Nursing Care Plan : Nanda Nursing Diagnosis

Nursing Diagnosis for Impaired Tissue integrity

NANDA Definition: Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues

Defining Characteristics: Damaged or destroyed tissue (e.g., cornea, mucous membrane, integumentary, or subcutaneous)

Related Factors:
  • Mechanical (e.g., pressure, shear, friction);
  • radiation (including therapeutic radiation);
  • nutritional deficit or excess;
  • thermal (temperature extremes);
  • knowledge deficit;
  • irritants, chemical (including body excretions, secretions, medications);
  • impaired physical mobility;
  • altered circulation;
  • fluid deficit or excess

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
  • Tissue Integrity: Skin and Mucous Membranes
  • Wound Healing: Primary Intention
  • Wound Healing: Secondary Intention

Client Outcomes
  • Reports any altered sensation or pain at site of tissue impairment
  • Demonstrates understanding of plan to heal tissue and prevent injury
  • Describes measures to protect and heal the tissue, including wound care
  • Wound decreases in size and has increased granulation tissue

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
  • Incision Site Care
  • Pressure Ulcer Care
  • Skin Care: Topical Treatments
  • Skin Surveillance
  • Wound Care

Read More : Nursing Interventions and Rationales

Nursing Diagnosis

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