1.

Resiko ketidakseimbangan kadar glukosa darah

Faktor resiko
-

Asupan diet tidak cukup

Gangguan status kesehatan
Gangguan status mental
Kehamilan
Keterlambatan perkembangan kgnitif
Kurang kepatuhan pada rencana manajemen diabetes
Kurang pengetahuan tentang manajemen penyakit
Manajemen diabetes tidak tepat
Manajemen diabetes tidak efektif
Pemantauan glukosa darah tidak adekuat
Penambahan berat badan berlebih
penurunan berat badan berlebih
periode pertumbuhan cepat
rata-rata aktifitas harian kurang dari yang dianjurkan menurut
jenis kelamin dan usia
stress berlebihan
tidak menerima diagnosis

Intervensi
NOC
Outcomes associated with risk factor :
- Acceptance : health status
- Compliance behavior : prescribed activity
- Compliance behavior : prescribed diet
- Complieance behavior : prescribed medication copling
- Depression level
- Endurance
- Exercise participation
- Knowledge : diabetes management

NIC
Suggest Of Nursing Intervention For Problem Resolution
- Hiperglikemia management
- Hypoglikemia management
- Medication management
- Self-Efficacy enhancement
- Teaching : disease process
- Teaching : prescribed diet
- Teaching : prescribed exercises
- Teaching : prescribed medication

Knowledge : medication
Knowledge : prescribed activity
Knowledge : prescribed diet
Knowledge : treatment regiment
Knowledge : weight management
Maternal status : antepartum
Maternal status : intrapartum
Maternal status : post partum
Medication response
Most equilibrium
Nutritional status
Nutritional status : biochemical
Nutritional status : food and fluid intake
Nutritional status : personal health status
Phisichal fitness
Prenatal health behavior
Risk control
Weight maintenance behavior

Kerusakan integritas jaringan

Batasan karakteristik
- Cedera jaringan
- Jaringan rusak

Teaching : procedure/treatment
Additional optional intervention
Behavior modification
Family involvement promotion
Health education
Health literacy enhancement
High-risk pregnancy care
Learning readiness enhancement
Nutritional counseling
Nutritional monitoring
Risk identification
Self-responsibility facilitation
Surveillance
Technologi management
Weight management

Factor yang berhubungan

- Agen cidera kimiawi (misalnya : luka bakar, kapsaisin,
metilien, klorida, dan agen mustard
- Agen farmaseukal
- Factor mekanik
- Gengguan metabolism
- Geangguan sensasi
- Gangguan sirkulasi
- Hambatan mobilitas fisik
- Kelebihan volume cairan
- Ketidakseimbangan status nutrisi (misalnya obesitas
dan malnutrisi

Intervensi
NOC
Additional outcomes to measure defining charactheristik
- Allergic response : localized
- Burn healing
- Burn recovery
- Dry eye severity
Outcomes Associated with related factor or
intermediate outcomes
- Body positioning : self-initiated
- Circulation status
- Fluid overload severity
- Hydration
- Immobility consequences : physiological
- Infection severity
- Infection severity : newborn
- Knowledge : infection management
- Knowledge : periphereal artery disease management
- Knowledge : treatment regiment
- Mobility nutritional status
- Nutritional status : nutrient intake
- Ostomy self-care
- Risk control : dry eye
- Risk control : infectious preses
- Self management
- Sensory function : tactile
- Tissue perfusion : periphereal

NIC
Suggest nursing intervention for problem resolution
- Bleeding reduction : gastrointestinal
- Bleeding reduction : nasal
- Bleeding reduction : post partum uterus
- Blood product administration
- Electrolyte monitoring
- Fluid management
- Hemorrhage control
- Incision site care
- Infection protection
- Latex precaution
- Medication administration : ear
- Medication administration : eye
- Medication administration : rectal
- Medication administration : vaginal
Additional optional intervention
- Bathing
- Infection control
- Intrapartal care : high-risk delivery
- Leech therapy
- Lower extremity monitoring
- Medication administration
- Medication management
- Pressure management
- Simple massage
- Teaching : foot care
- Tube care : urinary
- Vital sign monitoring

Resiko kekurangan volume cairan

Batasan karakteristik
- Agen farmaseukal
- Berier berlebihan
- Factor yang mempengaruhi kebutuhan cairan
- Gengguan mekanisme regulasi
- Kehilangan cairan melalui rute normal
- Kehilangan volume cairan aktif
- Kurang pengetahuan tentang kebutuhan cairan
- Penyimpangan yang memengaruhi absorbs cairan
- Penyimpangan yang mempengaruhi kelebihan
cairan
- Usia ekstrem

Factor yang berhubungan

Intervensi
NOC
Additional outcomes to measure defining
charactheristik
- Adherence behavior : healthy diet
- Blood glucose level
- Bowel elimination
- Breastfeeding establishment : infant
- Brastfeeding maintenance
- Burn healing
- Compliance behavior : prescribed diet
- Electrolyte and acid/base balance
- Gastrointestinal function
- Infection severity
- Infection severity : newborn
- Knowledge : healthy diet
- Knowledge : medication

NIC
Suggest nursing intervention for problem resolution
- Autotranfusion
- Bleeding precaution
- Bleeding reduction
- Bleeding reduction gastrointestinal
- Blood product administration
- Cardiac care : acute
- Electrolyte management
- Electrolyte management : hypercalsemia
- Electrolyte management : hypercalemia
- Electrolyte management : hypermagnesemia
- Electrolyte management : hypernatremia
- Electrolyte management : hyperphosphatemia
- Electrolyte management : hypocalcemia
- Electrolyte management : hypokalemia

Knowledge : prescribed diet

Medication response
Nausea and vomiting severity
Nutritional status : food and fluid intake
Risk control
Risk control : hypertemia
Risk detection
Swallowing status
Thermoregulation : newborn
Urinary elimination
Weigh : body mass
Weight gain behavior
Weigh loss behavior

Electrolyte management : hypomagnesemia

Electrolyte management : hyponatremia
Electrolyte management : hypophophastemia
Electrolyte monitoring
Fluid/electrolyte management
Intrapartal care : high risk delivery intravenous (IV)
therapy
Resuscitation : neonate
Shock management
Shock management : volume
Shock prevention
Surveillance
Venous assess devices (VAD) maintenance
Viyal sign monitoring

Additional optional intervention

- Capillary blood samle
- Cerebral edema management
- Dysritmia management
- Electrolyte fetal monitoring : intapartum
- Feeding
- Fever treatment
- Gastrointestinal intubation
- Hemodynamic regulation
- Invasive hemodynamic monitoring
- Medication management neurolgi monitoring
- Nutrition management
- Periphereal inserted central (ICP) chateter care
- Phlebotomy : cannulated vessel
- Phlebotomy : venous blood sample
- Temperature regulation
- Total parenteral nutrition (TPN) administration
- Tube care : chest

Tube care : gastro intestinal

Urinary catheterization
Weigh management
Wound care

Kesiapan meningkatkan kesehatan

Batasan karakteristik
- Meningkatkan minat untuk meningkatkan pengetahuan
- Perilaku sesuai dengan pengetahuan yang diungkapkan
- Mendeskripsikan pengalaman sebelumnya yang berkaitan dengan topic
- Menjelaskan pengetahuan tentang topik
Intervensi
NOC
Outcomes to measure defining charactheristic
- Adherence behavior
- Edherence behavior : healthy diet
- Alcohol abuse cessation behavior
- Body mechanics : performance
- Health promotion behavior
- Health seeking behavior
- Knowledge : depression management
- Knowledge : diabetes management
- Knowledge : disease prosses
- Knowledge : faal prevention
- Knowledge : health promotion
- Knowledge : helath behavior
- Knowledge : healthy diet

NIC
Suggest nursing intervention for problem resolution
- Commendation
- Dicission making support
- Heath education
- Learning facilitation
- Learning readiness enhancement
- Parenting promotion
- Self-effifacy enhancement
- Self modification assistance
- Self responsibility facillitation
Additional optional intervention
- Teaching : disease proses
- Teaching : prescribed diet

Knowledge : health life style

Knowledge : hypertension management
Knowledge : weight management
Self management : cardiac disease
Self management : chronic disease
Self management : coronary artery disease
Self management diabetes
Self management hypertension
Weight loss behavior
Weight gain behavior
Weight maintenance behavior

Teaching : prescribed execises

Teaching : prescribed medication
Teaching : procedure/treatment
Teaching : safe sex
Teaching : sexuality