New York, New York Date: Patient's Initials: P.E.R.S.O.N.- NEED and NURSING DIAGNOSIS GUI DE
Rm & Bed #: ANALYSIS: ASSESSMENT DATA and NURSING DIAGNOSES (NANDA International) LABELS Use recommended manual/pocket-guide. Compare your PERSON Need assessment data to the Nursing Diagnoses Labels. Encircle the Nursing Diagnoses Labels which may apply to your patient.
NEED
HEALTH/ILLNESS DATA
FAMILY/SIGNIFICANT OTHER/CAREGIVER
ENVIRONMENT/
COMMUNITY
NURSING DIAGNOSIS LABEL(S)
PROTECTION/
SAFETY
1. Infection: Risk for
2. Body Temperature: Risk for Imbalanced
3. Injury: Risk for
4. Falls: Risk for
5. Poisoning: Risk for
6. Suffocation: Risk for
7. Trauma: Risk for
8. Protection, Ineffective
9. Skin Integrity, Impaired
10. Skin Integrity, Impaired: Risk for
11. Tissue Integrity, Impaired
12. Other:
ELIMINATION
13. Incontinence, Bowel
14. Constipation
15. Constipation: Risk for
16. Constipation, Perceived
17. Diarrhea
18. Incontinence, Functional Urinary
19. Incontinence, Reflex Urinary
20. Incontinence, Stress Urinary
21. Incontinence, Overflow Urinary
22. Incontinence, Urge Urinary
23. Elimination, Impaired Urinary
24. Urinary Retention
25. Incontinence, Urge Urinary: Risk for
26. Other:
NEED
HEALTH/ILLNESS DATA
FAMILY/SIGNIFICANT OTHER/CAREGIVER
ENVIRONMENT/
COMMUNITY
NURSING DIAGNOSIS LABEL(S)
REST/ SLEEP/ ACTIVITY/ COMFORT
27. Disturbed Sleep Pattern
28. Sleep Deprivation
29. Acute Pain
30. Chronic Pain
31. Activity Intolerance