx and sepsis-induced alterations in
vascular permeability. Crit Care. 2015;19(1):26. doi:10.1186/s13054–015–0741-z
Ciumanghel AI, Grigoras I, Siriopol D, et al. Bio-electrical impedance analysis for peri-
operative fluid evaluation in open major abdominal surgery. J Clin Monit Comput.
2020;34:421–32. https://doi.org/10.1007/s10877–019–00334–8
D'Angelo A, Amso NN, Hassan R. Coasting (withholding gonadotrophins) for prevent-
ing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2017;5(5):
CD002811. doi:10.1002/14651858.CD002811.pub4
de Denus S, Rouleau JL, Mann DL, et al. A pharmacogenetic investigation of intrave-
nous furosemide in decompensated heart failure: a meta-analysis of three clinical tri-
als. Pharmacogenomics J. 2017;17(2):192–200. doi:10.1038/tpj.2016.4

150
Domain 2. Nutrition Class 5. Hydration

Ekinci C, Karabork M, Siriopol D, et al. Effects of volume overload and current techni-
ques for the assessment of fluid status in patients with renal disease. Blood Purif.
2018;46(1):34–47. doi: 10.1159/000487702
Fouche Y, Sikorski R, Dutton RP. Changing paradigms in surgical resuscitation. Crit
Care Med. 2010;38(9 Suppl):S411–20. doi: 10.1097/CCM.0b013e3181ec5bdf
Grant CJ, Wade TP, McKenzie CA, et al. Effect of ultrafiltration during hemodialysis
on hepatic and total-body water: an observational study. BMC Nephrol. 2018;19:356.
doi:10.1186/s12882–018–1150–8

2. Nutrition
Greenberg A. Diuretic complications. American Journal of the Medical Sciences.
2000;319(1):10–24. doi:10.1016/s0002–9629(15)40676–7
Gupta P, Patel P, Štrauch B, et al. Risk Factors for Nonadherence to Antihypertensive
Treatment. Hypertension. 2017;69(6):1113–20. doi:10.1161/HYPERTENSIONA-
HA.116.08729
Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: the evolution in definition, patho-
physiology, and management. SAGE Open Med. 2019;21;7:2050312119835043. doi:
10.1177/2050312119835043
Hale A, Hovey MJ. Fluid volume excess. In: ___ Fluid, electrolyte, and acid-base imbal-
ances: content review plus practice questions. Philadelphia: Davis Company; 2013. p.
1–30
Hoorn EJ. Intravenous fluids: balancing solutions. J Nephrol. 2017;30(4):485–92. doi:
10.1007/s40620–016–0363–9
Hundeshagen G, Kramer GC, Ribeiro Marques N, et al. Closed-loop and decision-as-
sist-guided fluid therapy of human hemorrhage. Crit Care Med. 2017;45(10):e1068–
74. doi:10.1097/CCM.0000000000002593
Ismael S, Savalle M, Trivin C, et al. The consequences of sudden fluid shifts on body
composition in critically ill patients. Crit Care. 2014;18(2):R49. doi:10.1186/cc13794
Ismael S, Savalle M, Trivin C, et al. The consequences of sudden fluid shifts on body
composition in critically ill patients. Crit Care. 2014;18(2):R49. doi:10.1186/cc13794
Jacob M, Chappell D, Hollmann MW. Current aspects of perioperative fluid handling
in vascular surgery. Curr Opin Anaesthesiol. 2009;22(1):100–8. doi: 10.1097/ACO.0-
b013e32831f1c65
John B, Tan BK, Dainty S, et al. Plasma volume, albumin, and fluid status in peritoneal
dialysis patients. Clin J Am Soc Nephrol. 2010;5(8):1463–70. doi:10.2215/
CJN.09411209
Keane DF, Baxter P, Lindley E, et al. Time to reconsider the role of relative blood vol-
ume monitoring for fluid management in hemodialysis. ASAIO Journal. 2018;64
(6):812–8. doi: 10.1097/MAT.0000000000000795
Khurram M, Qayyum W, Umar M, et al. Ultrasonographic pattern of plasma leak in
dengue haemorrhagic fever. J Pak Med Assoc. 2016;66(3):260–4
Kong Y-G, K J-Y, Yu J. Efficacy and safety of stroke volume variation-guided fluid ther-
apy for reducing blood loss and transfusion requirements during radical cystectomy:
A randomized clinical trial: erratum. Medicine (Baltimore). 2018;97(23):e11129.
doi:10.1097/MD.0000000000011129
Kong YG, Kim JY, Yu J, et al. Efficacy and safety of stroke volume variation-guided
fluid therapy for reducing blood loss and transfusion requirements during radical
cystectomy: a randomized clinical trial. Medicine (Baltimore). 2016;95(19):e3685.
doi:10.1097/MD.0000000000003685

151
Domain 2. Nutrition Class 5. Hydration

Kronish IM, Woodward M, Sergie Z, et al. Metaanalysis: impact of drug class on adher-
ence to antihypertensives. Circulation. 2011;123:1611–21. doi: 10.1161/CIRCULA-
TIONAHA.110.983874
Kuhlmann U, Maierhofer A, Canaud B, et al. Zero diffusive sodium balance in hemo-
dialysis provided by an algorithm-based electrolyte balancing controller: A proof of
principle clinical study. Artif Organs. 2019;43(2):150–8. doi: 10.1111/aor.13328
Kumar P, Sait SF, Sharma A, et al. Ovarian hyperstimulation syndrome. J Hum Reprod
Sci. 2011;4(2):70–5. doi: 10.4103/0974–1208.86080
2. Nutrition

Lamou H, Grassmann JP, Betsch M, et al. Systemic capillary leak syndrome associated
with a rare abdominal and four-limb compartment syndrome: a case report. J Med
Case Rep. 2014;8:196. doi:10.1186/1752–1947–8–196
Lee JY, Ryu HS, Yoon SS, et al. Extracellular-to-intracellular fluid volume ratio as a
prognostic factor for survival in patients with metastatic cancer. Integr Cancer Ther.
2019;18:1534735419847285. doi:10.1177/1534735419847285
Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165–80. doi:
10.1016/S0140–6736(11)60178–5
Lorenzo I, Serra-Prat M, Yébenes JC. The role of water homeostasis in muscle function
and frailty: A review. Nutrients. 2019;11(8):1857. doi:10.3390/nu11081857
Mascolo M, Chu ES, Mehler. Abuse and clinical value of diuretics in eating disorders
therapeutic applications. Int J Eat Disord. 2011;44(3):200–2. doi: 10.1002/eat.20814
Matsuyama K, Koizumi N, Nishibe T, et al. Effects of short-term administration of tol-
vaptan after open heart surgery. Int J Cardiol. 2016;220:192–5. doi: 10.1016/j.ij-
card.2016.06.156
Milazzo V, Cosentino N, Marenzi G. Extracorporeal ultrafiltration for acute heart fail-
ure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:449–456.
doi:10.2147/VHRM.S128608
Miller WL, Mullan BP. Understanding the heterogeneity in volume overload and fluid
distribution in decompensated heart failure is key to optimal volume management:
role for blood volume quantitation. JACC Heart Fail. 2014;2(3):298–305. doi:
10.1016/j.jchf.2014.02.007
Miller WL. Fluid volume overload and congestion in heart failure: time to reconsider
pathophysiology and how volume is assessed. Circ Heart Fail. 2016;9(8):e002922.
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152
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pone.0163114

2. Nutrition
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2. Nutrition

2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
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Press Res. 2016;41(6):802–14. doi:10.1159/000450565

154
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00421

Inadequate fluid volume

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Berthelsen RE, Itenov T, Perner A, et al. Forced fluid removal versus usual care in in-
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Bighamian R, Reisner AT, Hahn JO. A lumped-parameter subject-specific model of
blood volume response to fluid infusion. Front Physiol. 2016;7:390. doi:10.3389/
fphys.2016.00390
Cadwallader AB, Torre X, Tieri A, et al. Abuse of diuretics as performance-enhancing
drugs and masking agents in sport doping: pharmacology, toxicology and analysis.
Br J Pharmacol. 2010;161(1):1–16. doi: 10.1111/j.1476–5381.2010.00789.x
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s13019–019–0916–9
Chelazzi C, Villa G, Mancinelli P, et al. Glycocalyx and sepsis-induced alterations in
vascular permeability. Crit Care. 2015;19(1):26. doi:10.1186/s13054–015–0741-z
Ciumanghel AI, Grigoras I, Siriopol D, et al. Bio-electrical impedance analysis for peri-
operative fluid evaluation in open major abdominal surgery. J Clin Monit Comput.
2020;34:421–32. https://doi.org/10.1007/s10877–019–00334–8
D'Angelo A, Amso NN, Hassan R. Coasting (withholding gonadotrophins) for prevent-
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als. Pharmacogenomics J. 2017;17(2):192–200. doi:10.1038/tpj.2016.4

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Ekinci C, Karabork M, Siriopol D, et al. Effects of volume overload and current techni-
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2018;46(1):34–47. doi: 10.1159/000487702
Fouche Y, Sikorski R, Dutton RP. Changing paradigms in surgical resuscitation. Crit
Care Med. 2010;38(9 Suppl):S411–20. doi: 10.1097/CCM.0b013e3181ec5bdf
Grant CJ, Wade TP, McKenzie CA, et al. Effect of ultrafiltration during hemodialysis
on hepatic and total-body water: an observational study. BMC Nephrol. 2018;19:356.
doi:10.1186/s12882–018–1150–8
2. Nutrition

Greenberg A. Diuretic complications. American Journal of the Medical Sciences.

2000;319(1):10–24. doi:10.1016/s0002–9629(15)40676–7
Gupta P, Patel P, Štrauch B, et al. Risk Factors for Nonadherence to Antihypertensive
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HA.116.08729
Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: the evolution in definition, patho-
physiology, and management. SAGE Open Med. 2019;21;7:2050312119835043. doi:
10.1177/2050312119835043
Hale A, Hovey MJ. Fluid volume excess. In: Fluid, electrolyte, and acid-base imbalan-
ces: content review plus practice questions. Philadelphia: Davis Company; 2013. p.
1–30
Hoorn EJ. Intravenous fluids: balancing solutions. J Nephrol. 2017;30(4):485–92. doi:
10.1007/s40620–016–0363–9
Hundeshagen G, Kramer GC, Ribeiro Marques N, et al. Closed-loop and decision-as-
sist-guided fluid therapy of human hemorrhage. Crit Care Med. 2017;45(10):e1068–
74. doi:10.1097/CCM.0000000000002593
Ismael S, Savalle M, Trivin C, et al. The consequences of sudden fluid shifts on body
composition in critically ill patients. Crit Care. 2014;18(2):R49. doi:10.1186/cc13794
Ismael S, Savalle M, Trivin C, et al. The consequences of sudden fluid shifts on body
composition in critically ill patients. Crit Care. 2014;18(2):R49. doi:10.1186/cc13794
Jacob M, Chappell D, Hollmann MW. Current aspects of perioperative fluid handling
in vascular surgery. Curr Opin Anaesthesiol. 2009;22(1):100–8. doi: 10.1097/ACO.0-
b013e32831f1c65
John B, Tan BK, Dainty S, et al. Plasma volume, albumin, and fluid status in peritoneal
dialysis patients. Clin J Am Soc Nephrol. 2010;5(8):1463–70. doi:10.2215/
CJN.09411209
Keane DF, Baxter P, Lindley E, et al. Time to reconsider the role of relative blood vol-
ume monitoring for fluid management in hemodialysis. ASAIO Journal. 2018;64
(6):812–8. doi: 10.1097/MAT.0000000000000795
Khurram M, Qayyum W, Umar M, et al. Ultrasonographic pattern of plasma leak in
dengue haemorrhagic fever. J Pak Med Assoc. 2016;66(3):260–4
Kong Y-G, K J-Y, Yu J. Efficacy and safety of stroke volume variation-guided fluid ther-
apy for reducing blood loss and transfusion requirements during radical cystectomy:
A randomized clinical trial: erratum. Medicine (Baltimore). 2018;97(23):e11129.
doi:10.1097/MD.0000000000011129
Kong YG, Kim JY, Yu J, et al. Efficacy and safety of stroke volume variation-guided
fluid therapy for reducing blood loss and transfusion requirements during radical
cystectomy: a randomized clinical trial. Medicine (Baltimore). 2016;95(19):e3685.
doi:10.1097/MD.0000000000003685

156
Domain 2. Nutrition Class 5. Hydration

Kronish IM, Woodward M, Sergie Z, et al. Metaanalysis: impact of drug class on adher-
ence to antihypertensives. Circulation. 2011;123:1611–21. doi: 10.1161/CIRCULA-
TIONAHA.110.983874
Kuhlmann U, Maierhofer A, Canaud B, et al. Zero diffusive sodium balance in hemo-
dialysis provided by an algorithm-based electrolyte balancing controller: A proof of
principle clinical study. Artif Organs. 2019;43(2):150–8. doi: 10.1111/aor.13328
Kumar P, Sait SF, Sharma A, et al. Ovarian hyperstimulation syndrome. J Hum Reprod
Sci. 2011;4(2):70–5. doi: 10.4103/0974–1208.86080

2. Nutrition
Lamou H, Grassmann JP, Betsch M, et al. Systemic capillary leak syndrome associated
with a rare abdominal and four-limb compartment syndrome: a case report. J Med
Case Rep. 2014;8:196. doi:10.1186/1752–1947–8–196
Lee JY, Ryu HS, Yoon SS, et al. Extracellular-to-intracellular fluid volume ratio as a
prognostic factor for survival in patients with metastatic cancer. Integr Cancer Ther.
2019;18:1534735419847285. doi:10.1177/1534735419847285
Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165–80. doi:
10.1016/S0140–6736(11)60178–5
Lorenzo I, Serra-Prat M, Yébenes JC. The role of water homeostasis in muscle function
and frailty: A review. Nutrients. 2019;11(8):1857. doi:10.3390/nu11081857
Mascolo M, Chu ES, Mehler. Abuse and clinical value of diuretics in eating disorders
therapeutic applications. Int J Eat Disord. 2011;44(3):200–2. doi: 10.1002/eat.20814
Matsuyama K, Koizumi N, Nishibe T, et al. Effects of short-term administration of tol-
vaptan after open heart surgery. Int J Cardiol. 2016;220:192–5. doi: 10.1016/j.ij-
card.2016.06.156
Milazzo V, Cosentino N, Marenzi G. Extracorporeal ultrafiltration for acute heart fail-
ure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:449–456.
doi:10.2147/VHRM.S128608
Miller WL, Mullan BP. Understanding the heterogeneity in volume overload and fluid
distribution in decompensated heart failure is key to optimal volume management:
role for blood volume quantitation. JACC Heart Fail. 2014;2(3):298–305. doi:
10.1016/j.jchf.2014.02.007
Miller WL. Fluid volume overload and congestion in heart failure: time to reconsider
pathophysiology and how volume is assessed. Circ Heart Fail. 2016;9(8):e002922.
doi: 10.1161/CIRCHEARTFAILURE.115.002922
Montgomery LD, Gerth WA, Montgomery RW, et al. Monitoring intracellular, inter-
stitial, and intravascular volume changes during fluid management procedures. Med
Biol Eng Comput. 2013;51(10):1167–75. doi:10.1007/s11517–013–1064–3
Nagayama I, Masuda T, Nakagawa S, et al. Different effects on fluid distribution be-
tween tolvaptan and furosemide in a liver cirrhosis patient with chronic kidney dis-
ease. Intern Med. 2019;58(11):1587–91. doi:10.2169/internalmedicine.2174–18
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Norberg Å, Rooyackers O, Segersvärd R, et al. Leakage of albumin in major abdominal
surgery. Crit Care. 2016;20(1):113. doi:10.1186/s13054–016–1283–8
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-

157
Domain 2. Nutrition Class 5. Hydration

dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-
dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
2. Nutrition

Ogna A, Forni Ogna V, Mihalache A, et al. Obstructive sleep apnea severity and over-
night body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10
(6):1002–10. doi:10.2215/CJN.08760914
Ohashi Y, Joki N, Yamazaki K, et al. Changes in the fluid volume balance between in-
tra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a
cross-sectional study. Am J Physiol Renal Physiol. 2018;314(4):F614–22. doi:
10.1152/ajprenal.00477.2017
Orvieto R, Dratviman-Storobinsky O, Lantsberg D, et al. Interleukin-2 and SOCS-1
proteins involvement in the pathophysiology of severe ovarian hyperstimulation syn-
drome-a preliminary proof of concept. J Ovarian Res. 2014;7:106. doi: 10.1186/
s13048–014–0106–2
Patton KT, Thibodeau GA. Fluid and electrolyte balance. In: ___ Anatomy & Physiol-
ogy. St Louis: Mosby, 2016. p. 999–1018
Pietribiasi M, Waniewski J, Wójcik-Załuska A, et al. Model of fluid and solute shifts
during hemodialysis with active transport of sodium and potassium. PLoS ONE.
2018;13(12):e0209553. https://doi.org/10.1371/journal.pone.0209553
Pietribiasi M, Waniewski J, Załuska A, et al. Modelling transcapillary transport of fluid
and proteins in hemodialysis patients. PLoS ONE. 2016;11(8):e0159748. https://doi.
org/10.1371/journal.pone.0159748
Prakash A, Mathur R. Ovarian hyperstimulation syndrome. The Obstetrician & Gynae-
cologist. 2013;15:31–5. doi: 10.1111/j.1744–4667.2012.00153.x
Premaratna R, Ragupathy A, Miththinda JK, et al. Timing, predictors, and progress of
third space fluid accumulation during preliminary phase fluid resuscitation in adult
patients with dengue. Int J Infect Dis. 2013;17(7):e505–9. doi: 10.1016/j.
ijid.2012.12.021
Raina R, Krishnappa V, Das A, et al. Overview of monogenic or mendelian forms of
hypertension. Front Pediatr. 2019;7:263. doi:10.3389/fped.2019.00263
Riegel B, Lee S, Hill J, et al. Patterns of adherence to diuretics, dietary sodium and fluid
intake recommendations in adults with heart failure. Heart Lung. 2019;48(3):179–
185. doi:10.1016/j.hrtlng.2018.12.008
Sharma P, Newman K, Long CS, et al. Use of wavelet transform to detect compensated
and decompensated stages in the congestive heart failure patient. Biosensors (Basel).
2017;7(3):40. doi:10.3390/bios7030040
Shatat IF, Becton LJ, Woroniecki RP. Hypertension in childhood nephrotic syndrome.
Front Pediatr. 2019;7:287. doi:10.3389/fped.2019.00287
Simon DA, Taylor TL, Bayley G, et al. Four-limb compartment syndrome associated
with the systemic capillary leak syndrome. J Bone Joint Surg Br. 2010;92(12):1700–2.
doi: 10.1302/0301–620X.92B12.25225
Siparsky PN, Kirkendall DT, Garrett WE Jr. Muscle changes in aging: understanding
sarcopenia. Sports Health. 2014;6(1):36–40. doi:10.1177/1941738113502296

158
Domain 2. Nutrition Class 5. Hydration

Site UpToDate. Intraoperative fluid management. [acesso 16 jun 2020]. Disponível em:
https://www.uptodate.com/contents/intraoperative-fluid-management
Site UpToDate. Overview of postoperative fluid therapy in adults. [acesso 16 jun 2020].
Disponível em: https://www.uptodate.com/contents/overview-of-postoperative-flu-
id-therapy-in-adults
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.

2. Nutrition
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tanai E, Frantz S. Pathophysiology of heart failure. Compr Physiol. 2015;6(1):187–214.
doi: 10.1002/cphy.c140055
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Fluid volume, fluid balance and patient
outcome in severe sepsis and septic shock: a systematic review. J Crit Care.
2018;48:153–9. doi: 10.1016/j.jcrc.2018.08.018
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Response to letter to the editor: Fluid
volume, fluid balance and patient outcome in severe sepsis and septic shock: A sys-
tematic review. J Crit Care. 2019;50:314–5. doi: 10.1016/j.jcrc.2018.11.011
Törnudd M, Hahn RG, Zdolsek JH. Fluid distribution kinetics during cardiopulmonary
bypass. Clinics. 2014;69(8):535–41. doi:10.6061/clinics/2014(08)06
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. Relationship between dialytic parame-
ters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring
in dialysis study. BMC Nephrol. 2019;20(1):80. doi:10.1186/s12882–019–1212–6
Van Buren PN, Zhou Y, Neyra JA, et al. Extracellular volume overload and increased
vasoconstriction in patients with recurrent intradialytic hypertension. Kidney Blood
Press Res. 2016;41(6):802–14. doi:10.1159/000450565

159
Domain 2. Nutrition Class 5. Hydration

Domain 2 • Class 5 • Diagnosis Code 00420

Risk for inadequate fluid volume

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Sci. 2011;4(2):70–5. doi: 10.4103/0974–1208.86080
2. Nutrition

Lamou H, Grassmann JP, Betsch M, et al. Systemic capillary leak syndrome associated
with a rare abdominal and four-limb compartment syndrome: a case report. J Med
Case Rep. 2014;8:196. doi:10.1186/1752–1947–8–196
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10.1016/S0140–6736(11)60178–5
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and frailty: A review. Nutrients. 2019;11(8):1857. doi:10.3390/nu11081857
Mascolo M, Chu ES, Mehler. Abuse and clinical value of diuretics in eating disorders
therapeutic applications. Int J Eat Disord. 2011;44(3):200–2. doi: 10.1002/eat.20814
Matsuyama K, Koizumi N, Nishibe T, et al. Effects of short-term administration of tol-
vaptan after open heart surgery. Int J Cardiol. 2016;220:192–5. doi: 10.1016/j.ij-
card.2016.06.156
Milazzo V, Cosentino N, Marenzi G. Extracorporeal ultrafiltration for acute heart fail-
ure: patient selection and perspectives. Vasc Health Risk Manag. 2017;13:449–456.
doi:10.2147/VHRM.S128608
Miller WL, Mullan BP. Understanding the heterogeneity in volume overload and fluid
distribution in decompensated heart failure is key to optimal volume management:
role for blood volume quantitation. JACC Heart Fail. 2014;2(3):298–305. doi:
10.1016/j.jchf.2014.02.007
Miller WL. Fluid volume overload and congestion in heart failure: time to reconsider
pathophysiology and how volume is assessed. Circ Heart Fail. 2016;9(8):e002922.
doi: 10.1161/CIRCHEARTFAILURE.115.002922
Montgomery LD, Gerth WA, Montgomery RW, et al. Monitoring intracellular, inter-
stitial, and intravascular volume changes during fluid management procedures. Med
Biol Eng Comput. 2013;51(10):1167–75. doi:10.1007/s11517–013–1064–3
Nagayama I, Masuda T, Nakagawa S, et al. Different effects on fluid distribution be-
tween tolvaptan and furosemide in a liver cirrhosis patient with chronic kidney dis-
ease. Intern Med. 2019;58(11):1587–91. doi:10.2169/internalmedicine.2174–18
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Nishikawa H, Yoh K, Enomoto H, et al. Extracellular water to total body water ratio in
viral liver diseases: A study using bioimpedance analysis. Nutrients. 2018;10(8):1072.
doi:10.3390/nu10081072
Norberg Å, Rooyackers O, Segersvärd R, et al. Leakage of albumin in major abdominal
surgery. Crit Care. 2016;20(1):113. doi:10.1186/s13054–016–1283–8
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-

162
Domain 2. Nutrition Class 5. Hydration

dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114
Nwosu AC, Mayland CR, Mason S, et al. The association of hydration status with phys-
ical signs, symptoms and survival in advanced cancer-the use of bioelectrical impe-
dance vector analysis (BIVA) technology to evaluate fluid volume in palliative care:
an observational study. PLoS One. 2016;11(9):e0163114. doi:10.1371/journal.
pone.0163114

2. Nutrition
Ogna A, Forni Ogna V, Mihalache A, et al. Obstructive sleep apnea severity and over-
night body fluid shift before and after hemodialysis. Clin J Am Soc Nephrol. 2015;10
(6):1002–10. doi:10.2215/CJN.08760914
Ohashi Y, Joki N, Yamazaki K, et al. Changes in the fluid volume balance between in-
tra- and extracellular water in a sample of Japanese adults aged 15–88 yr old: a
cross-sectional study. Am J Physiol Renal Physiol. 2018;314(4):F614–22. doi:
10.1152/ajprenal.00477.2017
Orvieto R, Dratviman-Storobinsky O, Lantsberg D, et al. Interleukin-2 and SOCS-1
proteins involvement in the pathophysiology of severe ovarian hyperstimulation syn-
drome-a preliminary proof of concept. J Ovarian Res. 2014;7:106. doi: 10.1186/
s13048–014–0106–2
Patton KT, Thibodeau GA. Fluid and electrolyte balance. In: ___ Anatomy & Physiol-
ogy. St Louis: Mosby, 2016. p. 999–1018
Pietribiasi M, Waniewski J, Wójcik-Załuska A, et al. Model of fluid and solute shifts
during hemodialysis with active transport of sodium and potassium. PLoS ONE.
2018;13(12):e0209553. https://doi.org/10.1371/journal.pone.0209553
Pietribiasi M, Waniewski J, Załuska A, et al. Modelling transcapillary transport of fluid
and proteins in hemodialysis patients. PLoS ONE. 2016;11(8):e0159748. https://doi.
org/10.1371/journal.pone.0159748
Prakash A, Mathur R. Ovarian hyperstimulation syndrome. The Obstetrician & Gynae-
cologist. 2013;15:31–5. doi: 10.1111/j.1744–4667.2012.00153.x
Premaratna R, Ragupathy A, Miththinda JK, et al. Timing, predictors, and progress of
third space fluid accumulation during preliminary phase fluid resuscitation in adult
patients with dengue. Int J Infect Dis. 2013;17(7):e505–9. doi: 10.1016/j.
ijid.2012.12.021
Raina R, Krishnappa V, Das A, et al. Overview of monogenic or mendelian forms of
hypertension. Front Pediatr. 2019;7:263. doi:10.3389/fped.2019.00263
Riegel B, Lee S, Hill J, et al. Patterns of adherence to diuretics, dietary sodium and fluid
intake recommendations in adults with heart failure. Heart Lung. 2019;48(3):179–
185. doi:10.1016/j.hrtlng.2018.12.008
Sharma P, Newman K, Long CS, et al. Use of wavelet transform to detect compensated
and decompensated stages in the congestive heart failure patient. Biosensors (Basel).
2017;7(3):40. doi:10.3390/bios7030040
Shatat IF, Becton LJ, Woroniecki RP. Hypertension in childhood nephrotic syndrome.
Front Pediatr. 2019;7:287. doi:10.3389/fped.2019.00287
Simon DA, Taylor TL, Bayley G, et al. Four-limb compartment syndrome associated
with the systemic capillary leak syndrome. J Bone Joint Surg Br. 2010;92(12):1700–2.
doi: 10.1302/0301–620X.92B12.25225
Siparsky PN, Kirkendall DT, Garrett WE Jr. Muscle changes in aging: understanding
sarcopenia. Sports Health. 2014;6(1):36–40. doi:10.1177/1941738113502296

163
Domain 2. Nutrition Class 5. Hydration

Site UpToDate. Intraoperative fluid management. [acesso 16 jun 2020]. Disponível em:
https://www.uptodate.com/contents/intraoperative-fluid-management
Site UpToDate. Overview of postoperative fluid therapy in adults. [acesso 16 jun 2020].
Disponível em: https://www.uptodate.com/contents/overview-of-postoperative-flu-
id-therapy-in-adults
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2. Nutrition

2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tai R, Ohashi Y, Mizuiri S, et al. Association between ratio of measured extracellular
volume to expected body fluid volume and renal outcomes in patients with chronic
kidney disease: a retrospective single-center cohort study. BMC Nephrol.
2014;15:189. doi:10.1186/1471–2369–15–189
Tanai E, Frantz S. Pathophysiology of heart failure. Compr Physiol. 2015;6(1):187–214.
doi: 10.1002/cphy.c140055
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Fluid volume, fluid balance and patient
outcome in severe sepsis and septic shock: a systematic review. J Crit Care.
2018;48:153–9. doi: 10.1016/j.jcrc.2018.08.018
Tigabu BM, Davari M, Kebriaeezadeh A, et al. Response to letter to the editor: Fluid
volume, fluid balance and patient outcome in severe sepsis and septic shock: A sys-
tematic review. J Crit Care. 2019;50:314–5. doi: 10.1016/j.jcrc.2018.11.011
Törnudd M, Hahn RG, Zdolsek JH. Fluid distribution kinetics during cardiopulmonary
bypass. Clinics. 2014;69(8):535–41. doi:10.6061/clinics/2014(08)06
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. Relationship between dialytic parame-
ters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring
in dialysis study. BMC Nephrol. 2019;20(1):80. doi:10.1186/s12882–019–1212–6
Van Buren PN, Zhou Y, Neyra JA, et al. Extracellular volume overload and increased
vasoconstriction in patients with recurrent intradialytic hypertension. Kidney Blood
Press Res. 2016;41(6):802–14. doi:10.1159/000450565

164
Domain 3.
Elimination and exchange

Class 1. Urinary function

Code Diagnosis Page

00016 Impaired urinary elimination 167
00322 Risk for urinary retention 170
00297 Disability-associated urinary incontinence 171
00310 Mixed urinary incontinence 178
00017 Stress urinary incontinence 185
00019 Urge urinary incontinence 192
00022 Risk for urge urinary incontinence 199

Class 2. Gastrointestinal function

Code Diagnosis Page

00423 Impaired gastrointestinal motility 206
00422 Risk for impaired gastrointestinal motility 207
00344 Impaired intestinal elimination 208
00346 Risk for impaired intestinal elimination 210
00235 Chronic functional constipation 212
00236 Risk for chronic functional constipation 214
00424 Impaired fecal continence 216
00345 Risk for impaired fecal continence 217

Class 3. Integumentary function

Code Diagnosis Page

This class does not currently contain any diagnoses 218

165
Domain 3. Elimination and exchange

Class 4. Respiratory function

Code Diagnosis Page

00030 Impaired gas exchange 219

166
Domain 3. Elimination and exchange Class 1. Urinary function

Domain 3 • Class 1 • Diagnosis Code 00016

Impaired urinary elimination

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Domain 3 • Class 1 • Diagnosis Code 00322

Risk for urinary retention

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170
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Domain 3 • Class 1 • Diagnosis Code 00297

Disability-associated urinary incontinence

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Domain 3 • Class 1 • Diagnosis Code 00310

Mixed urinary incontinence

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Domain 3 • Class 1 • Diagnosis Code 00017

Stress urinary incontinence

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Domain 3 • Class 1 • Diagnosis Code 00019

Urge urinary incontinence

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Domain 3 • Class 1 • Diagnosis Code 00022

Risk for urge urinary incontinence

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Domain 3 • Class 2 • Diagnosis Code 00423

Impaired gastrointestinal motility

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Domain 3 • Class 2 • Diagnosis Code 00344

Impaired intestinal elimination

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Domain 3 • Class 2 • Diagnosis Code 00346

Risk for impaired intestinal elimination

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3. Elimination and exchange

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Enferm. 2007 May-Jun;60(3):348–352
Vitor AF, et al. Diagnósticos de enfermagem do domínio eliminação e troca identifica-
dos em pacientes em pós-operatório. J res.: fundam. care. Online. 2015 Apr-Jun;7
(2):2453–2463
Volpato MP, Cruz DALM. Diagnóstico de enfermagem de pacientes internados em
unidade médico-cirúrgica. Acta Paul Enferm. 2007;20(2):119–124
Wooley M, et al. Putting Evidence Into Practice: Evidence-Based Interventions for the
Prevention and Management of Constipation in Patients With Cancer. Clin J Oncol
Nurs. 2008 Apr;12(2):317–337

211
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Domain 3 • Class 2 • Diagnosis Code 00235

Chronic functional constipation

References
Belini M., Usai-Satta P., Bove A., Bocchini R., Galeazzi F., Battaglia E., Alduini P., Bus-
carini E., Bassotti G. & ChroCoDiTE Study Group AIGO (2017). Research Article.
Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.”
3. Elimination and exchange

study. BMC Gastroenterology; 17(11)

Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic
review on the management of chronic constipation in North America. Am J Gastro-
enterol. 2005; 100 Suppl 1:S5–S21
Dimidi E., Christodoulides, S., Fragkos K.C., Scott S.M. & Whelan K. (2014). The effect
of probiotics on functional constipation in adults: a systematic review and meta-
analysis of randomized control trials Am J Clin Nutr; 100, 1075–1084
Eoff JC. Optimal treatment of chronic constipation in managed care: review and
roundtable discussion. J Manag Care Pharm. 2008; 14(9) Suppl A:1–15
Gallagher P.F., O’Mahony D. & Quigley M.M. (2008). Review Article. Management of
chronic constipation in the elderly. Drugs & Aging; 25(10), 807–821
Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in
the elderly. Am J Gastroenterol. 2012; 107(1):18–25, quiz 26
Gray JR. What is chronic constipation? Definition and diagnosis. Can J Gastroenterol.
2011; 25 Suppl B:7B–10B
Gu MM, Gonzalez CE, Todd KH. Emergent management of constipation in cancer pa-
tients. Emerg Med. 2011; 43(11):6–12
Harris L.A., Horn J., Kissous-Hunt M., Magnus, L. & Quigley E.M.M. (2017). The bet-
ter understanding and recognition of the disconnects, experiences, and needs of pa-
tients with chronic idiopathic constipation (BURDEN-CIC) study: Results of an on-
line questionnaire. Adv Ther; 34, 2661–2673
Jamshed N, Lee ZE, Olden KW. Diagnostic approach to chronic constipation in adults.
Am Fam Physician. 2011; 84(3):299–306
Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based re-
view. J Am Board Fam Med. 2011; 24(4):436–451
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand
J Gastroenterol. 1997; 32(9):920–924
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Func-
tional bowel disorders. Gastroenterology. 2006; 130(5):1480–1491
Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am J
Gastroenterol. 1999; 94(3):609–615
Müller-Lissner S. The pathophysiology, diagnosis, and treatment of constipation. Dtsch
Arztebl Int. 2009; 106(25):424–431, quiz 431–432
Noguera A, Centeno C, Librada S, Nabal M. Screening for constipation in palliative
care patients. J Palliat Med. 2009; 12(10):915–920
Norton C., Emmanuel A., Stevens N., Scott S.M., Grossi U., Bannister S., Eldridge S.,
Mason J.M. & Knowles C.H. (2017). Study Protocol. Habit training versus habit
training with direct visual biofeedback in adults with chronic constipation: study
protocol for a randomised control trial. Trials 18(139)

212
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Rao SS, Meduri K. What is necessary to diagnose constipation?. Best Pract Res Clin
Gastroenterol. 2011; 25(1):127–140
Tabbers MM, Boluyt N, Berger MY, Benninga MA. Clinical practice : diagnosis and
treatment of functional constipation. Eur J Pediatr. 2011; 170(8):955–963
Tack J, Müller-Lissner S, Stanghellini V, et al. Diagnosis and treatment of chronic con-
stipation–a European perspective. Neurogastroenterol Motil. 2011; 23(8):697–710
Vazquez Roque M. & Bouras E.P. (2015). Review. Epidemiology and management of
chronic constipation in elderly patients. Clinical Interventions in Aging; 10, 919–930

3. Elimination and exchange

213
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Domain 3 • Class 2 • Diagnosis Code 00236

Risk for chronic functional constipation

References
Belini M., Usai-Satta P., Bove A., Bocchini R., Galeazzi F., Battaglia E., Alduini P., Bus-
carini E., Bassotti G. & ChroCoDiTE Study Group AIGO (2017). Research Article.
Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.”
3. Elimination and exchange

study. BMC Gastroenterology; 17(11)

Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic
review on the management of chronic constipation in North America. Am J Gastro-
enterol. 2005; 100 Suppl 1:S5–S21
Dimidi E., Christodoulides, S., Fragkos K.C., Scott S.M. & Whelan K. (2014). The effect
of probiotics on functional constipation in adults: a systematic review and meta-
analysis of randomized control trials Am J Clin Nutr; 100, 1075–1084
Eoff JC. Optimal treatment of chronic constipation in managed care: review and
roundtable discussion. J Manag Care Pharm. 2008; 14(9) Suppl A:1–15
Gallagher P.F., O’Mahony D. & Quigley M.M. (2008). Review Article. Management of
chronic constipation in the elderly. Drugs & Aging; 25(10), 807–821
Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in
the elderly. Am J Gastroenterol. 2012; 107(1):18–25, quiz 26
Gray JR. What is chronic constipation? Definition and diagnosis. Can J Gastroenterol.
2011; 25 Suppl B:7B–10B
Gu MM, Gonzalez CE, Todd KH. Emergent management of constipation in cancer pa-
tients. Emerg Med. 2011; 43(11):6–12
Harris L.A., Horn J., Kissous-Hunt M., Magnus, L. & Quigley E.M.M. (2017). The bet-
ter understanding and recognition of the disconnects, experiences, and needs of pa-
tients with chronic idiopathic constipation (BURDEN-CIC) study: Results of an on-
line questionnaire. Adv Ther; 34, 2661–2673
Jamshed N, Lee ZE, Olden KW. Diagnostic approach to chronic constipation in adults.
Am Fam Physician. 2011; 84(3):299–306
Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based re-
view. J Am Board Fam Med. 2011; 24(4):436–451
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand
J Gastroenterol. 1997; 32(9):920–924
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Func-
tional bowel disorders. Gastroenterology. 2006; 130(5):1480–1491
Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am J
Gastroenterol. 1999; 94(3):609–615
Müller-Lissner S. The pathophysiology, diagnosis, and treatment of constipation. Dtsch
Arztebl Int. 2009; 106(25):424–431, quiz 431–432
Noguera A, Centeno C, Librada S, Nabal M. Screening for constipation in palliative
care patients. J Palliat Med. 2009; 12(10):915–920
Norton C., Emmanuel A., Stevens N., Scott S.M., Grossi U., Bannister S., Eldridge S.,
Mason J.M. & Knowles C.H. (2017). Study Protocol. Habit training versus habit
training with direct visual biofeedback in adults with chronic constipation: study
protocol for a randomised control trial. Trials 18(139)

214
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Rao SS, Meduri K. What is necessary to diagnose constipation?. Best Pract Res Clin
Gastroenterol. 2011; 25(1):127–140
Tabbers MM, Boluyt N, Berger MY, Benninga MA. Clinical practice : diagnosis and
treatment of functional constipation. Eur J Pediatr. 2011; 170(8):955–963
Tack J, Müller-Lissner S, Stanghellini V, et al. Diagnosis and treatment of chronic con-
stipation–a European perspective. Neurogastroenterol Motil. 2011; 23(8):697–710
Vazquez Roque M. & Bouras E.P. (2015). Review. Epidemiology and management of
chronic constipation in elderly patients. Clinical Interventions in Aging; 10, 919–930

3. Elimination and exchange

215
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Domain 3 • Class 2 • Diagnosis Code 00424

Impaired fecal continence

References
Bartlett L., Sloots K. & Nowak M. (2011). Biofeedback for fecal incontinence. A
randomized study comparing exercise regimens. Diseases of the Colon and Rectum;
3. Elimination and exchange

54(7), 846–855
Bliss D. & Norton, C. (2010). Conservative management of fecal incontinence. AJN;
110(9), 30–38
Dombrowsky, T. A. (2012). Continence and incontinence: a concept analysis. Journal
of Theory Construction & Testing, 16(2), 31
Goodman C., Rycroft Malone J., Norton C., Harari D., Harwood R., Roe B., Russell B.,
Fader M., Buswell M., Drennan V. & Bunn F. (2015). Reducing and managing faecal
incontinence in people with advanced dementia who are resident in car homes: pro-
tocol for a realist synthesis. BMJ Open; 1–8
Jerez-Roig J., Souza, D., Amaral, F. & Lima K. (2015). Prevalence of fecal incontinence
(FI) and associated factors in institutionalized older adults. Archives of Gerontology
and Geriatrics; 60, 425–430
Lacy B.E., Mearin F., Chang L., Chey, W.D. & Lembo A.J. (2016). Bowel disorders.
Gastroenterology; 150, 1303–1407
Norton C., Whitehead W.E., Blizz D.Z., Harari D. & Lang J. (2010). Review Articles.
Management of fecal incontinence in adults. Neurourology and Urodynamics; 29,
199–206
Russell B., Buswell M., Norton C., Rycroft Malone J., Harari D., Harwood R., Roe B.,
Fader M., Drennan V., Bunn F. & Goodman C. (2017). Supporting people living
with dementia and faecal incontinence. British Journal of Community Nursing; 22
(3), 1–12
Saga S., Guttormsen Vinsnes A., Mørkved S., Norton C. & Seim A. (2015). What char-
acteristics predispose to continence in nursing home residents?: A population-based
cross-sectional study. Neurourology and Urodynamics; 34, 362–367
Saga S., Guttormsen Vinsnes A., Mørkved S., Norton C. & Seim A. (2013). Prevalence
and correlates of fecal incontinence among nursing home residents: a population-
based cross-sectional study. BMC Geriatrics; 13(87)
Scott K. (2014). Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin-
ics in Colon and Rectal Surgery; 27, 99–105

216
Domain 3. Elimination and exchange Class 2. Gastrointestinal function

Domain 3 • Class 2 • Diagnosis Code 00345

Risk for impaired fecal continence

References
Bartlett L., Sloots K. & Nowak M. (2011). Biofeedback for fecal incontinence. A
randomized study comparing exercise regimens. Diseases of the Colon and Rectum;

3. Elimination and exchange

54(7), 846–855
Bliss D. & Norton, C. (2010). Conservative management of fecal incontinence. AJN;
110(9), 30–38
Dombrowsky, T. A. (2012). Continence and incontinence: a concept analysis. Journal
of Theory Construction & Testing, 16(2), 31
Goodman C., Rycroft Malone J., Norton C., Harari D., Harwood R., Roe B., Russell B.,
Fader M., Buswell M., Drennan V. & Bunn F. (2015). Reducing and managing faecal
incontinence in people with advanced dementia who are resident in car homes: pro-
tocol for a realist synthesis. BMJ Open; 1–8
Jerez-Roig J., Souza, D., Amaral, F. & Lima K. (2015). Prevalence of fecal incontinence
(FI) and associated factors in institutionalized older adults. Archives of Gerontology
and Geriatrics; 60, 425–430
Lacy B.E., Mearin F., Chang L., Chey, W.D. & Lembo A.J. (2016). Bowel disorders.
Gastroenterology; 150, 1303–1407
Norton C., Whitehead W.E., Blizz D.Z., Harari D. & Lang J. (2010). Review Articles.
Management of fecal incontinence in adults. Neurourology and Urodynamics; 29,
199–206
Russell B., Buswell M., Norton C., Rycroft Malone J., Harari D., Harwood R., Roe B.,
Fader M., Drennan V., Bunn F. & Goodman C. (2017). Supporting people living
with dementia and faecal incontinence. British Journal of Community Nursing; 22
(3), 1–12
Saga S., Guttormsen Vinsnes A., Mørkved S., Norton C. & Seim A. (2015). What char-
acteristics predispose to continence in nursing home residents?: A population-based
cross-sectional study. Neurourology and Urodynamics; 34, 362–367
Saga S., Guttormsen Vinsnes A., Mørkved S., Norton C. & Seim A. (2013). Prevalence
and correlates of fecal incontinence among nursing home residents: a population-
based cross-sectional study. BMC Geriatrics; 13(87)
Scott K. (2014). Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin-
ics in Colon and Rectal Surgery; 27, 99–105

217
Domain 3. Elimination and exchange Class 3. Integumentary function

This class does not currently contain any diagnoses

3. Elimination and exchange

218
Domain 3. Elimination and exchange Class 4. Respiratory function

Domain 3 • Class 4 • Diagnosis Code 00030

Impaired gas exchange

References
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diagnoses for children with acute respiratory infection. Acta Paul Enferm. 2012;25

3. Elimination and exchange

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2175–6783.20192040159
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3095.12205
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Enfermería Clínica. 2015;25(6):296–304. DOI: 10.1016/j.enfcli.2015.07.007
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ineffective breathing pattern, and impaired gas exchange. Available from: [link]
Dutra CSK, Silveira LM, Santos AO, Pereira R, Stabile AM. Diagnósticos de enferma-
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and pulmonary gas exchange during systemic and pulmonary inflammation in hu-
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and Risk of Intellectual Disability and Autism: A Meta-analysis. J Autism Dev Dis-
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1169.0269.2581
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Nursing Diagnoses among Children with Acute Respiratory Infection. J Pediatr
Nurs. 2016;31(1):85–91. DOI: 10.1016/j.pedn.2015.08.002
Rocha DH, Sousa VEC, Pascoal LM, Montoril MH, Monteiro FPM, Lopes MVO. Troca
de gases em pacientes com angina. Esc Anna Nery Rev Enferm. 2009;13(3):471–76
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cli.2011.02.009
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cos de enfermagem respiratórios em Unidades de Terapia Intensiva Neonatal. Revis-
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2014;33:29–35

219
Domain 3. Elimination and exchange Class 4. Respiratory function

Sousa VE, Pascoal LM, de Matos TF, et al. Clinical Indicators of Impaired Gas Ex-
change in Cardiac Postoperative Patients. Int J Nurs Knowl. 2015;26(3):141–146.
DOI: 10.1111/2047–3095.12061
3. Elimination and exchange

220
Domain 4.
Activity / rest

Class 1. Sleep / rest

Code Diagnosis Page

00337 Ineffective sleep pattern 223
00407 Risk for ineffective sleep pattern 231
00417 Readiness for enhanced sleep pattern 239
00323 Ineffective sleep hygiene behaviors 247
00408 Risk for ineffective sleep hygiene behaviors 248

Class 2. Activity / exercise

Code Diagnosis Page

00085 Impaired physical mobility 249
00324 Risk for impaired physical mobility 250
00091 Impaired bed mobility 251
00089 Impaired wheelchair mobility 253
00363 Impaired sitting ability 255
00364 Impaired standing ability 256
00367 Impaired transferring ability 257
00365 Impaired walking ability 258

Class 3. Energy balance

Code Diagnosis Page

00298 Decreased activity tolerance 259
00299 Risk for decreased activity tolerance 261
00477 Excessive fatigue burden 263

221
Domain 4. Activity / rest

00465 Impaired surgical recovery 265

00464 Risk for impaired surgical recovery 268

Class 4. Cardiovascular / pulmonary responses

Code Diagnosis Page

00311 Risk for impaired cardiovascular function 271
00362 Risk for imbalanced blood pressure 275
00240 Risk for decreased cardiac output 277
00201 Risk for ineffective cerebral tissue perfusion 280
00204 Ineffective peripheral tissue perfusion 281
00228 Risk for ineffective peripheral tissue perfusion 282
00032 Ineffective breathing pattern 283
00033 Impaired spontaneous ventilation 285
00431 Impaired child ventilatory weaning response 286
00430 Impaired adult ventilatory weaning response 287

Class 5. Self-care

Code Diagnosis Page

00331 Decreased self-care ability syndrome 291
00332 Risk for decreased self-care ability syndrome 292
00442 Readiness for enhanced self-care abilities 293
00326 Decreased bathing abilities 295
00327 Decreased dressing abilities 296
00328 Decreased feeding abilities 297
00330 Decreased grooming abilities 298
00329 Decreased toileting abilities 299
00375 Ineffective oral hygiene behaviors 300
00414 Risk for ineffective oral hygiene behaviors 301

222
Domain 4. Activity / rest Class 1. Sleep / rest

Domain 4 • Class 1 • Diagnosis Code 00337

Ineffective sleep pattern

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223
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Domain 4 • Class 1 • Diagnosis Code 00407

Risk for ineffective sleep pattern

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Domain 4 • Class 1 • Diagnosis Code 00417

Readiness for enhanced sleep pattern

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Domain 4 • Class 1 • Diagnosis Code 00323

Ineffective sleep hygiene behaviors

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252
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Domain 4 • Class 2 • Diagnosis Code 00089

Impaired wheelchair mobility

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254
Domain 4. Activity / rest Class 2. Activity / exercise

Domain 4 • Class 2 • Diagnosis Code 00363

Impaired sitting ability

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255
Domain 4. Activity / rest Class 2. Activity / exercise

Domain 4 • Class 2 • Diagnosis Code 00364

Impaired standing ability

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4. Activity / rest

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256
Domain 4. Activity / rest Class 2. Activity / exercise

Domain 4 • Class 2 • Diagnosis Code 00367

Impaired transferring ability

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257
Domain 4. Activity / rest Class 2. Activity / exercise

Domain 4 • Class 2 • Diagnosis Code 00365

Impaired walking ability

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4. Activity / rest

258
Domain 4. Activity / rest Class 3. Energy balance

Domain 4 • Class 3 • Diagnosis Code 00298

Decreased activity tolerance

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4. Activity / rest
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sis of activity intolerance. Journal of Clinical Nursing. 2012;21(23–24):3579–82

259
Domain 4. Activity / rest Class 3. Energy balance

Rodrigues CG, Moraes MA, Sauer JM, Kalil RAK, de Souza EN. Nursing Diagnosis of
Activity Intolerance: Clinical validation in Patients With Refractory Angina. Interna-
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weeks. Heart & Lung. 1990;19(5):491–499
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of pain expression and activity intolerance in chronic pain patients. Pain. 2008;139
(1):47–54
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4. Activity / rest

Zusman M. Instigators of activity intolerance. Manual Therapy. 1997;2(2):75–86

260
Domain 4. Activity / rest Class 3. Energy balance

Domain 4 • Class 3 • Diagnosis Code 00299

Risk for decreased activity tolerance

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Couillard A, Muir JF, Veale D. COPD Recent Findings: Impact on Clinical Practice.
COPD: Journal of Chronic Obstructive Pulmonary Disease. 2010;7(3):204–213

4. Activity / rest
De Souza V, Zeitoun SS, Lopes CT, de Oliveira APD, Lopes JL, de Barros ALBL. Clin-
ical usefulness of the definition for defining characteristics of activity intolerance, ex-
cess fluid volume and decreased cardiac output in decompensated heart failure: a de-
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47
Giua R, Pedone C, Scarlata S, Carrozzo I, Rossi FF, Valiani V, et al. Relationship Be-
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Hur HK, Kim SS, Storey MJ, Kim GY. Activity Intolerance and Impaired Physical Mo-
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Kitzman DW, Nicklas B, Kraus WE, Lyles MF, Eggebeen J, Morgan TM, et al. Skeletal
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ficiency Is Associated with Lower Physical Function in Patients with Heart Failure
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Mol VJ, Baker CA. Activity Intolerance in the Geriatric Stroke Patient. Rehabilitation
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comparison of patients with refractory angina with and without the nursing diagno-
sis of activity intolerance. Journal of Clinical Nursing. 2012;21(23–24):3579–82

261
Domain 4. Activity / rest Class 3. Energy balance

Rodrigues CG, Moraes MA, Sauer JM, Kalil RAK, de Souza EN. Nursing Diagnosis of
Activity Intolerance: Clinical validation in Patients With Refractory Angina. Interna-
tional Journal of Nursing Terminologies and Classifications. 2011;22(3):117–122
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4. Activity / rest

Zusman M. Instigators of activity intolerance. Manual Therapy. 1997;2(2):75–86

262
Domain 4. Activity / rest Class 3. Energy balance

Domain 4 • Class 3 • Diagnosis Code 00477

Excessive fatigue burden

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264
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Domain 4 • Class 3 • Diagnosis Code 00465

Impaired surgical recovery

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Domain 4 • Class 4 • Diagnosis Code 00204

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Domain 4 • Class 4 • Diagnosis Code 00228

Risk for ineffective peripheral tissue perfusion

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Domain 4 • Class 4 • Diagnosis Code 00032

Ineffective breathing pattern

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284
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Domain 4 • Class 4 • Diagnosis Code 00033

Impaired spontaneous ventilation

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285
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Domain 4 • Class 4 • Diagnosis Code 00431

Impaired child ventilatory weaning response

None at this time
4. Activity / rest

286
Domain 4. Activity / rest Class 4. Cardiovascular / pulmonary responses

Domain 4 • Class 4 • Diagnosis Code 00430

Impaired adult ventilatory weaning response

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290
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Domain 4 • Class 5 • Diagnosis Code 00331

Decreased self-care ability syndrome

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Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

292
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00442

Readiness for enhanced self-care abilities

References
Artinian, N.T., Magnan, M., Sloan, M., & Lange, M.P. (2002). Self care behaviors
among patients with heart failure. Heart & Lung, 31(3), 161–172
Backscheider, J.E. (1974). Self care requirements, self care capabilities and nursing sys-
tems in the diabetic nurse management clinic. American Journal of Public Health,
64(12), 1138–1146
Becker, G., Gates, R. J., & E. Newsom (2004). Self-care among chronically ill African
Americans: Culture, health disparities, and health insurance status. American Jour-

4. Activity / rest
nal of Public Health, 94(12), 2066–2073
Biggs, A.J. (1990). Family caregiver versus nursing assessments of elderly self-care abil-
ities. Journal of Gerontological Nursing, 16(8): 11–16
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103
Conn, V. (1991). Self care actions taken by older adults for influenza and colds. Nurs-
ing Research, 40(3), 176–181
Dashiff, C., Bartolucci, A., Wallander, J., & Abdullatif, H. (2005). The relationship of
family structure, maternal employment, and family conflict with self-care adherence
of adolescents with Type 1 diabetes. Families, Systems, & Health, 23(1), 66–79
Fujita, T., Sato, A., Iokawa, K., Yamane, K., Yamamoto, Y., Tsuchiya, K., Ohira, Y. &
Otsuki, K. (2018). A path analysis model for grooming performance in stroke pa-
tients. Disability and Rehabilitation, 1–7. doi:10.1080/09638288.2018.1483431
Harris, J.L. & Williams, L.K. (1991). Universal self-care requisites as identified by
homeless elderly men. Journal of Gerontological Nursing, 17(6), 39–43
Hartweg, D.L. (1993). Self-care actions of healthy middle-aged women to promote
well-being. Nursing Research, 42(4), 221–227
Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & OMAE, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65

293
Domain 4. Activity / rest Class 5. Self-care

Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Moore, J.B. & Beckwitt, A.E. (2004). Children with cancer and their parents: Self care
and dependent care practices. Issues in Comprehensive Pediatric Nursing, 27(1), 1–
17
Oliver, M. (2005). Reaching positive outcomes by assessing and teaching patient self
efficacy. Home Healthcare Nurse, 23(9), 559–562
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Richardson, A. & Ream, E.K. (1997). Self-care behaviours initiated by chemotherapy
4. Activity / rest

patients in response to fatigue. International Journal of Nursing Studies. 34(1), 35–

43
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Smits, M.W. & Kee, C.C. (1992). Correlates of self-care among the independent elderly:
Self care affects well-being. Journal of Gerontological Nursing. 18(9), 13–18
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502
Weston-Eborn, R. (2004). Home care and the adult learner. Home Healthcare Nurse,
22(8), 522–523

294
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00326

Decreased bathing abilities

References
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103

4. Activity / rest
Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & Omae, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65
Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

295
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00327

Decreased dressing abilities

References
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103
4. Activity / rest

Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & OMAE, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65
Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

296
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00328

Decreased feeding abilities

References
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103

4. Activity / rest
Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & OMAE, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65
Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

297
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00330

Decreased grooming abilities

References
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103
4. Activity / rest

Fujita, T., Sato, A., Iokawa, K., Yamane, K., Yamamoto, Y., Tsuchiya, K., Ohira, Y. &
Otsuki, K. (2018). A path analysis model for grooming performance in stroke pa-
tients. Disability and Rehabilitation, 1–7. doi:10.1080/09638288.2018.1483431
Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & OMAE, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65
Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

298
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00329

Decreased toileting abilities

References
Cary, M.P., Pan, W., Sloane, R., Bettger, J. P., Hoenig, H., Merwin, E.I., & Anderson, R.
A. (2016). Self-Care and mobility following postacute rehabilitation for older adults
with hip fracture: A multilevel analysis. Archives of Physical Medicine and Rehabili-
tation, 97(5), 760–771. doi:10.1016/j.apmr.2016.01.012
Collin, C., Wade, D. T., Davies, S., & Horne, V. (1988). The Barthel ADL Index: A reli-
ability study. International Disability Studies, 10(2), 61–63. doi:10.3109/
09638288809164103

4. Activity / rest
Kamiyama, T., Muratani, H., Kimura, Y., Fukiyama, K., Abe, K., Fujii, J., Kuwajima, I.,
Ishii, M., Shiomi, T., Kawano, Y., Mikami, H., Ibayashi, S., & OMAE, T. (1999). Fac-
tors related to impairment of activities of daily living. Internal Medicine, 38(9), 698–
704. doi:10.2169/internalmedicine.38.698
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of
the index of ADL. Gerontologist, 10(1), 20–30. doi: 10.1093/geront/10.1_part_1.20
Katz, S., Ford, AB.., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of
illness in the aged: The Index of ADL: A standardized measure of biological and psy-
chosocial function. Journal of American Medical Association, 85(12), 914–9. doi:
10.1001/jama.1963.03060120024016
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index.
Maryland state medical journal, 14, 61–65
Mlinac, M.E., & Feng, M.C. (2016). Assessment of activities of daily living, self-care,
and independence. Archives of Clinical Neuropsychology, 31(6), 506–516.
doi:10.1093/arclin/acw049
Pashmdarfard, M, & Azad, Akram. (2020). Assessment tools to evaluate Activities of
Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older
adults: A systematic review. Medical Journal of the Islamic Republic of Iran, 34:33,
doi: 10.34171/mjiri.34.33
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel In-
dex for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.
doi:10.1016/0895–4356(89)90065–6
Wang, D. X. M., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2019). Muscle
mass, strength, and physical performance predicting activities of daily living: a meta-
analysis. Journal of Cachexia, Sarcopenia and Muscle, 11(1), 3–25. doi: 10.1002/
jcsm.12502

299
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00375

Ineffective oral hygiene behaviors

References
Souza EO, Pedreira LC, Silva RS, Góes RP, Cavaleiro AJBG. Oral hygiene self-care:
Concept analysis for the development of a new nursing diagnosis. Int J Nurs Knowl.
Published online December 3, 2023. doi:10.1111/2047–3095.12456
Souza EO. Autocuidado para higiene oral: teoria de enfermagem de médio alcance.
Tese de doutorado. Universidade Federal da Bahia; 2023
4. Activity / rest

300
Domain 4. Activity / rest Class 5. Self-care

Domain 4 • Class 5 • Diagnosis Code 00414

Risk for ineffective oral hygiene behaviors

References
Souza EO, Pedreira LC, Silva RS, Góes RP, Cavaleiro AJBG. Oral hygiene self-care:
Concept analysis for the development of a new nursing diagnosis. Int J Nurs Knowl.
Published online December 3, 2023. doi:10.1111/2047–3095.12456
Souza EO. Autocuidado para higiene oral: teoria de enfermagem de médio alcance.
Tese de doutorado. Universidade Federal da Bahia; 2023

4. Activity / rest

301
Domain 5.
Perception / cognition

Class 1. Attention

Code Diagnosis Page

This class does not currently contain any diagnoses 305

Class 2. Orientation

Code Diagnosis Page

This class does not currently contain any diagnoses 306

Class 3. Sensation / perception

Code Diagnosis Page

This class does not currently contain any diagnoses 307

Class 4. Cognition

Code Diagnosis Page

00128 Acute confusion 308
00173 Risk for acute confusion 312
00129 Chronic confusion 316
00222 Ineffective impulse control 317
00493 Disrupted thought processes 319
00435 Inadequate health knowledge 322
00499 Readiness for enhanced health knowledge 324
00131 Impaired memory 326
00429 Impaired decision-making 327

303
Domain 5. Perception / cognition

00184 Readiness for enhanced decision-making 328

00242 Impaired emancipated decision-making 329
00244 Risk for impaired emancipated decision-making 330
00243 Readiness for enhanced emancipated decision-making 331

Class 5. Communication

Code Diagnosis Page

00051 Impaired verbal communication 332
00434 Risk for impaired verbal communication 333
00368 Readiness for enhanced verbal communication 334

304
Domain 5. Perception / cognition Class 1. Attention

This class does not currently contain any diagnoses

5. Perception / cognition

305
Domain 5. Perception / cognition Class 2. Orientation

This class does not currently contain any diagnoses

5. Perception / cognition

306
Domain 5. Perception / cognition Class 3. Sensation / perception

This class does not currently contain any diagnoses

5. Perception / cognition

307
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00128

Acute confusion
References
Agostini, J.V., Leo-Summers, L.S., & Inouye, S.K. (2001). Cognitive and other adverse
effects of diphenhydramine use in hospitalized older patients. Archives of Internal
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Alciati, A., Scaramelli, B., Fusi, A., Butteri, E., Cattameo, M.L., & Mellado, C. (1999).
Three cases of delirium after “ecstasy” ingestion. Journal of Psychoactive Drugs, 31
(2), 167–170
Aldemir, M., Ozen, S., Kara, I.H., Sir, A., & Bac, B. (2001). Predisposing factors for
delirium in the surgical intensive care unit. Critical Care, 5(5), 265–270
Bowman, A.M. (1997). Sleep satisfaction, perceived pain and acute confusion in elderly
5. Perception / cognition

clients undergoing orthopaedic procedures. Journal of Advanced Nursing, 26(3),

550–564
Brauer, C., Morrison, R.S., Silberzweig, S.B., & Sui, A.L. (2000). The cause of delirium
in patients with hip fracture. Archives of Internal Medicine, 160(12),1856–1860
Coyle, N., Breitbart, W., Weaver, S., & Portenoy, R. (1994). Delirium as a contributing
factor to “crescendo” pain: three case reports. Journal of Pain and Symptom Ma-
nagement, 9(1), 44–47
Dalgalarrondo P. Psicopatologia e semiologia dos transtornos mentais. 3.ed. Porto Ale-
gre: ArtMed, 2017
Edlund, A., Lundstrom, M., Brannstrom, B., Bucht, G., & Gustafson, Y. (2001). Delir-
ium before and after operation for femoral neck fracture. Journal of the American
Geriatrics Society, 49(10), 1335–1340
Elie, M., Cole, M.G., Primeau, F. J., & Bellavance, F. (1998). Delirium risks factors in
elderly hospitalized patients. Journal of General Internal Medicine 13(3), 204–212
Erkinjuntti, T., Wikstrom, J. Palo, J., & Autio, L. (1986). Dementia among medical in-
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146(10), 1923–1926
Fisher, B.W. & Flowerdew, G. (1995). A simple model for predicting postoperative de-
lirium in older patients undergoing elective orthopedic surgery. Journal of the Amer-
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Foreman, M. (1989). Confusion in the hospitalized elderly: Incidence, onset, and asso-
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Grandberg, A.I., Malmros, C.W., Bergborn, I.L., & Lundberg, D.B. (2002) Intensive
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Gustafson, Y., Berggren, D., Brannstrom, B., et al. (1988). Acute confusional state in
elderly patients treated for femoral neck fracture. Journal of the American Geriatric
Association, 36(6), 525–530

308
Domain 5. Perception / cognition Class 4. Cognition

Han, L., McCusher, J., Cole, M. Abrahamowiz, M., Primeau, F., & Elie, M. (2001). Use
of medications with anticholinergic effect predicts clinical severity of delirium symp-
toms in older medical inpatients. Archives of Internal Medicine, 161(8), 1099– 1105
Haynes, C. (1999). Emergence delirium: a literature review. British Journal of Theatre
Nursing, 9(11), 502–510
Inouye, S.K. & Charpentier, P.A. (1996). Precipitating factors for delirium in hospital-
ized elderly persons: Predictive model and interrelationship with baseline vulnerabil-
ity. Journal of the American Medical Association, 275(11), 852–857
Jitapunkul, S., Pillay, I., & Ebrahim, S. (1992). Delirium in newly admitted elderly pa-
tients: A prospective study. The Quarterly Journal of Medicine, 83(300), 307–314
Kelly, M. (1997). The best is yet to be. Postoperative delirium in the elderly. Today’s
Surgical Nurse, 19(5), 10–12
Koponen, H., Stenback, U., Mattila, E., Soininen, H., Reinikainen, K., & Riekkinen, P.
(1989). Delirium among elderly persons admitted to a psychiatric hospital: clinical
course during the acute state and one-year follow-up. Acta Psychiatrica Scandinavi-

5. Perception / cognition
ca, 79(6), 579–585
Korevaar, J.C., van Munster, B.C., & de Rooij, S.E. (2005). Risk factors for delirium in
acutely admitted elderly patients: a prospective cohort study. Retrieved from http://
www.biomedcentral.com/1471–2318/5/6
Lawlor, P.G., Gagnon, B., Mancini, I.L., Pereira, J.L., Hanson, J., Suarez-Almazor, M.E.,
& Bruera, E.D. (2000). Occurrence, causes, and outcome of delirium in patients with
advanced cancer. Archives of Internal Medicine, 160(6), 786–794. Levkoff, S.E, Sa-
fran, C., Cleary, P.D., Gallop, J., & Phillips, R.S. (1988). Identification of factors asso-
ciated with the diagnosis of delirium in elderly hospitalized patients. Journal of the
American Geriatrics Society, 36(12), 1099–1104
Lipov, E.G. (1991). Emergence delirium in the PACU. Critical Care Nursing Clinics of
North America, 3(1), 145–149
Lynch, E.P., Lazor, M.A., Gellis, J.E., Orav, J., Goldman, L., & Marcantonioa, E.R.
(1998). The impact of postoperative pain on the development of post operative delir-
ium. Anesthesia & Analgesia, 86(4), 781–785
Marcantonio, E.R., Goldman, L., Mangione, C.M., et al. (1994). A clinical prediction
rule for delirium after elective noncardiac surgery. Journal of the American Medical
Association, 271(2), 134–139
Marcantonio, E.R., Simon, S.E., Bergmann, M.A., Jones, R.N., Murphy, K.M., & Morris,
J.N. (2003). Delirium symptoms in post-acute care: Prevalent, persistent, and associ-
ated with poor functional recovery. Journal of the American Geriatrics Society, 51
(1), 4–9
Massie, M.J. & Holland, J.C. (1992). The cancer patient with pain: psychiatric compli-
cations and their management. Journal of Pain and Symptom Management, 7(2),
99–109
Mathiesen V, Sivertsen L, Foreman, MD, Cronin-Stubs D. Acute confusion: nursing in-
tervention in older patients. Orthopaedic Nursing. 1994;13(2):21–7
McCuster, J., Cole, M., Abrahamowica, M., Han, L., Podoba, J., & Ramman-Haddad, L.
(2001). Environmental risk factors for delirium in hospitalized older people. Journal
of the American Geriatrics Society, 49(10), 1327–1334
Mentes, J., Culp, J., Maas, M., & Rantz, M. (1999). Acute confusion indicators: risk fac-
tors and prevalence using MDS data. Research in Nursing & Health, 22(2), 95–105

309
Domain 5. Perception / cognition Class 4. Cognition

Morita, T., Tei, Y. Tsunoda, J., Inouye, S., & Chihara, S. (2001). Underlying pathologies
and their associations with clinical features in terminal delirium of cancer patients.
Journal of Pain and Symptom Management, 22(6), 997–1006
Morrison, R.S., Magaziner, J., Gilbert, M., Koval, K. J., McLaughlin, M.A., Orosz, G.,
Strauss, E. & Siu, A. (2003). Relationship between pain and opioid analgesics on the
development of delirium following hip fracture. Journal of Gerontology Series A – A
Biological Sciences & Medical Sciences, 58(1), 76–81
Nishikawa, K., Nakayama, M., Omote, K., & Namiki, A. (2004). Recovery characteris-
tics and post operative delirium after long-duration laparoscope-assisted surgery in
elderly patients: propofol-based vs. sevoflurane-based anesthesia. Acta Anaesthesio-
logica Scandinavica, 48(2), 162–168
O’Brien, D. (2002). Acute postoperative delirium: definitions, incidence, recognition,
and interventions. Journal of Peri-Anesthesia Nursing 17, 384–392
Pompei, P., Foreman, M., Rudberg, M., Inouye, S., Braund, V., & Cassel, C. (1994). De-
lirium in hospitalized older persons: Outcomes and predictors. Journal of the Amer-
5. Perception / cognition

ican Geriatrics Society, 42, 809–815

Pratico, C., Quattrone, D., Lucanto, T., et al. (2005). Drugs of anesthesia acting on cen-
tral cholinergic system may cause post operative cognitive dysfunction and delirium.
Medical Hypotheses, 65, 972–982
Rockwood, K. (1989). Acute confusion in elderly medical patients. Journal of the
American Geriatrics Society, 37, 150–154
Rolfson, D.B., McElhaney, J.E., Rockwood, K., et al. (1999). Incidence and risk factors
for delirium and other adverse outcomes in older adults after coronary artery bypass
graft surgery. Canadian Journal of Cardiology, 15, 771–776
Ross, D.L. (1998). Factors associated with excited delirium, deaths in police custody.
Modern Pathology, 11, 1127–1137
Ruttenber, A.J., Lawler-Heavner, J., Yin, M., Wetli, C.V., Hearn, W.L. & Mash, D.C.
(1997). Fatal excited delirium following cocaine use: epidemiological findings pro-
vide new evidence for mechanisms of cocaine toxicity. Journal of Forensic Sciences,
42(1), 25–31
Ruttenber, A.J., McAnally, H.B., & Wetli, C.V. (1999). Cocaine-associated rhabdomyol-
ysis and excited delirium: different stages of the same syndrome. American Journal
of Forensic Medicine & Pathology, 20(2), 120–127
Schor, J.D., Levkoff, S.E., Lipsitz, L.A., et al. (1992). Risk factors for delirium in hospi-
talized elderly. Journal of the American Medical Association, 267(6), 827–831
Schururmans, M.J., Duursma, S.A., Shortridge-Baggett, L.M., Clevers, G., & Pel-Little,
R. (2003). Elderly patients with hip fracture: the risk for delirium. Applied Nursing
Research, 16(2), 75–84
Seaman, J.S., Schillerstrom, J., Carroll, D., & Brown, T.M. (2006). Impaired oxidative
metabolism precipitates delirium: a study of 101 ICU patients. Psychosomatics, 47
(1), 56–61
Seymour, D.G. & Vaz, F.G. (1989). A prospective study of elderly general surgical pa-
tients: II. Post operative complications. Age and Ageing, 18(5), 316–326
Seymour, D.G., Henschke, P.J, Cape, R.D., & Campbell, A.J. (1980). Acute confusional
states and dementia in the elderly: The role of dehydration/volume depletion, phys-
ical illness and age. Age and Ageing, 9(3), 137–146
Williams, M.A., Holloway, J.R., Winn, M.C., Wolanin, M.O., Lawler, M.L., Westwick,
C.R. & Chin, M.H. (1979). Nursing activities and acute confusional states in elderly
hip-fractured patients. Nursing Research, 28(1), 25–35

310
Domain 5. Perception / cognition Class 4. Cognition

Williams-Russo, P., Urquhart, B.L., Sharrock, N.E., & Charlson, M.E. (1992). Post-op-
erative delirium: Prognosis in elderly orthopedic patients. Journal of the American
Geriatrics Society, 40(8), 759–767
Wilson, L.M. (1972). Intensive care delirium. Archives of Internal Medicine, 130(2),
225–226

5. Perception / cognition

311
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00173

Risk for acute confusion

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Han, L., McCusher, J., Cole, M. Abrahamowiz, M., Primeau, F., & Elie, M. (2001). Use
of medications with anticholinergic effect predicts clinical severity of delirium symp-
toms in older medical inpatients. Archives of Internal Medicine, 161(8), 1099– 1105
Haynes, C. (1999). Emergence delirium: a literature review. British Journal of Theatre
Nursing, 9(11), 502–510
Inouye, S.K. & Charpentier, P.A. (1996). Precipitating factors for delirium in hospital-
ized elderly persons: Predictive model and interrelationship with baseline vulnerabil-
ity. Journal of the American Medical Association, 275(11), 852–857
Jitapunkul, S., Pillay, I., & Ebrahim, S. (1992). Delirium in newly admitted elderly pa-
tients: A prospective study. The Quarterly Journal of Medicine, 83(300), 307–314
Kelly, M. (1997). The best is yet to be. Postoperative delirium in the elderly. Today’s
Surgical Nurse, 19(5), 10–12
Koponen, H., Stenback, U., Mattila, E., Soininen, H., Reinikainen, K., & Riekkinen, P.
(1989). Delirium among elderly persons admitted to a psychiatric hospital: clinical
course during the acute state and one-year follow-up. Acta Psychiatrica Scandinavi-

5. Perception / cognition
ca, 79(6), 579–585
Korevaar, J.C., van Munster, B.C., & de Rooij, S.E. (2005). Risk factors for delirium in
acutely admitted elderly patients: a prospective cohort study. Retrieved from http://
www.biomedcentral.com/1471–2318/5/6
Lawlor, P.G., Gagnon, B., Mancini, I.L., Pereira, J.L., Hanson, J., Suarez-Almazor, M.E.,
& Bruera, E.D. (2000). Occurrence, causes, and outcome of delirium in patients with
advanced cancer. Archives of Internal Medicine, 160(6), 786–794. Levkoff, S.E, Sa-
fran, C., Cleary, P.D., Gallop, J., & Phillips, R.S. (1988). Identification of factors asso-
ciated with the diagnosis of delirium in elderly hospitalized patients. Journal of the
American Geriatrics Society, 36(12), 1099–1104
Lipov, E.G. (1991). Emergence delirium in the PACU. Critical Care Nursing Clinics of
North America, 3(1), 145–149
Lynch, E.P., Lazor, M.A., Gellis, J.E., Orav, J., Goldman, L., & Marcantonioa, E.R.
(1998). The impact of postoperative pain on the development of post operative delir-
ium. Anesthesia & Analgesia, 86(4), 781–785
Marcantonio, E.R., Goldman, L., Mangione, C.M., et al. (1994). A clinical prediction
rule for delirium after elective noncardiac surgery. Journal of the American Medical
Association, 271(2), 134–139
Marcantonio, E.R., Simon, S.E., Bergmann, M.A., Jones, R.N., Murphy, K.M., & Morris,
J.N. (2003). Delirium symptoms in post-acute care: Prevalent, persistent, and associ-
ated with poor functional recovery. Journal of the American Geriatrics Society, 51
(1), 4–9
Massie, M.J. & Holland, J.C. (1992). The cancer patient with pain: psychiatric compli-
cations and their management. Journal of Pain and Symptom Management, 7(2),
99–109
Mathiesen V, Sivertsen L, Foreman, MD, Cronin-Stubs D. Acute confusion: nursing in-
tervention in older patients. Orthopaedic Nursing. 1994;13(2):21–7
McCuster, J., Cole, M., Abrahamowica, M., Han, L., Podoba, J., & Ramman-Haddad, L.
(2001). Environmental risk factors for delirium in hospitalized older people. Journal
of the American Geriatrics Society, 49(10), 1327–1334
Mentes, J., Culp, J., Maas, M., & Rantz, M. (1999). Acute confusion indicators: risk fac-
tors and prevalence using MDS data. Research in Nursing & Health, 22(2), 95–105

313
Domain 5. Perception / cognition Class 4. Cognition

Morita, T., Tei, Y. Tsunoda, J., Inouye, S., & Chihara, S. (2001). Underlying pathologies
and their associations with clinical features in terminal delirium of cancer patients.
Journal of Pain and Symptom Management, 22(6), 997–1006
Morrison, R.S., Magaziner, J., Gilbert, M., Koval, K. J., McLaughlin, M.A., Orosz, G.,
Strauss, E. & Siu, A. (2003). Relationship between pain and opioid analgesics on the
development of delirium following hip fracture. Journal of Gerontology Series A – A
Biological Sciences & Medical Sciences, 58(1), 76–81
Nishikawa, K., Nakayama, M., Omote, K., & Namiki, A. (2004). Recovery characteris-
tics and post operative delirium after long-duration laparoscope-assisted surgery in
elderly patients: propofol-based vs. sevoflurane-based anesthesia. Acta Anaesthesio-
logica Scandinavica, 48(2), 162–168
O’Brien, D. (2002). Acute postoperative delirium: definitions, incidence, recognition,
and interventions. Journal of Peri-Anesthesia Nursing 17, 384–392
Pompei, P., Foreman, M., Rudberg, M., Inouye, S., Braund, V., & Cassel, C. (1994). De-
lirium in hospitalized older persons: Outcomes and predictors. Journal of the Amer-
5. Perception / cognition

ican Geriatrics Society, 42, 809–815

Pratico, C., Quattrone, D., Lucanto, T., et al. (2005). Drugs of anesthesia acting on cen-
tral cholinergic system may cause post operative cognitive dysfunction and delirium.
Medical Hypotheses, 65, 972–982
Rockwood, K. (1989). Acute confusion in elderly medical patients. Journal of the
American Geriatrics Society, 37, 150–154
Rolfson, D.B., McElhaney, J.E., Rockwood, K., et al. (1999). Incidence and risk factors
for delirium and other adverse outcomes in older adults after coronary artery bypass
graft surgery. Canadian Journal of Cardiology, 15, 771–776
Ross, D.L. (1998). Factors associated with excited delirium, deaths in police custody.
Modern Pathology, 11, 1127–1137
Ruttenber, A.J., Lawler-Heavner, J., Yin, M., Wetli, C.V., Hearn, W.L. & Mash, D.C.
(1997). Fatal excited delirium following cocaine use: epidemiological findings pro-
vide new evidence for mechanisms of cocaine toxicity. Journal of Forensic Sciences,
42(1), 25–31
Ruttenber, A.J., McAnally, H.B., & Wetli, C.V. (1999). Cocaine-associated rhabdomyol-
ysis and excited delirium: different stages of the same syndrome. American Journal
of Forensic Medicine & Pathology, 20(2), 120–127
Schor, J.D., Levkoff, S.E., Lipsitz, L.A., et al. (1992). Risk factors for delirium in hospi-
talized elderly. Journal of the American Medical Association, 267(6), 827–831
Schururmans, M.J., Duursma, S.A., Shortridge-Baggett, L.M., Clevers, G., & Pel-Little,
R. (2003). Elderly patients with hip fracture: the risk for delirium. Applied Nursing
Research, 16(2), 75–84
Seaman, J.S., Schillerstrom, J., Carroll, D., & Brown, T.M. (2006). Impaired oxidative
metabolism precipitates delirium: a study of 101 ICU patients. Psychosomatics, 47
(1), 56–61
Seymour, D.G. & Vaz, F.G. (1989). A prospective study of elderly general surgical pa-
tients: II. Post operative complications. Age and Ageing, 18(5), 316–326
Seymour, D.G., Henschke, P.J, Cape, R.D., & Campbell, A.J. (1980). Acute confusional
states and dementia in the elderly: The role of dehydration/volume depletion, phys-
ical illness and age. Age and Ageing, 9(3), 137–146
Williams, M.A., Holloway, J.R., Winn, M.C., Wolanin, M.O., Lawler, M.L., Westwick,
C.R. & Chin, M.H. (1979). Nursing activities and acute confusional states in elderly
hip-fractured patients. Nursing Research, 28(1), 25–35

314
Domain 5. Perception / cognition Class 4. Cognition

Williams-Russo, P., Urquhart, B.L., Sharrock, N.E., & Charlson, M.E. (1992). Post-op-
erative delirium: Prognosis in elderly orthopedic patients. Journal of the American
Geriatrics Society, 40(8), 759–767
Wilson, L.M. (1972). Intensive care delirium. Archives of Internal Medicine, 130(2),
225–226

5. Perception / cognition

315
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00129

Chronic confusion
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Domain 5 • Class 4 • Diagnosis Code 00222

Ineffective impulse control

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Domain 5 • Class 4 • Diagnosis Code 00435

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323
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00499

Readiness for enhanced health knowledge

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(1):41–9

324
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5. Perception / cognition
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ure patients’ knowledge of heart disease and self-care management. Proceedings of
Singapore Healthcare 2017; 26(1) 26–34

325
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Domain 5 • Class 4 • Diagnosis Code 00131

Impaired memory
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Domain 5 • Class 4 • Diagnosis Code 00429

Impaired decision-making
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health decisions. Health Expectations, 6(2), 97–109
O’Connor, A.M., Tugwell, P., Wells, G.A., et al. (1998). A decision aid for women con-
5. Perception / cognition

sidering hormone therapy after menopause: Decision support framework and evalu-
ation. Patient Education and Counseling, 33(3), 267–279
Paterson, B.L., Russell, C., & Thorne, (S. 2001). Critical analysis of everyday self-care
decision making in chronic illness. Journal of Advanced Nursing, 35(3), 335–341
Pender, N.J., Murdaugh, C.L., & Parsons, M.A. (2006). Health promotion in nursing
Practice (5th ed.). Upper Saddle River, NJ: Pearson Prentice-Hall
Roelands, M., Van Oost, P., Stevens, V., Depoorter, A., & Buysse, A. (2004). Clinical
practice guidelines to improve shared decision-making about assistive device use in
home care: A pilot interventions study. Patient Education and Counseling, 55(2),
252–64
Ross, M.M., Carswell, A., Hing, M., Hollingworth, G., & Dalziel, W.B. (2001). Seniors
decision making about pain management. Journal of Advanced Nursing, 35(3), 442–
451
Rothert, M.L., Holmes-Rovner, M., Rovner, D., et al. (1997). An educational interven-
tion as decision support for menopausal women. Research in Nursing & Health, 20,
377–387
Tunis, S.R. (2005). Perspective: A clinical research strategy to support shared decision
making. Health Affairs, 24(1), 180–184

328
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00242

Impaired emancipated decision-making

References
Stepanuk, K.M. (2011). Women's decision-making regarding medication use in preg-
nancy for anxiety and/or depression. Philadelphia, PA: Drexel University, College of
Nursing Health Professions, Doctor of Nursing Practice Program
Wittmann-Price, R. A. & Bhattacharya, A. (2008). Reexploring the subconcepts of the
Wittmann-Price Theory of Emancipated Decision-making in Women’s Healthcare.
Advances in Nursing Science, 31(3), 225–236
Wittmann-Price, R. A. (2006). Exploring the subconcepts of the Wittmann-Price
Theory of Emancipated Decision-making in Women’s Health Care. Journal of Nurs-
ing Scholarship. 38(4), 377–382

5. Perception / cognition
Wittmann-Price, R. A., Fliszar, R., & Bhattacharya, A. (2011). Elective Cesarean births:
Are women making emancipated decisions? Applied Nursing Eesearch, 24(3), 147–
152
Wittmann-Price, R.A. & Fisher, K.M. (2009). Patient Decision Aids: Tools for patients
and professionals. The American Journal of Nursing, 109(12), 60–64

329
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00244

Risk for impaired emancipated decision-making

References
Stepanuk, K.M. (2011). Women's decision-making regarding medication use in preg-
nancy for anxiety and/or depression. Philadelphia, PA: Drexel University, College of
Nursing Health Professions, Doctor of Nursing Practice Program
Wittmann-Price, R. A. & Bhattacharya, A. (2008). Reexploring the subconcepts of the
Wittmann-Price Theory of Emancipated Decision-making in Women’s Healthcare.
Advances in Nursing Science, 31(3), 225–236
Wittmann-Price, R. A. (2006). Exploring the subconcepts of the Wittmann-Price
Theory of Emancipated Decision-making in Women’s Health Care. Journal of Nurs-
ing Scholarship. 38(4), 377–382
5. Perception / cognition

Wittmann-Price, R. A., Fliszar, R., & Bhattacharya, A. (2011). Elective Cesarean births:
Are women making emancipated decisions? Applied Nursing Eesearch, 24(3), 147–
152
Wittmann-Price, R.A. & Fisher, K.M. (2009). Patient Decision Aids: Tools for patients
and professionals. The American Journal of Nursing, 109(12), 60–64

330
Domain 5. Perception / cognition Class 4. Cognition

Domain 5 • Class 4 • Diagnosis Code 00243

Readiness for enhanced emancipated decision-

making
References
Stepanuk, K.M. (2011). Women's decision-making regarding medication use in preg-
nancy for anxiety and/or depression. Philadelphia, PA: Drexel University, College of
Nursing Health Professions, Doctor of Nursing Practice Program
Wittmann-Price, R. A. & Bhattacharya, A. (2008). Reexploring the subconcepts of the
Wittmann-Price Theory of Emancipated Decision-making in Women’s Healthcare.
Advances in Nursing Science, 31(3), 225–236
Wittmann-Price, R. A. (2006). Exploring the subconcepts of the Wittmann-Price
Theory of Emancipated Decision-making in Women’s Health Care. Journal of Nurs-

5. Perception / cognition
ing Scholarship. 38(4), 377–382
Wittmann-Price, R. A., Fliszar, R., & Bhattacharya, A. (2011). Elective Cesarean births:
Are women making emancipated decisions? Applied Nursing Eesearch, 24(3), 147–
152
Wittmann-Price, R.A. & Fisher, K.M. (2009). Patient Decision Aids: Tools for patients
and professionals. The American Journal of Nursing, 109(12), 60–64

331
Domain 5. Perception / cognition Class 5. Communication

Domain 5 • Class 5 • Diagnosis Code 00051

Impaired verbal communication

References
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acidente vascular encefálico. Rev Rene. v. 14; n. 5, p. 877–85, 2013
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5. Perception / cognition

332
Domain 5. Perception / cognition Class 5. Communication

Domain 5 • Class 5 • Diagnosis Code 00434

Risk for impaired verbal communication

References
Chaves, D. B. R.; et al.Comunicação verbal prejudicada - investigação no período pós-
acidente vascular encefálico. Rev Rene. v. 14; n. 5, p. 877–85, 2013
Oxford Reference. Verbal communication. Available from: https://www.oxfordrefer-
ence.com/view/10.1093/oi/authority.20110803115457102
Puggina, A. C. G.; et al. Diagnóstico de enfermagem comunicação verbal prejudicada
na prática clínica: uma revisão integrativa. REFACS (online), v. 4, n. 2, p. 135–44,
2016
Severo AH, Carvalho ZMF, Lopes MVO, Brasileiro RSF, Braga DCO. Impaired Verbal
Communication: diagnosis review in patients with Amyotrophic Lateral Sclerosis

5. Perception / cognition

333
Domain 5. Perception / cognition Class 5. Communication

Domain 5 • Class 5 • Diagnosis Code 00368

Readiness for enhanced verbal communication

References
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5. Perception / cognition

334
Domain 6.
Self-perception

Class 1. Self-concept

Code Diagnosis Page

00167 Readiness for enhanced self-concept 336
00494 Disrupted personal identity 337
00495 Disrupted family identity syndrome 338
00496 Risk for disrupted family identity syndrome 339
00488 Risk for impaired human dignity 340
00341 Readiness for enhanced transgender social identity 341

Class 2. Self-esteem

Code Diagnosis Page

00483 Chronic inadequate self-esteem 342
00480 Risk for chronic inadequate self-esteem 345
00481 Situational inadequate self-esteem 348
00482 Risk for situational inadequate self-esteem 351
00338 Inadequate health self-efficacy 354

Class 3. Body image

Code Diagnosis Page

00497 Disrupted body image 355

335
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00167

Readiness for enhanced self-concept

None at this time
6. Self-perception

336
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00494

Disrupted personal identity

References
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gre: ArtMed, 2017

6. Self-perception

337
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00495

Disrupted family identity syndrome

References
Adjei, S.B. (2017). Entrapment of Victims of Spousal Abuse in Ghana: A Discursive
Analysis of Family Identity and Agency of Battered Women. Journal of Interpersonal
Violence, 32(5),730–754. Doi: 10.1177/0886260515586375
Bagheri-Lankarani N., Zarei F., Zandi M., Omani-Samani1 R., Karimi M. (2016).The
Experiences of Women Fertilized through Egg Donation during their Treatment
Process. EBCJ, 6 (1), 63–70. Doi: 10.22038/ebcj.2016.6741
Docan-Morga, S.J. (2014). They Were Strangers Who Loved Me”: Discussions, Narra-
tives, and Rituals During Korean Adoptees’ Initial Reunions with Birth Families.
Journal of Family Communication, 14(4), 352–373. https://doi.org/10.1111/
cch.12132
Epp, A.M., & Price, L.L. (2008). Family Identity: A Framework of Identity Interplay in
Consumption Practices. Journal of Consumer Research, 35, (1), 50–70. Doi: 10.1086/
529535
6. Self-perception

Langellier, K. M., & Peterson, E. E. (2006a). Narrative performance theory: Telling sto-
ries, doingfamily. In D. O. Braithwaite& L. A. Baxter (Eds.), Engagingtheoriesin fam-
ily communication: Multiple perspectives (pp. 99–114). Thousand Oaks, CA: SAGE
Michelson, D., & Day, C. (2014). From parent to ‘peer facilitator’: a qualitative study of
a peer-led parenting programme. Child: health, care and development, 41(1), 76–83.
Doi: 10.1111/cch.12132
Mitra M., Dabaghi S., Bagheri-Lankarani N., Omani-Samani R., Naderi-Taheri M.
(2020). Process of becoming a mother in women receiving donated egg: A grounded
theory. Asian Pac J Reprod., In Press
Zandi M., Vanaki, Z., Shiva, M., Mohammadi, E., & Bagheri-Lankarani, N. (2016). Se-
curity giving in surrogacy motherhood process as a caring model for commissioning
mothers: A theory synthesis. Pn J Nurs Sci., 13(3), 331–44. Doi: 10.1111/jjns.12111
Zandi, M. (2013). Exploration of becoming a mother process in commissioning moth-
ers and designing a caring model. Unpublished doctoral dissertation, Tarbiat Mod-
ares University, Tehran, Iran (in Persian)
Zandi, M., Mohammadi, E., Vanaki, Z., Shiva, M., Bagheri, Lankarani N. & Zarei F.
(2017). Confronting infertility in Iranian clients: a grounded theory. Human Fertil-
ity, 20(4):236–247. Doi: 10.1080/14647273.2017.1283447
Zandi, M., Vanaki, Z., Shiva, M., & Mohammadi, E. (2018). Process of becoming a
mother for Iranian surrogacy-commissioning mothers: A grounded theory study.
Jpn J Nurs Sci., 15(1), 3–16. Doi: 10.1111/jjns.12158

338
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00496

Risk for disrupted family identity syndrome

References
Adjei, S.B. (2017). Entrapment of Victims of Spousal Abuse in Ghana: A Discursive
Analysis of Family Identity and Agency of Battered Women. Journal of Interpersonal
Violence, 32(5),730–754. Doi: 10.1177/0886260515586375
Bagheri-Lankarani N., Zarei F., Zandi M., Omani-Samani1 R., Karimi M. (2016).The
Experiences of Women Fertilized through Egg Donation during their Treatment
Process. EBCJ, 6 (1), 63–70. Doi: 10.22038/ebcj.2016.6741
Docan-Morga, S.J. (2014). They Were Strangers Who Loved Me”: Discussions, Narra-
tives, and Rituals During Korean Adoptees’ Initial Reunions with Birth Families.
Journal of Family Communication, 14(4), 352–373. https://doi.org/10.1111/
cch.12132
Epp, A.M., & Price, L.L. (2008). Family Identity: A Framework of Identity Interplay in
Consumption Practices. Journal of Consumer Research, 35, (1), 50–70. Doi: 10.1086/
529535

6. Self-perception
Langellier, K. M., & Peterson, E. E. (2006a). Narrative performance theory: Telling sto-
ries, doingfamily. In D. O. Braithwaite& L. A. Baxter (Eds.), Engagingtheoriesin fam-
ily communication: Multiple perspectives (pp. 99–114). Thousand Oaks, CA: SAGE
Michelson, D., & Day, C. (2014). From parent to ‘peer facilitator’: a qualitative study of
a peer-led parenting programme. Child: health, care and development, 41(1), 76–83.
Doi: 10.1111/cch.12132
Mitra M., Dabaghi S., Bagheri-Lankarani N., Omani-Samani R., Naderi-Taheri M.
(2020). Process of becoming a mother in women receiving donated egg: A grounded
theory. Asian Pac J Reprod., In Press
Zandi M., Vanaki, Z., Shiva, M., Mohammadi, E., & Bagheri-Lankarani, N. (2016). Se-
curity giving in surrogacy motherhood process as a caring model for commissioning
mothers: A theory synthesis. Pn J Nurs Sci., 13(3), 331–44. Doi: 10.1111/jjns.12111
Zandi, M. (2013). Exploration of becoming a mother process in commissioning moth-
ers and designing a caring model. Unpublished doctoral dissertation, Tarbiat Mod-
ares University, Tehran, Iran (in Persian)
Zandi, M., Mohammadi, E., Vanaki, Z., Shiva, M., Bagheri, Lankarani N. & Zarei F.
(2017). Confronting infertility in Iranian clients: a grounded theory. Human Fertil-
ity, 20(4):236–247. Doi: 10.1080/14647273.2017.1283447
Zandi, M., Vanaki, Z., Shiva, M., & Mohammadi, E. (2018). Process of becoming a
mother for Iranian surrogacy-commissioning mothers: A grounded theory study.
Jpn J Nurs Sci., 15(1), 3–16. Doi: 10.1111/jjns.12158

339
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00488

Risk for impaired human dignity

References
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340
Domain 6. Self-perception Class 1. Self-concept

Domain 6 • Class 1 • Diagnosis Code 00341

Readiness for enhanced transgender social identity

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341
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Domain 6 • Class 2 • Diagnosis Code 00483

Chronic inadequate self-esteem

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caína e crack. Cad. Saúde Pública [Internet]. 2018 [cited 2019 May 09]; 34( 5 ):
e00110317. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&-
pid=S0102–311X2018000505004&lng=en. Epub May 10, 2018. http://dx.doi.org/
10.1590/0102–311 × 00110317
Silva, Ricardo Azevedo da et al. Transtornos mentais comuns e auto-estima na gesta-
6. Self-perception

ção: prevalência e fatores associados. Cadernos de Saúde Pública, v. 26, p. 1832–

1838, 2010
Steinberg, Julia R.; Becker, Davida; Henderson, Jillian T. Does the outcome of a first
pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the
National Comorbidity Survey. American Journal of Orthopsychiatry, v. 81, n. 2, p.
193, 2011
Swamy, Geeta K. et al. Predictors of adverse events among pregnant smokers exposed
in a nicotine replacement therapy trial. American journal of obstetrics and gynecol-
ogy, v. 201, n. 4, p. 354. e1–354. e7, 2009
Turnbull, Catherine; Osborn, David A. Home visits during pregnancy and after birth
for women with an alcohol or drug problem. Cochrane Database of Systematic Re-
views, n. 1, 2012
Webb, Jennifer B.; Siega-Riz, Anna M.; Dole, Nancy. Psychosocial determinants of ad-
equacy of gestational weight gain. Obesity, v. 17, n. 2, p. 300–309, 2009

344
Domain 6. Self-perception Class 2. Self-esteem

Domain 6 • Class 2 • Diagnosis Code 00480

Risk for chronic inadequate self-esteem

References
Akande WA. How Well do You Know Me: Culture and the Self. STA [Internet]. 8
Nov. 2010 [cited 8 May 2019] ;26:131–46. Available from: http://www.journals.vu.lt/
sociologija-mintis-ir-veiksmas/article/view/60990
Akiki, Salwa et al. Determinants of maternal antenatal state-anxiety in mid-pregnancy:
Role of maternal feelings about the pregnancy. Journal of Affective disorders, v. 196,
p. 260–267, 2016
Bandura A. Self-efficacy: The exercise of control. 1st ed. New York, NY: Worth Pub-
lishers; 1997
Biaggi, Alessandra et al. Identifying the women at risk of antenatal anxiety and depres-
sion: a systematic review. Journal of affective disorders, v. 191, p. 62–77, 2016
Castro, N.B. Acurácia dos indicadores clínicos dos diagnósticos de enfermagem baixa
autoestima crônica e baixa autoestima situacional em adultos com humor deprimido
[Master’s dissertation]. Universidade Federal do Ceará. http://www.repositorio.ufc.

6. Self-perception
br/handle/riufc/28970
Castro, N.B., Lopes, M.V.O., & Monteiro, A.R.M. (2020). Low Chronic Self-Esteem
and Low Situational Self-Esteem: a literature review. Revista Brasileira de Enferma-
gem, 73(1), e20180004. Epub February 10, 2020.https://dx.doi.org/10.1590/0034–
7167–2018–0004
Cavalcante Joyce Carolle Bezerra, Sousa Vanessa Emille Carvalho de, Lopes Marcos
Venícios de Oliveira. Baixa autoestima situacional em gestantes: uma análise de
acurácia. Rev. bras. enferm. [Internet]. 2012 Dec [cited 2020 June 28]; 65( 6 ): 977–
983. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034–
71672012000600014&lng=en. https://doi.org/10.1590/S0034–71672012000600014
Chamberlain, Catherine et al. Psychosocial interventions for supporting women to stop
smoking in pregnancy. Cochrane Database of Systematic Reviews, n. 2, 2017
Dávila Ramírez, Fabián Antonio et al. Factores de riesgo psicosocial para embarazo
temprano y deserción escolar en mujeres adolescentes. Revista Ciencias de la Salud,
v. 14, n. 1, p. 93–101, 2016
Doré C. Self esteem: A concept analysis. In Recherche en soins infirmiers. 2017; 129
(2):18–26
Dunkel Schetter, Christine et al. Demographic, medical, and psychosocial predictors of
pregnancy anxiety. Paediatric and perinatal epidemiology, v. 30, n. 5, p. 421–429,
2016
Fejes MAN, et al. Saúde e cotidiano de mulheres em uso abusivo de álcool e outras
drogas. Rev Ter Ocup Univ São Paulo. 2016 set./dez.;27(3):254–62. http://dx.doi.org/
10.11606/issn.2238–6149.v27i3p254–262
Fertig Adriana, Schneider Jacó Fernando, Oliveira Gustavo Costa de, Olschowsky
Agnes, Camatta Marcio Wagner, Pinho Leandro Barbosa de. Mulheres usuárias de
crack: Conhecendo suas histórias de vida. Esc. Anna Nery [Internet]. 2016 June
[cited 2019 May 09]; 20( 2 ): 310–316. Available from: http://www.scielo.br/scielo.
php?script=sci_arttext&pid=S1414–81452016000200310&lng=en. http://dx.doi.org/
10.5935/1414–8145.20160042

345
Domain 6. Self-perception Class 2. Self-esteem

Finfgeld-Connett, D., Bloom, TL e Johnson, ED (2011). Competência Percebida e Res-

olução de Sem-Abrigo Entre Mulheres com Problemas de Abuso de Substâncias.
Pesquisa qualitativa em saúde. 2012; 22 (3), 416–427. doi: 10.1177 /
1049732311421493
Geng L, Jiang T, Han D. Relationships among self-esteem, self-efficacy, and faith in
people in Chinese heroin abusers. Soc Behav Personal an Int J. 2011;39(6):797–806
González-Guarda, Rosa María; Peragallo, Nilda; Lynch, Ami; Nemes, Susanna Drugs,
Women and Violence in the Americas: U.S. Results of a Multi-Centric Pilot Project
(Phase 1) Revista Colombiana de Psiquiatría, vol. 39, 2010, pp. 46 S-65 S Asociación
Colombiana de Psiquiatría Bogotá, D.C., Colombia
Harrison, M. E. et al. Embodied Motherhood: Exploring Body Image in Pregnant and
Parenting Youth. Journal of pediatric and adolescent gynecology, v. 32, n. 1, p. 44–
50, 2019
Heidari, M., Ghodusi, M., Bathaei, S. A., Shakeri, K. (2018). Self-esteem and Locus of
Control in the Initial and Final Stages of Drug Withdrawal Among Addicts Attend-
ing Rehabilitation Centers. Addictive Disorders & Their Treatment, 17(2), 92–97.
doi:10.1097/adt.0000000000000128
Hutz Claudio Simon, Zanon Cristian. Revisão da apadtação, validação e normatização
da escala de autoestima de Rosenberg: Revision of the adaptation, validation, and
6. Self-perception

normatization of the Roserberg self-esteem scale. Aval. psicol. [Internet]. 2011 Abr
[citado 2019 Maio 09]; 10( 1 ): 41–49. Disponível em: http://pepsic.bvsalud.org/scie-
lo.php?script=sci_arttext&pid=S1677–04712011000100005&lng=pt
Kapadia, Mufiza Zia et al. Psychological antecedents of excess gestational weight gain:
a systematic review. BMC Pregnancy & Childbirth, v. 15, n. 1, p. 107, 2015
Knoph Berg, Cecilie et al. Factors associated with binge eating disorder in pregnancy.
International Journal of Eating Disorders, v. 44, n. 2, p. 124–133, 2011
Limberger Jéssica, Andretta Ilana. Desenvolvimento das habilidades sociais na vida de
mulheres usuárias de crack: estudo de casos múltiplos. Temas psicol. [Internet].
2017 Dez [citado 2019 Maio 09]; 25( 4 ): 1709–1724. Disponível em: http://pepsic.
bvsalud.org/scielo.php?script=sci_arttext&pid=S1413–389X2017000400011&lng=pt.
http://dx.doi.org/10.9788/TP2017.4–11Pt
Ludermir, Ana Bernarda; VALONGUEIRO, Sandra; ARAÚJO, Thália Velho Barreto
de. Common mental disorders and intimate partner violence in pregnancy. Revista
de saude publica, v. 48, p. 29–35, 2014
Mukherjee, Soumyadeep et al. Racial/ethnic disparities in antenatal depression in the
United States: A systematic review. Maternal and child health journal, v. 20, n. 9, p.
1780–1797, 2016
Norris, J. (1992). Nursing Intervention for Self-Esteem Disturbances. International
Journal of Nursing Terminologies and Classifications, 3(2), 48–53. doi:10.1111/
j.1744–618x.1992.tb00203.x
Orth U, Robins RW. Understanding the Link Between Low Self-Esteem and Depres-
sion. Curr Dir Psychol Sci [Internet]. 2013;22(6):455–60. Available from: http://jour-
nals.sagepub.com/doi/10.1177/0963721413492763
Phoosuwan, Nitikorn; Eriksson, Leif; Lundberg, Pranee C. Antenatal depressive symp-
toms during late pregnancy among women in a north-eastern province of Thailand:
Prevalence and associated factors. Asian journal of psychiatry, v. 36, p. 102–107,
2018

346
Domain 6. Self-perception Class 2. Self-esteem

Recto, Pamela; Champion, Jane Dimmitt. Psychosocial risk factors for perinatal depres-
sion among female adolescents: A systematic review. Issues in mental health nursing,
v. 38, n. 8, p. 633–642, 2017
Rodríguez Kuri, Solveig Erendira; Córdova Alcaráz, Alberto Javier; Fernández Cáceres,
María del Carmen Estudio comparativo del proceso de inserción social en hombres
y Mujeres usuarios de drogas en rehabilitación Salud y drogas, vol. 15, núm. 1, 2015,
pp. 49–54 Instituto de Investigación de Drogodependencias Alicante, España
Santos, Daianny de Paulaet al. Histórico de violência entre mulheres que fazem uso de
crack no estado de Pernambuco, Brasil. Saúde em Debate [online]. 2018, v. 42, n.
119 [Acessado 9 Maio 2019], pp. 862–875. Disponível em: < https://doi.org/10.1590/
0103–1104201811906 > . ISSN 2358–2898. https://doi.org/10.1590/0103–
1104201811906
Silva Érika Barbosa de Oliveira, Pereira Adriana Lenho de Figueiredo, Penna Lúcia
Helena Garcia. Estereótipos de gênero no cuidado psicossocial das usuárias de co-
caína e crack. Cad. Saúde Pública [Internet]. 2018 [cited 2019 May 09]; 34( 5 ):
e00110317. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&-
pid=S0102–311X2018000505004&lng=en. Epub May 10, 2018. http://dx.doi.org/
10.1590/0102–311 × 00110317
Silva, Ricardo Azevedo da et al. Transtornos mentais comuns e auto-estima na gesta-

6. Self-perception
ção: prevalência e fatores associados. Cadernos de Saúde Pública, v. 26, p. 1832–
1838, 2010
Steinberg, Julia R.; Becker, Davida; Henderson, Jillian T. Does the outcome of a first
pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the
National Comorbidity Survey. American Journal of Orthopsychiatry, v. 81, n. 2, p.
193, 2011
Swamy, Geeta K. et al. Predictors of adverse events among pregnant smokers exposed
in a nicotine replacement therapy trial. American journal of obstetrics and gynecol-
ogy, v. 201, n. 4, p. 354. e1–354. e7, 2009
Turnbull, Catherine; Osborn, David A. Home visits during pregnancy and after birth
for women with an alcohol or drug problem. Cochrane Database of Systematic Re-
views, n. 1, 2012
Webb, Jennifer B.; Siega-Riz, Anna M.; Dole, Nancy. Psychosocial determinants of ad-
equacy of gestational weight gain. Obesity, v. 17, n. 2, p. 300–309, 2009

347
Domain 6. Self-perception Class 2. Self-esteem

Domain 6 • Class 2 • Diagnosis Code 00481

Situational inadequate self-esteem

References
Akande WA. How Well do You Know Me: Culture and the Self. STA [Internet]. 8
Nov. 2010 [cited 8 May 2019] ;26:131–46. Available from: http://www.journals.vu.lt/
sociologija-mintis-ir-veiksmas/article/view/60990
Akiki, Salwa et al. Determinants of maternal antenatal state-anxiety in mid-pregnancy:
Role of maternal feelings about the pregnancy. Journal of Affective disorders, v. 196,
p. 260–267, 2016
Bandura A. Self-efficacy: The exercise of control. 1st ed. New York, NY: Worth Pub-
lishers; 1997
Biaggi, Alessandra et al. Identifying the women at risk of antenatal anxiety and depres-
sion: a systematic review. Journal of affective disorders, v. 191, p. 62–77, 2016
Castro, N.B. Acurácia dos indicadores clínicos dos diagnósticos de enfermagem baixa
autoestima crônica e baixa autoestima situacional em adultos com humor deprimido
[Master’s dissertation]. Universidade Federal do Ceará. http://www.repositorio.ufc.
6. Self-perception

br/handle/riufc/28970
Castro, N.B., Lopes, M.V.O., & Monteiro, A.R.M. (2020). Low Chronic Self-Esteem
and Low Situational Self-Esteem: a literature review. Revista Brasileira de Enferma-
gem, 73(1), e20180004. Epub February 10, 2020.https://dx.doi.org/10.1590/0034–
7167–2018–0004
Cavalcante Joyce Carolle Bezerra, Sousa Vanessa Emille Carvalho de, Lopes Marcos
Venícios de Oliveira. Baixa autoestima situacional em gestantes: uma análise de
acurácia. Rev. bras. enferm. [Internet]. 2012 Dec [cited 2020 June 28]; 65( 6 ): 977–
983. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034–
71672012000600014&lng=en. https://doi.org/10.1590/S0034–71672012000600014
Chamberlain, Catherine et al. Psychosocial interventions for supporting women to stop
smoking in pregnancy. Cochrane Database of Systematic Reviews, n. 2, 2017
Dávila Ramírez, Fabián Antonio et al. Factores de riesgo psicosocial para embarazo
temprano y deserción escolar en mujeres adolescentes. Revista Ciencias de la Salud,
v. 14, n. 1, p. 93–101, 2016
Doré C. Self esteem: A concept analysis. In Recherche en soins infirmiers. 2017; 129
(2):18–26
Dunkel Schetter, Christine et al. Demographic, medical, and psychosocial predictors of
pregnancy anxiety. Paediatric and perinatal epidemiology, v. 30, n. 5, p. 421–429,
2016
Fejes MAN, et al. Saúde e cotidiano de mulheres em uso abusivo de álcool e outras
drogas. Rev Ter Ocup Univ São Paulo. 2016 set./dez.;27(3):254–62. http://dx.doi.org/
10.11606/issn.2238–6149.v27i3p254–262
Fertig Adriana, Schneider Jacó Fernando, Oliveira Gustavo Costa de, Olschowsky
Agnes, Camatta Marcio Wagner, Pinho Leandro Barbosa de. Mulheres usuárias de
crack: Conhecendo suas histórias de vida. Esc. Anna Nery [Internet]. 2016 June
[cited 2019 May 09]; 20( 2 ): 310–316. Available from: http://www.scielo.br/scielo.
php?script=sci_arttext&pid=S1414–81452016000200310&lng=en. http://dx.doi.org/
10.5935/1414–8145.20160042

348
Domain 6. Self-perception Class 2. Self-esteem

Finfgeld-Connett, D., Bloom, TL e Johnson, ED (2011). Competência Percebida e Res-

olução de Sem-Abrigo Entre Mulheres com Problemas de Abuso de Substâncias.
Pesquisa qualitativa em saúde. 2012; 22 (3), 416–427. doi: 10.1177 /
1049732311421493
Geng L, Jiang T, Han D. Relationships among self-esteem, self-efficacy, and faith in
people in Chinese heroin abusers. Soc Behav Personal an Int J. 2011;39(6):797–806
González-Guarda, Rosa María; Peragallo, Nilda; Lynch, Ami; Nemes, Susanna Drugs,
Women and Violence in the Americas: U.S. Results of a Multi-Centric Pilot Project
(Phase 1) Revista Colombiana de Psiquiatría, vol. 39, 2010, pp. 46 S-65 S Asociación
Colombiana de Psiquiatría Bogotá, D.C., Colombia
Harrison, M. E. et al. Embodied Motherhood: Exploring Body Image in Pregnant and
Parenting Youth. Journal of pediatric and adolescent gynecology, v. 32, n. 1, p. 44–
50, 2019
Heidari, M., Ghodusi, M., Bathaei, S. A., Shakeri, K. (2018). Self-esteem and Locus of
Control in the Initial and Final Stages of Drug Withdrawal Among Addicts Attend-
ing Rehabilitation Centers. Addictive Disorders & Their Treatment, 17(2), 92–97.
doi:10.1097/adt.0000000000000128
Hutz Claudio Simon, Zanon Cristian. Revisão da apadtação, validação e normatização
da escala de autoestima de Rosenberg: Revision of the adaptation, validation, and

6. Self-perception
normatization of the Roserberg self-esteem scale. Aval. psicol. [Internet]. 2011 Abr
[citado 2019 Maio 09]; 10( 1 ): 41–49. Disponível em: http://pepsic.bvsalud.org/scie-
lo.php?script=sci_arttext&pid=S1677–04712011000100005&lng=pt
Kapadia, Mufiza Zia et al. Psychological antecedents of excess gestational weight gain:
a systematic review. BMC Pregnancy & Childbirth, v. 15, n. 1, p. 107, 2015
Knoph Berg, Cecilie et al. Factors associated with binge eating disorder in pregnancy.
International Journal of Eating Disorders, v. 44, n. 2, p. 124–133, 2011
Limberger Jéssica, Andretta Ilana. Desenvolvimento das habilidades sociais na vida de
mulheres usuárias de crack: estudo de casos múltiplos. Temas psicol. [Internet].
2017 Dez [citado 2019 Maio 09]; 25( 4 ): 1709–1724. Disponível em: http://pepsic.
bvsalud.org/scielo.php?script=sci_arttext&pid=S1413–389X2017000400011&lng=pt.
http://dx.doi.org/10.9788/TP2017.4–11Pt
Ludermir, Ana Bernarda; Valongueiro, Sandra; ARAÚJO, Thália Velho Barreto de.
Common mental disorders and intimate partner violence in pregnancy. Revista de
saude publica, v. 48, p. 29–35, 2014
Mukherjee, Soumyadeep et al. Racial/ethnic disparities in antenatal depression in the
United States: A systematic review. Maternal and child health journal, v. 20, n. 9, p.
1780–1797, 2016
Norris, J. (1992). Nursing Intervention for Self-Esteem Disturbances. International
Journal of Nursing Terminologies and Classifications, 3(2), 48–53. doi:10.1111/
j.1744–618x.1992.tb00203.x
Orth U, Robins RW. Understanding the Link Between Low Self-Esteem and Depres-
sion. Curr Dir Psychol Sci [Internet]. 2013;22(6):455–60. Available from: http://jour-
nals.sagepub.com/doi/10.1177/0963721413492763
Phoosuwan, Nitikorn; Eriksson, Leif; Lundberg, Pranee C. Antenatal depressive symp-
toms during late pregnancy among women in a north-eastern province of Thailand:
Prevalence and associated factors. Asian journal of psychiatry, v. 36, p. 102–107,
2018

349
Domain 6. Self-perception Class 2. Self-esteem

Recto, Pamela; Champion, Jane Dimmitt. Psychosocial risk factors for perinatal depres-
sion among female adolescents: A systematic review. Issues in mental health nursing,
v. 38, n. 8, p. 633–642, 2017
Rodríguez Kuri, Solveig Erendira; Córdova Alcaráz, Alberto Javier; Fernández Cáceres,
María del Carmen Estudio comparativo del proceso de inserción social en hombres
y Mujeres usuarios de drogas en rehabilitación Salud y drogas, vol. 15, núm. 1, 2015,
pp. 49–54 Instituto de Investigación de Drogodependencias Alicante, España
Santos, Daianny de Paulaet al. Histórico de violência entre mulheres que fazem uso de
crack no estado de Pernambuco, Brasil. Saúde em Debate [online]. 2018, v. 42, n.
119 [Acessado 9 Maio 2019], pp. 862–875. Disponível em: < https://doi.org/10.1590/
0103–1104201811906 > . ISSN 2358–2898. https://doi.org/10.1590/0103–
1104201811906
Silva Érika Barbosa de Oliveira, Pereira Adriana Lenho de Figueiredo, Penna Lúcia
Helena Garcia. Estereótipos de gênero no cuidado psicossocial das usuárias de co-
caína e crack. Cad. Saúde Pública [Internet]. 2018 [cited 2019 May 09]; 34( 5 ):
e00110317. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&-
pid=S0102–311X2018000505004&lng=en. Epub May 10, 2018. http://dx.doi.org/
10.1590/0102–311 × 00110317
Silva, Ricardo Azevedo da et al. Transtornos mentais comuns e auto-estima na gesta-
6. Self-perception

ção: prevalência e fatores associados. Cadernos de Saúde Pública, v. 26, p. 1832–

1838, 2010
Steinberg, Julia R.; Becker, Davida; Henderson, Jillian T. Does the outcome of a first
pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the
National Comorbidity Survey. American Journal of Orthopsychiatry, v. 81, n. 2, p.
193, 2011
Swamy, Geeta K. et al. Predictors of adverse events among pregnant smokers exposed
in a nicotine replacement therapy trial. American journal of obstetrics and gynecol-
ogy, v. 201, n. 4, p. 354. e1–354. e7, 2009
Turnbull, Catherine; Osborn, David A. Home visits during pregnancy and after birth
for women with an alcohol or drug problem. Cochrane Database of Systematic Re-
views, n. 1, 2012
Webb, Jennifer B.; Siega-Riz, Anna M.; Dole, Nancy. Psychosocial determinants of ad-
equacy of gestational weight gain. Obesity, v. 17, n. 2, p. 300–309, 2009

350
Domain 6. Self-perception Class 2. Self-esteem

Domain 6 • Class 2 • Diagnosis Code 00482

Risk for situational inadequate self-esteem

References
Akande WA. How Well do You Know Me: Culture and the Self. STA [Internet]. 8
Nov. 2010 [cited 8 May 2019] ;26:131–46. Available from: http://www.journals.vu.lt/
sociologija-mintis-ir-veiksmas/article/view/60990
Akiki, Salwa et al. Determinants of maternal antenatal state-anxiety in mid-pregnancy:
Role of maternal feelings about the pregnancy. Journal of Affective disorders, v. 196,
p. 260–267, 2016
Bandura A. Self-efficacy: The exercise of control. 1st ed. New York, NY: Worth Pub-
lishers; 1997
Biaggi, Alessandra et al. Identifying the women at risk of antenatal anxiety and depres-
sion: a systematic review. Journal of affective disorders, v. 191, p. 62–77, 2016
Castro, N.B. Acurácia dos indicadores clínicos dos diagnósticos de enfermagem baixa
autoestima crônica e baixa autoestima situacional em adultos com humor deprimido
[Master’s dissertation]. Universidade Federal do Ceará. http://www.repositorio.ufc.

6. Self-perception
br/handle/riufc/28970
Castro, N.B., Lopes, M.V.O., & Monteiro, A.R.M. (2020). Low Chronic Self-Esteem
and Low Situational Self-Esteem: a literature review. Revista Brasileira de Enferma-
gem, 73(1), e20180004. Epub February 10, 2020.https://dx.doi.org/10.1590/0034–
7167–2018–0004
Cavalcante Joyce Carolle Bezerra, Sousa Vanessa Emille Carvalho de, Lopes Marcos
Venícios de Oliveira. Baixa autoestima situacional em gestantes: uma análise de
acurácia. Rev. bras. enferm. [Internet]. 2012 Dec [cited 2020 June 28]; 65( 6 ): 977–
983. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034–
71672012000600014&lng=en. https://doi.org/10.1590/S0034–71672012000600014
Chamberlain, Catherine et al. Psychosocial interventions for supporting women to stop
smoking in pregnancy. Cochrane Database of Systematic Reviews, n. 2, 2017
Dávila Ramírez, Fabián Antonio et al. Factores de riesgo psicosocial para embarazo
temprano y deserción escolar en mujeres adolescentes. Revista Ciencias de la Salud,
v. 14, n. 1, p. 93–101, 2016
Doré C. Self esteem: A concept analysis. In Recherche en soins infirmiers. 2017; 129
(2):18–26
Dunkel Schetter, Christine et al. Demographic, medical, and psychosocial predictors of
pregnancy anxiety. Paediatric and perinatal epidemiology, v. 30, n. 5, p. 421–429,
2016
Fejes MAN, et al. Saúde e cotidiano de mulheres em uso abusivo de álcool e outras
drogas. Rev Ter Ocup Univ São Paulo. 2016 set./dez.;27(3):254–62. http://dx.doi.org/
10.11606/issn.2238–6149.v27i3p254–262
Fertig Adriana, Schneider Jacó Fernando, Oliveira Gustavo Costa de, Olschowsky
Agnes, Camatta Marcio Wagner, Pinho Leandro Barbosa de. Mulheres usuárias de
crack: Conhecendo suas histórias de vida. Esc. Anna Nery [Internet]. 2016 June
[cited 2019 May 09]; 20( 2 ): 310–316. Available from: http://www.scielo.br/scielo.
php?script=sci_arttext&pid=S1414–81452016000200310&lng=en. http://dx.doi.org/
10.5935/1414–8145.20160042

351
Domain 6. Self-perception Class 2. Self-esteem

Finfgeld-Connett, D., Bloom, TL e Johnson, ED (2011). Competência Percebida e Res-

olução de Sem-Abrigo Entre Mulheres com Problemas de Abuso de Substâncias.
Pesquisa qualitativa em saúde. 2012; 22 (3), 416–427. doi: 10.1177 /
1049732311421493
Geng L, Jiang T, Han D. Relationships among self-esteem, self-efficacy, and faith in
people in Chinese heroin abusers. Soc Behav Personal an Int J. 2011;39(6):797–806
González-Guarda, Rosa María; Peragallo, Nilda; Lynch, Ami; Nemes, Susanna Drugs,
Women and Violence in the Americas: U.S. Results of a Multi-Centric Pilot Project
(Phase 1) Revista Colombiana de Psiquiatría, vol. 39, 2010, pp. 46 S-65 S Asociación
Colombiana de Psiquiatría Bogotá, D.C., Colombia
Harrison, M. E. et al. Embodied Motherhood: Exploring Body Image in Pregnant and
Parenting Youth. Journal of pediatric and adolescent gynecology, v. 32, n. 1, p. 44–
50, 2019
Heidari, M., Ghodusi, M., Bathaei, S. A., Shakeri, K. (2018). Self-esteem and Locus of
Control in the Initial and Final Stages of Drug Withdrawal Among Addicts Attend-
ing Rehabilitation Centers. Addictive Disorders & Their Treatment, 17(2), 92–97.
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Domain 6 • Class 2 • Diagnosis Code 00338

Inadequate health self-efficacy

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Domain 6 • Class 3 • Diagnosis Code 00497

Disrupted body image

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357
Domain 7.
Role relationship

Class 1. Caregiving roles

Code Diagnosis Page

00436 Impaired parenting behaviors 361
00437 Risk for impaired parenting behaviors 366
00438 Readiness for enhanced parenting behaviors 371
00387 Excessive parental role conflict 374

Class 2. Family relationships

Code Diagnosis Page

00389 Disrupted family interaction patterns 376
00440 Risk for disrupted family interaction patterns 377
00388 Impaired family processes 378
00159 Readiness for enhanced family processes 379
00439 Risk for disrupted attachment behaviors 380

Class 3. Role performance

Code Diagnosis Page

00055 Ineffective role performance 381
00449 Ineffective intimate partner relationship 382
00445 Risk for ineffective intimate partner relationship 383
00446 Readiness for enhanced intimate partner relationship 384
00052 Impaired social interaction 385
00221 Ineffective childbearing process 387
00227 Risk for ineffective childbearing process 388

359
Domain 7. Role relationship

00208 Readiness for enhanced childbearing process 389

360
Domain 7. Role relationship Class 1. Caregiving roles

Domain 7 • Class 1 • Diagnosis Code 00436

Impaired parenting behaviors

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(8), 2712
7. Role relationship

Reinhardt Andrade, F., Capelas, M., Charepe, Z., & Deodato, S. (2020). Experiences of
Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative
Evidence. International Journal of Environmental Research and Public Health, 17
(8), 2712
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequen-
ces of maternal postpartum depression: A systematic review of maternal and infant
outcomes. Women’s Health. https://doi.org/10.1177/1745506519844044
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequen-
ces of maternal postpartum depression: A systematic review of maternal and infant
outcomes. Women’s Health. https://doi.org/10.1177/1745506519844044
Tabak, I., Zabłocka-Żytka, L., Ryan, P., Poma, S., Joronen, K., Viganò, G.,. .. Dawson, I.
(2016). Needs, expectations and consequences for children growing up in a family
where the parent has a mental illness. International Journal of Mental Health Nurs-
ing, 25(4), 319–329
Tabak, I., Zabłocka-Żytka, L., Ryan, P., Poma, S., Joronen, K., Viganò, G.,. .. Dawson, I.
(2016). Needs, expectations and consequences for children growing up in a family
where the parent has a mental illness. International Journal of Mental Health Nurs-
ing, 25(4), 319–329
Van Wert, M., Anreiter, I., Fallon, B., & Sokolowski, M. (2019). Intergenerational
Transmission of Child Abuse and Neglect: A Transdisciplinary Analysis. Gender
and the Genome, 3, Gender and the Genome, 19 February 2019, Vol.3
Van Wert, M., Anreiter, I., Fallon, B., & Sokolowski, M. (2019). Intergenerational
Transmission of Child Abuse and Neglect: A Transdisciplinary Analysis. Gender
and the Genome, 3, Gender and the Genome, 19 February 2019, Vol.3
Vreeland, A., Gruhn, M. A., Watson, K. H., Bettis, A. H., Compas, B. E., Forehand, R.,
& Sullivan, A. D. (2019). Parenting in context: associations of parental depression

364
Domain 7. Role relationship Class 1. Caregiving roles

and socioeconomic factors with parenting behaviors. Journal of Child and Family
Studies, 28(4), 1124–1133
Walsh, T. B., Dayton, C. J., Erwin, M. S., Muzik, M., Busuito, A., & Rosenblum, K. L.
(2014). Fathering after military deployment: Parenting challenges and goals of fa-
thers of young children. Health & Social Work, 39(1), 35–44. – Grounded theory
study Readiness for enhanced parenting

7. Role relationship

365
Domain 7. Role relationship Class 1. Caregiving roles

Domain 7 • Class 1 • Diagnosis Code 00437

Risk for impaired parenting behaviors

References
Baca, A., Barnett, M., Ellis, A., Jordan, T., & Tilley, C. (2015). Associations Among
Child Perceptions of Parenting Support, Maternal Parenting Efficacy and Maternal
Depressive Symptoms. Child & Youth Care Forum, 44(1), 17–32
Barnett, M., Baca, A., Jordan, T., Tilley, C., & Ellis, A. (2015). Associations Among
Child Perceptions of Parenting Support, Maternal Parenting Efficacy and Maternal
Depressive Symptoms. Child & Youth Care Forum, 44(1), 17–32
Bartlett, J. D., Guzman, L., & Ramos-Olazagasti, M. A. (2018). Parenting knowledge
among first-time parents of young children (No. 28). Issue Brief. (2 studies, sum-
marized – one was systematic review, one was focus group with parents). Readiness
for enhanced parenting
Beers, L. A. S., & Hollo, R. E. (2009). Approaching the adolescent-headed family: A re-
view of teen parenting. Current problems in pediatric and adolescent health care, 39
(9), 216–233. – Article review showing teen fathers desire to improve parenting
skills, to be good fathers, etc. Readiness for enhanced parenting
Berg-Nielsen, T. S., Dahl, A. A., & Vikan, A. (2003). Specific parenting problems when
adolescents have emotional and behavioural disorders. Nordic journal of psychiatry,
7. Role relationship

57(2), 139–146. https://doi.org/10.1080/08039480310000978

Berg-Nielsen, T. S., Vikan, A., & Dahl, A. A. (2003). Specific parenting problems when
adolescents have emotional and behavioural disorders. Nordic journal of psychiatry,
57(2), 139–146. https://doi.org/10.1080/08039480310000978
Burstein, M., Ginsburg, G., & Tein, J. (2010). Parental Anxiety and Child Symptoma-
tology: An Examination of Additive and Interactive Effects of Parent Psychopathol-
ogy. Journal of Abnormal Child Psychology, 38(7), 897–909
Burstein, M., Ginsburg, G., & Tein, J. (2010). Parental Anxiety and Child Symptoma-
tology: An Examination of Additive and Interactive Effects of Parent Psychopathol-
ogy. Journal of Abnormal Child Psychology, 38(7), 897–909
Dougherty, L., Rose, S., Smith, V., & Tolep, M. (2013). Early Exposure to Parental De-
pression and Parenting: Associations with Young Offspring's Stress Physiology and
Oppositional Behavior. Journal of Abnormal Child Psychology, 41(8), 1299–310
Dougherty, L., Tolep, M., Smith, V., & Rose, S. (2013). Early Exposure to Parental De-
pression and Parenting: Associations with Young Offspring's Stress Physiology and
Oppositional Behavior. Journal of Abnormal Child Psychology, 41(8), 1299–310
Dunn, E. (2019). Smartphones distract parents from cultivating feelings of connection
when spending time with their children. Journal of Social and Personal Relation-
ships, 36(6), 1619–1639
Dunn, E. (2019). Smartphones distract parents from cultivating feelings of connection
when spending time with their children. Journal of Social and Personal Relation-
ships, 36(6), 1619–1639
Fuemmeler, B., Behrman, P., Taylor, M., Sokol, R., Rothman, E., Jacobson, L., & Wi-
schenka, D. (2017). Child and family health in the era of prevention: New opportu-
nities and challenges. Journal of Behavioral Medicine, 40(1), 159

366
Domain 7. Role relationship Class 1. Caregiving roles

Fuemmeler, B., Behrman, P., Taylor, M., Sokol, R., Rothman, E., Jacobson, L., & Wi-
schenka, D. (2017). Child and family health in the era of prevention: New opportu-
nities and challenges. Journal of Behavioral Medicine, 40(1), 159
Gewirtz, A. H., Erbes, C. R., Polusny, M. A., Forgatch, M. S., & DeGarmo, D. S. (2011).
Helping military families through the deployment process: strategies to support pa-
renting. Professional psychology: Research and practice, 42(1), 56. Readiness for en-
hanced parenting
Gray, P. H., Edwards, D. M., & Gibbons, K. (2018). Parenting stress trajectories in
mothers of very preterm infants to 2 years. Archives of Disease in Childhood-Fetal
and Neonatal Edition, 103(1), F43-F48
Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., &
Fearon, R. P. (2012). The significance of insecure and disorganized attachment for
children’s internalizing symptoms: A meta-analytic study. Child development, 83(2),
591–610
Gruhn, M. A., Dunbar, J. P., Watson, K. H., Reising, M. M., McKee, L., Forehand, R., ...
& Compas, B. E. (2016). Testing specificity among parents’ depressive symptoms,
parenting, and child internalizing and externalizing symptoms. Journal of Family
Psychology, 30(3), 309
Hu, X., Li, Y., Situ, M., Guo, K., Yang, P., Zhang, M., & Huang, Y. (2018). Parents’
impaired emotion recognition abilities are related to children’s autistic symptoms in
autism spectrum disorder. Neuropsychiatric Disease and Treatment, 14, 2973–2980
Hu, X., Li, Y., Situ, M., Guo, K., Yang, P., Zhang, M., & Huang, Y. (2018). Parents’

7. Role relationship
impaired emotion recognition abilities are related to children’s autistic symptoms in
autism spectrum disorder. Neuropsychiatric Disease and Treatment, 14, 2973–2980
Janßen, M., Holodynski, M., Müller, J., Reinersmann, A., & Romer, G. (2019). Im-
paired predictability: Enhanced fluctuations in the parenting behaviour of mothers
of pre-school children with clinical diagnoses across three different play tasks. Euro-
pean Child & Adolescent Psychiatry, 28(12), 1645–1658
Janßen, M., Holodynski, M., Müller, J., Reinersmann, A., & Romer, G. (2019). Im-
paired predictability: Enhanced fluctuations in the parenting behaviour of mothers
of pre-school children with clinical diagnoses across three different play tasks. Euro-
pean Child & Adolescent Psychiatry, 28(12), 1645–1658
Kerstis, Aarts, Tillman, Persson, Engström, Edlund, & Skalkidou. (2016). Association
between parental depressive symptoms and impaired bonding with the infant. Ar-
chives of Women's Mental Health, 19(1), 87–94
Kerstis, Aarts, Tillman, Persson, Engström, Edlund,. .. Skalkidou. (2016). Association
between parental depressive symptoms and impaired bonding with the infant. Ar-
chives of Women's Mental Health, 19(1), 87–94
Kim, Ah. Rim, Kim, Soo-yeon, & Yun, Ji Eun. (2020). Attachment and relationship-
based interventions for families during neonatal intensive care hospitalization: A
study protocol for a systematic review and meta-analysis. Systematic Reviews, 9, Sys-
tematic Reviews, 2020, Vol.9
Kim, Ah. Rim, Kim, Soo-yeon, & Yun, Ji Eun. (2020). Attachment and relationship-
based interventions for families during neonatal intensive care hospitalization: A
study protocol for a systematic review and meta-analysis. Systematic Reviews, 9, Sys-
tematic Reviews, 2020, Vol.9
Kushlev, K., & Dunn, E. W. (2019). Smartphones distract parents from cultivating feel-
ings of connection when spending time with their children. Journal of Social and

367
Domain 7. Role relationship Class 1. Caregiving roles

Personal Relationships, 36(6), 1619–1639. https://doi.org/10.1177/

0265407518769387
Kushlev, K., & Dunn, E. W. (2019). Smartphones distract parents from cultivating feel-
ings of connection when spending time with their children. Journal of Social and
Personal Relationships, 36(6), 1619–1639. https://doi.org/10.1177/
0265407518769387
Martel, M. M., Levinson, C. A., Lee, C. A., & Smith, T. E. (2017). Impulsivity Symp-
toms as Core to the Developmental Externalizing Spectrum. Journal of abnormal
child psychology, 45(1), 83–90. https://doi.org/10.1007/s10802–016–0148–6
Mirick, R. G., & Steenrod, S. A. (2016). Opioid use disorder, attachment, and parent-
ing: Key concerns for practitioners. Child and adolescent social work journal, 33(6),
547–557
Nath, S., Russell, G., Ford, T., Kuyken, W., & Psychogiou, L. (2015). Postnatal paternal
depressive symptoms associated with fathers' subsequent parenting: Findings from
the Millennium Cohort Study. British Journal of Psychiatry, 207(6), 558–559.
doi:10.1192/bjp.bp.114.148379
Nath, S., Russell, G., Ford, T., Kuyken, W., & Psychogiou, L. (2015). Postnatal paternal
depressive symptoms associated with fathers' subsequent parenting: Findings from
the Millennium Cohort Study. British Journal of Psychiatry, 207(6), 558–559.
doi:10.1192/bjp.bp.114.148379
Ng-Knight, T., Shelton, K. H., Frederickson, N., McManus, I. C., & Rice, F. (2018). Ma-
ternal depressive symptoms and adolescent academic attainment: Testing pathways
7. Role relationship

via parenting and self-control. Journal of adolescence, 62, 61–69. https://doi.org/

10.1016/j.adolescence.2017.11.003
Ng-Knight, T., Shelton, K. H., Frederickson, N., McManus, I. C., & Rice, F. (2018). Ma-
ternal depressive symptoms and adolescent academic attainment: Testing pathways
via parenting and self-control. Journal of adolescence, 62, 61–69. https://doi.org/
10.1016/j.adolescence.2017.11.003
Orozco-Vargas, Luis Carlos, & Villamizar-Carvajal, Beatriz, & Vargas-Porras, Carolina
(2015). Impaired Parenting (00056) in Primiparous Mothers: Clinical Validation
through Rasch Analysis. Aquichan, 15(2),176–187.[fecha de Consulta 25 de Mayo de
2020]. ISSN: 1657–5997. Disponible en: https://www.redalyc.org/articulo.oa?id=741/
74140060002
Orozco-Vargas, Luis Carlos, & Villamizar-Carvajal, Beatriz, & Vargas-Porras, Carolina
(2015). Impaired Parenting (00056) in Primiparous Mothers: Clinical Validation
through Rasch Analysis. Aquichan, 15(2),176–187.[fecha de Consulta 25 de Mayo de
2020]. ISSN: 1657–5997. Disponible en: https://www.redalyc.org/articulo.oa?id=741/
74140060002
Parent, J., Forehand, R., Dunbar, J., Watson, K., Reising, M., Seehuus, M., & Compas,
B. (2014). Parent and Adolescent Reports of Parenting When a Parent Has a History
of Depression: Associations with Observations of Parenting. Journal of Abnormal
Child Psychology, 42(2), 173–83
Parent, J., Forehand, R., Dunbar, J., Watson, K., Reising, M., Seehuus, M., & Compas,
B. (2014). Parent and Adolescent Reports of Parenting When a Parent Has a History
of Depression: Associations with Observations of Parenting. Journal of Abnormal
Child Psychology, 42(2), 173–83
Perreira, K. M., Chapman, M. V., & Stein, G. L. (2006). Becoming an American parent:
Overcoming challenges and finding strength in a new immigrant Latino community.

368
Domain 7. Role relationship Class 1. Caregiving roles

Journal of Family Issues, 27(10), 1383–1414. – Qualitative design to understand pa-

renting desires Readiness for enhanced parenting
Pignotti, M, & Donzelli, G. (2015). Preterm babies at a glance. Journal of Clinical Neo-
natology, 4(2), 75
Pignotti, M, & Donzelli, G. (2015). Preterm babies at a glance. Journal of Clinical Neo-
natology, 4(2), 75
Pisinger, V., Bloomfield, K., & Tolstrup, J. (2016). Perceived parental alcohol problems,
internalizing problems and impaired parent-child relationships among 71988 young
people in Denmark. Addiction, 111(11), 1966–1974
Pisinger, V., Bloomfield, K., & Tolstrup, J. (2016). Perceived parental alcohol problems,
internalizing problems and impaired parent–child relationships among 71988 young
people in Denmark. Addiction, 111(11), 1966–1974
Reeb, B., Conger, K., & Martin, M. (2013). Perceived Economic Strain Exacerbates the
Effect of Paternal Depressed Mood on Hostility. Journal of Family Psychology, 27
(2), 263–270
Reeb, B., Conger, K., & Martin, M. (2013). Perceived Economic Strain Exacerbates the
Effect of Paternal Depressed Mood on Hostility. Journal of Family Psychology, 27
(2), 263–270
Reinhardt Andrade, F., Capelas, M., Charepe, Z., & Deodato, S. (2020). Experiences of
Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative
Evidence. International Journal of Environmental Research and Public Health, 17
(8), 2712

7. Role relationship
Reinhardt Andrade, F., Capelas, M., Charepe, Z., & Deodato, S. (2020). Experiences of
Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative
Evidence. International Journal of Environmental Research and Public Health, 17
(8), 2712
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequen-
ces of maternal postpartum depression: A systematic review of maternal and infant
outcomes. Women’s Health. https://doi.org/10.1177/1745506519844044
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequen-
ces of maternal postpartum depression: A systematic review of maternal and infant
outcomes. Women’s Health. https://doi.org/10.1177/1745506519844044
Tabak, I., Zabłocka-Żytka, L., Ryan, P., Poma, S., Joronen, K., Viganò, G.,. .. Dawson, I.
(2016). Needs, expectations and consequences for children growing up in a family
where the parent has a mental illness. International Journal of Mental Health Nurs-
ing, 25(4), 319–329
Tabak, I., Zabłocka-Żytka, L., Ryan, P., Poma, S., Joronen, K., Viganò, G.,. .. Dawson, I.
(2016). Needs, expectations and consequences for children growing up in a family
where the parent has a mental illness. International Journal of Mental Health Nurs-
ing, 25(4), 319–329
Van Wert, M., Anreiter, I., Fallon, B., & Sokolowski, M. (2019). Intergenerational
Transmission of Child Abuse and Neglect: A Transdisciplinary Analysis. Gender
and the Genome, 3, Gender and the Genome, 19 February 2019, Vol.3
Van Wert, M., Anreiter, I., Fallon, B., & Sokolowski, M. (2019). Intergenerational
Transmission of Child Abuse and Neglect: A Transdisciplinary Analysis. Gender
and the Genome, 3, Gender and the Genome, 19 February 2019, Vol.3
Vreeland, A., Gruhn, M. A., Watson, K. H., Bettis, A. H., Compas, B. E., Forehand, R.,
& Sullivan, A. D. (2019). Parenting in context: associations of parental depression

369
Domain 7. Role relationship Class 1. Caregiving roles

and socioeconomic factors with parenting behaviors. Journal of Child and Family
Studies, 28(4), 1124–1133
Walsh, T. B., Dayton, C. J., Erwin, M. S., Muzik, M., Busuito, A., & Rosenblum, K. L.
(2014). Fathering after military deployment: Parenting challenges and goals of fa-
thers of young children. Health & Social Work, 39(1), 35–44. – Grounded theory
study Readiness for enhanced parenting
7. Role relationship

370
Domain 7. Role relationship Class 1. Caregiving roles

Domain 7 • Class 1 • Diagnosis Code 00438

Readiness for enhanced parenting behaviors

References
Barnett, M., Baca, A., Jordan, T., Tilley, C., & Ellis, A. (2015). Associations Among
Child Perceptions of Parenting Support, Maternal Parenting Efficacy and Maternal
Depressive Symptoms. Child & Youth Care Forum, 44(1), 17–32
Bartlett, J. D., Guzman, L., & Ramos-Olazagasti, M. A. (2018). Parenting knowledge
among first-time parents of young children (No. 28). Issue Brief. (2 studies, sum-
marized – one was systematic review, one was focus group with parents). Readiness
for enhanced parenting
Beers, L. A. S., & Hollo, R. E. (2009). Approaching the adolescent-headed family: A re-
view of teen parenting. Current problems in pediatric and adolescent health care, 39
(9), 216–233. – Article review showing teen fathers desire to improve parenting
skills, to be good fathers, etc. Readiness for enhanced parenting
Berg-Nielsen, T. S., Vikan, A., & Dahl, A. A. (2003). Specific parenting problems when
adolescents have emotional and behavioural disorders. Nordic journal of psychiatry,
57(2), 139–146. https://doi.org/10.1080/08039480310000978
Burstein, M., Ginsburg, G., & Tein, J. (2010). Parental Anxiety and Child Symptoma-
tology: An Examination of Additive and Interactive Effects of Parent Psychopathol-

7. Role relationship
ogy. Journal of Abnormal Child Psychology, 38(7), 897–909
Dougherty, L., Tolep, M., Smith, V., & Rose, S. (2013). Early Exposure to Parental De-
pression and Parenting: Associations with Young Offspring's Stress Physiology and
Oppositional Behavior. Journal of Abnormal Child Psychology, 41(8), 1299–310
Dunn, E. (2019). Smartphones distract parents from cultivating feelings of connection
when spending time with their children. Journal of Social and Personal Relation-
ships, 36(6), 1619–1639
Fuemmeler, B., Behrman, P., Taylor, M., Sokol, R., Rothman, E., Jacobson, L., & Wi-
schenka, D. (2017). Child and family health in the era of prevention: New opportu-
nities and challenges. Journal of Behavioral Medicine, 40(1), 159
Gewirtz, A. H., Erbes, C. R., Polusny, M. A., Forgatch, M. S., & DeGarmo, D. S. (2011).
Helping military families through the deployment process: strategies to support pa-
renting. Professional psychology: Research and practice, 42(1), 56. Readiness for en-
hanced parenting
Gray, P. H., Edwards, D. M., & Gibbons, K. (2018). Parenting stress trajectories in
mothers of very preterm infants to 2 years. Archives of Disease in Childhood-Fetal
and Neonatal Edition, 103(1), F43-F48
Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., &
Fearon, R. P. (2012). The significance of insecure and disorganized attachment for
children’s internalizing symptoms: A meta-analytic study. Child development, 83(2),
591–610
Gruhn, M. A., Dunbar, J. P., Watson, K. H., Reising, M. M., McKee, L., Forehand, R., ...
& Compas, B. E. (2016). Testing specificity among parents’ depressive symptoms,
parenting, and child internalizing and externalizing symptoms. Journal of Family
Psychology, 30(3), 309

371
Domain 7. Role relationship Class 1. Caregiving roles

Hu, X., Li, Y., Situ, M., Guo, K., Yang, P., Zhang, M., & Huang, Y. (2018). Parents’
impaired emotion recognition abilities are related to children’s autistic symptoms in
autism spectrum disorder. Neuropsychiatric Disease and Treatment, 14, 2973–2980
Janßen, M., Holodynski, M., Müller, J., Reinersmann, A., & Romer, G. (2019). Im-
paired predictability: Enhanced fluctuations in the parenting behaviour of mothers
of pre-school children with clinical diagnoses across three different play tasks. Euro-
pean Child & Adolescent Psychiatry, 28(12), 1645–1658
Kerstis, Aarts, Tillman, Persson, Engström, Edlund,. .. Skalkidou. (2016). Association
between parental depressive symptoms and impaired bonding with the infant. Ar-
chives of Women's Mental Health, 19(1), 87–94
Kim, Ah. Rim, Kim, Soo-yeon, & Yun, Ji Eun. (2020). Attachment and relationship-
based interventions for families during neonatal intensive care hospitalization: A
study protocol for a systematic review and meta-analysis. Systematic Reviews, 9, Sys-
tematic Reviews, 2020, Vol.9
Kushlev, K., & Dunn, E. W. (2019). Smartphones distract parents from cultivating feel-
ings of connection when spending time with their children. Journal of Social and
Personal Relationships, 36(6), 1619–1639. https://doi.org/10.1177/
0265407518769387
Martel, M. M., Levinson, C. A., Lee, C. A., & Smith, T. E. (2017). Impulsivity Symp-
toms as Core to the Developmental Externalizing Spectrum. Journal of abnormal
child psychology, 45(1), 83–90. https://doi.org/10.1007/s10802–016–0148–6
Mirick, R. G., & Steenrod, S. A. (2016). Opioid use disorder, attachment, and parent-
7. Role relationship

ing: Key concerns for practitioners. Child and adolescent social work journal, 33(6),
547–557
Nath, S., Russell, G., Ford, T., Kuyken, W., & Psychogiou, L. (2015). Postnatal paternal
depressive symptoms associated with fathers' subsequent parenting: Findings from
the Millennium Cohort Study. British Journal of Psychiatry, 207(6), 558–559.
doi:10.1192/bjp.bp.114.148379
Ng-Knight, T., Shelton, K. H., Frederickson, N., McManus, I. C., & Rice, F. (2018). Ma-
ternal depressive symptoms and adolescent academic attainment: Testing pathways
via parenting and self-control. Journal of adolescence, 62, 61–69. https://doi.org/
10.1016/j.adolescence.2017.11.003
Orozco-Vargas, Luis Carlos, & Villamizar-Carvajal, Beatriz, & Vargas-Porras, Carolina
(2015). Impaired Parenting (00056) in Primiparous Mothers: Clinical Validation
through Rasch Analysis. Aquichan, 15(2),176–187.[fecha de Consulta 25 de Mayo de
2020]. ISSN: 1657–5997. Disponible en: https://www.redalyc.org/articulo.oa?id=741/
74140060002
Parent, J., Forehand, R., Dunbar, J., Watson, K., Reising, M., Seehuus, M., & Compas,
B. (2014). Parent and Adolescent Reports of Parenting When a Parent Has a History
of Depression: Associations with Observations of Parenting. Journal of Abnormal
Child Psychology, 42(2), 173–83
Perreira, K. M., Chapman, M. V., & Stein, G. L. (2006). Becoming an American parent:
Overcoming challenges and finding strength in a new immigrant Latino community.
Journal of Family Issues, 27(10), 1383–1414. – Qualitative design to understand pa-
renting desires Readiness for enhanced parenting
Pignotti, M, & Donzelli, G. (2015). Preterm babies at a glance. Journal of Clinical Neo-
natology, 4(2), 75

372
Domain 7. Role relationship Class 1. Caregiving roles

Pisinger, V., Bloomfield, K., & Tolstrup, J. (2016). Perceived parental alcohol problems,
internalizing problems and impaired parent–child relationships among 71988 young
people in Denmark. Addiction, 111(11), 1966–1974
Reeb, B., Conger, K., & Martin, M. (2013). Perceived Economic Strain Exacerbates the
Effect of Paternal Depressed Mood on Hostility. Journal of Family Psychology, 27
(2), 263–270
Reinhardt Andrade, F., Capelas, M., Charepe, Z., & Deodato, S. (2020). Experiences of
Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative
Evidence. International Journal of Environmental Research and Public Health, 17
(8), 2712
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequen-
ces of maternal postpartum depression: A systematic review of maternal and infant
outcomes. Women’s Health. https://doi.org/10.1177/1745506519844044
Tabak, I., Zabłocka-Żytka, L., Ryan, P., Poma, S., Joronen, K., Viganò, G.,. .. Dawson, I.
(2016). Needs, expectations and consequences for children growing up in a family
where the parent has a mental illness. International Journal of Mental Health Nurs-
ing, 25(4), 319–329
Van Wert, M., Anreiter, I., Fallon, B., & Sokolowski, M. (2019). Intergenerational
Transmission of Child Abuse and Neglect: A Transdisciplinary Analysis. Gender
and the Genome, 3, Gender and the Genome, 19 February 2019, Vol.3
Vreeland, A., Gruhn, M. A., Watson, K. H., Bettis, A. H., Compas, B. E., Forehand, R.,
& Sullivan, A. D. (2019). Parenting in context: associations of parental depression

7. Role relationship
and socioeconomic factors with parenting behaviors. Journal of Child and Family
Studies, 28(4), 1124–1133
Walsh, T. B., Dayton, C. J., Erwin, M. S., Muzik, M., Busuito, A., & Rosenblum, K. L.
(2014). Fathering after military deployment: Parenting challenges and goals of fa-
thers of young children. Health & Social Work, 39(1), 35–44. – Grounded theory
study Readiness for enhanced parenting

373
Domain 7. Role relationship Class 1. Caregiving roles

Domain 7 • Class 1 • Diagnosis Code 00387

Excessive parental role conflict

References
Aagaard, H. & Hall, E. O. C. (2008). Mothers’ Experiences of Having a Preterm Infant
in the Neonatal Care Unit: A Meta-Synthesis. Journal of Pediatric Nursing, 23(3):
e26-e36. doi:10.1016/j.pedn.2007.02.003
Al Maghaireh, D. F., Abdullah, K. L., Chan, C. M., Piaw, C. Y., & Al Kawafha, M. M.
(2016). Systematic review of qualitative studies exploring parental experiences in the
Neonatal Intensive Care Unit. J Clin Nurs, 25(19–20), 2745–2756. doi:10.1111/
jocn.13259
Boykova, M. (2016). Transition From Hospital to Home in Parents of Preterm Infants.
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375
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Domain 7 • Class 2 • Diagnosis Code 00389

Disrupted family interaction patterns

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376
Domain 7. Role relationship Class 2. Family relationships

Domain 7 • Class 2 • Diagnosis Code 00440

Risk for disrupted family interaction patterns

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7. Role relationship

377
Domain 7. Role relationship Class 2. Family relationships

Domain 7 • Class 2 • Diagnosis Code 00388

Impaired family processes

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thology, 29(1), 273–301. https://doi.org/10.1017/s095457941600016x

378
Domain 7. Role relationship Class 2. Family relationships

Domain 7 • Class 2 • Diagnosis Code 00159

Readiness for enhanced family processes

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7. Role relationship
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lems: A Triadic Model of Etiology and Intervention. Development and Psychopa-
thology, 29(1), 273–301. https://doi.org/10.1017/s095457941600016x

379
Domain 7. Role relationship Class 2. Family relationships

Domain 7 • Class 2 • Diagnosis Code 00439

Risk for disrupted attachment behaviors

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380
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00055

Ineffective role performance

None at this time

7. Role relationship

381
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00449

Ineffective intimate partner relationship

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7. Role relationship

behavioral models. Clinical psychology review, 70, 13–25

382
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00445

Risk for ineffective intimate partner relationship

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7. Role relationship
behavioral models. Clinical psychology review, 70, 13–25

383
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00446

Readiness for enhanced intimate partner relationship

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7. Role relationship

behavioral models. Clinical psychology review, 70, 13–25

384
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Domain 7 • Class 3 • Diagnosis Code 00052

Impaired social interaction

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Domain 7 • Class 3 • Diagnosis Code 00221

Ineffective childbearing process

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7. Role relationship
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[Guidebook of maternity diagnoses]. Tokyo: Igakushoin
Kabeyama, K., (Ed.). (2006). Rinsho Josanfu Hikkei: Seimei to Bunka wo Fumaeta Shi-
gen [Essentials of clinical midwifery: Caring based on life and culture, 2nd ed)]. To-
kyo: Igakushoin
Okayama National Hospital, ed. (2000). Akachan ni Yasashii Byouin no Bonyuu Ikuji
Shidou [Breast-feeding and newborn-care teaching manuals from a baby—friendly
hospital]. Tokyo: Medica Publishing Co
Savage, C. (2009). A proposed framework related to the care of addicted mothers. Jour-
nal of Addictions Nursing, 20(3), 158–160
Sharps, P., Laughon, K., & S. Giangrande (2007). Intimate partner violence and the
childbearing year: maternal and infant health consequences. Trauma Violence
Abuse, 8(2), 105–116
Taketani, Y. & Kabeyama, S., (Eds). (2007). Josangaku Kouza 6 [Midwifery Course
Vol. 6]. Tokyo: Igakushoin

387
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00227

Risk for ineffective childbearing process

References
Aoki, Y., (Ed.) (1998). Bosei Hoken wo meguru Shidou Kyouiku Soudan 2 [Coaching,
education, and counseling in maternal health, Vol. 2]. Tokyo: Life Science Co
Aoki, Y., Kato, N., & Hirasawa, M., (Eds.) (2002). Josangaku Taikei 5 Boshi no Shinri
Shakaigaku [Midwifery System Vol. 5 Psychosociology for mother and child]. Tokyo:
Japanese Nursing Association Publishing Co
Aoki, Y., Kato, N., & Hirasawa, M., (Eds.) (2003). Josangaku Taikei 8 Josan Shindan
Gijyutsu-gaku 2 [Midwifery System Vol. 8 Maternity diagnoses and techniques 2].
Tokyo: Japanese Nursing Association Publishing Co
Callister, L.C., Holt, S.T., & Kuhre, M. (2010). Giving Birth: The Voices of Australian
Women Journal of Perinatal & Neonatal Nursing, (24)2, 128–136
Darvill, R., Skirton, H. & P. Farrand (2008). Psychological factors that impact on wom-
en's experiences of first—time motherhood: a qualitative study of the transition.
Midwifery, 26(3), 357–366
Furber, C., Garrod, D., Maloney, E., Lovell, K. & L. McGowan (2009). A qualitative
study of mild to moderate psychological distress during pregnancy. International
Journal of Nursing Studies, 46(5), 669–677
7. Role relationship

Japan Society for Maternity Diagnoses, (Ed.). (2004). Maternity Shindan guidebook
[Guidebook of maternity diagnoses]. Tokyo: Igakushoin
Kabeyama, K., (Ed.). (2006). Rinsho Josanfu Hikkei: Seimei to Bunka wo Fumaeta Shi-
gen [Essentials of clinical midwifery: Caring based on life and culture, 2nd ed)]. To-
kyo: Igakushoin
Okayama National Hospital, ed. (2000). Akachan ni Yasashii Byouin no Bonyuu Ikuji
Shidou [Breast-feeding and newborn-care teaching manuals from a baby—friendly
hospital]. Tokyo: Medica Publishing Co
Savage, C. (2009). A proposed framework related to the care of addicted mothers. Jour-
nal of Addictions Nursing, 20(3), 158–160
Sharps, P., Laughon, K., & S. Giangrande (2007). Intimate partner violence and the
childbearing year: maternal and infant health consequences. Trauma Violence
Abuse, 8(2), 105–116
Taketani, Y. & Kabeyama, S., (Eds). (2007). Josangaku Kouza 6 [Midwifery Course
Vol. 6]. Tokyo: Igakushoin

388
Domain 7. Role relationship Class 3. Role performance

Domain 7 • Class 3 • Diagnosis Code 00208

Readiness for enhanced childbearing process

References
Aoki, Y., (Ed.) (1998). Bosei Hoken wo meguru Shidou Kyouiku Soudan 2 [Coaching,
education, and counseling in maternal health, Vol. 2]. Tokyo: Life Science Co
Aoki, Y., Kato, N., & Hirasawa, M., (Eds.) (2002). Josangaku Taikei 5 Boshi no Shinri
Shakaigaku [Midwifery System Vol. 5 Psychosociology for mother and child]. Tokyo:
Japanese Nursing Association Publishing Co
Aoki, Y., Kato, N., & Hirasawa, M., (Eds.) (2003). Josangaku Taikei 8 Josan Shindan
Gijyutsu-gaku 2 [Midwifery System Vol. 8 Maternity diagnoses and techniques 2].
Tokyo: Japanese Nursing Association Publishing Co
Japan Society for Maternity Diagnoses, (Ed.) (2004). Maternity Shindan guidebook
[Guidebook of maternity diagnoses]. Tokyo: Igakushoin
Kabeyama, K., (Ed.) (2006). Rinsho Josanfu Hikkei: Seimei to Bunka wo Fumaeta Shi-
gen [Essentials of clinical midwifery: Caring based on life and culture, 2nd ed)]. To-
kyo: Igakushoin
Okayama National Hospital, ed. (2000). Akachan ni Yasashii Byouin no Bonyuu Ikuji
Shidou [Breast-feeding and newborn-care teaching manuals from a baby-friendly
hospital]. Tokyo: Medica Publishing Co

7. Role relationship
Taketani, Y. & Kabeyama, S., (Eds.). (2007). Josangaku Kouza 6 [Midwifery Course
Vol. 6]. Tokyo: Igakushoin

389
Domain 8.
Sexuality

Class 1. Sexual identity

Code Diagnosis Page

This class does not currently contain any diagnoses 392

Class 2. Sexual function

Code Diagnosis Page

00386 Impaired sexual function 393

Class 3. Reproduction

Code Diagnosis Page

00349 Risk for impaired maternal-fetal dyad 394

391
Domain 8. Sexuality Class 1. Sexual identity

This class does not currently contain any diagnoses

8. Sexuality

392
Domain 8. Sexuality Class 2. Sexual function

Domain 8 • Class 2 • Diagnosis Code 00386

Impaired sexual function

References
Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E. S., …
Wylie, K. (2016). Psychological and Interpersonal Dimensions of Sexual Function
and Dysfunction. The Journal of Sexual Medicine, 13(4), 538–571. doi:10.1016/j.
jsxm.2016.01.019
Cavalcanti, R. & Cavalcanti, M. (1996). Tratamento clinico das inadequacies sexuals,
2nd ed. São Paulo: Roca
Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Question-
naire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33
(4):731–745
Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Question-
naire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33
(4):731–745
Esfahani SB, Pal S. Obesity, mental health, and sexual dysfunction: A critical review.
Health Psychology Open. 2018;5(2). doi:10.1177/2055102918786867
Hogan, R.M. (1985). Human sexuality: A nursing perspective. New York: Appleton-
Century-Crofts
Kaplan, H.S. (1977). A nova terapia do sexo: tratamento dinâmico das disfuncões sex-
uals. Rio de Janeiro: Nova Fronteira
Kaplan, H.S. (1983). O desejo sexual – e novos conceitos etécnicas da terapia do sexo.
Rio de Janeiro: Nova Fronteira

8. Sexuality
Mollaioli D, Ciocca G, Limoncin E, et al. Lifestyles and sexuality in men and women:
the gender perspective in sexual medicine. Reprod Biol Endocrinol. 2020;18(1):10.
Published 2020 Feb 17. doi:10.1186/s12958–019–0557–9
Quinn-Nilas C, Benson L, Milhausen RR, Buchholz AC, Goncalves M. The Relation-
ship Between Body Image and Domains of Sexual Functioning Among Heterosexual,
Emerging Adult Women. Sex Med. 2016 Sep;4(3):e182–9. doi: 10.1016/j.
esxm.2016.02.004. Epub 2016 Mar 29. PMID: 27036088; PMCID: PMC5005305

393
Domain 8. Sexuality Class 3. Reproduction

Domain 8 • Class 3 • Diagnosis Code 00349

Risk for impaired maternal-fetal dyad

References
Berg, M. (2005). Pregnancy and diabetes: How women handle the challenges. Journal
of Perinatal Education, 14(3), 23–32. Curran, C.A. (2003). Intrapartum emergencies.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(6), 802–813
Gomes RCM, Lopes MVO, Perrelli JGA, Pontes CM, Linhares FMP, Mangueira SO.
Analysis of the NANDA-I taxonomy “maternal-fetal dyad” concept in high-risk
pregnancy: integrative review. Rev Bras Enferm. 2020;73(Suppl 4):e20190649. doi:
http://dx.doi.org/10.1590/0034-7167-2019-0649
Higgins, L.P. & Hawkins, J.W. (2005). Screening for abuse during pregnancy: Imple-
menting a multisite program. American Journal of Maternal/Child Nursing, 30(2),
109–114
Lange, S.S. & Jenner, M. (2004). Myocardial infarction in the obstetric patient. In:
Campbell, P.T. (Ed.), Critical care nursing clinics of North America: Obstetric and
neonatal intensive care, 16(2), 211–219
McCarter-Spaulding, D.E. (2005). Medications in pregnancy and lactation. American
Journal of Maternal/Child Nursing, 30(1), 10–17
Mendes RCMG, Frazão CMFQ, Lacerda ACT, Lopes MVO, Linhares FMP, Mangueira
SO. Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dy-
ad. Rev Esc Enferm USP. 2021;55:e03689. doi: https://doi.org/10.1590/S1980-
220X2019041403689
Poole, J.H. (2004). Multiorgan dysfunction in the perinatal patient. In: Campbell, P.T.
8. Sexuality

(ed.), Critical Care Nursing Clinics of North America: Obstetric and Neonatal Inten-
sive Care, 16(2), 193–204
Rudisill, P.T. (2004). Amniotic fluid embolism. In: Campbell, P.T. (ed.), Critical Care
Nursing Clinics of North America: Obstetric and Neonatal Intensive Care, 16(2),
221–225
Shannon, M., King, T.L., & Kennedy, H.P. (2007). Allostasis: A theoretical framework
for understanding and evaluating perinatal health outcomes. Journal of Obstetric,
Gynecologic, & Neonatal Nursing, 36(2), 125–134
Simpson, K.R. (2004). Monitoring the preterm fetus during labor. American Journal of
Maternal/Child Nursing, 29(6), 380–388. Stark, C.J. & Stepans, M.B.F. (2004). A
comparison of blood pressure in term, low birth weight infants of smoking and non-
smoking mothers. Journal of Perinatal Education, 13(4), 17–26
Stringer, M., Miesnik, S. R., Brown, L., Martz, A.H., & Macones, G. (2004). Nursing
care of the patient with preterm premature rupture of membranes. American Journal
of Maternal/Child Nursing, 29(3), 144–150
Torgersen, K.L. & Curran, C.A. (2006). A systematic approach to the physiologic adap-
tations of pregnancy. Critical Care Nursing Quarterly, 29(1), 2–19
Wolfe, B.E. (2005). Reproductive health in women with eating disorders. Journal of
Obstetric, Gynecologic, & Neonatal Nursing, 34(2), 255–263

394
Domain 9.
Coping / stress tolerance

Class 1. Post-trauma responses

Code Diagnosis Page

00141 Post-trauma syndrome 397
00145 Risk for post-trauma syndrome 398
00484 Risk for disrupted immigration transition 399

Class 2. Coping responses

Code Diagnosis Page

00405 Maladaptive coping 401
00158 Readiness for enhanced coping 403
00373 Maladaptive family coping 405
00075 Readiness for enhanced family coping 406
00456 Maladaptive community coping 407
00076 Readiness for enhanced community coping 408
00366 Excessive caregiving burden 409
00401 Risk for excessive caregiving burden 410
00301 Maladaptive grieving 411
00302 Risk for maladaptive grieving 413
00285 Readiness for enhanced grieving 415
00210 Impaired resilience 417
00211 Risk for impaired resilience 418
00212 Readiness for enhanced resilience 419
00185 Readiness for enhanced hope 421
00325 Inadequate self-compassion 422
00400 Excessive anxiety 429

395
Domain 9. Coping / stress tolerance

00399 Excessive death anxiety 432

00390 Excessive fear 433

Class 3. Neurobehavioral responses

Code Diagnosis Page

00010 Risk for autonomic dysreflexia 436
00372 Ineffective emotion regulation 437
00241 Impaired mood regulation 439
00258 Acute substance withdrawal syndrome 440
00259 Risk for acute substance withdrawal syndrome 441

396
Domain 9. Coping / stress tolerance Class 1. Post-trauma responses

Domain 9 • Class 1 • Diagnosis Code 00141

Post-trauma syndrome
None at this time

9. Coping / stress tolerance

397
Domain 9. Coping / stress tolerance Class 1. Post-trauma responses

Domain 9 • Class 1 • Diagnosis Code 00145

Risk for post-trauma syndrome

None at this time
9. Coping / stress tolerance

398
Domain 9. Coping / stress tolerance Class 1. Post-trauma responses

Domain 9 • Class 1 • Diagnosis Code 00484

Risk for disrupted immigration transition

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sistema de salud. Tesis (Doctorado). Universitat Autónoma Barcelona; 2007
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9. Coping / stress tolerance

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health care experiences from the perspectives of health care providers. Issues Ment
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vivencias de un inmigrante rifeño sin papeles. Index Enferm (Gran). 2006; 55:59–62
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Los Cuidados. 2006; 20:92–98
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sequence=1

399
Domain 9. Coping / stress tolerance Class 1. Post-trauma responses

Rifà R. Diagnósticos de enfermería vinculados al proceso migratorio. Revisión de la lit-

eratura científica. Rev ROL Enf. 2012; 35(3):94–99
Simich L, Hamilton H, Baya BK. Mental distress, economic hardship and expectations
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9. Coping / stress tolerance

400
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00405

Maladaptive coping
References
Audulv, Å., Packer, T., Hutchinson, S., Roger, K. S., & Kephart, G. (2016). Coping,
adapting or self-managing - what is the difference? A concept review based on the
neurological literature. Journal of Advanced Nursing, 72(11), 2629–2643.
doi:10.1111/jan.13037
Britt, T. W., Crane, M., Hodson, S. E., & Adler, A. B. (2016). Effective and ineffective
coping strategies in a low-autonomy work environment. Journal of Occupational
Health Psychology, 21(2), 154–168. doi:10.1037/a0039898
Brown, L. J., & Bond, M. J. (2019). The pragmatic derivation and validation of meas-
ures of adaptive and maladaptive coping styles. Cogent Psychology, 6(1).
doi:10.1080/23311908.2019.1568070
Carver, C. S. (1997). You want to measure coping but your protocol’ too long: Consider
the brief cope. International Journal of Behavioral Medicine, 4(1), 92–100.
doi:10.1207/s15327558ijbm0401_6
Charlton, A. C., & G Wofford, L. G. (2022). Maladaptive coping behaviors in pre-licen-
sure nursing students: An integrative review. Journal of Professional Nursing, 39,
156–164. doi: 10.1016/j.profnurs.2022.01.011
Higuchi, D. (2019). Adaptive and maladaptive coping strategies in older adults with
chronic pain after lumbar surgery. International Journal of Rehabilitation Research,
1. doi:10.1097/mrr.0000000000000389
Ho, L. Y. W. (2019). A concept analysis of coping with chronic pain in older adults.
Pain Management Nursing. 20(6):563–571. doi:10.1016/j.pmn.2019.03.002

9. Coping / stress tolerance

Joseph, P. L., Applewhite, J., & Fleary, S. A. Housing and food insecurity, health liter-
acy, and maladaptive coping behaviors. Health Literacy Research and Practice, 6(4),
e280-e289. doi: 10.3928/24748307–20221019–01
Owen, C. P., Djukic, M., Whisenant, M., & Lobiondo-Wood, G. (2023). Factors of mal-
adaptive coping in emergency healthcare professionals: A systematic review. Journal
of Nursing Scholarship, 55(2), 536–548. doi: 10.1111/jnu.12848
Parasuraman, S., & Hansen, D. (1987). Coping with work stressors in nursing: Effects
of adaptive versus maladaptive strategies. Work and Occupations, 14(1), 88–105.
doi:10.1177/0730888487014001005
Smout, M. F., Simpson, S. G., Stacey, F., & Reid, C. (2021). The influence of maladap-
tive coping modes, resilience and job demands on emotional exhaustion in psychol-
ogists. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2631
Wadsworth, M. E. (2015). Development of maladaptive coping: a functional adaptation
to chronic, uncontrollable stress. Child Development Perspectives, 9(2), 96–100
Wong, M. C. S, Huang, J., Wang, H. H., Yuan, J., Xu, W., Zheng, Z. J., Xue, H., Zhang,
L., Jiang, J. Y., Huang, J. L. W., Chen, P., Jia, Z., Z., Palaganas, E., Viwattanakulvanid,
P., Somrongthong, R., Caicedo, A., Medina-Arellano, M. de. J., Murphy, J., Paredes,
M. B. A., & Withers, M. (2022). Resilience level and its association with maladaptive
coping behaviors in the COVID-19 pandemic: a global survey of the general popula-
tions, Global Health, 19(1), 1. doi: 10.1186/s12992–022–00903–8

401
Domain 9. Coping / stress tolerance Class 2. Coping responses

Yang, H-M, Kim, H-R. (2022). Mediation effect of maladaptive coping between work-
to-family conflict and cardiovascular health behaviors. Int J Environ Res Public
Health, 19(21), 4121. doi: 10.3390/ijerph192114121
9. Coping / stress tolerance

402
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00158

Readiness for enhanced coping

References
Audulv, Å., Packer, T., Hutchinson, S., Roger, K. S., & Kephart, G. (2016). Coping,
adapting or self-managing - what is the difference? A concept review based on the
neurological literature. Journal of Advanced Nursing, 72(11), 2629–2643.
doi:10.1111/jan.13037
Britt, T. W., Crane, M., Hodson, S. E., & Adler, A. B. (2016). Effective and ineffective
coping strategies in a low-autonomy work environment. Journal of Occupational
Health Psychology, 21(2), 154–168. doi:10.1037/a0039898
Brown, L. J., & Bond, M. J. (2019). The pragmatic derivation and validation of meas-
ures of adaptive and maladaptive coping styles. Cogent Psychology, 6(1).
doi:10.1080/23311908.2019.1568070
Carver, C. S. (1997). You want to measure coping but your protocol’ too long: Consider
the brief cope. International Journal of Behavioral Medicine, 4(1), 92–100.
doi:10.1207/s15327558ijbm0401_6
Charlton, A. C., & G Wofford, L. G. (2022). Maladaptive coping behaviors in pre-licen-
sure nursing students: An integrative review. Journal of Professional Nursing, 39,
156–164. doi: 10.1016/j.profnurs.2022.01.011
Higuchi, D. (2019). Adaptive and maladaptive coping strategies in older adults with
chronic pain after lumbar surgery. International Journal of Rehabilitation Research,
1. doi:10.1097/mrr.0000000000000389
Ho, L. Y. W. (2019). A concept analysis of coping with chronic pain in older adults.
Pain Management Nursing. 20(6):563–571. doi:10.1016/j.pmn.2019.03.002

9. Coping / stress tolerance

Joseph, P. L., Applewhite, J., & Fleary, S. A. Housing and food insecurity, health liter-
acy, and maladaptive coping behaviors. Health Literacy Research and Practice, 6(4),
e280-e289. doi: 10.3928/24748307–20221019–01
Owen, C. P., Djukic, M., Whisenant, M., & Lobiondo-Wood, G. (2023). Factors of mal-
adaptive coping in emergency healthcare professionals: A systematic review. Journal
of Nursing Scholarship, 55(2), 536–548. doi: 10.1111/jnu.12848
Parasuraman, S., & Hansen, D. (1987). Coping with work stressors in nursing: Effects
of adaptive versus maladaptive strategies. Work and Occupations, 14(1), 88–105.
doi:10.1177/0730888487014001005
Smout, M. F., Simpson, S. G., Stacey, F., & Reid, C. (2021). The influence of maladap-
tive coping modes, resilience and job demands on emotional exhaustion in psychol-
ogists. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2631
Wadsworth, M. E. (2015). Development of maladaptive coping: a functional adaptation
to chronic, uncontrollable stress. Child Development Perspectives, 9(2), 96–100
Wong, M. C. S, Huang, J., Wang, H. H., Yuan, J., Xu, W., Zheng, Z. J., Xue, H., Zhang,
L., Jiang, J. Y., Huang, J. L. W., Chen, P., Jia, Z., Z., Palaganas, E., Viwattanakulvanid,
P., Somrongthong, R., Caicedo, A., Medina-Arellano, M. de. J., Murphy, J., Paredes,
M. B. A., & Withers, M. (2022). Resilience level and its association with maladaptive
coping behaviors in the COVID-19 pandemic: a global survey of the general popula-
tions, Global Health, 19(1), 1. doi: 10.1186/s12992–022–00903–8

403
Domain 9. Coping / stress tolerance Class 2. Coping responses

Yang, H-M, Kim, H-R. (2022). Mediation effect of maladaptive coping between work-
to-family conflict and cardiovascular health behaviors. Int J Environ Res Public
Health, 19(21), 4121. doi: 10.3390/ijerph192114121
9. Coping / stress tolerance

404
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00373

Maladaptive family coping

References
Chan EM, Dowling NA, Jackson AC, Shek DT. Gambling related family coping and
the impact of problem gambling on families in Hong Kong. Asian J Gambl Issues
Public Health. 2016;6(1):1. doi:10.1186/s40405–016–0009–9
Johnson EM, Ross DB. The Cost of Cancer: The Association of Financial and Cancer-
Related Stress on Maladaptive Coping Styles in Families with a Cancer Diagnosis.
Contemp Fam Ther. Published online July 20, 2021. doi:10.1007/s10591–021–
09595–5
Moore, B. C., Biegel, D. E., & McMahon, T. J. (2011). Maladaptive Coping as a Media-
tor of Family Stress. Journal of social work practice in the addictions, 11(1), 17–39.
https://doi.org/10.1080/1533256X.2011.544600
van der Sanden RL, Pryor JB, Stutterheim SE, Kok G, Bos AE. Stigma by association
and family burden among family members of people with mental illness: the media-
ting role of coping. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1233–1245.
doi:10.1007/s00127–016–1256-x

9. Coping / stress tolerance

405
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00075

Readiness for enhanced family coping

References
Chan EM, Dowling NA, Jackson AC, Shek DT. Gambling related family coping and
the impact of problem gambling on families in Hong Kong. Asian J Gambl Issues
Public Health. 2016;6(1):1. doi:10.1186/s40405–016–0009–9
Johnson EM, Ross DB. The Cost of Cancer: The Association of Financial and Cancer-
Related Stress on Maladaptive Coping Styles in Families with a Cancer Diagnosis.
Contemp Fam Ther. Published online July 20, 2021. doi:10.1007/s10591–021–
09595–5
Moore, B. C., Biegel, D. E., & McMahon, T. J. (2011). Maladaptive Coping as a Media-
tor of Family Stress. Journal of social work practice in the addictions, 11(1), 17–39.
https://doi.org/10.1080/1533256X.2011.544600
van der Sanden RL, Pryor JB, Stutterheim SE, Kok G, Bos AE. Stigma by association
and family burden among family members of people with mental illness: the media-
ting role of coping. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1233–1245.
doi:10.1007/s00127–016–1256-x
9. Coping / stress tolerance

406
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00456

Maladaptive community coping

None at this time

9. Coping / stress tolerance

407
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00076

Readiness for enhanced community coping

None at this time
9. Coping / stress tolerance

408
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00366

Excessive caregiving burden

References
AARP and National Alliance for Caregiving. (2020) Caregiving in the United States
2020. Washington, DC: AARP. May 2020. https://doi.org/10.26419/ppi.00103.001
Antoniadi, A. M., Galvin, M., Heverin, M., Hardiman, O., & Mooney, C. (2020). Pre-
diction of caregiver burden in amyotrophic lateral sclerosis: a machine learning ap-
proach using random forests applied to a cohort study. BMJ Open, 10(2), e033109.
doi:10.1136/bmjopen-2019–033109
Chou, K.-R. (2000). Caregiver burden: A concept analysis. Journal of Pediatric Nursing,
15(6), 398–407. doi:10.1053/jpdn.2000.16709
Ha, N. H. L., Chong, M. S., Choo, R. W. M., Tam, W. J., & Yap, P. L. K. (2018). Care-
giving burden in foreign domestic workers caring for frail older adults in Singapore.
International Psychogeriatrics, 1–9. doi:10.1017/s1041610218000200
João, R. B., Nogueira, M. H., Morita-Sherman, M. E., Alvim, M. K. M., Johnny, S., Per-
eira, H., Pinheiro, H. P., Cendes, F., & Yasuda, C. L. (2022). The relationship be-
tween depression and anxiety symptoms of adult PWE and caregivers in a tertiary
center. Frontiers in Neurology, vol13, 766009. doi: 10.3389/fneur.2022.766009
Liu, Z., Heffernan, C., & Tan J. (2020). Caregiver burden: A concept analysis. Interna-
tional Journal of Nursing Sciences, 7(4), 438–445. doi: 10.1016/j.ijnss.2020.07.012
McCullagh, E., Brigstocke, G., Donaldson, N., & Kalra, L. (2005). Determinants of care-
giving burden and quality of life in caregivers of stroke patients. Stroke, 36(10),
2181–2186. doi:10.1161/01.str.0000181755.23914.53
Perkins, M., Howard, V. J., Wadley, V. G., Crowe, M., Safford, M. M., Haley, W. E., …

9. Coping / stress tolerance

Roth, D. L. (2012). Caregiving strain and all-cause mortality: Evidence from the RE-
GARDS study. The Journals of Gerontology Series B: Psychological Sciences and So-
cial Sciences, 68(4), 504–512. doi:10.1093/geronb/gbs084
Ribé, J. M., Salamero, M., Pérez-Testor, C., Mercadal, J., Aguilera, C., & Cleris, M.
(2017). Quality of life in family caregivers of schizophrenia patients in Spain: care-
giver characteristics, caregiving burden, family functioning, and social and professio-
nal support. International Journal of Psychiatry in Clinical Practice, 22(1), 25–33.
doi:10.1080/13651501.2017.1360500
Roth, D. L., Fredman, L., & Haley, W. E. (2015). Informal caregiving and its impact on
health: A reappraisal from population-based studies. The Gerontologist, 55(2), 309–
319. doi:10.1093/geront/gnu177
Thornton, M., & Travis, S. S. (2003). Analysis of the reliability of the modified care-
giver strain index. The Journals of Gerontology Series B: Psychological Sciences and
Social Sciences, 58(2), S127–S132. doi:10.1093/geronb/58.2.s127
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly:
Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. doi:10.1093/ger-
ont/20.6.649

409
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00401

Risk for excessive caregiving burden

References
AARP and National Alliance for Caregiving. (2020) Caregiving in the United States
2020. Washington, DC: AARP. May 2020. https://doi.org/10.26419/ppi.00103.001
Antoniadi, A. M., Galvin, M., Heverin, M., Hardiman, O., & Mooney, C. (2020). Pre-
diction of caregiver burden in amyotrophic lateral sclerosis: a machine learning ap-
proach using random forests applied to a cohort study. BMJ Open, 10(2), e033109.
doi:10.1136/bmjopen-2019–033109
Chou, K.-R. (2000). Caregiver burden: A concept analysis. Journal of Pediatric Nursing,
15(6), 398–407. doi:10.1053/jpdn.2000.16709
Ha, N. H. L., Chong, M. S., Choo, R. W. M., Tam, W. J., & Yap, P. L. K. (2018). Care-
giving burden in foreign domestic workers caring for frail older adults in Singapore.
International Psychogeriatrics, 1–9. doi:10.1017/s1041610218000200
João, R. B., Nogueira, M. H., Morita-Sherman, M. E., Alvim, M. K. M., Johnny, S., Per-
eira, H., Pinheiro, H. P., Cendes, F., & Yasuda, C. L. (2022). The relationship be-
tween depression and anxiety symptoms of adult PWE and caregivers in a tertiary
center. Frontiers in Neurology, vol13, 766009. doi: 10.3389/fneur.2022.766009
Liu, Z., Heffernan, C., & Tan J. (2020). Caregiver burden: A concept analysis. Interna-
tional Journal of Nursing Sciences, 7(4), 438–445. doi: 10.1016/j.ijnss.2020.07.012
McCullagh, E., Brigstocke, G., Donaldson, N., & Kalra, L. (2005). Determinants of care-
giving burden and quality of life in caregivers of stroke patients. Stroke, 36(10),
2181–2186. doi:10.1161/01.str.0000181755.23914.53
Perkins, M., Howard, V. J., Wadley, V. G., Crowe, M., Safford, M. M., Haley, W. E., …
9. Coping / stress tolerance

Roth, D. L. (2012). Caregiving strain and all-cause mortality: Evidence from the RE-
GARDS study. The Journals of Gerontology Series B: Psychological Sciences and So-
cial Sciences, 68(4), 504–512. doi:10.1093/geronb/gbs084
Ribé, J. M., Salamero, M., Pérez-Testor, C., Mercadal, J., Aguilera, C., & Cleris, M.
(2017). Quality of life in family caregivers of schizophrenia patients in Spain: care-
giver characteristics, caregiving burden, family functioning, and social and professio-
nal support. International Journal of Psychiatry in Clinical Practice, 22(1), 25–33.
doi:10.1080/13651501.2017.1360500
Roth, D. L., Fredman, L., & Haley, W. E. (2015). Informal caregiving and its impact on
health: A reappraisal from population-based studies. The Gerontologist, 55(2), 309–
319. doi:10.1093/geront/gnu177
Thornton, M., & Travis, S. S. (2003). Analysis of the reliability of the modified care-
giver strain index. The Journals of Gerontology Series B: Psychological Sciences and
Social Sciences, 58(2), S127–S132. doi:10.1093/geronb/58.2.s127
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly:
Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. doi:10.1093/ger-
ont/20.6.649

410
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00301

Maladaptive grieving
References
Barreto, P., de la Torre, O., & Pérez-Marín, M. (2012). Detección de duelo complicado.
Psicooncología, 9(2–3), 355–368
Brito, P. R., & Aguirre, A. (2014). El diagnóstico psicosocial desde una perspectiva en-
fermera. Barcelona: Elsevier
Burke, L. A., & Neimeyer, R. A. (2013) Prospective risk factors for complicated grief: A
review of the empirical literature. In M. S. Stroebe, H. Schut, J. van der Bout & P.
Boelen. (Eds.), Complicated grief: Scientific foundations for healthcare professionals
(pp. 145–161). New York: Routledge
Burke, L. A., Neimeyer, R. A., Bottomley, J. S., & Smigelsky, M. A. (2017). Prospective
Risk Factors for Intense Grief in Family Members of Veterans Who Died of Termi-
nal Illness. Illness, Crisis & Loss, 105413731769958
Cruse (2017) Current Issues in Grief Therapy: Complicated Grief http://www.cruse.
org.uk/sites/default/files/default_images/pdf/Events/ColinMPcomplicatedgrief.pdf
García-Hernández, A.M. (2010). Vivir el duelo. La experiencia de perder un hijo. Ten-
erife: Ediciones Idea
Gray, J. A., & Kim, J. (2017). Direct care workers’ experiences of grief and needs for
support. Journal of Applied Research in Intellectual Disabilities, 30(6), 995–1006
Lai, C., Luciani, M., Galli, F., Morelli, E., Moriconi, F., Penco, I.,. .. Lombardo, L.
(2017). Persistent complex bereavement disorder in caregivers of terminally ill pa-
tients undergoing supportive-expressive treatment: A pilot study. Journal of Mental
Health, 26(2), 111–118

9. Coping / stress tolerance

Maccallum, F., & Bryant, R. A. (2013). A Cognitive Attachment Model of prolonged
grief: Integrating attachments, memory, and identity. Clinical Psychology Review, 33
(6), 713–727. Doi:10.1016/j.cpr.2013.05.001
Maciejewski, P., Maercker, A., Boelen, P., & Prigerson, H. (2016). "Prolonged grief dis-
order" and "persistent complex bereavement disorder", but not "complicated grief",
are one and the same diagnostic entity: An analysis of data from the Yale Bereave-
ment Study. World Psychiatry, 15(3), 266–275
McSpedden, M., Mullan, B., Sharpe, L., Breen, L. J., & Lobb, E. A. (2016). The presence
and predictors of complicated grief symptoms in perinatally bereaved mothers from
a bereavement support organization. Death Studies, 41(2), 112–117
Moayedoddin, B., & Markowitz, J. C. (2015). Abnormal Grief: Should We Consider a
More Patient-Centered Approach? American Journal of Psychotherapy, 69(4), 361–
378
Paloma-Castro O, Romero-Sánchez JM, Paramio-Cuevas JC, Pastor-Montero SM, Cas-
tro-Yuste C, Frandsen AJ, Albar-Marín MJ, Bas-Sarmiento P, Moreno-Corral LJ.
Nursing diagnosis of grieving: content validity in perinatal loss situations. Int J Nurs
Knowl. 2014 Jun;25(2):102–9
Prigerson, H.G., Horowitz, M.J., Jacobs, S.C., Parkes, C.M., Aslan, M., Goodkin, K., et
al.(2009). Prolonged grief disorder: Psychometric validation of criteria proposed for
DSM-V and ICD-11. Public Library of Science Medicine, 6(8), doi: 10.1371/journal.
pmed.1000121

411
Domain 9. Coping / stress tolerance Class 2. Coping responses

Rodríguez-Álvaro M (2017). Epidemiología Enfermera del Duelo en Canarias (Tesis

Doctoral). Universidad de La Laguna
Rodríguez-Álvaro M, Brito-Brito PR, García-Hernández AM, Aguirre-Jaime A, Fer-
nandez-Gutierrez DA. The Grieving Nursing Diagnoses in the Primary Healthcare
Setting. Int J Nurs Knowl. 2019;30(1):34–42
Rodríguez-Álvaro, M. (2019). IMPACTO DEL DUELO COMPLICADO. UNA LEC-
TURA A TRAVÉS DEL LENGUAJE DEL CUIDADO. Revista Ene De Enfermería,
13(3). Consultado de http://ene-enfermeria.org/ojs/index.php/ENE/article/view/915
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., et
al. (2011). Complicated grief and related bereavement issues for DSM-5. Depression
and anxiety, 28(2), 103–17. doi:10.1002/da.20780
Smigelsky MA, Bottomley JS, Relyea G, Neimeyer RA. Investigating risk for grief se-
verity: Attachment to the deceased and relationship quality. Death Stud. 2019; 9:1–
10
Yi Yi P (2015). Factores de riesgo de duelo complicado en cuidados paliativos (Tesis
Doctoral). Facultad de Psicología, Universidad de Valencia
9. Coping / stress tolerance

412
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00302

Risk for maladaptive grieving

References
Barreto, P., de la Torre, O., & Pérez-Marín, M. (2012). Detección de duelo complicado.
Psicooncología, 9(2–3), 355–368
Brito, P. R., & Aguirre, A. (2014). El diagnóstico psicosocial desde una perspectiva en-
fermera. Barcelona: Elsevier
Burke, L. A., & Neimeyer, R. A. (2013) Prospective risk factors for complicated grief: A
review of the empirical literature. In M. S. Stroebe, H. Schut, J. van der Bout & P.
Boelen. (Eds.), Complicated grief: Scientific foundations for healthcare professionals
(pp. 145–161). New York: Routledge
Burke, L. A., Neimeyer, R. A., Bottomley, J. S., & Smigelsky, M. A. (2017). Prospective
Risk Factors for Intense Grief in Family Members of Veterans Who Died of Termi-
nal Illness. Illness, Crisis & Loss, 105413731769958
Cruse (2017) Current Issues in Grief Therapy: Complicated Grief http://www.cruse.
org.uk/sites/default/files/default_images/pdf/Events/ColinMPcomplicatedgrief.pdf
García-Hernández, A.M. (2010). Vivir el duelo. La experiencia de perder un hijo. Ten-
erife: Ediciones Idea
Gray, J. A., & Kim, J. (2017). Direct care workers’ experiences of grief and needs for
support. Journal of Applied Research in Intellectual Disabilities, 30(6), 995–1006
Lai, C., Luciani, M., Galli, F., Morelli, E., Moriconi, F., Penco, I.,. .. Lombardo, L.
(2017). Persistent complex bereavement disorder in caregivers of terminally ill pa-
tients undergoing supportive-expressive treatment: A pilot study. Journal of Mental
Health, 26(2), 111–118

9. Coping / stress tolerance

Maccallum, F., & Bryant, R. A. (2013). A Cognitive Attachment Model of prolonged
grief: Integrating attachments, memory, and identity. Clinical Psychology Review, 33
(6), 713–727. Doi:10.1016/j.cpr.2013.05.001
Maciejewski, P., Maercker, A., Boelen, P., & Prigerson, H. (2016). "Prolonged grief dis-
order" and "persistent complex bereavement disorder", but not "complicated grief",
are one and the same diagnostic entity: An analysis of data from the Yale Bereave-
ment Study. World Psychiatry, 15(3), 266–275
McSpedden, M., Mullan, B., Sharpe, L., Breen, L. J., & Lobb, E. A. (2016). The presence
and predictors of complicated grief symptoms in perinatally bereaved mothers from
a bereavement support organization. Death Studies, 41(2), 112–117
Moayedoddin, B., & Markowitz, J. C. (2015). Abnormal Grief: Should We Consider a
More Patient-Centered Approach? American Journal of Psychotherapy, 69(4), 361–
378
Paloma-Castro O, Romero-Sánchez JM, Paramio-Cuevas JC, Pastor-Montero SM, Cas-
tro-Yuste C, Frandsen AJ, Albar-Marín MJ, Bas-Sarmiento P, Moreno-Corral LJ.
Nursing diagnosis of grieving: content validity in perinatal loss situations. Int J Nurs
Knowl. 2014 Jun;25(2):102–9
Prigerson, H.G., Horowitz, M.J., Jacobs, S.C., Parkes, C.M., Aslan, M., Goodkin, K., et
al.(2009). Prolonged grief disorder: Psychometric validation of criteria proposed for
DSM-V and ICD-11. Public Library of Science Medicine, 6(8), doi: 10.1371/journal.
pmed.1000121

413
Domain 9. Coping / stress tolerance Class 2. Coping responses

Rodríguez-Álvaro M (2017). Epidemiología Enfermera del Duelo en Canarias (Tesis

Doctoral). Universidad de La Laguna
Rodríguez-Álvaro M, Brito-Brito PR, García-Hernández AM, Aguirre-Jaime A, Fer-
nandez-Gutierrez DA. The Grieving Nursing Diagnoses in the Primary Healthcare
Setting. Int J Nurs Knowl. 2019;30(1):34–42
Rodríguez-Álvaro, M. (2019). IMPACTO DEL DUELO COMPLICADO. UNA LEC-
TURA A TRAVÉS DEL LENGUAJE DEL CUIDADO. Revista Ene De Enfermería,
13(3). Consultado de http://ene-enfermeria.org/ojs/index.php/ENE/article/view/915
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., et
al. (2011). Complicated grief and related bereavement issues for DSM-5. Depression
and anxiety, 28(2), 103–17. doi:10.1002/da.20780
Smigelsky MA, Bottomley JS, Relyea G, Neimeyer RA. Investigating risk for grief se-
verity: Attachment to the deceased and relationship quality. Death Stud. 2019; 9:1–
10
Yi Yi P (2015). Factores de riesgo de duelo complicado en cuidados paliativos (Tesis
Doctoral). Facultad de Psicología, Universidad de Valencia
9. Coping / stress tolerance

414
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00285

Readiness for enhanced grieving

References
Barreto, P., de la Torre, O., & Pérez-Marín, M. (2012). Detección de duelo complicado.
Psicooncología, 9(2–3), 355–368
Brito, P. R., & Aguirre, A. (2014). El diagnóstico psicosocial desde una perspectiva en-
fermera. Barcelona: Elsevier
Burke, L. A., & Neimeyer, R. A. (2013) Prospective risk factors for complicated grief: A
review of the empirical literature. In M. S. Stroebe, H. Schut, J. van der Bout & P.
Boelen. (Eds.), Complicated grief: Scientific foundations for healthcare professionals
(pp. 145–161). New York: Routledge
Burke, L. A., Neimeyer, R. A., Bottomley, J. S., & Smigelsky, M. A. (2017). Prospective
Risk Factors for Intense Grief in Family Members of Veterans Who Died of Termi-
nal Illness. Illness, Crisis & Loss, 105413731769958
Cruse (2017) Current Issues in Grief Therapy: Complicated Grief http://www.cruse.
org.uk/sites/default/files/default_images/pdf/Events/ColinMPcomplicatedgrief.pdf
García-Hernández, A.M. (2010). Vivir el duelo. La experiencia de perder un hijo. Ten-
erife: Ediciones Idea
Gray, J. A., & Kim, J. (2017). Direct care workers’ experiences of grief and needs for
support. Journal of Applied Research in Intellectual Disabilities, 30(6), 995–1006
Lai, C., Luciani, M., Galli, F., Morelli, E., Moriconi, F., Penco, I.,. .. Lombardo, L.
(2017). Persistent complex bereavement disorder in caregivers of terminally ill pa-
tients undergoing supportive-expressive treatment: A pilot study. Journal of Mental
Health, 26(2), 111–118

9. Coping / stress tolerance

Maccallum, F., & Bryant, R. A. (2013). A Cognitive Attachment Model of prolonged
grief: Integrating attachments, memory, and identity. Clinical Psychology Review, 33
(6), 713–727. Doi:10.1016/j.cpr.2013.05.001
Maciejewski, P., Maercker, A., Boelen, P., & Prigerson, H. (2016). "Prolonged grief dis-
order" and "persistent complex bereavement disorder", but not "complicated grief",
are one and the same diagnostic entity: An analysis of data from the Yale Bereave-
ment Study. World Psychiatry, 15(3), 266–275
McSpedden, M., Mullan, B., Sharpe, L., Breen, L. J., & Lobb, E. A. (2016). The presence
and predictors of complicated grief symptoms in perinatally bereaved mothers from
a bereavement support organization. Death Studies, 41(2), 112–117
Moayedoddin, B., & Markowitz, J. C. (2015). Abnormal Grief: Should We Consider a
More Patient-Centered Approach? American Journal of Psychotherapy, 69(4), 361–
378
Paloma-Castro O, Romero-Sánchez JM, Paramio-Cuevas JC, Pastor-Montero SM, Cas-
tro-Yuste C, Frandsen AJ, Albar-Marín MJ, Bas-Sarmiento P, Moreno-Corral LJ.
Nursing diagnosis of grieving: content validity in perinatal loss situations. Int J Nurs
Knowl. 2014 Jun;25(2):102–9
Prigerson, H.G., Horowitz, M.J., Jacobs, S.C., Parkes, C.M., Aslan, M., Goodkin, K., et
al.(2009). Prolonged grief disorder: Psychometric validation of criteria proposed for
DSM-V and ICD-11. Public Library of Science Medicine, 6(8), doi: 10.1371/journal.
pmed.1000121

415
Domain 9. Coping / stress tolerance Class 2. Coping responses

Rodríguez-Álvaro M (2017). Epidemiología Enfermera del Duelo en Canarias (Tesis

Doctoral). Universidad de La Laguna
Rodríguez-Álvaro M, Brito-Brito PR, García-Hernández AM, Aguirre-Jaime A, Fer-
nandez-Gutierrez DA. The Grieving Nursing Diagnoses in the Primary Healthcare
Setting. Int J Nurs Knowl. 2019;30(1):34–42
Rodríguez-Álvaro, M. (2019). IMPACTO DEL DUELO COMPLICADO. UNA LEC-
TURA A TRAVÉS DEL LENGUAJE DEL CUIDADO. Revista Ene De Enfermería,
13(3). Consultado de http://ene-enfermeria.org/ojs/index.php/ENE/article/view/915
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., et
al. (2011). Complicated grief and related bereavement issues for DSM-5. Depression
and anxiety, 28(2), 103–17. doi:10.1002/da.20780
Smigelsky MA, Bottomley JS, Relyea G, Neimeyer RA. Investigating risk for grief se-
verity: Attachment to the deceased and relationship quality. Death Stud. 2019; 9:1–
10
Yi Yi P (2015). Factores de riesgo de duelo complicado en cuidados paliativos (Tesis
Doctoral). Facultad de Psicología, Universidad de Valencia
9. Coping / stress tolerance

416
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00210

Impaired resilience
References
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port family wellbeing, quality of parenting and child resilience: What we know. Jour-
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Bonanno, G.A. (2005). Clarifying and extending the construct of adult resilience.
American Psychologist, 60, 265–267
Brown, J.H. & Brown, D. (2005). Why ‘at risk’ is at risk. American School Board Jour-
nal, 192(11), 44–46
Crosnoe, R. & Elder, G. (2004). Family dynamics, supportive relationships, and educa-
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Taylor, J. (2000). Sisters of the yam: African American women’s healing and self-recov-
ery from intimate male partner violence. Issues in Mental Health Nursing, 21(5),
515–531

9. Coping / stress tolerance

417
Domain 9. Coping / stress tolerance Class 2. Coping responses

Domain 9 • Class 2 • Diagnosis Code 00211

Risk for impaired resilience

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9. Coping / stress tolerance

ience concept. Geriatr Nurs. 2013; 34(2):122–127

West C, Buettner P, Stewart L, Foster K, Usher K. Resilience in families with a member
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418
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Domain 9 • Class 2 • Diagnosis Code 00212

Readiness for enhanced resilience

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Press
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among children who have been maltreated. Child Development, 69(4), 1171–1197
Bonanno, G.A. (2005). Clarifying and extending the construct of adult resilience.
American Psychologist, 60, 265–267
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Domain 9 • Class 2 • Diagnosis Code 00185

Readiness for enhanced hope

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Inadequate self-compassion
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Domain 9 • Class 2 • Diagnosis Code 00400

Excessive anxiety
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Domain 9 • Class 2 • Diagnosis Code 00399

Excessive death anxiety

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Domain 9 • Class 2 • Diagnosis Code 00390

Excessive fear
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435
Domain 9. Coping / stress tolerance Class 3. Neurobehavioral responses

Domain 9 • Class 3 • Diagnosis Code 00010

Risk for autonomic dysreflexia

None at this time
9. Coping / stress tolerance

436
Domain 9. Coping / stress tolerance Class 3. Neurobehavioral responses

Domain 9 • Class 3 • Diagnosis Code 00372

Ineffective emotion regulation

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Angelini, C. (2009). Emotional lability in MND: Relationship to cognition and psy-
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Parvizi, J., Arciniegas, D.B., Bernardini, G.L., Hoffmann, M.W., Mohr, J.P., Rapoport,
M.J., Schmahmann, J.D., ... Tuhrim, S. (2006). Diagnosis and management of patho-
logical laughter and crying. Mayo Clinic Proceedings, 81(11), 1482–1486
Parvizi, J., Joseph, J., Press, D.Z., & Schmahmann, J.D. (2007). Pathological laughter
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double-blind treatment study. The American Journal of Psychiatry, 150(2), 286–293
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disorder. Journal of Neuroscience Nursing, 39(4), 202–207
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9. Coping / stress tolerance

Smith, R.A., Berg, J.E., Pope, L.E., Callahan, J.D., Wynn, D., & Thisted, R.A. (2004).
Validitation of the CNS emotional lability scale for psedobulbar affect (pathological
laughing and crying) in multiple sclerosis patients. Multiple Sclerosis, 10, 679–685
Tang, W.K., Chen, Y., Lam, W.W.M., Mok, V., Wong, A., Ungvari, G.S., … Sing Wong,
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Turner-Stokes, L., Hassan, N., Pierce, K., & Clegg, F. (2002). Managing depression in
brain injury rehabilitation: the use of an integrated care pathway and preliminary
report of response to sertraline. Clinical Rehabilitation, 16, 261–268
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438
Domain 9. Coping / stress tolerance Class 3. Neurobehavioral responses

Domain 9 • Class 3 • Diagnosis Code 00241

Impaired mood regulation

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9. Coping / stress tolerance

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type 2 diabetics. Journal of Clinical Nursing, 17(19), 2524–2530

439
Domain 9. Coping / stress tolerance Class 3. Neurobehavioral responses

Domain 9 • Class 3 • Diagnosis Code 00258

Acute substance withdrawal syndrome

References
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Treat. 2012; 1(4):128
9. Coping / stress tolerance

440
Domain 9. Coping / stress tolerance Class 3. Neurobehavioral responses

Domain 9 • Class 3 • Diagnosis Code 00259

Risk for acute substance withdrawal syndrome

References
Carlson RW, Kumar NN, Wong-Mckinstry E, et al. Alcohol withdrawal syndrome. Crit
Care Clin. 2012; 28(4):549–585
Carr GD. Alcoholism: a modern look at an ancient illness. Prim Care. 2011; 38(1):9–
21, v
Corfee FA. Alcohol withdrawal in the critical care unit. Aust Crit Care. 2011; 24(2):
110–116
Genung V. Understanding the neurobiology, assessment, and treatment of substances
of abuse and dependence: a guide for the critical care nurse. Crit Care Nurs Clin
North Am. 2012; 24(1):117–130
Lemon SJ, Winstead PW, Weant KA. Alcohol withdrawal syndrome. Advanced Emer-
gency Nursing. 2010; 32(1):20–27
McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neuro-
surg Psychiatry. 2008; 79(8):854–862
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drome. Am Fam Physician. 2013; 88(9):589–595
Pitzele HZ, Tolia VM. Twenty per hour: altered mental state due to ethanol abuse and
withdrawal. Emerg Med Clin North Am. 2010; 28(3):683–705
Sharp B, Schermer CR, Esposito TJ, Omi EC, Ton-That H, Santaniello JM. Alcohol
withdrawal syndrome in trauma patients: A prospective cohort study. J Trauma
Treat. 2012; 1(4):128

9. Coping / stress tolerance

441
Domain 10.
Life principles

Class 1. Values

Code Diagnosis Page

This class does not currently contain any diagnoses 444

Class 2. Beliefs

Code Diagnosis Page

This class does not currently contain any diagnoses 445

Class 3. Value / belief / action congruence

Code Diagnosis Page

00175 Moral distress 446
00454 Impaired spiritual well-being 447
00460 Risk for impaired spiritual well-being 449
00068 Readiness for enhanced spiritual well-being 451
00169 Impaired religiosity 452
00170 Risk for impaired religiosity 454
00171 Readiness for enhanced religiosity 456

443
Domain 10. Life principles Class 1. Values

This class does not currently contain any diagnoses

10. Life principles

444
Domain 10. Life principles Class 2. Beliefs

This class does not currently contain any diagnoses

10. Life principles

445
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00175

Moral distress
References
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NANDA diagnoses. International Journal of Nursing Terminologies and Classifica-
10. Life principles

tions, 16(1), 3–13

McGee, G., Spanogle, J.P., Caplan, A.L., & Asch, D.A. (2001). A national study of ethics
committees. American Journal of Bioethics, 1(4), 60–64
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9(3), 43–53

446
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00454

Impaired spiritual well-being

References
Aktar, S. & Barlow, J. (2018). Forgiveness therapy for the promotion of mental well-
being: A systematic review and meta-analysis. Trauma, Violence, & Abuse, 19, 107–
122
Barnes, D. V. (2015). Processes and Outcomes of Theistic Spiritually Oriente Psycho-
therapy: A Practice-Based Evidence Investigation. Spirituality in Clinical Practice, 2,
180 –190
Caldeira, S., Carvalho, E. C. de, & Vieira, M. (2014). Between spiritual wellbeing and
spiritual distress: possible related factors in elderly patients with cancer. Revista Lat-
ino-Americana de Enfermagem, 22(1), 28–34. doi:10.1590/0104–1169.3073.2382
Caldeira, S., Carvalho, E. C., & Vieira, M. (2013). Spiritual distress–Proposing a new
definition and defining characteristic. International Journal of Nursing Knowledge,
24, 77–84
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. (2015). Clinical Validation
of the Nursing Diagnosis Spiritual Distress in Cancer Patients Undergoing Chemo-
therapy. International Journal of Nursing Knowledge, 28(1), 44–52. doi:10.1111/
2047–3095.12105
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. (2016). Nursing Diagnosis of
“Spiritual Distress” in Women With Breast Cancer. Cancer Nursing, 39(4), 321–327.
doi:10.1097/ncc.0000000000000310
Kwan, C. W.M., Chan, C.W.H., & Choi, K.C. (2019). The effectiveness of a nurse-led
short term life review intervention in enhancing the spiritual and psychological well-
being of people receiving palliative care: A mixed method study. International Jour-
nal of Nursing Studies, 91, 134–143
Martins, H., & Caldeira, S. (2018). Spiritual Distress in Cancer Patients: A Synthesis of
Qualitative Studies. Religions, 9(10), 285. doi:10.3390/rel9100285

10. Life principles

Martins, H., & Caldeira, S. (2018). Spiritual Distress in Cancer Patients: A Synthesis of
Qualitative Studies. Religions, 9(10), 285. doi:10.3390/rel9100285
Neto, G. L., Rodrigues, L., da Silva, D.A.R., Turato, E.R., & Campos, C.J.G. (2018). Spi-
rituality review on mental health and psychiatric nursing. Mental Health, 71, 2323–
33. DOI: http://dx.doi.org/10.1590/0034–7167–2016–0429
Recine, A. (2015). Designing forgiveness interventions: Guidance from five meta-anal-
yses. Journal of Holistic Nursing, 33, 161–167
Romeiro J, Caldeira S, Brady V, Hall J, Timmins F. The Spiritual Journey of Infertile
Couples: Discussing the Opportunity for Spiritual Care. Religions. 2017;8(4):76
Romeiro J, Caldeira S, Brady V, Timmins F, Hall J. Spiritual aspects of living with in-
fertility: A synthesis of qualitative studies. Journal of Clinical Nursing.
2017;26:3917–35
Romeiro J, Caldeira S. A qualitative systematic review of the human responses of those
living with infertility: implications for nursing diagnoses. International Journal of
Nursing Knowledge. 2018; https://doi.org/10.1111/2047–3095.12223
Roze des Ordons, A. L., Sinuff, T., Stelfox, H. T., Kondejewski, J., & Sinclair, S. (2018)
Sanders, P. W., Richards, P. S., McBride, J. A., Lea, T., Young, B., Hardman, R. K., &

447
Domain 10. Life principles Class 3. Value / belief / action congruence

Simão, T. P., Chaves, E.C. L., & Lunes, D. H. (2015). Spiritual distress: the search for
new evidence. J. Res.: Fundamental Care, 7, 2591–2602 DOI: 10.9789/
21755361.2015.v7i2.2591–2602
Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families'
Experiences. Journal of Pain & Symptom Management, 56, 122–145
Velosa, T., Caldeira, S., & Capelas, M. (2017). Depression and Spiritual Distress in
Adult Palliative Patients: A Cross-Sectional Study. Religions, 8(8), 156. doi:10.3390/
rel8080156
Wang, Chong-W., Chow, A. Y. M., Chan, & C. L. W. (2017). The effects of life review
interventions on spiritual well-being, psychological distress, and quality of life in pa-
tients with terminal or advanced cancer: A systematic review and meta-analysis of
randomized controlled trials. Palliative Medicine, 31, 883–894
10. Life principles

448
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00460

Risk for impaired spiritual well-being

References
Aktar, S. & Barlow, J. (2018). Forgiveness therapy for the promotion of mental well-
being: A systematic review and meta-analysis. Trauma, Violence, & Abuse, 19, 107–
122
Barnes, D. V. (2015). Processes and Outcomes of Theistic Spiritually Oriente Psycho-
therapy: A Practice-Based Evidence Investigation. Spirituality in Clinical Practice, 2,
180 –190
Caldeira, S., Carvalho, E. C. de, & Vieira, M. (2014). Between spiritual wellbeing and
spiritual distress: possible related factors in elderly patients with cancer. Revista Lat-
ino-Americana de Enfermagem, 22(1), 28–34. doi:10.1590/0104–1169.3073.2382
Caldeira, S., Carvalho, E. C., & Vieira, M. (2013). Spiritual distress–Proposing a new
definition and defining characteristic. International Journal of Nursing Knowledge,
24, 77–84
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. (2015). Clinical Validation
of the Nursing Diagnosis Spiritual Distress in Cancer Patients Undergoing Chemo-
therapy. International Journal of Nursing Knowledge, 28(1), 44–52. doi:10.1111/
2047–3095.12105
Caldeira, S., Timmins, F., de Carvalho, E. C., & Vieira, M. (2016). Nursing Diagnosis of
“Spiritual Distress” in Women With Breast Cancer. Cancer Nursing, 39(4), 321–327.
doi:10.1097/ncc.0000000000000310
Kwan, C. W.M., Chan, C.W.H., & Choi, K.C. (2019). The effectiveness of a nurse-led
short term life review intervention in enhancing the spiritual and psychological well-
being of people receiving palliative care: A mixed method study. International Jour-
nal of Nursing Studies, 91, 134–143
Martins, H., & Caldeira, S. (2018). Spiritual Distress in Cancer Patients: A Synthesis of
Qualitative Studies. Religions, 9(10), 285. doi:10.3390/rel9100285

10. Life principles

Martins, H., & Caldeira, S. (2018). Spiritual Distress in Cancer Patients: A Synthesis of
Qualitative Studies. Religions, 9(10), 285. doi:10.3390/rel9100285
Neto, G. L., Rodrigues, L., da Silva, D.A.R., Turato, E.R., & Campos, C.J.G. (2018). Spi-
rituality review on mental health and psychiatric nursing. Mental Health, 71, 2323–
33. DOI: http://dx.doi.org/10.1590/0034–7167–2016–0429
Recine, A. (2015). Designing forgiveness interventions: Guidance from five meta-anal-
yses. Journal of Holistic Nursing, 33, 161–167
Romeiro J, Caldeira S, Brady V, Hall J, Timmins F. The Spiritual Journey of Infertile
Couples: Discussing the Opportunity for Spiritual Care. Religions. 2017;8(4):76
Romeiro J, Caldeira S, Brady V, Timmins F, Hall J. Spiritual aspects of living with in-
fertility: A synthesis of qualitative studies. Journal of Clinical Nursing.
2017;26:3917–35
Romeiro J, Caldeira S. A qualitative systematic review of the human responses of those
living with infertility: implications for nursing diagnoses. International Journal of
Nursing Knowledge. 2018; https://doi.org/10.1111/2047–3095.12223
Roze des Ordons, A. L., Sinuff, T., Stelfox, H. T., Kondejewski, J., & Sinclair, S. (2018)
Sanders, P. W., Richards, P. S., McBride, J. A., Lea, T., Young, B., Hardman, R. K., &

449
Domain 10. Life principles Class 3. Value / belief / action congruence

Simão, T. P., Chaves, E.C. L., & Lunes, D. H. (2015). Spiritual distress: the search for
new evidence. J. Res.: Fundamental Care, 7, 2591–2602 DOI: 10.9789/
21755361.2015.v7i2.2591–2602
Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families'
Experiences. Journal of Pain & Symptom Management, 56, 122–145
Velosa, T., Caldeira, S., & Capelas, M. (2017). Depression and Spiritual Distress in
Adult Palliative Patients: A Cross-Sectional Study. Religions, 8(8), 156. doi:10.3390/
rel8080156
Wang, Chong-W., Chow, A. Y. M., Chan, & C. L. W. (2017). The effects of life review
interventions on spiritual well-being, psychological distress, and quality of life in pa-
tients with terminal or advanced cancer: A systematic review and meta-analysis of
randomized controlled trials. Palliative Medicine, 31, 883–894
10. Life principles

450
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00068

Readiness for enhanced spiritual well-being

References
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Fisher, J. (2010) Development and application of a spiritual well-being questionnaire
called SHALOM. Religions, 1: 105–121
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Fisher, J., Brumley, D. (2008). Nurses’and Carers’ Spiritual Well-Being in the Work-
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caregivers. Psycho-Oncology, 25(12), 1448–1455. doi:10.1002/pon.3987

10. Life principles

Weathers, E., McCarthy, G., & Coffey, A. (2015). Concept Analysis of Spirituality: An
Evolutionary Approach. Nursing Forum, 51(2), 79–96. doi:10.1111/nuf.12128

451
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00169

Impaired religiosity
References
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10. Life principles

Care, 12(2), 30–37

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istintial predictors of psychological wellbeing in community-residing and institu-
tional care elders. Aging & Mental Health, 4(4), 375–387
Haase, J. El, Britt, T., Copward, D.D., Leidy, N.K. & Penn, P.E. (1992). Simultaneous
Concept Analysis of Spiritual Perspective, Hope, Acceptance, and Self-transcen-
dence, Image, 24(2), 141–147

452
Domain 10. Life principles Class 3. Value / belief / action congruence

Hover-Kramer, D. (1989). Creating a context for self-healing: The transpersonal per-

spective. Holistic Nursing Practice, 3(3), 27–34. Labun, E. (1988). Spiritual care: An
element in nursing care planning. Journal of Advanced Nursing, 13(3), 314–320
Maltby, J. & Day, L. (2002). Religious experience, religious orientation and schizotypy.
Mental Health, Religion & Culture. 5(2), 163–174
Mansen, T. J. (1993). The spiritual dimension of individuals: Conceptual development.
Nursing Diagnosis, 4(4), 140–147
Mayer. J. (1992). Wholly responsible for a part, or partly responsible for a whole? The
concept of spiritual care in nursing. Second Opinion, 17(3), 26–55
Mickley, J. R., Soeken, K., & Belcher, A. (1992) Spiritual Well-being, religiousness and
hope among women with breast cancer. Image: Journal of Nursing Scholarship, 24
(4), 267–336
Moberg, D. O. (1984). Subjective Measures of Spiritual Well-being. Review of Religious
Research, 25(4), 351–364
Nagai-Jacobson, M. G. & Burkhardt, M. A. (1989). Spirituality: Cornerstone of holistic
nursing practice. Holistic Nursing Practice, 3(3), 18–26
Narayanasamy, A. (1996). Spiritual care of chronically ill patients. British Journal of
Nursing, 5(7)
Pullen, L, Modrcin-Talbott, M. A., West, W. R., & Muenchen, R. (1999). Spiritual high
vs high on spirits: Is religiosity related to adolescent alcohol and drug abuse? Journal
of Psychiatric and Mental Health Nursing: 6, 3–8
Reed, P. G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Re-
search in nursing & health, 10(5), 335–344
Reed, P. G. (1991). Preferences for spiritually related nursing interventions among ter-
minally ill and on terminally ill hospitalized adults and well adults. Applied Nursing
Research, 4(3), 122–128
Reed, P. G. (1992). An emerging paradigm for the investigation of spirituality in nurs-
ing. Research in Nursing and Health, 15(5), 349–357
Siddle, R., Haddock, G., Tarrier, & Faragher, E. B. (2002). The validation of a religiosity
measure for individuals with schizophrenia. Mental Health, Religion & Culture, 5(3),
267–284

10. Life principles

Stolley, J. M, Buckwalter, K. C., Koenig, H. G. (1999). Prayer and religious coping for
caregivers of persons with Alzheimer’s disease and related disorders. American Jour-
nal of Alzheimer’s Disease, 14(3), 181–191
Thomas, S. A. (1989). Spirituality: An essential dimension in the treatment of hyper-
tension, Holistic Nursing Practice, 3(3), 47–55. Watson, J. (1994). A Frog, a rock, a
ritual: Myth, mystery, and metaphors for an ecocaring cosmology in a universe that
is turning over. In E. A. Schuster & C. L. Brown (Eds.) Exploring Our Environmental
Connections, New York: National League for Nursing
Whitfield, W. (2002). Research in religion and mental health: Naming of parts–some
reflections. The International Journal of Psychiatric Nursing Research, 8(1), 891–896

453
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00170

Risk for impaired religiosity

References
Bellingham, R., Cohen, B., Jones, T, Spaniol, L. (1989). Connectedness: Some skills for
spiritual health. American Journal of Health Promotion, 4(1), 18–24
Bergan, A. & McConatha, J. T. (2000). Religiosity and life satisfaction. Activities, Adap-
tation & Aging, 24(3), 23–34
Besthorn, F. H. (2001). Transpersonal psychology and deep ecological philosophy: Ex-
ploring linkages and applications for social work, Social Thought, 20(1/2), 23–44
Burkhardt, M. A. (1994). Environmental connections and reawakened spirit. In E. A.
Schuster & C. L. Brown (eds.) Exploring Our Environmental Connections, New
York: National League for Nursing
Burkhardt, M. A., (1989). Spirituality: An analysis of the concept. Holistic Nursing
Practice, 3(3), 69–77
Burkhart, L. & Solari-Twadell, P.A. (2001). Spirituality and Religiousness: Differentiat-
ing the diagnosis through a review of the nursing literature. Nursing Diagnosis: The
International Journal of Nursing Language and Classification, 12(2), 45–54
Carroll, M. M. (2001). Conceptual models of spirituality. Social Thought, 20(1/2), 5–21
Carson, V. B., Winkelstein, M. Soeken, K. & Bruinins, M. (1986). The effect of didactic
teaching on spiritual attitudes, Image: Journal of Nursing Scholarship, 18(4), 161–
164
Charnes, L. S. & Moore, P. S. (1992). Meeting patients’ spiritual needs. The Jewish per-
spective. Holistic Nursing Practice, 6(3), 64–72
Chatters, L. M., Taylor, R. J., & Lincoln, K. D. (2001). Advances in the measurement of
religiosity among older African Americans: Implications for health and mental
health researchers. Journal of Mental Health and Aging, 7(1), 181–200
Dudley, J. R., Smith, C., & Millison, M. B. (1995). Unfinished business: Assessing the
spiritual needs of hospice clients. The American Journal of Hospice & Palliative
10. Life principles

Care, 12(2), 30–37

Durienz, B., Luyten, P., Snauwaert, B., & Hutsebaut, D. (2002). The importance of reli-
giosity and values in predicitng political attitudes: Evidence for the continuing im-
portance of religiosity in Fladers (Belgium). Mental Health, Religion, & Culture, 5
(1), 35–54
Fahlberg, L., Wolfer, J. & Fahlberg, L. A. (1992). Personal crisis: Growth or pathology?
Health Promotion, 7(1), 45–52
Fehring, R. J., Brennan, P. F., & Keller, M. L. (1987). Psychological and spiritual well-
being in college students, Research in Nursing & Health, 10, 391–398
Freeman, D. R., (2001). The relationship between spiritual development and ethnicity
in violent men. Social Thought, 20(1/2), 95–107
Fry, P S. (2000). Religious involvement, spirituality and personal meaning for life: ex-
istintial predictors of psychological wellbeing in community-residing and institu-
tional care elders. Aging & Mental Health, 4(4), 375–387
Haase, J. El, Britt, T., Copward, D.D., Leidy, N.K. & Penn, P.E. (1992). Simultaneous
Concept Analysis of Spiritual Perspective, Hope, Acceptance, and Self-transcen-
dence, Image, 24(2), 141–147

454
Domain 10. Life principles Class 3. Value / belief / action congruence

Hover-Kramer, D. (1989). Creating a context for self-healing: The transpersonal per-

spective. Holistic Nursing Practice, 3(3), 27–34. Labun, E. (1988). Spiritual care: An
element in nursing care planning. Journal of Advanced Nursing, 13(3), 314–320
Maltby, J. & Day, L. (2002). Religious experience, religious orientation and schizotypy.
Mental Health, Religion & Culture. 5(2), 163–174
Mansen, T. J. (1993). The spiritual dimension of individuals: Conceptual development.
Nursing Diagnosis, 4(4), 140–147
Mayer. J. (1992). Wholly responsible for a part, or partly responsible for a whole? The
concept of spiritual care in nursing. Second Opinion, 17(3), 26–55
Mickley, J. R., Soeken, K., & Belcher, A. (1992) Spiritual Well-being, religiousness and
hope among women with breast cancer. Image: Journal of Nursing Scholarship, 24
(4), 267–336
Moberg, D. O. (1984). Subjective Measures of Spiritual Well-being. Review of Religious
Research, 25(4), 351–364
Nagai-Jacobson, M. G. & Burkhardt, M. A. (1989). Spirituality: Cornerstone of holistic
nursing practice. Holistic Nursing Practice, 3(3), 18–26
Narayanasamy, A. (1996). Spiritual care of chronically ill patients. British Journal of
Nursing, 5(7)
Pullen, L, Modrcin-Talbott, M. A., West, W. R., & Muenchen, R. (1999). Spiritual high
vs high on spirits: Is religiosity related to adolescent alcohol and drug abuse? Journal
of Psychiatric and Mental Health Nursing: 6, 3–8
Reed, P. G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Re-
search in nursing & health, 10(5), 335–344
Reed, P. G. (1991). Preferences for spiritually related nursing interventions among ter-
minally ill and on terminally ill hospitalized adults and well adults. Applied Nursing
Research, 4(3), 122–128
Reed, P. G. (1992). An emerging paradigm for the investigation of spirituality in nurs-
ing. Research in Nursing and Health, 15(5), 349–357
Siddle, R., Haddock, G., Tarrier, & Faragher, E. B. (2002). The validation of a religiosity
measure for individuals with schizophrenia. Mental Health, Religion & Culture, 5(3),
267–284

10. Life principles

Stolley, J. M, Buckwalter, K. C., Koenig, H. G. (1999). Prayer and religious coping for
caregivers of persons with Alzheimer’s disease and related disorders. American Jour-
nal of Alzheimer’s Disease, 14(3), 181–191
Thomas, S. A. (1989). Spirituality: An essential dimension in the treatment of hyper-
tension, Holistic Nursing Practice, 3(3), 47–55. Watson, J. (1994). A Frog, a rock, a
ritual: Myth, mystery, and metaphors for an ecocaring cosmology in a universe that
is turning over. In E. A. Schuster & C. L. Brown (Eds.) Exploring Our Environmental
Connections, New York: National League for Nursing
Whitfield, W. (2002). Research in religion and mental health: Naming of parts–some
reflections. The International Journal of Psychiatric Nursing Research, 8(1), 891–896

455
Domain 10. Life principles Class 3. Value / belief / action congruence

Domain 10 • Class 3 • Diagnosis Code 00171

Readiness for enhanced religiosity

References
Bellingham, R., Cohen, B., Jones, T, Spaniol, L. (1989). Connectedness: Some skills for
spiritual health. American Journal of Health Promotion, 4(1), 18–24
Bergan, A. & McConatha, J. T. (2000). Religiosity and life satisfaction. Activities, Adap-
tation & Aging, 24(3), 23–34
Besthorn, F. H. (2001). Transpersonal psychology and deep ecological philosophy: Ex-
ploring linkages and applications for social work, Social Thought, 20(1/2), 23–44
Burkhardt, M. A. (1994). Environmental connections and reawakened spirit. In E. A.
Schuster & C. L. Brown (eds.) Exploring Our Environmental Connections, New
York: National League for Nursing
Burkhardt, M. A., (1989). Spirituality: An analysis of the concept. Holistic Nursing
Practice, 3(3), 69–77
Burkhart, L. & Solari-Twadell, P.A. (2001). Spirituality and Religiousness: Differentiat-
ing the diagnosis through a review of the nursing literature. Nursing Diagnosis: The
International Journal of Nursing Language and Classification, 12(2), 45–54
Carroll, M. M. (2001). Conceptual models of spirituality. Social Thought, 20(1/2), 5–21
Carson, V. B., Winkelstein, M. Soeken, K. & Bruinins, M. (1986). The effect of didactic
teaching on spiritual attitudes, Image: Journal of Nursing Scholarship, 18(4), 161–
164
Charnes, L. S. & Moore, P. S. (1992). Meeting patients’ spiritual needs. The Jewish per-
spective. Holistic Nursing Practice, 6(3), 64–72
Chatters, L. M., Taylor, R. J., & Lincoln, K. D. (2001). Advances in the measurement of
religiosity among older African Americans: Implications for health and mental
health researchers. Journal of Mental Health and Aging, 7(1), 181–200
Dudley, J. R., Smith, C., & Millison, M. B. (1995). Unfinished business: Assessing the
spiritual needs of hospice clients. The American Journal of Hospice & Palliative
10. Life principles

Care, 12(2), 30–37

Durienz, B., Luyten, P., Snauwaert, B., & Hutsebaut, D. (2002). The importance of reli-
giosity and values in predicitng political attitudes: Evidence for the continuing im-
portance of religiosity in Fladers (Belgium). Mental Health, Religion, & Culture, 5
(1), 35–54
Fahlberg, L., Wolfer, J. & Fahlberg, L. A. (1992). Personal crisis: Growth or pathology?
Health Promotion, 7(1), 45–52
Fehring, R. J., Brennan, P. F., & Keller, M. L. (1987). Psychological and spiritual well-
being in college students, Research in Nursing & Health, 10, 391–398
Freeman, D. R., (2001). The relationship between spiritual development and ethnicity
in violent men. Social Thought, 20(1/2), 95–107
Fry, P S. (2000). Religious involvement, spirituality and personal meaning for life: ex-
istintial predictors of psychological wellbeing in community-residing and institu-
tional care elders. Aging & Mental Health, 4(4), 375–387
Haase, J. El, Britt, T., Copward, D.D., Leidy, N.K. & Penn, P.E. (1992). Simultaneous
Concept Analysis of Spiritual Perspective, Hope, Acceptance, and Self-transcen-
dence, Image, 24(2), 141–147

456
Domain 10. Life principles Class 3. Value / belief / action congruence

Hover-Kramer, D. (1989). Creating a context for self-healing: The transpersonal per-

spective. Holistic Nursing Practice, 3(3), 27–34. Labun, E. (1988). Spiritual care: An
element in nursing care planning. Journal of Advanced Nursing, 13(3), 314–320
Maltby, J. & Day, L. (2002). Religious experience, religious orientation and schizotypy.
Mental Health, Religion & Culture. 5(2), 163–174
Mansen, T. J. (1993). The spiritual dimension of individuals: Conceptual development.
Nursing Diagnosis, 4(4), 140–147
Mayer. J. (1992). Wholly responsible for a part, or partly responsible for a whole? The
concept of spiritual care in nursing. Second Opinion, 17(3), 26–55
Mickley, J. R., Soeken, K., & Belcher, A. (1992) Spiritual Well-being, religiousness and
hope among women with breast cancer. Image: Journal of Nursing Scholarship, 24
(4), 267–336
Moberg, D. O. (1984). Subjective Measures of Spiritual Well-being. Review of Religious
Research, 25(4), 351–364
Nagai-Jacobson, M. G. & Burkhardt, M. A. (1989). Spirituality: Cornerstone of holistic
nursing practice. Holistic Nursing Practice, 3(3), 18–26
Narayanasamy, A. (1996). Spiritual care of chronically ill patients. British Journal of
Nursing, 5(7)
Pullen, L, Modrcin-Talbott, M. A., West, W. R., & Muenchen, R. (1999). Spiritual high
vs high on spirits: Is religiosity related to adolescent alcohol and drug abuse? Journal
of Psychiatric and Mental Health Nursing: 6, 3–8
Reed, P. G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Re-
search in nursing & health, 10(5), 335–344
Reed, P. G. (1991). Preferences for spiritually related nursing interventions among ter-
minally ill and on terminally ill hospitalized adults and well adults. Applied Nursing
Research, 4(3), 122–128
Reed, P. G. (1992). An emerging paradigm for the investigation of spirituality in nurs-
ing. Research in Nursing and Health, 15(5), 349–357
Siddle, R., Haddock, G., Tarrier, & Faragher, E. B. (2002). The validation of a religiosity
measure for individuals with schizophrenia. Mental Health, Religion & Culture, 5(3),
267–284

10. Life principles

Stolley, J. M, Buckwalter, K. C., Koenig, H. G. (1999). Prayer and religious coping for
caregivers of persons with Alzheimer’s disease and related disorders. American Jour-
nal of Alzheimer’s Disease, 14(3), 181–191
Thomas, S. A. (1989). Spirituality: An essential dimension in the treatment of hyper-
tension, Holistic Nursing Practice, 3(3), 47–55. Watson, J. (1994). A Frog, a rock, a
ritual: Myth, mystery, and metaphors for an ecocaring cosmology in a universe that
is turning over. In E. A. Schuster & C. L. Brown (Eds.) Exploring Our Environmental
Connections, New York: National League for Nursing
Whitfield, W. (2002). Research in religion and mental health: Naming of parts–some
reflections. The International Journal of Psychiatric Nursing Research, 8(1), 891–896

457
Domain 11.
Safety / protection

Class 1. Infection

Code Diagnosis Page

00361 Impaired immune response 462
00004 Risk for infection 463
00500 Risk for surgical wound infection 469

Class 2. Physical injury

Code Diagnosis Page

00336 Risk for physical injury 471
00350 Risk for burn injury 472
00351 Risk for cold injury 473
00245 Risk for corneal injury 474
00219 Risk for dry eye 478
00087 Risk for perioperative positioning injury 480
00287 Neonatal pressure injury 482
00288 Risk for neonatal pressure injury 484
00313 Child pressure injury 486
00286 Risk for child pressure injury 488
00312 Adult pressure injury 490
00304 Risk for adult pressure injury 492
00250 Risk for urinary tract injury 494
00044 Impaired tissue integrity 495
00248 Risk for impaired tissue integrity 498
00046 Impaired skin integrity 501
00047 Risk for impaired skin integrity 504

459
Domain 11. Safety / protection

00461 Impaired nipple-areolar complex integrity 507

00462 Risk for impaired nipple-areolar complex integrity 511
00045 Impaired oral mucous membrane integrity 515
00247 Risk for impaired oral mucous membrane integrity 517
00306 Risk for child falls 519
00303 Risk for adult falls 520
00039 Risk for aspiration 522
00031 Ineffective airway clearance 524
00463 Risk for accidental suffocation 530
00374 Risk for excessive bleeding 531
00205 Risk for shock 533
00291 Risk for thrombosis 537
00425 Risk for impaired peripheral neurovascular function 542
00156 Risk for sudden infant death 543
00290 Risk for elopement attempt 545

Class 3. Violence

Code Diagnosis Page

00138 Risk for other-directed violence 547
00272 Risk for female genital mutilation 548
00466 Risk for suicidal self-injurious behavior 550
00467 Non-suicidal self-injurious behavior 552
00468 Risk for non-suicidal self-injurious behavior 553

Class 4. Environmental hazards

Code Diagnosis Page

00181 Contamination 554
00180 Risk for contamination 556
00469 Risk for accidental poisoning 558
00404 Risk for occupational illness 560
00402 Risk for occupational physical injury 563

Class 5. Defensive processes

Code Diagnosis Page

00217 Risk for allergic reaction 566

460
Domain 11. Safety / protection

00042 Risk for latex allergy reaction 567

Class 6. Thermoregulation

Code Diagnosis Page

00008 Ineffective thermoregulation 568
00274 Risk for ineffective thermoregulation 569
00474 Decreased neonatal body temperature 570
00476 Risk for decreased neonatal body temperature 576
00472 Decreased body temperature 582
00473 Risk for decreased body temperature 584
00490 Risk for decreased perioperative body temperature 586
00007 Hyperthermia 590
00471 Risk for hyperthermia 591

461
Domain 11. Safety / protection Class 1. Infection

Domain 11 • Class 1 • Diagnosis Code 00361

Impaired immune response

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462
Domain 11. Safety / protection Class 1. Infection

Domain 11 • Class 1 • Diagnosis Code 00004

Risk for infection

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Domain 11 • Class 1 • Diagnosis Code 00500

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Domain 11 • Class 2 • Diagnosis Code 00219

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Domain 11 • Class 2 • Diagnosis Code 00087

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tric Nursing, 28(6), 585–595. https://doi.org/10.1016/j.pedn.2013.05.004
Neta, A. P. R., Cavalcante, T. B., Lima, A. B. S., Maciel, S. M., Miranda, S. M., & de
Sousa, A. R. A. Epidemiological and Clinical Characterization of Children with Pres-
sure Injuries Caracterização Epidemiológica e Clínica de Crianças com Lesões por
Pressão. Revista Enfermagem Atual, 86
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Injury Prevalence and the Rate of
Hospital-Acquired Pressure Injury Among Pediatric Patients in Acute Care. Journal
of wound, ostomy, and continence nursing : official publication of The Wound, Os-
tomy and Continence Nurses Society, 44(2), 110–117. https://doi.org/10.1097/
WON.0000000000000306
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Ulcer Risk and Prevention Practi-
ces in Pediatric Patients: A Secondary Analysis of Data from the National Database
of Nursing Quality Indicators®. Ostomy/wound management, 63(2), 28–32
Rowe, A., Mccarty, K., & Huett, A. (2018). Implementation of a Nurse Driven Pathway
to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive
Care Setting. Journal of Pediatric Nursing, 41, 104–109
Smith, H., Moore, Z., & Tan, M. (2019). Cohort study to determine the risk of pressure
ulcers and developing a care bundle within a paediatric intensive care unit setting.
Intensive & Critical Care Nursing, 53, 68–72
Sweeney, K. A., Cogill, K., Davis, K., & Jauncey-Cooke, J. I. (2018). Neonatal and pedia-
tric pressure injuries secondary to limb splinting for intravascular access: case series
and literature review. Journal of the Association for Vascular Access, 23(2), 108–116
Vocci, M.B., Fontes,, C.M.B., Abbade, L.P.F. (2018). Pressure injury in the pediatric
population: Cohort study using the Braden Q Scale. Advances in Skin & Wound
Care, 31(10), 456–461 doi: 10.1097/01.ASW.0000542529.94557.0a
Wang, D., Xu, H., Chen, S., Lou, X., Tan, J., Xu, Y. (2019) Medical adhesive-related
skin injuries and associated risk factors in a pediatric intensive care unit. Advances
in Skin & Wound Care, 32(4), 176–182. doi: 10.1097/01.ASW.0000553601.05196.fb

11. Safety / protection

483
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00288

Risk for neonatal pressure injury

References
Aredes, N. D. A., de Araújo Santos, R. C., & Fonseca, L. M. M. (2017). Skin care of
premature newborns: integrative review. Revista electrónica de Enfermagem [Inter-
net]
Chamblee, T., Pasek, T., Caillouette, C., Stellar, J., Quigley, S., & Curley, M. (2018). CE:
How to predict pediatric pressure injury risk with the Braden QD Scale. The Ameri-
can Journal of Nursing, 118(11), 34–43
Clay, P., Cruz, C., Ayotte, K., Jones, J., & Fowler, S. B. (2018). Device related pressure
ulcers Pre and post identification and intervention. Journal of Pediatric Nursing, 41,
77–79
Csoma, Z., Meszes, A., Ábrahám, R., Kemény, L., Tálosi, G., & Doró, P. (2016). Iatro-
genic Skin Disorders and Related Factors in Newborn Infants. Pediatric Dermatol-
ogy, 33(5), 543–548
Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., Nie, A.M. (2019). Pressure
Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel
White Paper, Advances in Skin & Wound Care, 32(9), 394–408
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance (2019). Prevention and treatment of pressure
ulcers/injuries: clinical practice guideline (3rd Ed.). ISBN 978–0–6480097–8–11
He, M., Tang, A., Ge, X., & Zheng, J. (2016). Pressure ulcers in the intensive care unit:
An analysis of skin barrier risk factors, Advances in Skin & Wound Care, 29(11),
493–498. doi: 10.1097/01.ASW.0000494779.66288.c9
Huan, L. I., Jiang, S., Qun, Y. U., Yaqin, H. U., & Jiang, L. (2018). Characteristics and
risk factors of pressure injuries in patients admitted to the PICU. Chinese Journal of
Nursing, 53(3), 261–266
Jackson, D., Sarki, A. M., Betteridge, R., & Brooke, J. (2019). Medical device-related
pressure ulcers: A systematic review and meta-analysis. International Journal of
Nursing Studies, 92, 109–120
11. Safety / protection

Kayser, S. A., VanGilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence
and analysis of medical device-related pressure injuries: results from the internation-
al pressure ulcer prevalence survey. Advances in Skin & Wound Care, 31(6), 276
Kim, M.J., Jang, J. M., Kim, H.K., Heo, H. J., Jeong, I. S. (2019). Medical adhesives-re-
lated skin injury in a pediatric intensive care unit. Journal of Wound, Ostomy and
Continence Nursing, 46(6), 491–496
Ko H-Y. Management and Rehabilitation of Spinal Cord Injuries. Springer Singapore,
2019
Kulik, L., Connor, J., Graham, D., & Hickey, P. (2018). Pressure injury prevention for
paediatric cardiac surgical patients using a nurse-driven standardized clinical assess-
ment and management plan. Cardiology in the Young, 28(9), 1151–1162
Kulik, L.A., Hasbani, N.R., Stellar, J.J., Quigley, S.M., Shelley, S.S., Wypij, D., Curley,
Martha A. Q., for Braden QD Study Group Hospital-Acquired Pressure Injuries in
Children With Congenital Heart Disease: Prevalence and Associated Factors*. Pedia-
tric Critical Care Medicine, 20(11), 1048–1056. doi: 10.1097/
PCC.0000000000002077

484
Domain 11. Safety / protection Class 2. Physical injury

Murray, J.S., Noonan, C., Quigley, S., & Curley, M.A.Q. (2013). Medical device-related
hospital-acquired pressure ulcers in children: an integrative review. Journal of Pedia-
tric Nursing, 28(6), 585–595. https://doi.org/10.1016/j.pedn.2013.05.004
Neta, A. P. R., Cavalcante, T. B., Lima, A. B. S., Maciel, S. M., Miranda, S. M., & de
Sousa, A. R. A. Epidemiological and Clinical Characterization of Children with Pres-
sure Injuries Caracterização Epidemiológica e Clínica de Crianças com Lesões por
Pressão. Revista Enfermagem Atual, 86
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Injury Prevalence and the Rate of
Hospital-Acquired Pressure Injury Among Pediatric Patients in Acute Care. Journal
of wound, ostomy, and continence nursing : official publication of The Wound, Os-
tomy and Continence Nurses Society, 44(2), 110–117. https://doi.org/10.1097/
WON.0000000000000306
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Ulcer Risk and Prevention Practi-
ces in Pediatric Patients: A Secondary Analysis of Data from the National Database
of Nursing Quality Indicators®. Ostomy/wound management, 63(2), 28–32
Rowe, A., Mccarty, K., & Huett, A. (2018). Implementation of a Nurse Driven Pathway
to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive
Care Setting. Journal of Pediatric Nursing, 41, 104–109
Smith, H., Moore, Z., & Tan, M. (2019). Cohort study to determine the risk of pressure
ulcers and developing a care bundle within a paediatric intensive care unit setting.
Intensive & Critical Care Nursing, 53, 68–72
Sweeney, K. A., Cogill, K., Davis, K., & Jauncey-Cooke, J. I. (2018). Neonatal and pedia-
tric pressure injuries secondary to limb splinting for intravascular access: case series
and literature review. Journal of the Association for Vascular Access, 23(2), 108–116
Vocci, M.B., Fontes,, C.M.B., Abbade, L.P.F. (2018). Pressure injury in the pediatric
population: Cohort study using the Braden Q Scale. Advances in Skin & Wound
Care, 31(10), 456–461 doi: 10.1097/01.ASW.0000542529.94557.0a
Wang, D., Xu, H., Chen, S., Lou, X., Tan, J., Xu, Y. (2019) Medical adhesive-related
skin injuries and associated risk factors in a pediatric intensive care unit. Advances
in Skin & Wound Care, 32(4), 176–182. doi: 10.1097/01.ASW.0000553601.05196.fb

11. Safety / protection

485
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00313

Child pressure injury

References
Clay, P., Cruz, C., Ayotte, K., Jones, J., & Fowler, S. B. (2018). Device related pressure
ulcers Pre and post identification and intervention. Journal of Pediatric Nursing, 41,
77–79
Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., Nie, A.M. (2019). Pressure
Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel
White Paper, Advances in Skin & Wound Care, 32(9), 394–408
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/
Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler
(Ed.). EPUAP/NPIAP/PPPIA: 2019.Chamblee, T., Pasek, T., Caillouette, C., Stellar,
J., Quigley, S., & Curley, M. (2018). CE: How to predict pediatric pressure injury risk
with the Braden QD Scale. The American Journal of Nursing, 118(11), 34–43
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance (2019). Prevention and treatment of pressure
ulcers/injuries: clinical practice guideline (3rd Ed.). ISBN 978–0–6480097–8–11
Huan, L. I., Jiang, S., Qun, Y. U., Yaqin, H. U., & Jiang, L. (2018). Characteristics and
risk factors of pressure injuries in patients admitted to the PICU. Chinese Journal of
Nursing, 53(3), 261–266
Jackson, D., Sarki, A. M., Betteridge, R., & Brooke, J. (2019). Medical device-related
pressure ulcers: A systematic review and meta-analysis. International Journal of
Nursing Studies, 92, 109–120
Kayser, S. A., VanGilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence
and analysis of medical device-related pressure injuries: results from the internation-
al pressure ulcer prevalence survey. Advances in Skin & Wound Care, 31(6), 276
Kim, M.J., Jang, J. M., Kim, H.K., Heo, H. J., Jeong, I. S. (2019). Medical adhesives-re-
lated skin injury in a pediatric intensive care unit. Journal of Wound, Ostomy and
Continence Nursing, 46(6), 491–496. doi: 10.1097/WON.0000000000000592
11. Safety / protection

Ko H-Y. Management and Rehabilitation of Spinal Cord Injuries. Springer Singapore,

2019
Kulik, L., Connor, J., Graham, D., & Hickey, P. (2018). Pressure injury prevention for
paediatric cardiac surgical patients using a nurse-driven standardized clinical assess-
ment and management plan. Cardiology in the Young, 28(9), 1151–1162
Kulik, L.A., Hasbani, N.R., Stellar, J.J., Quigley, S.M., Shelley, S.S., Wypij, D., Curley,
Martha A. Q., for Braden QD Study Group Hospital-Acquired Pressure Injuries in
Children With Congenital Heart Disease: Prevalence and Associated Factors*. Pedia-
tric Critical Care Medicine, 20(11), 1048–1056. doi: 10.1097/
PCC.0000000000002077
Murray, J.S., Noonan, C., Quigley, S., & Curley, M.A.Q. (2013). Medical device-related
hospital-acquired pressure ulcers in children: an integrative review. Journal of Pedia-
tric Nursing, 28(6), 585–595. https://doi.org/10.1016/j.pedn.2013.05.004
Neta, A. P. R., Cavalcante, T. B., Lima, A. B. S., Maciel, S. M., Miranda, S. M., & de
Sousa, A. R. A. Epidemiological and Clinical Characterization of Children with Pres-

486
Domain 11. Safety / protection Class 2. Physical injury

sure Injuries Caracterização Epidemiológica e Clínica de Crianças com Lesões por

Pressão. Revista Enfermagem Atual, 86
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Ulcer Risk and Prevention Practi-
ces in Pediatric Patients: A Secondary Analysis of Data from the National Database
of Nursing Quality Indicators®. Ostomy/wound management, 63(2), 28–32
Rowe, A., Mccarty, K., & Huett, A. (2018). Implementation of a Nurse Driven Pathway
to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive
Care Setting. Journal of Pediatric Nursing, 41, 104–109
Smith, H.A., Moore, Z., Tan, M.H. (2019). Cohort study to determine the risk of pres-
sure ulcers and developing a care bundle within a paediatric intensive care unit set-
ting. Intensive and Critical Care Nursing, 53, 68–72. ISSN 0964–3397, https://doi.
org/10.1016/j.iccn.2019.04.008
Sweeney, K. A., Cogill, K., Davis, K., & Jauncey-Cooke, J. I. (2018). Neonatal and pedia-
tric pressure injuries secondary to limb splinting for intravascular access: case series
and literature review. Journal of the Association for Vascular Access, 23(2), 108–116
Vocci, M.B., Fontes,, C.M.B., Abbade, L.P.F. (2018). Pressure injury in the pediatric
population: Cohort study using the Braden Q Scale. Advances in Skin & Wound
Care, 31(10), 456–461 doi: 10.1097/01.ASW.0000542529.94557.0a 10.1097/01.AS-
W.0000542529.94557.0a
Wang, D., Xu, H., Chen, S., Lou, X., Tan, J., Xu, Y. (2019) Medical adhesive-related
skin injuries and associated risk factors in a pediatric intensive care unit. Advances
in Skin & Wound Care, 32(4), 176–182. doi: 10.1097/01.ASW.0000553601.05196.fb

11. Safety / protection

487
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00286

Risk for child pressure injury

References
Clay, P., Cruz, C., Ayotte, K., Jones, J., & Fowler, S. B. (2018). Device related pressure
ulcers Pre and post identification and intervention. Journal of Pediatric Nursing, 41,
77–79
Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., Nie, A.M. (2019). Pressure
Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel
White Paper, Advances in Skin & Wound Care, 32(9), 394–408
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/
Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler
(Ed.). EPUAP/NPIAP/PPPIA: 2019.Chamblee, T., Pasek, T., Caillouette, C., Stellar,
J., Quigley, S., & Curley, M. (2018). CE: How to predict pediatric pressure injury risk
with the Braden QD Scale. The American Journal of Nursing, 118(11), 34–43
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance (2019). Prevention and treatment of pressure
ulcers/injuries: clinical practice guideline (3rd Ed.). ISBN 978–0–6480097–8–11
Huan, L. I., Jiang, S., Qun, Y. U., Yaqin, H. U., & Jiang, L. (2018). Characteristics and
risk factors of pressure injuries in patients admitted to the PICU. Chinese Journal of
Nursing, 53(3), 261–266
Jackson, D., Sarki, A. M., Betteridge, R., & Brooke, J. (2019). Medical device-related
pressure ulcers: A systematic review and meta-analysis. International Journal of
Nursing Studies, 92, 109–120
Kayser, S. A., VanGilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence
and analysis of medical device-related pressure injuries: results from the internation-
al pressure ulcer prevalence survey. Advances in Skin & Wound Care, 31(6), 276
Kim, M.J., Jang, J. M., Kim, H.K., Heo, H. J., Jeong, I. S. (2019). Medical adhesives-re-
lated skin injury in a pediatric intensive care unit. Journal of Wound, Ostomy and
Continence Nursing, 46(6), 491–496. doi: 10.1097/WON.0000000000000592
11. Safety / protection

Ko H-Y. Management and Rehabilitation of Spinal Cord Injuries. Springer Singapore,

2019
Kulik, L., Connor, J., Graham, D., & Hickey, P. (2018). Pressure injury prevention for
paediatric cardiac surgical patients using a nurse-driven standardized clinical assess-
ment and management plan. Cardiology in the Young, 28(9), 1151–1162
Kulik, L.A., Hasbani, N.R., Stellar, J.J., Quigley, S.M., Shelley, S.S., Wypij, D., Curley,
Martha A. Q., for Braden QD Study Group Hospital-Acquired Pressure Injuries in
Children With Congenital Heart Disease: Prevalence and Associated Factors*. Pedia-
tric Critical Care Medicine, 20(11), 1048–1056. doi: 10.1097/
PCC.0000000000002077
Murray, J.S., Noonan, C., Quigley, S., & Curley, M.A.Q. (2013). Medical device-related
hospital-acquired pressure ulcers in children: an integrative review. Journal of Pedia-
tric Nursing, 28(6), 585–595. https://doi.org/10.1016/j.pedn.2013.05.004
Neta, A. P. R., Cavalcante, T. B., Lima, A. B. S., Maciel, S. M., Miranda, S. M., & de
Sousa, A. R. A. Epidemiological and Clinical Characterization of Children with Pres-

488
Domain 11. Safety / protection Class 2. Physical injury

sure Injuries Caracterização Epidemiológica e Clínica de Crianças com Lesões por

Pressão. Revista Enfermagem Atual, 86
Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Ulcer Risk and Prevention Practi-
ces in Pediatric Patients: A Secondary Analysis of Data from the National Database
of Nursing Quality Indicators®. Ostomy/wound management, 63(2), 28–32
Rowe, A., Mccarty, K., & Huett, A. (2018). Implementation of a Nurse Driven Pathway
to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive
Care Setting. Journal of Pediatric Nursing, 41, 104–109
Smith, H.A., Moore, Z., Tan, M.H. (2019). Cohort study to determine the risk of pres-
sure ulcers and developing a care bundle within a paediatric intensive care unit set-
ting. Intensive and Critical Care Nursing, 53, 68–72. ISSN 0964–3397, https://doi.
org/10.1016/j.iccn.2019.04.008
Sweeney, K. A., Cogill, K., Davis, K., & Jauncey-Cooke, J. I. (2018). Neonatal and pedia-
tric pressure injuries secondary to limb splinting for intravascular access: case series
and literature review. Journal of the Association for Vascular Access, 23(2), 108–116
Vocci, M.B., Fontes,, C.M.B., Abbade, L.P.F. (2018). Pressure injury in the pediatric
population: Cohort study using the Braden Q Scale. Advances in Skin & Wound
Care, 31(10), 456–461 doi: 10.1097/01.ASW.0000542529.94557.0a 10.1097/01.AS-
W.0000542529.94557.0a
Wang, D., Xu, H., Chen, S., Lou, X., Tan, J., Xu, Y. (2019) Medical adhesive-related
skin injuries and associated risk factors in a pediatric intensive care unit. Advances
in Skin & Wound Care, 32(4), 176–182. doi: 10.1097/01.ASW.0000553601.05196.fb

11. Safety / protection

489
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00312

Adult pressure injury

References
Abouleish AE, Leib ML, Cohen NH (2015). ASA provides examples to each ASA phys-
ical status class. ASA Monitor, 79, 38–39
Agrawal K, Chauhan N. (2012). Pressure ulcers: Back to the basics. Indian J PlastSurg,
45(2), 244–254. DOI: 10.4103/0970–0358.101287
Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, Von Renteln-Kruse
W. (2010). Decubitus Ulcers: Pathophysiology and Primary Prevention. Dtsch Arzte-
blInt, 107(21), 371–382. DOI: 10.3238/arztebl.2010.0371
Barrientos C. et al. (2005). Efectos de la implementación de un protocolo de prevención
de úlceras por presión en pacientes en estado crítico de salud. Rev. Chil. Med. In-
tens., Santiago; 20(1):12–20
Canter H, Aksu A, Abusafa A, Latipov E, Safak T, Kecik A. Atypical Pressure Sores
Developing In A Patient With Alcohol Intoxication The Internet Journal of Internal
Medicine 2013; Volume 5 Number 1
Consortium for Spinal Cord Medicine Member Organizations. Pressure Ulcer Preven-
tion and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for
Health-Care Professionals. 2 ed. 2014. Consortium for Spinal Cord Medicine
Costa ACO, Pinho CPS, Santos ADA, Nascimento ACS. (2015). Ulcera por presión:
incidencia y factores demográficos, clínicos y nutricionales asociados en pacientes de
una unidad de cuidados intensivos. Nutr Hosp. 32(5):2242–2252
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance (2019). Prevention and treatment of pressure
ulcers/injuries: clinical practice guideline (3rd Ed.). ISBN 978–0–6480097–8–11
Irgens, I., Hoff, J. M., Jelnes, R., Alexander, M., Stanghelle, J. K., Thoresen, M., & Re-
kand, T. (2020). Spinal cord injury and development of pressure injury during acute
rehabilitation in Norway: a national retrospective cross-sectional study. Spinal Cord.
doi:10.1038/s41393–020–0465-z
Jackson, D., Sarki, A. M., Betteridge, R., &Brooke, J. (2019). Medical device-related
11. Safety / protection

pressure ulcers: A systematic review and meta-analysis. International Journal of

Nursing Studies, 92, 109–120
Kayser, S. A., Van Gilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence
and analysis of medical device-related pressure injuries: results from the internation-
al pressure ulcer prevalence survey. Advances in Skin &WoundCare, 31(6), 276
Ko H-Y. Management and Rehabilitation of Spinal Cord Injuries. Springer Singapore,
2019
Nixon J, Cranny G, Bond S. (2007). Skin alterations of intact skin and risk factors asso-
ciated with pressure ulcer development in surgical patients: a cohort study. Int. J.
Nurs. Stud., Oxford; 44(5):655–663
Santos CT, Almeida MA, Oliveira MC, Victor, MAG, Lucena, AF. (2015). Develop-
ment of the nursing diagnosis risk for pressure ulcer. Rev. Gaúcha Enferm. 36(2),
113–121. ISSN 1983–1447
Schryvers, O. I., Stranc, M. F., & Nance, P. W. (2000). Surgical treatment of pressure
ulcers: 20-year experience. Archives of Physical Medicine and Rehabilitation, 81(12),
1556–1562. doi:10.1053/apmr.2000.17828

490
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Sibbald RG. et al. (2012).Prevention and treatment of pressure ulcers. Skin Therapy
Lett., Vancouver; 17(8):4–7
Tate, D. G., Forchheimer, M. B., Krause, J. S., Meade, M. A., & Bombardier, C. H.
(2004). Patterns of alcohol and substance use and abuse in persons with spinal cord
injury: Risk factors and correlates. Archives of Physical Medicine and Rehabilitation,
85(11), 1837–1847. doi:10.1016/j.apmr.2004.02.022
Tschannen D, Bates O, Talsma A, Guo Y. (2012). Patient-specific and surgical charac-
teristics in the development of pressure ulcers. American Journal Of Critical Care,
21(2), 116–124. DOI: 10.4037/ajcc2012716
Waters, R. L., Adkins, R. H., Sie, I., & Cressy, J. (1998). Postrehabilitation outcomes
after spinal cord injury caused by firearms and motor vehicle crash among ethnically
diverse groups. Archives of Physical Medicine and Rehabilitation, 79(10), 1237–
1243. doi:10.1016/s0003–9993(98)90268–4

11. Safety / protection

491
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00304

Risk for adult pressure injury

References
Abouleish AE, Leib ML, Cohen NH (2015). ASA provides examples to each ASA phys-
ical status class. ASA Monitor, 79, 38–39
Agrawal K, Chauhan N. (2012). Pressure ulcers: Back to the basics. Indian J PlastSurg,
45(2), 244–254. DOI: 10.4103/0970–0358.101287
Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, Von Renteln-Kruse
W. (2010). Decubitus Ulcers: Pathophysiology and Primary Prevention. Dtsch Arzte-
blInt, 107(21), 371–382. DOI: 10.3238/arztebl.2010.0371
Barrientos C. et al. (2005). Efectos de la implementación de un protocolo de prevención
de úlceras por presión en pacientes en estado crítico de salud. Rev. Chil. Med. In-
tens., Santiago; 20(1):12–20
Canter H, Aksu A, Abusafa A, Latipov E, Safak T, Kecik A. Atypical Pressure Sores
Developing In A Patient With Alcohol Intoxication The Internet Journal of Internal
Medicine 2013; Volume 5 Number 1
Consortium for Spinal Cord Medicine Member Organizations. Pressure Ulcer Preven-
tion and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for
Health-Care Professionals. 2 ed. 2014. Consortium for Spinal Cord Medicine
Costa ACO, Pinho CPS, Santos ADA, Nascimento ACS. (2015). Ulcera por presión:
incidencia y factores demográficos, clínicos y nutricionales asociados en pacientes de
una unidad de cuidados intensivos. Nutr Hosp. 32(5):2242–2252
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and
Pan Pacific Pressure Injury Alliance (2019). Prevention and treatment of pressure
ulcers/injuries: clinical practice guideline (3rd Ed.). ISBN 978–0–6480097–8–11
Irgens, I., Hoff, J. M., Jelnes, R., Alexander, M., Stanghelle, J. K., Thoresen, M., & Re-
kand, T. (2020). Spinal cord injury and development of pressure injury during acute
rehabilitation in Norway: a national retrospective cross-sectional study. Spinal Cord.
doi:10.1038/s41393–020–0465-z
Jackson, D., Sarki, A. M., Betteridge, R., &Brooke, J. (2019). Medical device-related
11. Safety / protection

pressure ulcers: A systematic review and meta-analysis. International Journal of

Nursing Studies, 92, 109–120
Kayser, S. A., Van Gilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence
and analysis of medical device-related pressure injuries: results from the internation-
al pressure ulcer prevalence survey. Advances in Skin &WoundCare, 31(6), 276
Nixon J, Cranny G, Bond S. (2007). Skin alterations of intact skin and risk factors asso-
ciated with pressure ulcer development in surgical patients: a cohort study. Int. J.
Nurs. Stud., Oxford; 44(5):655–663
Santos CT, Almeida MA, Oliveira MC, Victor, MAG, Lucena, AF. (2015). Develop-
ment of the nursing diagnosis risk for pressure ulcer. Rev. Gaúcha Enferm. 36(2),
113–121. ISSN 1983–1447
Schryvers, O. I., Stranc, M. F., & Nance, P. W. (2000). Surgical treatment of pressure
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492
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11. Safety / protection

493
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Domain 11 • Class 2 • Diagnosis Code 00250

Risk for urinary tract injury

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494
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Domain 11 • Class 2 • Diagnosis Code 00044

Impaired tissue integrity

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ríodo imediato e tardio no contexto da comunidade (Dissertação). Faculdade de En-
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Barros, K.M. (2012). Revisão do diagnóstico de enfermagem integridade tissular preju-
dicada: uma análise de conceito (Dissertação). Escola de Enfermagem, Universidade
Federal de Minas Gerais, Belo Horizonte
Bassoli, S.R.B., Guimarães, H.C.Q.C.P., Virmond, M. da C.L. (2007). Identificação dos
Diagnósticos de Enfermagem mais freqüente em pacientes afetados pela hanseníase.
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tocuidado (Dissertação). Faculdade de Enfermagem, Universidade Federal de Goiás,
Goiana
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Louis: Mosby
Cavalcante AMRZ, Moreira A, Azevedo KB, Lima LR, Coimbra WKAM. Diagnóstico
de enfermagem: integridade tissular prejudicada identificado em idosos na Estratégia
de Saúde da Família. Rev. Eletr. Enf. [Internet]. 2010 out/dez;12(4):727–35. Available
from: http://dx.doi.org/10.5216/ree.v12i4.8425
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submetidos a cateterismo cardiac (Dissertação). Escola de Enfermagem,
Cyrillo, R.M.Z. & Dalri, M.C.B. (2005). Diagnósticos de enfermagem em vítimas de
trauma atendidas em um serviço pré-hospitalar avançado móvel. Revista Eletrônica 11. Safety / protection
de Enfermagem, 11(4), 811–819
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pós-operatório imediato de colecistectomia laparoscópica (Dissertação). Escola de
Enfermagem, Universidade de São Paulo, Ribeirão Preto
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mentados para pacientes de clínica médica. Revista da Escola de Enfermagem da
USP, 41(3), 395–402
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nologies and Classifications, 20(1), 16–24. Grixti, A., Sadri, M., Edgar, J., & Datta, A.
V. (2012). Common ocular surface disorders in patients in intensive care units. The
ocular surface, 10(1), 26–42
Guimarães, H.C.Q.C.P., Barros, A.L.B.L., Bassoli, S.R.B., Salotti, S.R.A., Oda, R.M., &
Lunney, M. (2009). Helping a Man with Leprosy: A Case Study. International Jour-
nal of Nursing and Terminologies and Classifications, 20(3), 141–144

495
Domain 11. Safety / protection Class 2. Physical injury

Handford, C., Buxton, P., Russell, K., Imray, C. E., McIntosh, S. E., Freer, L., Cochran,
A., & Imray, C. H. (2014). Frostbite: a practical approach to hospital management.
Extreme physiology & medicine, 3, 7. https://doi.org/10.1186/2046–7648–3–7
Hermann, A.P. & Lacerda, M.R. (2007). Atendimento domiciliar à saúde: um relato de
experiência. Cogitare Enfermagem, 12(4), 513–518
Kumar, V., Abbas, A.K., & Fausto, N. (2005). Robbins e Contran: fundamentos de pa-
tologia (7th ed.). Tradução de Edda Palmeiro et al. Rio de Janeiro: Editora Elsevier
Lima, L.R. de., Pereira, S.V.M., & Chianca, T.C.M. (2006). Diagnósticos de enfermagem
em pacientes póscateterismo cardíaco-contribuição de Orem. Revista Brasileira de
Enfermagem, 59(3), 285–290
Lin, H., & Yiu, S.C. (2014). Dry eye disease: a review of diagnostic approaches and
treatments. Saudi Journal of Ophthalmology, 28, 173–181
Malaquias, S.G., Bachion, M.M., Martins, M.A., Nunes, C.A.B., Torre, G.V., Pereira, L.
V. (2014). Impaired tissue integrity, related factors and defining characteristics in
persons with vascular ulcers. Texto contexto – enferm, 23(2), 434–442
Napoleão, A.A., Caldato, V.G., & Petrilli Filho, J.F. (2009). Diagnósticos de enferma-
gem para o planejamento da alta de homens prostatectomizados: um estudo prelimi-
nar. Revista Eletrônica de Enfermagem, 11(2), 286–294
Oliveira, A.P. de F. (2009). Assistência de Enfermagem a pacientes submetidos à cirur-
gia bariátrica baseada na North American Nursing Diagnosis Association (Tese).
Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo
Paganin, A., & Rabelo, E. R. (2012). Clinical validation of the nursing diagnoses of Im-
paired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac
catheterization. Journal of Advanced Nursing, 69(6), 1338–1345. doi:10.1111/j.1365–
2648.2012.06125.x
Patine, F.S. & Furlan, M. de F.F.M. (2006). Diagnósticos de enfermagem no atendimen-
to a puérperas e recém-nascidos internados em alojamento conjunto. Arquivos de
Ciências da Saúde, 13(4), 202–208
PHTLS. (2011). Atendimento pré-hospitalar ao traumatizado: básico e avançado. Tra-
dução de Renata Scavone et al.(7th ed.). Rio de Janeiro: Elsevier
Ramos, I. C., Oliveira, M.A.L. de., & Baga, V.A.B. (2011). Assistência de enfermagem
no pós-operatório de transplante hepático: identificando diagnósticos de enferma-
gem. Ciência, Cuidado e Saúde, 10(1), 116–126
11. Safety / protection

Salviano, M.E.M.S. (2007). Transplante hepático: diagnósticos de enfermagem segundo

a NANDA em pacientes no pós-operatório na unidade de internação (Dissertação).
Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte
Sampaio, L.M.S. & Carvalho, L.D.P. (2010). Pseudoaneurisma de artéria femural super-
ficial: relato de caso. Revista de Pesquisa em Saúde, 11(1), 55–59. Sharma, A., &
Hindman, H.B. (2014). Aging: a predisposition to dry eyes. Journal of Ophthalmol-
ogy, 2014, 781683
Sheu, Y., Cauley, J. A., Patrick, A. L., Wheeler, V. W., Bunker, C. H., & Zmuda, J. M.
(2013). Risk Factors for Fracture in Middle-Age and Older-Age Men of African De-
scent. Journal of Bone and Mineral Research, 29(1), 234–241. doi:10.1002/jbmr.2016
Silva, F.S., Viana, M.F., & Volpato, M.P. (2008). Diagnósticos de enfermagem em pa-
cientes internados pela clínica ortopédica em unidade médico-cirúrgica. Revista
Gaúcha De Enfermagem / Eenfufrgs, 29(4), 565–72
Silva, P.A. & Silva, S.R. (2010). Coriocarcinoma: um estudo de caso. Revista Brasileira
De Enfermagem, 63(1), 148–157

496
Domain 11. Safety / protection Class 2. Physical injury

Silva, R.C.L., Figueiredo, N.M.A., & Meireles, I.B. (2009). Feridas: Fundamentos e atua-
lizações em enfermagem. São Caetano do Sul: YENDIS
Silva.P.D.O. & Gorini, M.I.P.C. (2008). Diagnósticos de enfermagem do paciente com
neoplasia colorretal em tratamento quimioterápico - Uma pesquisa qualitativa. On-
line Brazilian Journal of Nursing, 7(2)

11. Safety / protection

497
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00248

Risk for impaired tissue integrity

References
Andrade, F.V. (2008). Diagnósticos de enfermagem identificados em puérperas no pe-
ríodo imediato e tardio no contexto da comunidade (Dissertação). Faculdade de En-
fermagem, Universidade Federal de Goiás, Goiana
Barros, K.M. (2012). Revisão do diagnóstico de enfermagem integridade tissular preju-
dicada: uma análise de conceito (Dissertação). Escola de Enfermagem, Universidade
Federal de Minas Gerais, Belo Horizonte
Bassoli, S.R.B., Guimarães, H.C.Q.C.P., Virmond, M. da C.L. (2007). Identificação dos
Diagnósticos de Enfermagem mais freqüente em pacientes afetados pela hanseníase.
Hansenologia Internationalis, 32(2), 175–184
Batista, L.T. de O., Rodrigues, F. de A., & Vasconelos, J. de M.B. (2011). Características
clínicas e diagnósticos de enfermagem em crianças vítimas de queimadura. Revista
da Rede de Enfermagem do Nordeste, 12(1), 158–165
Brito, M.A.G. de M. (2007). Diagnósticos de enfermagem da NANDA identificados em
pessoas com lesão medular mediante abordagem baseada na teoria do déficit de au-
tocuidado (Dissertação). Faculdade de Enfermagem, Universidade Federal de Goiás,
Goiana
Bryant, R.A. (2000). Acute and chronic wounds: Nursing Management (2nd ed.). St
Louis: Mosby
Cavalcante AMRZ, Moreira A, Azevedo KB, Lima LR, Coimbra WKAM. Diagnóstico
de enfermagem: integridade tissular prejudicada identificado em idosos na Estratégia
de Saúde da Família. Rev. Eletr. Enf. [Internet]. 2010 out/dez;12(4):727–35. Available
from: http://dx.doi.org/10.5216/ree.v12i4.8425
Costanzi, A.P. (2011). Validação clínica dos diagnósticos de enfermagem mobilidade
física prejudicada, integridade tissular prejudicada e integridade da pele em pacientes
submetidos a cateterismo cardiac (Dissertação). Escola de Enfermagem,
Cyrillo, R.M.Z. & Dalri, M.C.B. (2005). Diagnósticos de enfermagem em vítimas de
trauma atendidas em um serviço pré-hospitalar avançado móvel. Revista Eletrônica
11. Safety / protection

de Enfermagem, 11(4), 811–819

Dalri, C.C. & Rossi, L.A. (2006). Diagnósticos de enfermagem de pacientes em período
pós-operatório imediato de colecistectomia laparoscópica (Dissertação). Escola de
Enfermagem, Universidade de São Paulo, Ribeirão Preto
Fontes, C.M.B. & Cruz, D. de A.L.M. da. (2007). Diagnósticos de enfermagem docu-
mentados para pacientes de clínica médica. Revista da Escola de Enfermagem da
USP, 41(3), 395–402
Goyatá, S.L.T., & Rossi, L.A. (2009). N Nursing Diagnoses of Burned Patients and Rel-
atives’ Perceptions of Patients’ Needs. International Journal of Nursing and Termi-
nologies and Classifications, 20(1), 16–24. Grixti, A., Sadri, M., Edgar, J., & Datta, A.
V. (2012). Common ocular surface disorders in patients in intensive care units. The
ocular surface, 10(1), 26–42
Guimarães, H.C.Q.C.P., Barros, A.L.B.L., Bassoli, S.R.B., Salotti, S.R.A., Oda, R.M., &
Lunney, M. (2009). Helping a Man with Leprosy: A Case Study. International Jour-
nal of Nursing and Terminologies and Classifications, 20(3), 141–144

498
Domain 11. Safety / protection Class 2. Physical injury

Handford, C., Buxton, P., Russell, K., Imray, C. E., McIntosh, S. E., Freer, L., Cochran,
A., & Imray, C. H. (2014). Frostbite: a practical approach to hospital management.
Extreme physiology & medicine, 3, 7. https://doi.org/10.1186/2046–7648–3–7
Hermann, A.P. & Lacerda, M.R. (2007). Atendimento domiciliar à saúde: um relato de
experiência. Cogitare Enfermagem, 12(4), 513–518
Kumar, V., Abbas, A.K., & Fausto, N. (2005). Robbins e Contran: fundamentos de pa-
tologia (7th ed.). Tradução de Edda Palmeiro et al. Rio de Janeiro: Editora Elsevier
Lima, L.R. de., Pereira, S.V.M., & Chianca, T.C.M. (2006). Diagnósticos de enfermagem
em pacientes póscateterismo cardíaco-contribuição de Orem. Revista Brasileira de
Enfermagem, 59(3), 285–290
Lin, H., & Yiu, S.C. (2014). Dry eye disease: a review of diagnostic approaches and
treatments. Saudi Journal of Ophthalmology, 28, 173–181
Malaquias, S.G., Bachion, M.M., Martins, M.A., Nunes, C.A.B., Torre, G.V., Pereira, L.
V. (2014). Impaired tissue integrity, related factors and defining characteristics in
persons with vascular ulcers. Texto contexto – enferm, 23(2), 434–442
Napoleão, A.A., Caldato, V.G., & Petrilli Filho, J.F. (2009). Diagnósticos de enferma-
gem para o planejamento da alta de homens prostatectomizados: um estudo prelimi-
nar. Revista Eletrônica de Enfermagem, 11(2), 286–294
Oliveira, A.P. de F. (2009). Assistência de Enfermagem a pacientes submetidos à cirur-
gia bariátrica baseada na North American Nursing Diagnosis Association (Tese).
Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo
Paganin, A., & Rabelo, E. R. (2012). Clinical validation of the nursing diagnoses of Im-
paired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac
catheterization. Journal of Advanced Nursing, 69(6), 1338–1345. doi:10.1111/j.1365–
2648.2012.06125.x
Patine, F.S. & Furlan, M. de F.F.M. (2006). Diagnósticos de enfermagem no atendimen-
to a puérperas e recém-nascidos internados em alojamento conjunto. Arquivos de
Ciências da Saúde, 13(4), 202–208
PHTLS. (2011). Atendimento pré-hospitalar ao traumatizado: básico e avançado. Tra-
dução de Renata Scavone et al.(7th ed.). Rio de Janeiro: Elsevier
Ramos, I. C., Oliveira, M.A.L. de., & Baga, V.A.B. (2011). Assistência de enfermagem
no pós-operatório de transplante hepático: identificando diagnósticos de enferma-
gem. Ciência, Cuidado e Saúde, 10(1), 116–126 11. Safety / protection
Salviano, M.E.M.S. (2007). Transplante hepático: diagnósticos de enfermagem segundo
a NANDA em pacientes no pós-operatório na unidade de internação (Dissertação).
Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte
Sampaio, L.M.S. & Carvalho, L.D.P. (2010). Pseudoaneurisma de artéria femural super-
ficial: relato de caso. Revista de Pesquisa em Saúde, 11(1), 55–59. Sharma, A., &
Hindman, H.B. (2014). Aging: a predisposition to dry eyes. Journal of Ophthalmol-
ogy, 2014, 781683
Sheu, Y., Cauley, J. A., Patrick, A. L., Wheeler, V. W., Bunker, C. H., & Zmuda, J. M.
(2013). Risk Factors for Fracture in Middle-Age and Older-Age Men of African De-
scent. Journal of Bone and Mineral Research, 29(1), 234–241. doi:10.1002/jbmr.2016
Silva, F.S., Viana, M.F., & Volpato, M.P. (2008). Diagnósticos de enfermagem em pa-
cientes internados pela clínica ortopédica em unidade médico-cirúrgica. Revista
Gaúcha De Enfermagem / Eenfufrgs, 29(4), 565–72
Silva, P.A. & Silva, S.R. (2010). Coriocarcinoma: um estudo de caso. Revista Brasileira
De Enfermagem, 63(1), 148–157

499
Domain 11. Safety / protection Class 2. Physical injury

Silva, R.C.L., Figueiredo, N.M.A., & Meireles, I.B. (2009). Feridas: Fundamentos e atua-
lizações em enfermagem. São Caetano do Sul: YENDIS
Silva.P.D.O. & Gorini, M.I.P.C. (2008). Diagnósticos de enfermagem do paciente com
neoplasia colorretal em tratamento quimioterápico - Uma pesquisa qualitativa. On-
line Brazilian Journal of Nursing, 7(2)
11. Safety / protection

500
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00046

Impaired skin integrity

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Konya, C., Sanada, H., Sugama, J., Okuwa, M., Kamatani, Y., Nakagami, G., & Sakaki,
K. (2010). Skin injuries caused by medical adhesive tape in older people and associ-
ated factors. Journal of Clinical Nursing, 19(9–10), 1236–1242.doi:10.1111/j.1365–
2702.2009.03168.x
Lund, C. H., Kuller, J., Lane, A. T., Lott, J. W., Raines, D. A., & Thomas, K. K. (2001).
Neonatal Skin Care: Evaluation of the AWHONN/NANN Research-Based Practice
Project on Knowledge and Skin Care Practices. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 30(1), 30–40.doi:10.1111/j.1552–6909.2001.tb01519.x
Madanchi, N., Tabatabaei-Malazy, O., Pajouhi, M., Heshmat, R., Larijani, B., & Moha-
jeri-Tehrani, M.-R. (2013). Who are diabetic foot patients? A descriptive study on
873 patients. Journal of Diabetes & Metabolic Disorders, 12(1), 36.doi:10.1186/
2251–6581–12–36
Muñoz M, Paula, Gómez H, Oríetta, & Luzoro V, Amaranta. (2008). Skin diseases in
human immunodeficiency virus positive children from Santiago, Chile. Revista chi-
lena de infectología, 25(4), 277–282. https://dx.doi.org/10.4067/S0716–
10182008000400005
Nagano, M., Ogata, Y., Ikeda, M., Tsukada, K., Tokunaga, K., & Iida, S. (2019). Peristo-
mal Moisture-Associated Skin Damage and Independence in Pouching System
Changes in Persons With New Fecal Ostomies. Journal of Wound, Ostomy and
Continence Nursing, 46(2), 137–142.doi:10.1097/won.0000000000000491
Oe, M., Sanada, H., Nagase, T., Minematsu, T., Ohashi, Y., Kadono, T., … Kadowaki,
T. (2012). Factors associated with deep foot fissures in diabetic patients: A cross-sec-
tional observational study. International Journal of Nursing Studies, 49(6), 739–746.
doi:10.1016/j.ijnurstu.2012.01.007
Paganin, A., & Rabelo, E. R. (2012). Clinical validation of the nursing diagnoses of Im-
paired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac
catheterization. Journal of Advanced Nursing, 69(6), 1338–1345. doi:10.1111/j.1365–
2648.2012.06125.x
11. Safety / protection

Piñeros B., J., Calderón O., W., Castillo D., P., Steiner G., M., & Léniz M., P. (2018).
Quemaduras químicas. Cuadernos de Cirugía, 16(1), 26–30. doi:10.4206/cuad.
cir.2002.v16n1–05
Quiroga Cuellar, J. P., Lafuente Lafuente, L. A., Rorigues Correia, T. R., Meireles Salo-
mao, G., & Chacon Paco, L. (2018). Accidentes por quemaduras en edad pediátrica.
Revista Científica De Salud UNITEPC, 5(2), 16–22. https://doi.org/10.36716/uni-
tepc.v5i2.39
Ratliff, C. R. (2017). Descriptive study of the frequency of medical adhesive–related
skin injuries in a vascular clinic. Journal of Vascular Nursing, 35(2), 86–89.
doi:10.1016/j.jvn.2017.01.001
Ratliff, C. R., Scarano, K. A., & Donovan, A. M. (2005). Descriptive Study of Peristomal
Complications. Journal of Wound, Ostomy and Continence Nursing, 32(1), 33–37.
doi:10.1097/00152192–200501000–00008
Resende, Daniella de Moura, Bachion, Maria Márcia, & Araújo, Lorena Aparecida de
Oliveira. (2006). Integridade da pele prejudicada em idosos: estudo de ocorrência nu-

502
Domain 11. Safety / protection Class 2. Physical injury

ma comunidade atendida pelo Programa Saúde da Família. Acta Paulista de Enfer-

magem, 19(2), 168–173. https://dx.doi.org/10.1590/S0103–21002006000200008
Ribeiro, M.A.S., Lages, J.S.S., & Lopes, M.H.B.M. (2012). Nursing diagnoses related to
skin: operational definitions. Revista Latino-Americana de Enfermagem, 20(5), 863–
872
Sanada, H., Sugama, J., Kitagawa, A., Thigpen, B., Kinosita, S., & Murayama, S. (2007).
Risk factors in the development of pressure ulcers in an intensive care unit in Pontia-
nak, Indonesia. International Wound Journal, 4(3), 208–215. doi:10.1111/j.1742–
481x.2007.00315.x
Stegensek Mejía, E.M., Jiménez Mendoza, A., Romero Gálvez, L.E., & Aparicio Aguilar,
A. (2015). Úlceras por presión en diversos servicios de un hospital de segundo nivel
de atención. Enfermería universitaria, 12(4), 173–181. https://dx.doi.org/10.1016/j.
reu.2015.08.004
Ter, N., Yavuz, M., Aydoğdu, S., & Kaya Biçer, E. (2015). The Effect of 2 Adhesive
Products on Skin Integrity Used for Fixation of Hip and Knee Surgical Dressings.
Journal of Wound, Ostomy and Continence Nursing, 42(2), 145–150. doi:10.1097/
won.0000000000000112
Valls-Matarín, J., del Cotillo-Fuente, M., Ribal-Prior, R., Pujol-Vila, M., & Sandalinas-
Mulero, I. (2017). Incidencia de lesiones cutáneas asociadas a la humedad en una
unidad de cuidados intensivos. Enfermería Intensiva, 28(1), 13–20.doi:10.1016/j.en-
fi.2016.11.001
Zhang, Y., Wang, S., Zhang, X., Zhang, W., & Wang, X. (2020). Incidence and Influ-
encing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients. Ad-
vances in Skin & Wound Care, 33(5), 260–266.doi:10.1097/01.
asw.0000658584.09988.fa
Zhao, H., He, Y., Huang, H., Ling, Y., Zhou, X., Wei, Q., … Ying, Y. (2018). Prevalence
of medical adhesive-related skin injury at peripherally inserted central catheter inser-
tion site in oncology patients. The Journal of Vascular Access, 19(1), 23–27.
doi:10.5301/jva.5000805
Zhao, H., He, Y., Wei, Q., & Ying, Y. (2018). Medical Adhesive–Related Skin Injury
Prevalence at the Peripherally Inserted Central Catheter Insertion Site. Journal of
Wound, Ostomy and Continence Nursing, 45(1), 22–25.doi:10.1097/
won.0000000000000394 11. Safety / protection

503
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00047

Risk for impaired skin integrity

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mal Moisture-Associated Skin Damage and Independence in Pouching System
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Paganin, A., & Rabelo, E. R. (2012). Clinical validation of the nursing diagnoses of Im-
paired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac
catheterization. Journal of Advanced Nursing, 69(6), 1338–1345. doi:10.1111/j.1365–
2648.2012.06125.x 11. Safety / protection
Piñeros B., J., Calderón O., W., Castillo D., P., Steiner G., M., & Léniz M., P. (2018).
Quemaduras químicas. Cuadernos de Cirugía, 16(1), 26–30. doi:10.4206/cuad.
cir.2002.v16n1–05
Quiroga Cuellar, J. P., Lafuente Lafuente, L. A., Rorigues Correia, T. R., Meireles Salo-
mao, G., & Chacon Paco, L. (2018). Accidentes por quemaduras en edad pediátrica.
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tepc.v5i2.39
Ratliff, C. R. (2017). Descriptive study of the frequency of medical adhesive–related
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505
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ma comunidade atendida pelo Programa Saúde da Família. Acta Paulista de Enfer-

magem, 19(2), 168–173. https://dx.doi.org/10.1590/S0103–21002006000200008
Ribeiro, M.A.S., Lages, J.S.S., & Lopes, M.H.B.M. (2012). Nursing diagnoses related to
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872
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nak, Indonesia. International Wound Journal, 4(3), 208–215. doi:10.1111/j.1742–
481x.2007.00315.x
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A. (2015). Úlceras por presión en diversos servicios de un hospital de segundo nivel
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Products on Skin Integrity Used for Fixation of Hip and Knee Surgical Dressings.
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Mulero, I. (2017). Incidencia de lesiones cutáneas asociadas a la humedad en una
unidad de cuidados intensivos. Enfermería Intensiva, 28(1), 13–20.doi:10.1016/j.en-
fi.2016.11.001
Zhang, Y., Wang, S., Zhang, X., Zhang, W., & Wang, X. (2020). Incidence and Influ-
encing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients. Ad-
vances in Skin & Wound Care, 33(5), 260–266.doi:10.1097/01.
asw.0000658584.09988.fa
Zhao, H., He, Y., Huang, H., Ling, Y., Zhou, X., Wei, Q., … Ying, Y. (2018). Prevalence
of medical adhesive-related skin injury at peripherally inserted central catheter inser-
tion site in oncology patients. The Journal of Vascular Access, 19(1), 23–27.
doi:10.5301/jva.5000805
Zhao, H., He, Y., Wei, Q., & Ying, Y. (2018). Medical Adhesive–Related Skin Injury
Prevalence at the Peripherally Inserted Central Catheter Insertion Site. Journal of
Wound, Ostomy and Continence Nursing, 45(1), 22–25.doi:10.1097/
won.0000000000000394
11. Safety / protection

506
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00461

Impaired nipple-areolar complex integrity

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s12884–016–0999–4
Shimoda GT, Aragaki IMM, Sousa CA, Silva IA. Association between persistent nipple
lesions and breastfeeding conditions. Rev Min Enferm. 2014; 18(1): 68–74. http://
www.dx.doi.org/10.5935/1415–2762.20140006
Shimoda GT, Silva IA, Santos JLF. Characteristics, frequency and factors present in
nipples damage occurence in lactating women. Rev Bras Enferm. 2005; 58 (5): 529–
34
Tait P. Nipple pain in breastfeeding women: causes, treatment, and prevention strat-
egies. Journal of midwifery & women's health. 2000 May 1;45(3):212–5. doi.org/
10.1016/S1526–9523(00)00011–8
Thompson R, Kruske S, Barclay L, Linden K, Gao Y, Kildea S. Potential predictors of
nipple trauma from an in-home breastfeeding programme: A cross-sectional study.
Women Birth. 2016;29(4):336–44. Available from: https://doi.org/10.1016/j.wom-
bi.2016.01.002 11. Safety / protection
Vieira F, Mota DDCF, Castral TC, Guimarães JV, Salge AKM, Bachion MM. Effects of
Anhydrous Lanolin versus Breast Milk Combined with a Breast Shell for the Treat-
ment of Nipple Trauma and Pain During Breastfeeding: A Randomized Clinical Tri-
al. J Midwifery Womens Health. 2017 Sep;62(5):572–9. doi: 10.1111/jmwh.12644
Vieira F. The effect of lanolin anhydrous compared to breast milk combined with pro-
tection shells to treat nipple pain and trauma in breastfeeding mothers: a random-
ized clinical trial [thesis]. Goiânia: College of Nursing/UFG; 2013. p. 170
Vinha VHP, Pelá NTR, Shimo AKK, Scochi CGS. Trauma mamilar: proposta de trata-
mento. Femina. 1987; 15 (5): 370–8
Walker M, Driscoll JW. Sore nipples: the new mother's nemesis. MCN Am J Matern
Child Nurs.1989;14(4):260–5
Weigert EML, Giugliani E RJ, França MCT, Oliveira LD, Bonilha A, Espírito Santo LC,
Köhler CVF. Influência da técnica de amamentação nas frequências de aleitamento
materno exclusivo e lesões mamilares no primeiro mês de lactação. J Pediatr. 2005;
81(4):310–6

509
Domain 11. Safety / protection Class 2. Physical injury

Wockel A, Schumann M, Abou-Dakn M: Development of a wound score for the evalu-

ation of cracked nipples during lactation. Arch Gyn Obst 2004;17(suppl 1):270
Ziemer MM, Cooper DM, Pigeon JG. Evaluation of a dressing to reduce nipple pain
and improve nipple skin condition in breastfeeding women. Nurs Res. 1995; 44 (6):
347–51
Ziemer MM, Pigeon JG. Skin changes and pain in the nipple during the 1st week of
lactation. J Obstet Gynecol Neonatal Nurs. 1993;22(3):247–56
11. Safety / protection

510
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00462

Risk for impaired nipple-areolar complex integrity

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s12884–016–0999–4
Shimoda GT, Aragaki IMM, Sousa CA, Silva IA. Association between persistent nipple
lesions and breastfeeding conditions. Rev Min Enferm. 2014; 18(1): 68–74. http://
www.dx.doi.org/10.5935/1415–2762.20140006
Shimoda GT, Silva IA, Santos JLF. Characteristics, frequency and factors present in
nipples damage occurence in lactating women. Rev Bras Enferm. 2005; 58 (5): 529–
34
Tait P. Nipple pain in breastfeeding women: causes, treatment, and prevention strat-
egies. Journal of midwifery & women's health. 2000 May 1;45(3):212–5. doi.org/
10.1016/S1526–9523(00)00011–8
Thompson R, Kruske S, Barclay L, Linden K, Gao Y, Kildea S. Potential predictors of
nipple trauma from an in-home breastfeeding programme: A cross-sectional study.
Women Birth. 2016;29(4):336–44. Available from: https://doi.org/10.1016/j.wom-
bi.2016.01.002 11. Safety / protection
Vieira F, Mota DDCF, Castral TC, Guimarães JV, Salge AKM, Bachion MM. Effects of
Anhydrous Lanolin versus Breast Milk Combined with a Breast Shell for the Treat-
ment of Nipple Trauma and Pain During Breastfeeding: A Randomized Clinical Tri-
al. J Midwifery Womens Health. 2017 Sep;62(5):572–9. doi: 10.1111/jmwh.12644
Vieira F. The effect of lanolin anhydrous compared to breast milk combined with pro-
tection shells to treat nipple pain and trauma in breastfeeding mothers: a random-
ized clinical trial [thesis]. Goiânia: College of Nursing/UFG; 2013. p. 170
Vinha VHP, Pelá NTR, Shimo AKK, Scochi CGS. Trauma mamilar: proposta de trata-
mento. Femina. 1987; 15 (5): 370–8
Walker M, Driscoll JW. Sore nipples: the new mother's nemesis. MCN Am J Matern
Child Nurs.1989;14(4):260–5
Weigert EML, Giugliani E RJ, França MCT, Oliveira LD, Bonilha A, Espírito Santo LC,
Köhler CVF. Influência da técnica de amamentação nas frequências de aleitamento
materno exclusivo e lesões mamilares no primeiro mês de lactação. J Pediatr. 2005;
81(4):310–6

513
Domain 11. Safety / protection Class 2. Physical injury

Wockel A, Schumann M, Abou-Dakn M: Development of a wound score for the evalu-

ation of cracked nipples during lactation. Arch Gyn Obst 2004;17(suppl 1):270
Ziemer MM, Cooper DM, Pigeon JG. Evaluation of a dressing to reduce nipple pain
and improve nipple skin condition in breastfeeding women. Nurs Res. 1995; 44 (6):
347–51
Ziemer MM, Pigeon JG. Skin changes and pain in the nipple during the 1st week of
lactation. J Obstet Gynecol Neonatal Nurs. 1993;22(3):247–56
11. Safety / protection

514
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00045

Impaired oral mucous membrane integrity

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terations to oral intake during the first year after treatment for head and neck cancer.
Head Neck. 2011; 33(6):774–779

515
Domain 11. Safety / protection Class 2. Physical injury

Rolim AEH, Costa LJ, Ramalho LMP. Repercussões da radioterapia na região orofacial
e seu tratamento. Radiol Bras. 2011; 44(6):388–395
Santos RCS. Mucosite em pacientes portadores de câncer de cabeça e pescoço submeti-
dos a radioterapia e quimioterapia concomitantes. Radiol Bras. 2010; 43(2):136 Sil-
veira JLGC, Stanke R. Condição e representações da saúde bucal entre os sem-teto
do município de Blumenau – Santa Catarina. Ciências & Cognição. 2008; 13(1):2–
11
Stellingsma C, Dijkstra PU, Dijkstra J, Duipmans JC, Jonkman MF, Dekker R. Restric-
tions in oral functions caused by oral manifestations of epidermolysis bullosa. Eur J
Dermatol. 2011; 21(3):405–409
11. Safety / protection

516
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00247

Risk for impaired oral mucous membrane integrity

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Bastiani C, Soares Cota AL, Arias Provenzano MG, Calvo Fracasso ML, Marques Hon-
ório H, Rios D. Conhecimento das gestantes sobre alterações bucais e tratamento
odontológico durante a gravidez. Odontologia Clínico-Científica., Recife. 2010; 9(2):
155–160
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de crianças infectadas pelo HIV: revisão de literatura. Cien Saude Colet. 2008; 13(6):
1797–1805
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cal: considerações sobre os mecanismos relacionados. Rev Bras Cancerol. 2008; 54
(1):49–56
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nados ao sistema estomatognático. Revista de Ciências Médicas e Biológicas. 2010; 9
Suppl.1:49–52
Côrte-Real IS, Figueiral MH, Campos JCR. As doenças orais no idoso – Considerações
gerais. Revista Portuguesa de Estomatologia Medicina Dentária e Cirurgia Maxilofa-
cial. 2011; 52(3):175–180
Costa LJ, Soares MSM, Komatsu AA, Albuquerque ACL. Pacientes com Doenças Sistê-
micas de Origem Auto-Imune/Dermatológicas: Incidência das Manifestações Bucais
e Revisão de Literatura. Rev Bras Ciênc Saúde. 2009; 13(3):49–54
Cruz MCFN, Braga VAS, Garcia JGF, Lopes FF, Maia ECS. Condições bucais relacio-
nadas com o estresse: uma revisão dos achados atuais. Rev Fac Odontol Porto Ale-
gre. 2008; 49(1):8–11
Ghezzi EM, Ship JA, Mich AA. Dentina and oral health. Oral Surg Oral Med Oral
Pathol Oral Radiol. 2000; 89(1):2–5 11. Safety / protection
Gonçalves LM, Júnior JRSB, Cruz MCFN. Avaliação clínica das lesões orais associadas
a doenças Dermatológicas. An Bras Dermatol. 2009; 84(6):585–592
Goursand D, Borges CM, Alves KM, et al. Sequelas bucais em crianças submetidas à
terapia antineoplásica: causas e definição do papel do cirurgião dentista. Arq Odon-
tol. 2006; 42(3):161–256
Lopes FL, Tier CG, Filho WL, Santos SSC. Diagnósticos de enfermagem de idosos resi-
dentes em uma instituição de longa permanência (ILP). Ciênc Cuid Saúde. 2007; 6
(1):59–67
Pace MA, Watanabe E, Facetto MP, Andrade D. Staphylococcus spp. na saliva de pa-
cientes com intubação orotraqueal. Rev Panam Infectol. 2008; 10(2):8–12
Paschoal CP, Azevedo MF. O cigarro como um fator de risco para alterações auditivas.
Braz J Otorrinolaringol (Engl Ed). 2009; 75(6):893–902
Pauloski BR, Rademaker AW, Logemann JA, et al. Relation of mucous membrane al-
terations to oral intake during the first year after treatment for head and neck cancer.
Head Neck. 2011; 33(6):774–779

517
Domain 11. Safety / protection Class 2. Physical injury

Rolim AEH, Costa LJ, Ramalho LMP. Repercussões da radioterapia na região orofacial
e seu tratamento. Radiol Bras. 2011; 44(6):388–395
Santos RCS. Mucosite em pacientes portadores de câncer de cabeça e pescoço submeti-
dos a radioterapia e quimioterapia concomitantes. Radiol Bras. 2010; 43(2):136 Sil-
veira JLGC, Stanke R. Condição e representações da saúde bucal entre os sem-teto
do município de Blumenau – Santa Catarina. Ciências & Cognição. 2008; 13(1):2–
11
Stellingsma C, Dijkstra PU, Dijkstra J, Duipmans JC, Jonkman MF, Dekker R. Restric-
tions in oral functions caused by oral manifestations of epidermolysis bullosa. Eur J
Dermatol. 2011; 21(3):405–409
11. Safety / protection

518
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00306

Risk for child falls

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519
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Domain 11 • Class 2 • Diagnosis Code 00303

Risk for adult falls

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Domain 11 • Class 2 • Diagnosis Code 00463

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Domain 11 • Class 2 • Diagnosis Code 00291

Risk for thrombosis

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541
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Domain 11 • Class 2 • Diagnosis Code 00425

Risk for impaired peripheral neurovascular function

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542
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544
Domain 11. Safety / protection Class 2. Physical injury

Domain 11 • Class 2 • Diagnosis Code 00290

Risk for elopement attempt

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546
Domain 11. Safety / protection Class 3. Violence

Domain 11 • Class 3 • Diagnosis Code 00138

Risk for other-directed violence

None at this time

11. Safety / protection

547
Domain 11. Safety / protection Class 3. Violence

Domain 11 • Class 3 • Diagnosis Code 00272

Risk for female genital mutilation

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549
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Domain 11 • Class 3 • Diagnosis Code 00466

Risk for suicidal self-injurious behavior

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Domain 11 • Class 3 • Diagnosis Code 00467

Non-suicidal self-injurious behavior

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552
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Domain 11 • Class 3 • Diagnosis Code 00468

Risk for non-suicidal self-injurious behavior

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11. Safety / protection

553
Domain 11. Safety / protection Class 4. Environmental hazards

Domain 11 • Class 4 • Diagnosis Code 00181

Contamination
References
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related illness in farmers. Journal of Community Health Nursing, 9(4), 245–253
Berkowitz, G. S., Obel, J., Deych, E., Lapinski, R., Godbold, J., & Liu, Z. (2003). Expo-
sure to indoor pesticides during pregnancy in a multiethnic, urban cohort. Environ-
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Brender, J., Suarez, L., Hendricks, K., Baetz, R.A., & Larsen, R. (2002). Parental occupa-
tion and neural tube defect-affected pregnancies among Mexican Americans. Journal
of Occupational and Environmental Medicine, 44(7), 650–656
Butterfield, P.G. (2002). Upstream reflections on environmental health: An abbreviated
history and framework for action. Advances in Nursing Science, 25(1), 32–49
Center for Disease Control and Prevention (2004). Agency for Toxic Substances and
Disease Registry. Retrieved from http://www.atsdr.cdc.gov
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exposure to environmental chemicals: Executive summary. Atlanta, GA: Center for
Disease Control and Prevention. NCEH Pub # 05–0725. Atlanta, GA: Center for Dis-
ease Control and Prevention
Chalupka, S.M. (2001). Essentials of environmental health. Enhancing your occupa-
tional health nursing practice. (Part I). American Association of Occupational
Health Nurses or Nursing, 49(3), 137–154
Chalupka, S.M. (2001). Essentials of environmental health. Enhancing your occupa-
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Health Nurses or Nursing, 49(4), 194–213
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Diaz, J.D.M., Lopez, M.A., & Campbell, P. (1999). Voluntary ingestion of organophos-
11. Safety / protection

phate insecticide by a young farmer. Journal of Emergency Nursing, 25(4), 266–268

Dixon, J.K. & Dixon, J.P. (2002). An integrative model for environmental health re-
search. Advances in Nursing Science, 24(3), 43–57
Environmental Protection Agency (2004). Understanding radiation health effects. EPA.
Retrieved from http://www.epa.gov
Etzel, R. & Balk, S. (1999). Handbook of pediatric environmental health (1st ed.). Elk
Grove, IL: American Academy of Pediatrics. Gerrard, C.E. (1998). Farmer’s occupa-
tional health: Cause for concern, cause for action. Journal of Advanced Nursing, 28
(1), 155–163
Goldman, L.R., Shannon, M.W., & the Committee on Environmental Health. (2001).
Technical report: Mercury in the environment: Implications for physicians. Pedia-
trics, 108(1), 197–205
King, C. & Harber, (P. 1998). Community environmental health concerns and the
nursing process: four environmental health nursing care plans. American Associa-
tion of Occupational Health Nursing Journal, 46(1), 20–27

554
Domain 11. Safety / protection Class 4. Environmental hazards

Larsson, L.S. & Butterfield, P. (2002). Mapping the future of environmental health and
nursing: strategies for integrating national competencies into nursing practice. Public
Health Nursing, 19(4), 301–308
Massey-Stokes, M. & Lanning, B. (2002). Childhood cancer and environmental toxins:
The debate continues. Family and Community Health, 24(4), 27–38
McCauley, L.A., Michaels, S., Rothlein, J., Muniz, J., Lasarev, M., & Ebbert, C. (2003).
Pesticide exposure and self-reported home hygiene: practices in agricultural families.
American Association of Occupational Health Nurses or Nursing, 51(3), 113 – 119
Meeker, B.J., Curruth, A., & Holland, C.B. (2002). Health hazards and preventive meas-
ures of farm women: emerging issues. AAOHN, 50(7), 307–314
Melum, M.F. (2001). Organophosphate toxicity. American Journal of Nursing, 101(5),
57–58
Rice, R. (1999). Environmental threats in the home: Home care nursing perspectives.
Geriatric Nursing, 20(6), 332–336. Schneider, D. & Freeman, N. (2001). Children’s
environmental health risks: A state of the art conference. Archives of Environmental
Health, 56(2), 103–110
Silbergeld, E.K. & Flaws, J.A. (2002). Environmental exposures and women’s health.
Clinical Obstetrics and Gynecology, 45(4), 1119–1128
Thornton, J.W., McCally, M., & Houlihan, J. (2002). Biomonitoring of industrial pollu-
tants: Health and policy implications of the chemical body burden. Public Health
Reports, 117(4), 315–323

11. Safety / protection

555
Domain 11. Safety / protection Class 4. Environmental hazards

Domain 11 • Class 4 • Diagnosis Code 00180

Risk for contamination

References
Baker, J.E.L. (1992). Primary, secondary, and tertiary prevention in reducing pesticide
related illness in farmers. Journal of Community Health Nursing, 9(4), 245–253
Berkowitz, G. S., Obel, J., Deych, E., Lapinski, R., Godbold, J., & Liu, Z. (2003). Expo-
sure to indoor pesticides during pregnancy in a multiethnic, urban cohort. Environ-
mental Health Perspectives, 111(1), 79–84
Brender, J., Suarez, L., Hendricks, K., Baetz, R.A., & Larsen, R. (2002). Parental occupa-
tion and neural tube defect-affected pregnancies among Mexican Americans. Journal
of Occupational and Environmental Medicine, 44(7), 650–656
Butterfield, P.G. (2002). Upstream reflections on environmental health: An abbreviated
history and framework for action. Advances in Nursing Science, 25(1), 32–49
Center for Disease Control and Prevention (2004). Agency for Toxic Substances and
Disease Registry. Retrieved from http://www.atsdr.cdc.gov
Center for Disease Control and Prevention (2005). Third national report on human
exposure to environmental chemicals: Executive summary. Atlanta, GA: Center for
Disease Control and Prevention. NCEH Pub # 05–0725. Atlanta, GA: Center for Dis-
ease Control and Prevention
Chalupka, S.M. (2001). Essentials of environmental health. Enhancing your occupa-
tional health nursing practice. (Part I). American Association of Occupational
Health Nurses or Nursing, 49(3), 137–154
Chalupka, S.M. (2001). Essentials of environmental health. Enhancing your occupa-
tional health nursing practice. (Part II). American Association of Occupational
Health Nurses or Nursing, 49(4), 194–213
Children’s Environmental Health Network. (2004). Resource guide on children’s envi-
ronmental health. Retrieved from http://www.cehn.org
Children’s Environmental Health Network. (2005). Training manual on pediatric envi-
ronmental health: Putting it into practice. Retrieved from http://www.cehn.org
Diaz, J.D.M., Lopez, M.A., & Campbell, P. (1999). Voluntary ingestion of organophos-
11. Safety / protection

phate insecticide by a young farmer. Journal of Emergency Nursing, 25(4), 266–268

Dixon, J.K. & Dixon, J.P. (2002). An integrative model for environmental health re-
search. Advances in Nursing Science, 24(3), 43–57
Environmental Protection Agency (2004). Understanding radiation health effects. EPA.
Retrieved from http://www.epa.gov
Etzel, R. & Balk, S. (1999). Handbook of pediatric environmental health (1st ed.). Elk
Grove, IL: American Academy of Pediatrics. Gerrard, C.E. (1998). Farmer’s occupa-
tional health: Cause for concern, cause for action. Journal of Advanced Nursing, 28
(1), 155–163
Goldman, L.R., Shannon, M.W., & the Committee on Environmental Health. (2001).
Technical report: Mercury in the environment: Implications for physicians. Pedia-
trics, 108(1), 197–205
King, C. & Harber, (P. 1998). Community environmental health concerns and the
nursing process: four environmental health nursing care plans. American Associa-
tion of Occupational Health Nursing Journal, 46(1), 20–27

556
Domain 11. Safety / protection Class 4. Environmental hazards

Larsson, L.S. & Butterfield, P. (2002). Mapping the future of environmental health and
nursing: strategies for integrating national competencies into nursing practice. Public
Health Nursing, 19(4), 301–308
Massey-Stokes, M. & Lanning, B. (2002). Childhood cancer and environmental toxins:
The debate continues. Family and Community Health, 24(4), 27–38
McCauley, L.A., Michaels, S., Rothlein, J., Muniz, J., Lasarev, M., & Ebbert, C. (2003).
Pesticide exposure and self-reported home hygiene: practices in agricultural families.
American Association of Occupational Health Nurses or Nursing, 51(3), 113 – 119
Meeker, B.J., Curruth, A., & Holland, C.B. (2002). Health hazards and preventive meas-
ures of farm women: emerging issues. AAOHN, 50(7), 307–314
Melum, M.F. (2001). Organophosphate toxicity. American Journal of Nursing, 101(5),
57–58
Rice, R. (1999). Environmental threats in the home: Home care nursing perspectives.
Geriatric Nursing, 20(6), 332–336. Schneider, D. & Freeman, N. (2001). Children’s
environmental health risks: A state of the art conference. Archives of Environmental
Health, 56(2), 103–110
Silbergeld, E.K. & Flaws, J.A. (2002). Environmental exposures and women’s health.
Clinical Obstetrics and Gynecology, 45(4), 1119–1128
Thornton, J.W., McCally, M., & Houlihan, J. (2002). Biomonitoring of industrial pollu-
tants: Health and policy implications of the chemical body burden. Public Health
Reports, 117(4), 315–323

11. Safety / protection

557
Domain 11. Safety / protection Class 4. Environmental hazards

Domain 11 • Class 4 • Diagnosis Code 00469

Risk for accidental poisoning

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559
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Domain 11 • Class 4 • Diagnosis Code 00404

Risk for occupational illness

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562
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Domain 11 • Class 4 • Diagnosis Code 00402

Risk for occupational physical injury

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11. Safety / protection

565
Domain 11. Safety / protection Class 5. Defensive processes

Domain 11 • Class 5 • Diagnosis Code 00217

Risk for allergic reaction

References
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11. Safety / protection

566
Domain 11. Safety / protection Class 5. Defensive processes

Domain 11 • Class 5 • Diagnosis Code 00042

Risk for latex allergy reaction

References
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11. Safety / protection

567
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00008

Ineffective thermoregulation
None at this time
11. Safety / protection

568
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00274

Risk for ineffective thermoregulation

None at this time

11. Safety / protection

569
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00474

Decreased neonatal body temperature

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573
Domain 11. Safety / protection Class 6. Thermoregulation

Richardson, D., Shah, B., Frantz, I., Bednarek, F., Rubin, L., & McCormick, M. (1999).
Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units.
American Journal Of Public Health, 89(4), 511–516. doi:10.2105/AJPH.89.4.511
Sauer, P.J., Dane, H.J., Visser, H.K. (1984). New standards for neutral thermal environ-
ment of healthy very low birthweight infants in week one of life. Arch Dis Child, 59
(1), 18–22
Sedin, G. (2004). Physics and physiology of human neonatal incubation. In: Polin, R.
A., Fox, W.W., Abman, S.H., (eds.) Fetal and Neonatal Physiology. Philadelphia, PA:
Saunders, 570–581
Sharek, P.J., Horbar, J.D., Mason, W., Bisarya, H., Thurm, C.W., Suresh, G., Gray, J.E.,
Edwards, W.H., Goldmann, D., Classen, D. (2006). Adverse events in the neonatal
intensive care unit: development, testing, and findings of an NICU-focused trigger
tool to identify harm in North American NICUs. Pediatrics, 118(4), 1332–40
Silverman, W.A., Fertig, J.W., Berger, A.P. (1958). The influence of the thermal envi-
ronment upon the survival of newly born premature infants. Pediatrics, 22, 876–86
Singer D. (2021). Pediatric hypothermia: an ambiguous issue. International Journal of
Environmental Research and Public Health, 18(21), 11484
Stern, L., Lees, M.H., Leduc, J. (1965). Environmental temperature, oxygen consump-
tion and catecholamine excretion in newborn infants. Pediatrics, 36, 367
Tessema T, Asena TF, Alemayehu MM, Wube AM. (2022). Risk factors for neonatal
hypothermia at Arba Minch General Hospital, Ethiopia. PloS one, 17(12), e0267868
Topper, W.H., Stewart, T.P. (1984). Thermal support for the very-low-birth-weight in-
fant: role of supplemental conductive heat. J Pediatr, 105, 810–4
Tourneux, P., Libert, J. P., Ghyselen, L., Leke, A., Delanaud, S., Degrugilliers, L., et al.
(2009). Heat exchanges and thermoregulation in the neonate. Archives De Pediatrie:
Organe Officiel De La Societe Francaise De Pediatrie, 16(7), 1057–1062
Trivedi, S.S., Chudasama, R.K., Srivastava, A. (2009). Study of Early Predictors of Fatal-
ity in Mechanically Ventilated Neonates in NICU. Online Journal of Health & Allied
Sciences, 8(3), 9. Open Access Archives: http://cogprints.org/view/subjects/OJHAS.
html and http://openmed.nic.in/view/subjects/ojhas.html
Urubuto F, Agaba F, Choi J, Dusabimana R, Teteli R, Kumwami M, ... & Cartledge P.
(2021). Prevalence, risk factors and outcomes of neonatal hypothermia at admission
at a tertiary neonatal unit, Kigali, Rwanda–a cross-sectional study. The Journal of
11. Safety / protection

Maternal-Fetal & Neonatal Medicine, 34(17), 2793–2800

Vento, M. Cheung, P-Y, & Aguar, M. (2009). The first golden minutes of the ex-
tremely-low-gestational-age neonate: a gentle approach. Neonatology, 95, 286–298.
doi: 10.1159/000178770
Ventura, C.M.U., Alves, J.G.B., & Meneses, J.A. (2012). [Adverse events in a Neonatal
Intensive Care Unit]. Revista Brasileira de Enfermagem, 65(1), 49–55. (Portuguese)
Watkinson, M. (2006). Temperature control of premature infants in the delivery room.
Clin Perinatol, 33, 43–53
World Health Organization (1993). Thermal control of the newborn: a practical guide.
Maternal health and safe motherhood programme. (WHO/FHE/MSM/93.2). Geneva
(Switzerland): World Health Organization
World Health Organization (1997). Thermal protection of the newborn: a practical
guide, Maternal and Newborn Health / Safe Motherhood Unit, Reproductive Health
(Technical Support). Geneva (Switzerland): World Health Organization
Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. (2020). Neonatal hypothermia
and associated factors among newborns admitted in the neonatal intensive care unit

574
Domain 11. Safety / protection Class 6. Thermoregulation

of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. International Jour-

nal of Pediatrics, 2020
Zayeri F, Kazemnejad A, Ganjali M, Babaei G, Khanafshar N, Nayeri F. (2005). Hypo-
thermia in Iranian newborns. Incidence, risk factors and related complications. Saudi
Med J. 2005 Sep;26(9):1367–7
Zayeri F, Kazemnejad A, Ganjali M, Babaei G, Nayeri F. (2007). Incidence and risk
factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of
Iran. East Mediterr Health J. 2007 Nov-Dec;13(6):1308–18

11. Safety / protection

575
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00476

Risk for decreased neonatal body temperature

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(1), 18–22
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A., Fox, W.W., Abman, S.H., (eds.) Fetal and Neonatal Physiology. Philadelphia, PA:
Saunders, 570–581
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Edwards, W.H., Goldmann, D., Classen, D. (2006). Adverse events in the neonatal
intensive care unit: development, testing, and findings of an NICU-focused trigger
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ronment upon the survival of newly born premature infants. Pediatrics, 22, 876–86
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Stern, L., Lees, M.H., Leduc, J. (1965). Environmental temperature, oxygen consump-
tion and catecholamine excretion in newborn infants. Pediatrics, 36, 367
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fant: role of supplemental conductive heat. J Pediatr, 105, 810–4
Tourneux, P., Libert, J. P., Ghyselen, L., Leke, A., Delanaud, S., Degrugilliers, L., et al.
(2009). Heat exchanges and thermoregulation in the neonate. Archives De Pediatrie:
Organe Officiel De La Societe Francaise De Pediatrie, 16(7), 1057–1062
Trivedi, S.S., Chudasama, R.K., Srivastava, A. (2009). Study of Early Predictors of Fatal-
ity in Mechanically Ventilated Neonates in NICU. Online Journal of Health & Allied
Sciences, 8(3), 9. Open Access Archives: http://cogprints.org/view/subjects/OJHAS.
html and http://openmed.nic.in/view/subjects/ojhas.html
Urubuto F, Agaba F, Choi J, Dusabimana R, Teteli R, Kumwami M, ... & Cartledge P.
(2021). Prevalence, risk factors and outcomes of neonatal hypothermia at admission
at a tertiary neonatal unit, Kigali, Rwanda–a cross-sectional study. The Journal of
11. Safety / protection

Maternal-Fetal & Neonatal Medicine, 34(17), 2793–2800

Vento, M. Cheung, P-Y, & Aguar, M. (2009). The first golden minutes of the ex-
tremely-low-gestational-age neonate: a gentle approach. Neonatology, 95, 286–298.
doi: 10.1159/000178770
Ventura, C.M.U., Alves, J.G.B., & Meneses, J.A. (2012). [Adverse events in a Neonatal
Intensive Care Unit]. Revista Brasileira de Enfermagem, 65(1), 49–55. (Portuguese)
Watkinson, M. (2006). Temperature control of premature infants in the delivery room.
Clin Perinatol, 33, 43–53
World Health Organization (1993). Thermal control of the newborn: a practical guide.
Maternal health and safe motherhood programme. (WHO/FHE/MSM/93.2). Geneva
(Switzerland): World Health Organization
World Health Organization (1997). Thermal protection of the newborn: a practical
guide, Maternal and Newborn Health / Safe Motherhood Unit, Reproductive Health
(Technical Support). Geneva (Switzerland): World Health Organization
Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. (2020). Neonatal hypothermia
and associated factors among newborns admitted in the neonatal intensive care unit

580
Domain 11. Safety / protection Class 6. Thermoregulation

of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. International Jour-

nal of Pediatrics, 2020
Zayeri F, Kazemnejad A, Ganjali M, Babaei G, Khanafshar N, Nayeri F. (2005). Hypo-
thermia in Iranian newborns. Incidence, risk factors and related complications. Saudi
Med J. 2005 Sep;26(9):1367–7
Zayeri F, Kazemnejad A, Ganjali M, Babaei G, Nayeri F. (2007). Incidence and risk
factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of
Iran. East Mediterr Health J. 2007 Nov-Dec;13(6):1308–18

11. Safety / protection

581
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00472

Decreased body temperature

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and during neonatal intensive-care unit stabilization of extremely low-birthweight
11. Safety / protection

infants. J Obstet Gynecol Neonatal Nurs. 2007; 36(3):280–287

Knobel RB, Holditch-Davis D, Schwartz TA, Wimmer JE, Jr. Extremely low birth
weight preterm infants lack vasomotor response in relationship to cold body temper-
atures at birth. J Perinatol. 2009; 29(12):814–821
Knobel RB, Holditch-Davis D, Schwartz TA. Optimal body temperature in transitional
extremely low birth weight infants using heart rate and temperature as indicators. J
Obstet Gynecol Neonatal Nurs. 2010; 39(1):3–14
Kumar V, Shearer JC, Kumar A, Darmstadt GL. Neonatal hypothermia in low resource
settings: a review. J Perinatol. 2009; 29(6):401–412
Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypo-
thermia: systematic review of a major challenge for newborn survival. BMC Med.
2013; 11:24
Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environ-
ments. J Perinatol. 2012; 32(5):317–324
Mance MJ. Keeping infants warm: challenges of hypothermia. Adv Neonatal Care.
2008; 8(1):6–12

582
Domain 11. Safety / protection Class 6. Thermoregulation

Merklin RJ. Growth and distribution of human fetal brown fat. Anat Rec. 1974; 178
(3):637–645
Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Risk of mortal-
ity associated with neonatal hypothermia in southern Nepal. Semin Perinatol. 2010;
34(6):426–433
Mullany LC, Katz J, Khatry SK, Leclerq SC, Darmstadt GL, Tielsch JM. Incidence and
seasonality of hypothermia among newborns in southern Nepal. Arch Pediatr Ado-
lesc Med. 2010; 164(1):71–77
Mullany LC. Neonatal hypothermia in low-resource settings. Semin Perinatol. 2010; 34
(6):426–433
Muralidhara DV, Muralidhara KD, Zubaidi A. Brown Fat and Its Thermoregulatory
Role in the Human Neonate. Journal of Physiological and Biomedical Sciences. 2010;
23(2):5–10
Nayeri F, Nili F. Hypothermia at Birth and its Associated Complications in Newborns:
A Follow up Study. Iran J Public Health. 2006; 35(1):48–52
Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, Brugger
H. (2022). Accidental Hypothermia: 2021 Update. International Journal of Environ-
mental Research and Public Health, 19(1), 501. https://doi.org/10.3390/
ijerph19010501
Rasyid MUH, Sukaridhoto S, Sudarsono A, Kaffah AN. (2020). Design and implemen-
tation of hypothermia symptoms early detection with smart jacket based on wireless
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ma. Management of bleeding following major trauma: an updated European guide-
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Søreide E, Smith CE. Hypothermia in trauma. In: Smith CE, ed. Trauma Anesthesia.
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Thorsen K, Ringdal KG, Strand K, Søreide E, Hagemo J, Søreide K. Clinical and cellu-
lareffects of hypothermia, acidosis and coagulopathy in major injury. Br J Surg.
2011; 98(7):894–907
van Veelen MJ, Brodmann Maeder M. (2021). Hypothermia in Trauma. International
Journal of Environmental Research and Public Health, 18(16), 8719. https://doi.org/
10.3390/ijerph18168719 11. Safety / protection
Vento M, Cheung P-Y, Aguar M. The first golden minutes of the extremely-low-gesta-
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Waldren S, Mackinnon R. Neonatal thermoregulation. Infant. 2007; 3(3):101–104
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Zayeri F, Kazemnejad A, Ganjali M, Babaei G, Khanafshar N, Nayeri F. Hypothermia
in Iranian newborns. Incidence, risk factors and related complications. Saudi Med J.
2005; 26(9):1367–1371

583
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00473

Risk for decreased body temperature

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584
Domain 11. Safety / protection Class 6. Thermoregulation

Merklin RJ. Growth and distribution of human fetal brown fat. Anat Rec. 1974; 178
(3):637–645
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(6):426–433
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Journal of Environmental Research and Public Health, 18(16), 8719. https://doi.org/
10.3390/ijerph18168719 11. Safety / protection
Vento M, Cheung P-Y, Aguar M. The first golden minutes of the extremely-low-gesta-
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in Iranian newborns. Incidence, risk factors and related complications. Saudi Med J.
2005; 26(9):1367–1371

585
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00490

Risk for decreased perioperative body temperature

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11. Safety / protection

589
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00007

Hyperthermia
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Harpin VA, Chellappah G, Rutter N. Responses of the newborn infant to overheating.
Biol Neonate. 1983; 44(2):65–75
Kattwinkel J, d. Textbook of neonatal resuscitation. 5th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2006
Laptook AR, Watkinson M. Temperature management in the delivery room. SeminFe-
tal Neonatal Med. 2008; 13(6):383–391
Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environ-
ments. J Perinatol. 2012; 32(5):317–324
Mechem CC, Danzl DF, Grayzel J. (2011). Severe hyperthermia (heat stroke) in adults.
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disclosure#H2140224
Silverman WA, Fertig JW, Berger AP. The influence of the thermal environment upon
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11. Safety / protection

590
Domain 11. Safety / protection Class 6. Thermoregulation

Domain 11 • Class 6 • Diagnosis Code 00471

Risk for hyperthermia

References
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fant deaths?.Lancet. 1980; 1(8177):1054–1057
World Health Organization. Thermal protection of the newborn: A practical guide.
Geneva: World Health Organization; 1997
11. Safety / protection

591
Domain 12.
Comfort

Class 1. Physical comfort

Code Diagnosis Page

00380 Impaired physical comfort 595
00378 Readiness for enhanced physical comfort 596
00342 Impaired end-of-life comfort syndrome 597
00132 Acute pain 598
00255 Chronic pain syndrome 600
00133 Chronic pain 604
00256 Labor pain 607

Class 2. Environmental comfort

Code Diagnosis Page

This class does not currently contain any diagnoses 610

Class 3. Social comfort

Code Diagnosis Page

00376 Readiness for enhanced social comfort 611
00383 Inadequate social connectedness 612
00358 Inadequate social support network 614
00475 Excessive loneliness 617
00335 Risk for excessive loneliness 618

Class 4. Psychological comfort

593
Domain 12. Comfort

Code Diagnosis Page

00379 Impaired psychological comfort 619
00377 Readiness for enhanced psychological comfort 620

594
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00380

Impaired physical comfort

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12. Comfort

595
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00378

Readiness for enhanced physical comfort

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the Characterization of Comfort. Holistic Nursing Practice, 30(1), 14–24.
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12. Comfort

596
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00342

Impaired end-of-life comfort syndrome

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12. Comfort

597
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00132

Acute pain
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598
Domain 12. Comfort Class 1. Physical comfort

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12. Comfort

599
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00255

Chronic pain syndrome

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603
Domain 12. Comfort Class 1. Physical comfort

Domain 12 • Class 1 • Diagnosis Code 00133

Chronic pain
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606
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Domain 12 • Class 1 • Diagnosis Code 00256

Labor pain
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12. Comfort

609
Domain 12. Comfort Class 2. Environmental comfort

This class does not currently contain any diagnoses

12. Comfort

610
Domain 12. Comfort Class 3. Social comfort

Domain 12 • Class 3 • Diagnosis Code 00376

Readiness for enhanced social comfort

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12. Comfort

611
Domain 12. Comfort Class 3. Social comfort

Domain 12 • Class 3 • Diagnosis Code 00383

Inadequate social connectedness

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613
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Domain 12 • Class 3 • Diagnosis Code 00358

Inadequate social support network

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616
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Domain 12 • Class 3 • Diagnosis Code 00475

Excessive loneliness
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12. Comfort

617
Domain 12. Comfort Class 3. Social comfort

Domain 12 • Class 3 • Diagnosis Code 00335

Risk for excessive loneliness

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12. Comfort

618
Domain 12. Comfort Class 4. Psychological comfort

Domain 12 • Class 4 • Diagnosis Code 00379

Impaired psychological comfort

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12. Comfort

619
Domain 12. Comfort Class 4. Psychological comfort

Domain 12 • Class 4 • Diagnosis Code 00377

Readiness for enhanced psychological comfort

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12. Comfort

620
Domain 13.
Growth / development

Class 1. Growth

Code Diagnosis Page

00348 Delayed child growth 622
00478 Risk for delayed child growth 630

Class 2. Development

Code Diagnosis Page

00314 Delayed child development 638
00305 Risk for delayed child development 640
00315 Delayed infant motor development 642
00316 Risk for delayed infant motor development 644
00451 Impaired infant neurodevelopmental organization 646
00452 Risk for impaired infant neurodevelopmental organization 647
00453 Readiness for enhanced infant neurodevelopmental
organization 648
00295 Ineffective infant suck-swallow response 649

621
Domain 13. Growth / development Class 1. Growth

Domain 13 • Class 1 • Diagnosis Code 00348

Delayed child growth

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13. Growth / development

637
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00314

Delayed child development

References
Als, H., Duffy, F.H., McAnulty, G.B., Fischer, C.B., Kosta, S., Butler, S.C., Parad, R.B.,
Blickman, J.G., Zurakowski, D. & Ringer, S.A. (2011). Is the (NIDCAP) effective for
preterm infants with intrauterine growth restriction. Journal of Perinatology, 31 (2),
130–6
Belsky, J. & de Haan, M. (2011). Annual research review: parenting and children's
brain development - The end of the beginning. Journal of Child Psychology and Psy-
chiatry, 52 (4), 409–28
Blackman, J.A., Gurka, M.J., Gurka, K.K. & Oliver, M.N.J. (2011). Emotional, develop-
mental and behavioural co-morbidities of children with chronic health conditions.
Paediatr Child Health, 47 (10), 742–7
Bradley, R.H., McKelvey, L.M. & Whiteside-Mansell, L. (2011). Does the quality of sti-
mulation and support in the home environment moderate the effect of early educa-
tion programs? Child Development, 82 (6), 2110–22
Brito, C.M.L.; Vieira, G.O.; Costa, M.C.O; Oliveira, N.F. (2011). Neuropsychomotor
development: the Denver scale for screening cognitive and neuromotor delays in
preschoolers. Cad. Saúde Pública, 27 (7), 1403–14
Cohen, M.J., Meador, K.J., Browning, N., Baker, G.A., Clayton-Smith, J., Kalayjian, L.
A., Kanner, A., Liporace, J.D., Pennell, P.B., Privitera, M. & Loring, D.W. (2011). Fe-
tal antiepileptic drug exposure: Motor, adaptive, and emotional/behavioral function-
ing at age 3years. Epilepsy and Behavior, 22 (2), 240–6
Cohen, N.J. & Farnia, F. (2011). Social-emotional adjustment and attachment in chil-
dren adopted from china: Processes and predictors of change. International Journal
of Behavioral Development, 35 (1), 67–77
Collings, S. & Llewellyn, G. (2012). Children of parents with intellectual disability: Fac-
ing poor outcomes or faring okay? Journal of Intellectual and Developmental Dis-
ability, 37 (1), 65–82
Fazzi, E., Signorini, S.G., Bomba, M., Luparia, A., Lanners, J. & Balottin, U. (2011).
Reach on sound: A key to object permanence in visually impaired children. Early
Human Development, 87 (4), 289–96
Gompels, U.A, Larke, N., Sanz-Ramos, M., Bates, M., Musonda, K. & Manno D., Sia-
mo, J., Monze, M. & Filteau, S. (2012). Human cytomegalovirus infant infection ad-
versely affects growth and development in maternally HIV-exposed and unexposed
infants in Zambia. Clinical Infectious Diseases, 54 (3), 434–42
13. Growth / development

Guxens, M. Aguilera, I., Ballester. F, Estarlich. M., Fernandez-Somoano, A., Lertxundi,

A., Lertxund, N., Mendes, M.A., Tardon, A., Vrijheid, M. & Sunyer,J. (2012). Prena-
tal exposure to residential air pollution and infant mental development. Environ-
mental Health Perspectives, 120 (1), 144–9
Hillemeier, M.M., Morgan, P.L., Farkas, G. & Maczuga, S.A. (2011). Perinatal and soci-
oeconomic risk factors for variable and persistent cognitive delay at 24 and 48
months of age in a national sample. Matern Child Health, 15 (7), 1001–10
Mensah, F.K. & Kiernan, K.E. (2011). Maternal general health and children's cognitive
development and behaviour in the early years. Child: Care, Health and Develop-
ment, 37 (1), 44–54

638
Domain 13. Growth / development Class 2. Development

Meunier, J.C., Wade, M. & Jenkins, J.M. (2012). Mothers' differential parenting and
children's behavioural outcomes. Infant and Child Development, 21 (1), 107–33
Minnes, S., Lang, A. & Singer, L. (2011). Prenatal tobacco, marijuana, stimulant, and
opiate exposure: outcomes and practice implications. Addiction science & clinical
practice, 6 (1), 57–70
Nash, A., Dunn, M., Asztalos, E., Corey, M., Mulvihill-Jory, B. & O'Connor, D.L.
(2011). Pattern of growth of very low birth weight preterm infants, assessed using
the WHO growth standards, is associated with neurodevelopment. Applied Physiol-
ogy, Nutrition and Metabolism, 36 (4), 562- 9
Souza, J. M. de, Veríssimo, M. D. L. Ó R., & Cruz, D. A. L. M. da. (2018). Content
analysis of nursing diagnoses about child development. Revista Eletrônica De Enfer-
magem, 20. https://doi.org/10.5216/ree.v20.45041
Souza, J.M. & Veríssimo MLOR. (2015). Child development: analysis of a new concept.
Rev. Latino-Am Enfermagem, 23 (6), 1097–104
Souza, J.M. & Veríssimo, M.L.O.R. (2013). Child Development in the NANDA-I and
International Classification for Nursing Practices Nursing Classifications. Interna-
tional Journal of Nursing Knowledge, 24, 44–48
Sun, Q., Chen, Y.L., Yu, Z.B., Han, S.P., Dong, X.Y., Qiu, Y.F, Sha, L. & Guo, X.R.
(2012). Long-term consequences of the early treatment of children with congenital
hypothyroidism detected by neonatal screening in Nanjing, China: A 12-year follow-
up study. Journal of Tropical Pediatrics, 58 (1), 79–80
Tudella, E., Pereira, K., Basso, R.P., & Savelsbergh, G.J.P. (2011). Description of the
motor development of 3–12 month old infants with Down syndrome: The influence
of the postural body position. Research in Developmental Disabilities, 32 (5), 1514–
20

13. Growth / development

639
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00305

Risk for delayed child development

References
Als, H., Duffy, F.H., McAnulty, G.B., Fischer, C.B., Kosta, S., Butler, S.C., Parad, R.B.,
Blickman, J.G., Zurakowski, D. & Ringer, S.A. (2011). Is the (NIDCAP) effective for
preterm infants with intrauterine growth restriction. Journal of Perinatology, 31 (2),
130–6
Belsky, J. & de Haan, M. (2011). Annual research review: parenting and children's
brain development - The end of the beginning. Journal of Child Psychology and Psy-
chiatry, 52 (4), 409–28
Blackman, J.A., Gurka, M.J., Gurka, K.K. & Oliver, M.N.J. (2011). Emotional, develop-
mental and behavioural co-morbidities of children with chronic health conditions.
Paediatr Child Health, 47 (10), 742–7
Bradley, R.H., McKelvey, L.M. & Whiteside-Mansell, L. (2011). Does the quality of sti-
mulation and support in the home environment moderate the effect of early educa-
tion programs? Child Development, 82 (6), 2110–22
Brito, C.M.L.; Vieira, G.O.; Costa, M.C.O; Oliveira, N.F. (2011). Neuropsychomotor
development: the Denver scale for screening cognitive and neuromotor delays in
preschoolers. Cad. Saúde Pública, 27 (7), 1403–14
Cohen, M.J., Meador, K.J., Browning, N., Baker, G.A., Clayton-Smith, J., Kalayjian, L.
A., Kanner, A., Liporace, J.D., Pennell, P.B., Privitera, M. & Loring, D.W. (2011). Fe-
tal antiepileptic drug exposure: Motor, adaptive, and emotional/behavioral function-
ing at age 3years. Epilepsy and Behavior, 22 (2), 240–6
Cohen, N.J. & Farnia, F. (2011). Social-emotional adjustment and attachment in chil-
dren adopted from china: Processes and predictors of change. International Journal
of Behavioral Development, 35 (1), 67–77
Collings, S. & Llewellyn, G. (2012). Children of parents with intellectual disability: Fac-
ing poor outcomes or faring okay? Journal of Intellectual and Developmental Dis-
ability, 37 (1), 65–82
Fazzi, E., Signorini, S.G., Bomba, M., Luparia, A., Lanners, J. & Balottin, U. (2011).
Reach on sound: A key to object permanence in visually impaired children. Early
Human Development, 87 (4), 289–96
Gompels, U.A, Larke, N., Sanz-Ramos, M., Bates, M., Musonda, K. & Manno D., Sia-
mo, J., Monze, M. & Filteau, S. (2012). Human cytomegalovirus infant infection ad-
versely affects growth and development in maternally HIV-exposed and unexposed
infants in Zambia. Clinical Infectious Diseases, 54 (3), 434–42
13. Growth / development

Guxens, M. Aguilera, I., Ballester. F, Estarlich. M., Fernandez-Somoano, A., Lertxundi,

A., Lertxund, N., Mendes, M.A., Tardon, A., Vrijheid, M. & Sunyer,J. (2012). Prena-
tal exposure to residential air pollution and infant mental development. Environ-
mental Health Perspectives, 120 (1), 144–9
Hillemeier, M.M., Morgan, P.L., Farkas, G. & Maczuga, S.A. (2011). Perinatal and soci-
oeconomic risk factors for variable and persistent cognitive delay at 24 and 48
months of age in a national sample. Matern Child Health, 15 (7), 1001–10
Mensah, F.K. & Kiernan, K.E. (2011). Maternal general health and children's cognitive
development and behaviour in the early years. Child: Care, Health and Develop-
ment, 37 (1), 44–54

640
Domain 13. Growth / development Class 2. Development

Meunier, J.C., Wade, M. & Jenkins, J.M. (2012). Mothers' differential parenting and
children's behavioural outcomes. Infant and Child Development, 21 (1), 107–33
Minnes, S., Lang, A. & Singer, L. (2011). Prenatal tobacco, marijuana, stimulant, and
opiate exposure: outcomes and practice implications. Addiction science & clinical
practice, 6 (1), 57–70
Nash, A., Dunn, M., Asztalos, E., Corey, M., Mulvihill-Jory, B. & O'Connor, D.L.
(2011). Pattern of growth of very low birth weight preterm infants, assessed using
the WHO growth standards, is associated with neurodevelopment. Applied Physiol-
ogy, Nutrition and Metabolism, 36 (4), 562- 9
Souza, J. M. de, Veríssimo, M. D. L. Ó R., & Cruz, D. A. L. M. da. (2018). Content
analysis of nursing diagnoses about child development. Revista Eletrônica De Enfer-
magem, 20. https://doi.org/10.5216/ree.v20.45041
Souza, J.M. & Veríssimo MLOR. (2015). Child development: analysis of a new concept.
Rev. Latino-Am Enfermagem, 23 (6), 1097–104
Souza, J.M. & Veríssimo, M.L.O.R. (2013). Child Development in the NANDA-I and
International Classification for Nursing Practices Nursing Classifications. Interna-
tional Journal of Nursing Knowledge, 24, 44–48
Sun, Q., Chen, Y.L., Yu, Z.B., Han, S.P., Dong, X.Y., Qiu, Y.F, Sha, L. & Guo, X.R.
(2012). Long-term consequences of the early treatment of children with congenital
hypothyroidism detected by neonatal screening in Nanjing, China: A 12-year follow-
up study. Journal of Tropical Pediatrics, 58 (1), 79–80
Tudella, E., Pereira, K., Basso, R.P., & Savelsbergh, G.J.P. (2011). Description of the
motor development of 3–12 month old infants with Down syndrome: The influence
of the postural body position. Research in Developmental Disabilities, 32 (5), 1514–
20

13. Growth / development

641
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00315

Delayed infant motor development

References
Boswell, L., Wecj, M., Fjørtoft, T., Støen, R., Adde, L., & Deregnier, R. (2015). The im-
pact of prolonged hospitalization on infant motor development compared with
healthy controls. Developmental Medicine & Child Neurology, 57, 79–80
Cabral, T., Pereira da Silva, L., Tudella, E., & Simões Martinez, C. (2015). Motor devel-
opment and sensory processing: A comparative study between preterm and term in-
fants. Research in Developmental Disabilities, 36, 102–107
Celik, Halil Ibrahim, Elbasan, Bulent, Gucuyener, Kivilcim, Kayihan, Hulya, & Huri,
Meral. (2018). Investigation of the Relationship Between Sensory Processing and
Motor Development in Preterm Infants. AJOT: American Journal of Occupational
Therapy, 72(1), 7201195020p1–7201195020p7
Chiang, Yi-Chen, Lin, Dai-Chan, Lee, Chun-Yang, & Lee, Meng-Chih. (2015). Effects
of parenting role and parent–child interaction on infant motor development in Tai-
wan Birth Cohort Study. Early Human Development, 91(4), 259–264
Doralp, S., & Bartlett, D. (2014). Infant Movement Motivation Questionnaire: Develop-
ment of a measure evaluating infant characteristics relating to motor development in
the first year of life. Infant Behavior and Development, 37(3), 326–333
Galbally, M., Spigset, O., Johnson, A., Kohan, R., Lappas, M., & Lewis, A. (2017). Neo-
natal adaptation following intrauterine antidepressant exposure: Assessment, drug
assay levels, and infant development outcomes. Pediatric Research, 82(5), 806–813
Glass, T., Chau, V., Grunau, R., Synnes, A., Guo, T., Duerden, E.,. .. Miller, S. (2018).
Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Matura-
tion of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3
Years. The Journal of Pediatrics, 196, 91–97.e1
Grove, K., Lewis, A., & Galbally, M. (2018). Prenatal Antidepressant Exposure and
Child Motor Development: A Meta-analysis. Pediatrics, 142(1), Pediatrics, July 2018,
Vol.142(1)
Lee, Eun-Ju, & Lee, Sang-Yeol. (2018). The effects of early-stage neurodevelopmental
treatment on the growth of premature infants in neonatal intensive care unit. Journal
of Exercise Rehabilitation, 14(3), 523–529
Mazze, N., Cory, Gardner, Alexanian-Farr, Mutch, Marcus,. .. Van Den Heuvel. (2019).
Biopsychosocial Factors in Children Referred With Failure to Thrive: Modern Char-
acterization for Multidisciplinary Care. Global Pediatric Health, 6,
2333794X19858526
13. Growth / development

Müller, A.B., Pufal, E.C., Bandeira, P.F.R., & Valentini, N.C. (2018). Motor develop-
ment in the hospitalized infant and its biological and environmental characteristics.
Clinical and Biomedical Research, 38(1), 66–73
Nasreen, H., Nahar Kabir, Z., Forsell, Y., & Edhborg, M. (2013). Impact of maternal
depressive symptoms and infant temperament on early infant growth and motor de-
velopment: Results from a population based study in Bangladesh. Journal of Affec-
tive Disorders, 146(2), 254–261
Neelon, B., Shoaibi, A., & Benjamin-Neelon, S. (2019). A multivariate discrete failure
time model for the analysis of infant motor development. Statistics in Medicine, 38
(9), 1543–1557

642
Domain 13. Growth / development Class 2. Development

Saccani, R., Valentini, N., Pereira, K., Müller, A., & Gabbard, C. (2013). Associations of
biological factors and affordances in the home with infant motor development. Pe-
diatrics International, 55(2), 197–203
Tran, Thach D, Tran, Tuan, Simpson, Julie A, Tran, Ha T, Nguyen, Trang T, Hanieh,
Sarah,. .. Fisher, Jane. (2014). Infant motor development in rural Vietnam and intra-
uterine exposures to anaemia, iron deficiency and common mental disorders: A pro-
spective community-based study. BMC Pregnancy and Childbirth, 14(1), 8
Valla, L., Birkeland, M., Hofoss, D., & Slinning, K. (2017). Developmental pathways in
infants from 4 to 24 months. Child: Care, Health and Development, 43(4), 546–555
Watson, L. (2017). Neonatal Abstinence Syndrome: Inpatient and Outpatient Diagno-
sis. The Journal for Nurse Practitioners, 13(7), E355-E356
Wylie, A., Sundaram, R., Kus, C., Ghassabian, A., & Yeung, E. (2015). Maternal pre-
pregnancy obesity and achievement of infant motor developmental milestones in the
upstate KIDS study. Obesity (Silver Spring, Md.), 23(4), 907–913

13. Growth / development

643
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00316

Risk for delayed infant motor development

References
Boswell, L., Wecj, M., Fjørtoft, T., Støen, R., Adde, L., & Deregnier, R. (2015). The im-
pact of prolonged hospitalization on infant motor development compared with
healthy controls. Developmental Medicine & Child Neurology, 57, 79–80
Cabral, T., Pereira da Silva, L., Tudella, E., & Simões Martinez, C. (2015). Motor devel-
opment and sensory processing: A comparative study between preterm and term in-
fants. Research in Developmental Disabilities, 36, 102–107
Celik, Halil Ibrahim, Elbasan, Bulent, Gucuyener, Kivilcim, Kayihan, Hulya, & Huri,
Meral. (2018). Investigation of the Relationship Between Sensory Processing and
Motor Development in Preterm Infants. AJOT: American Journal of Occupational
Therapy, 72(1), 7201195020p1–7201195020p7
Chiang, Yi-Chen, Lin, Dai-Chan, Lee, Chun-Yang, & Lee, Meng-Chih. (2015). Effects
of parenting role and parent–child interaction on infant motor development in Tai-
wan Birth Cohort Study. Early Human Development, 91(4), 259–264
Doralp, S., & Bartlett, D. (2014). Infant Movement Motivation Questionnaire: Develop-
ment of a measure evaluating infant characteristics relating to motor development in
the first year of life. Infant Behavior and Development, 37(3), 326–333
Galbally, M., Spigset, O., Johnson, A., Kohan, R., Lappas, M., & Lewis, A. (2017). Neo-
natal adaptation following intrauterine antidepressant exposure: Assessment, drug
assay levels, and infant development outcomes. Pediatric Research, 82(5), 806–813
Glass, T., Chau, V., Grunau, R., Synnes, A., Guo, T., Duerden, E.,. .. Miller, S. (2018).
Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Matura-
tion of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3
Years. The Journal of Pediatrics, 196, 91–97.e1
Grove, K., Lewis, A., & Galbally, M. (2018). Prenatal Antidepressant Exposure and
Child Motor Development: A Meta-analysis. Pediatrics, 142(1), Pediatrics, July 2018,
Vol.142(1)
Lee, Eun-Ju, & Lee, Sang-Yeol. (2018). The effects of early-stage neurodevelopmental
treatment on the growth of premature infants in neonatal intensive care unit. Journal
of Exercise Rehabilitation, 14(3), 523–529
Mazze, N., Cory, Gardner, Alexanian-Farr, Mutch, Marcus,. .. Van Den Heuvel. (2019).
Biopsychosocial Factors in Children Referred With Failure to Thrive: Modern Char-
acterization for Multidisciplinary Care. Global Pediatric Health, 6,
2333794X19858526
13. Growth / development

Müller, A.B., Pufal, E.C., Bandeira, P.F.R., & Valentini, N.C. (2018). Motor develop-
ment in the hospitalized infant and its biological and environmental characteristics.
Clinical and Biomedical Research, 38(1), 66–73
Nasreen, H., Nahar Kabir, Z., Forsell, Y., & Edhborg, M. (2013). Impact of maternal
depressive symptoms and infant temperament on early infant growth and motor de-
velopment: Results from a population based study in Bangladesh. Journal of Affec-
tive Disorders, 146(2), 254–261
Neelon, B., Shoaibi, A., & Benjamin-Neelon, S. (2019). A multivariate discrete failure
time model for the analysis of infant motor development. Statistics in Medicine, 38
(9), 1543–1557

644
Domain 13. Growth / development Class 2. Development

Saccani, R., Valentini, N., Pereira, K., Müller, A., & Gabbard, C. (2013). Associations of
biological factors and affordances in the home with infant motor development. Pe-
diatrics International, 55(2), 197–203
Tran, Thach D, Tran, Tuan, Simpson, Julie A, Tran, Ha T, Nguyen, Trang T, Hanieh,
Sarah,. .. Fisher, Jane. (2014). Infant motor development in rural Vietnam and intra-
uterine exposures to anaemia, iron deficiency and common mental disorders: A pro-
spective community-based study. BMC Pregnancy and Childbirth, 14(1), 8
Valla, L., Birkeland, M., Hofoss, D., & Slinning, K. (2017). Developmental pathways in
infants from 4 to 24 months. Child: Care, Health and Development, 43(4), 546–555
Watson, L. (2017). Neonatal Abstinence Syndrome: Inpatient and Outpatient Diagno-
sis. The Journal for Nurse Practitioners, 13(7), E355-E356
Wylie, A., Sundaram, R., Kus, C., Ghassabian, A., & Yeung, E. (2015). Maternal pre-
pregnancy obesity and achievement of infant motor developmental milestones in the
upstate KIDS study. Obesity (Silver Spring, Md.), 23(4), 907–913

13. Growth / development

645
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00451

Impaired infant neurodevelopmental organization

References
Bakhireva, L. N., Holbrook, B. D., Shrestha, S., Leyva, Y., Ashley, M., Cano, S., ... & Lee-
man, L. (2019). Association between prenatal opioid exposure, neonatal opioid with-
drawal syndrome, and neurodevelopmental and behavioral outcomes at 5–8 months
of age. Early human development, 128, 69–76
Creeley, C. E., & Denton, L. K. (2019). Use of prescribed psychotropics during preg-
nancy: a systematic review of pregnancy, neonatal, and childhood outcomes. Brain
sciences, 9(9), 235
Grecco, G. G., Mork, B. E., Huang, J. Y., Metzger, C. E., Haggerty, D. L., Reeves, K. C.,
... & Atwood, B. K. (2021). Prenatal methadone exposure disrupts behavioral devel-
opment and alters motor neuron intrinsic properties and local circuitry. Elife, 10,
e66230
Grossman, M., & Berkwitt, A. (2019, April). Neonatal abstinence syndrome. In Semi-
nars in perinatology (Vol. 43, No. 3, pp. 173–186). WB Saunders
Jansson, L. M., & Patrick, S. W. (2019). Neonatal abstinence syndrome. Pediatric Clin-
ics, 66(2), 353–367
Lammertink, F., Vinkers, C. H., Tataranno, M. L., & Benders, M. J. (2021). Premature
birth and developmental programming: mechanisms of resilience and vulnerability.
Frontiers in psychiatry, 11, 531571
Larson, J. J., Graham, D. L., Singer, L. T., Beckwith, A. M., Terplan, M., Davis, J. M., ...
& Bada, H. S. (2019). Cognitive and behavioral impact on children exposed to
opioids during pregnancy. Pediatrics, 144(2)
Micai, M., Fulceri, F., Caruso, A., Guzzetta, A., Gila, L., & Scattoni, M. L. (2020). Early
behavioral markers for neurodevelopmental disorders in the first 3 years of life: An
overview of systematic reviews. Neuroscience & Biobehavioral Reviews, 116, 183–
201
Spann, M. N., Bansal, R., Hao, X., Rosen, T. S., & Peterson, B. S. (2020). Prenatal socio-
economic status and social support are associated with neonatal brain morphology,
toddler language and psychiatric symptoms. Child Neuropsychology, 26(2), 170–188
13. Growth / development

646
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00452

Risk for impaired infant neurodevelopmental organi-

zation
References
Bakhireva, L. N., Holbrook, B. D., Shrestha, S., Leyva, Y., Ashley, M., Cano, S., ... & Lee-
man, L. (2019). Association between prenatal opioid exposure, neonatal opioid with-
drawal syndrome, and neurodevelopmental and behavioral outcomes at 5–8 months
of age. Early human development, 128, 69–76
Creeley, C. E., & Denton, L. K. (2019). Use of prescribed psychotropics during preg-
nancy: a systematic review of pregnancy, neonatal, and childhood outcomes. Brain
sciences, 9(9), 235
Grecco, G. G., Mork, B. E., Huang, J. Y., Metzger, C. E., Haggerty, D. L., Reeves, K. C.,
... & Atwood, B. K. (2021). Prenatal methadone exposure disrupts behavioral devel-
opment and alters motor neuron intrinsic properties and local circuitry. Elife, 10,
e66230
Grossman, M., & Berkwitt, A. (2019, April). Neonatal abstinence syndrome. In Semi-
nars in perinatology (Vol. 43, No. 3, pp. 173–186). WB Saunders
Jansson, L. M., & Patrick, S. W. (2019). Neonatal abstinence syndrome. Pediatric Clin-
ics, 66(2), 353–367
Lammertink, F., Vinkers, C. H., Tataranno, M. L., & Benders, M. J. (2021). Premature
birth and developmental programming: mechanisms of resilience and vulnerability.
Frontiers in psychiatry, 11, 531571
Larson, J. J., Graham, D. L., Singer, L. T., Beckwith, A. M., Terplan, M., Davis, J. M., ...
& Bada, H. S. (2019). Cognitive and behavioral impact on children exposed to
opioids during pregnancy. Pediatrics, 144(2)
Micai, M., Fulceri, F., Caruso, A., Guzzetta, A., Gila, L., & Scattoni, M. L. (2020). Early
behavioral markers for neurodevelopmental disorders in the first 3 years of life: An
overview of systematic reviews. Neuroscience & Biobehavioral Reviews, 116, 183–
201
Spann, M. N., Bansal, R., Hao, X., Rosen, T. S., & Peterson, B. S. (2020). Prenatal socio-
economic status and social support are associated with neonatal brain morphology,
toddler language and psychiatric symptoms. Child Neuropsychology, 26(2), 170–188
13. Growth / development

647
Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00453

Readiness for enhanced infant neurodevelopmental

organization
References
Bakhireva, L. N., Holbrook, B. D., Shrestha, S., Leyva, Y., Ashley, M., Cano, S., ... & Lee-
man, L. (2019). Association between prenatal opioid exposure, neonatal opioid with-
drawal syndrome, and neurodevelopmental and behavioral outcomes at 5–8 months
of age. Early human development, 128, 69–76
Creeley, C. E., & Denton, L. K. (2019). Use of prescribed psychotropics during preg-
nancy: a systematic review of pregnancy, neonatal, and childhood outcomes. Brain
sciences, 9(9), 235
Grecco, G. G., Mork, B. E., Huang, J. Y., Metzger, C. E., Haggerty, D. L., Reeves, K. C.,
... & Atwood, B. K. (2021). Prenatal methadone exposure disrupts behavioral devel-
opment and alters motor neuron intrinsic properties and local circuitry. Elife, 10,
e66230
Grossman, M., & Berkwitt, A. (2019, April). Neonatal abstinence syndrome. In Semi-
nars in perinatology (Vol. 43, No. 3, pp. 173–186). WB Saunders
Jansson, L. M., & Patrick, S. W. (2019). Neonatal abstinence syndrome. Pediatric Clin-
ics, 66(2), 353–367
Lammertink, F., Vinkers, C. H., Tataranno, M. L., & Benders, M. J. (2021). Premature
birth and developmental programming: mechanisms of resilience and vulnerability.
Frontiers in psychiatry, 11, 531571
Larson, J. J., Graham, D. L., Singer, L. T., Beckwith, A. M., Terplan, M., Davis, J. M., ...
& Bada, H. S. (2019). Cognitive and behavioral impact on children exposed to
opioids during pregnancy. Pediatrics, 144(2)
Micai, M., Fulceri, F., Caruso, A., Guzzetta, A., Gila, L., & Scattoni, M. L. (2020). Early
behavioral markers for neurodevelopmental disorders in the first 3 years of life: An
overview of systematic reviews. Neuroscience & Biobehavioral Reviews, 116, 183–
201
Spann, M. N., Bansal, R., Hao, X., Rosen, T. S., & Peterson, B. S. (2020). Prenatal socio-
economic status and social support are associated with neonatal brain morphology,
toddler language and psychiatric symptoms. Child Neuropsychology, 26(2), 170–188
13. Growth / development

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Domain 13. Growth / development Class 2. Development

Domain 13 • Class 2 • Diagnosis Code 00295

Ineffective infant suck-swallow response

References
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populations requiring high-flow oxygen via nasal cannula”. Dysphagia, 31(6), 781–
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ceptual Model for Health Care Practitioners. Neonatal Network, 38(6), 348–356
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integrative literature review. International Journal of Nursing Education and Re-
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Smith, L. J. (2016). Impact of birth practices on infant suck. In: Genna, C.W.Support-
ing Sucking Skills in Breastfeeding Infants (erd. Ed.). Burlington, MA: Jones & Bar-
tlett Learning. 444p

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