00087 Risk for perioperative positioning injury

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00087 Risk for perioperative positioning injury

Definition of the NANDA label

State in which the individual is at risk of injury as a result of the environmental conditions that occur in the perioperative environment.

Susceptible to inadvertent anatomical and physical changes as a result of posture or positioning equipment used during an invasive/surgical procedure, which may compromise health.

Risk factors

• Disorientation.
• Immobilization.
• Muscular weakness.
• Sensory-perceptual alterations due to anesthesia.
• Obesity.
• Emaciation.
• Edema.

Associated condition

• Disorientation
• Edema
• Emaciation
• Muscle weakness
• Obesity
• Sensoriperceptual disturbance from anesthesia

NOC

• Maintenance of tissue integrity.
• Risk control.

NIC

• Monitoring of vital signs.
• Support.
• Postural control.
• Surveillance.

Due to limited amount of the patient contact preoperatively, nurses may not be able to intervene on many of these associated conditions.

 

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