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Taber's Cyclopedic Medical Dictionary 20th ed., Hardcover – January 1, 2005 4.7 out of 5 stars 196 ratings See all formats and editions Hide other formats and editions More than three fourths of the images are fourcolor photographs and line drawings. Find 65,000 medical and nursing definitions. Find 65,000 medical and nursing definitions. Davis and Unbound Medicine. RELATED FACTORS High urethral pressure caused by weak [/absent] detrusor; Inhibition of reflex arc; Strong sphincter; Blockage [e.g., BPH, perineal swelling]; [Habituation of reflex arc]; [Use of medications with side effect of retention (e.g., atropine, belladonna, psychotropics, antihistamines, opiates)]; [Infections]; [Neurologic diseases/trauma] DEFINING CHARACTERISTICS Subjective Sensation of bladder fullness; Dribbling; Dysuria Objective Bladder distention; Small, frequent voiding or absence of urine output; Residual urine [150 ml or more]; Overflow incontinence; [Reduced stream] VENTILATION, IMPAIRED SPONTANEOUS Diagnostic Division: Respiration Definition: Decreased energy reserves results in an individual’s inability to maintain breathing adequate to support life RELATED FACTORS Metabolic factors; [hypermetabolic state (e.g., infection), nutritional deficits/depletion of energy stores]; Respiratory muscle fatigue; [Airway size/resistance; problems with secretion management] DEFINING CHARACTERISTICS Subjective Dyspnea; Apprehension 2786 Appendix N7 Nursing Diagnoses Objective Increased metabolic rate; Increased heart rate; Increased restlessness; Decreased cooperation; Increased use of accessory muscles; Decreased tidal volume; Decreased PO ; Decreased SaO ; Increased PCO 2 VENTILATORY WEANING RESPONSE, DYSFUNCTIONAL (DVWR) Diagnostic Division: Respiration Definition: Inability to adjust to lowered levels of mechanical ventilator support, that interrupts and prolongs the weaning process RELATED FACTORS Physical Ineffective airway clearance; Sleep pattern disturbance; Inadequate nutrition; Uncontrolled pain or discomfort; [Muscle weakness/fatigue, inability to control respiratory muscles; immobility] Psychological Knowledge deficit of the weaning process, patient role; Patient-perceived inefficacy about the ability to wean; Decreased motivation; Decreased self-esteem; Anxiety (moderate, severe); fear; insufficient trust in the nurse; Hopelessness; Powerlessness; [Unprepared for weaning attempt] Situational Uncontrolled episodic energy demands or problems; Inappropriate pacing of diminished ventilator support; Inadequate social support; Adverse environment (noisy, active environment, negative events in the room, low nurse-patient ratio, extended nurse absence from bedside, unfamiliar nursing staff); History of ventilator dependence Ͼ1 week; History of multiple unsuccessful weaning attempts DEFINING CHARACTERISTICS Responds to lowered levels of mechanical ventilator support with: Mild DVWR Subjective Expressed feelings of increased need for oxygen, breathing discomfort, fatigue, warmth; Queries about possible machine malfunction Objective Restlessness; Slight increased respiratory rate from baseline; Increased concentration on breathing Moderate DVWR Subjective Apprehension Objective Slight increase from baseline blood pressure 20 mm Hg; Slight increase from baseline heart rate 20 beats/min; Baseline increase in respiratory rate breaths/min; Hypervigilance to activities; Inability to respond to coaching/cooperate; Diaphoresis; Eye widening, “wide-eyed look”; Decreased air entry on auscultation; Color changes: pale, slight cyanosis; Slight respiratory accessory muscle use Severe DVWR Objective Agitation; Deterioration in arterial blood gases from current baseline; Increase from baseline blood pressure 20 mm Hg; Increase from baseline heart rate 20 beats/min; Respiratory rate increases significantly from baseline; Profuse diaphoresis; Full respiratory accessory muscle use; Shallow, gasping breaths; Paradoxical abdominal breathing; Discoordinated breathing with the ventilator; Decreased level of consciousness; Adventitious breath sounds, audible airway secretions; Cyanosis VIOLENCE, [ACTUAL]/RISK FOR OTHER-DIRECTED Diagnostic Division: Safety Definition: Behaviors in which an individual demonstrates that he/she can be physically, emotionally, and/or sexually harmful to others Appendix N7– Nursing Diagnoses in Alphabetical Order 2787 RISK FACTORS History of violence: against others (e.g., hitting, kicking, scratching, biting or spitting, throwing objects at someone; attempted rape, rape, sexual molestation, urinating/ defecating on a person); Threats (e.g, verbal threats against property/person, social threats, cursing, threatening notes/letters or gestures, sexual threats); Antisocial behavior (e.g., stealing, insistent borrowing, insistent demands for privileges, insistent interruption of meetings; refusal to eat or take medication, ignoring instructions); Indirect (e.g., tearing off clothes, urinating/defecating on floor, stamping feet, temper tantrum; running in corridors, yelling, writing on walls, ripping objects off walls, throwing objects, breaking a window, slamming doors; sexual advances) OTHER FACTORS Neurological impairment (e.g., positive ECG, CT, or MRI; head trauma; positive neurological findings; seizure disorders, [temporal lobe epilepsy]); Cognitive impairment (e.g., learning disabilities, attention deficit disorder, decreased intellectual functioning); [organic brain syndrome]; History of childhood abuse/witnessing family violence, [negative role modeling]; cruelty to animals; firesetting; Prenatal and perinatal complications/abnormalities; History of drug/alcohol abuse; pathological intoxication, [toxic reaction to medication]; Psychotic symptomatology (e.g, auditory, visual, command hallucinations; paranoid delusions; loose, rambling, or illogical thought processes); [panic states; rate reactions; catatonic/manic excitement]; Motor vehicle offenses (e.g., frequent traffic violations, use of motor vehicle to release anger); Suicidal behavior, impulsivity; availability and/or possession of weapon(s); Body language: rigid posture, clenching of fists and jaw, hyperactivity, pacing, breathlessness, threatening stances; [Hormonal imbalance (e.g., premenstrual syndrome, postpartal depression/psychosis)]; [Expressed intent/desire to harm others directly or indirectly]; [Almost continuous thoughts of violence] VIOLENCE, [ACTUAL]/RISK FOR SELF-DIRECTED Diagnostic Division: Safety Definition: Behaviors in which an individual demonstrates that he/she can be physically, emotionally, and/or sexually harmful to self RISK FACTORS Age 15– 19, over 45; Marital status (single, widowed, divorced) ; Employment (unemployed, recent job loss/failure); occupation (executive, administrator, owner of business, professional, semiskilled worker); Conflictual interpersonal relationships; Family background (chaotic or conflictual, history of suicide); Sexual orientation: bisexual (active), homosexual (inactive); Physical health (hypochondriac, chronic or terminal illness); Mental health (severe depression, psychosis, severe personality disorder, alcoholism or drug abuse); Emotional status (hopelessness, despair [lifting of depressed mood]; increased anxiety, panic, anger, hostility); history of multiple suicide attempts; suicidal ideation (frequent, intense, prolonged); suicide plan (clear and specific; lethality: method and availability of destructive means); Personal resources (poor achievement, poor insight, affect unavailable and poorly controlled); Social resources (poor rapport, socially isolated, unresponsive family); Verbal clues (e.g., talking about death, “better off without me,” asking questions about lethal dosages of drugs; Behavioral clues (e.g., writing forlorn love notes, directing angry messages at a significant other who has rejected the person, giving away personal items, taking out a large life insurance policy); Persons who engage in autoerotic sexual acts [e.g., asphyxiation] WALKING, IMPAIRED Diagnostic Division: Safety Definition: Limitation of independent movement within the environment on foot RELATED FACTORS To be developed; [Condition affecting muscles/joints impairing ability to walk] DEFINING CHARACTERISTICS Impaired ability to walk required distances, walk on an incline/decline, or walk on uneven surfaces, to navigate curbs, climb stairs 2788 Appendix N7 Nursing Diagnoses WANDERING [Specify sporadic or continual] Diagnostic Division: Safety Definition: Meandering, aimless or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles RELATED FACTORS Cognitive impairment, specifically memory and recall deficits, disorientation, poor visuoconstructive (or visuospatial) ability, language (primarily expressive) defects; Cortical atrophy; Premorbid behavior (e.g., outgoing, sociable personality; premorbid dementia); Separation from familiar people and places; Emotional state, especially frustration, anxiety, boredom, or depression (agitation); Physiological state or need (e.g., hunger/thirst, pain, urination, constipation); Over/understimulating social or physical environment; Sedation; Time of day DEFINING CHARACTERISTICS Objective Frequent or continuous movement from place to place, often revisiting the same destinations; Persistent locomotion in search of “missing” or unattainable people or places; Scanning, seeking, or searching behaviors; Haphazard locomotion; Fretful locomotion or pacing; Long periods of locomotion without an apparent destination; Locomotion into unauthorized or private spaces; Trespassing; Locomotion resulting in unintended leaving of a premise; Inability to locate significant landmarks in a familiar setting; Getting lost; Locomotion that cannot be easily dissuaded or redirected; Following behind or shadowing a caregiver’s locomotion; Hyperactivity; Periods of locomotion interspersed with periods of nonlocomotion (e.g., sitting, standing, sleeping) Notes F A Davis offers Taber’s in print, on CD, online, and for your PDA Which version of Taber’s is right for you? 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