Nursing Diagnosis: Inefficacious Peripheral Tissue Perfusion Risk
nursing diagnosis is a recognized, standardized classification system of nursing diagnoses. Inefficacious Peripheral Tissue Perfusion Risk (IPTP) is one such nursing diagnosis that is used to assess and identify the problems related to perfusion of peripheral tissue.
Nursing Diagnosis Definition
The nursing diagnosis definition of Inefficacious Peripheral Tissue Perfusion Risk is “the state in which an individual is at risk for decreased peripheral tissue perfusion resulting in an inability to adequately meet metabolic needs.”
Defining Characteristics
Subjective
- Agitation
- Altered circulation status
- Changes in respiration
- Decreased consciousness
- Fatigue
- Numbness or tingling sensation
- Pain
- Paleness of skin
- Paresthesia
Objective
- Abnormal cardiac output
- Abnormal capillary refill
- Abnormal color of extremities
- Altered peripheral pulses
- Altered peripheral skin temperature
- Diminished peripheral sensation
- Inefficacious nutrient delivery
- Ineffective tissue perfusion
- Age-related physiological changes: Age-related factors such as decreased mobility, alterations in autonomic nervous system functioning, and increased susceptibility to infection can affect blood circulation.
- Environmental/contextual factors: Living in an environment that is poor in quality nourishment or is physically stressful can lead to poor perfusion of peripheral tissue.
- Excessive body weight: Excessive body weight can reduce the effectiveness of peripheral tissue perfusion.
- Infection: Certain types of infections, such as sepsis, can reduce blood circulation in affected areas.
- Surgery: Surgical procedures can temporarily prevent/reduce the circulation of blood in certain areas.
- Toxins: Exposure to toxins can induce congestion, leading to reduced tissue perfusion.
Risk Population
- Elderly: Elderly individuals may be more prone to poor perfusion of peripheral tissues due to age-related changes.
- Malnourished: Malnourished individuals may have a lower ability to fight infection, as well as a higher risk for poor peripheral perfusion.
- Postoperative: Patients who have recently undergone surgery may require extra vigilance as they adjust to new lifestyle activities and potential tissue ischemia.
- Sedentary: Individuals who lead a sedentary lifestyle may be at higher risk for poor peripheral perfusion due to lack of exercise.
Associated Problems
- Acute pain
- Altered immune function
- Altered nutrition less than body requirements
- Body image disturbance
- Inefficient activity planning
- Loneliness
- Risk for infection
- Social isolation
- Self-care deficit
Suggested Use
The IPTP nursing diagnosis should be used to assess the risk for decreased peripheral tissue perfusion in any settings where poor tissue perfusion has been identified. It should be used in conjunction with other nursing assessments to develop an appropriate plan of care.
Suggested Alternative NANDA Nursing Diagnoses
- Altered Circulation
- Ineffective Energy Conservation
- Ineffective Nutritional Intake
- Ineffective Peripheral Tissue Perfusion
- Risk for Infection
- Risk for Injury
Usage Tips
- Include children in the assessment of risk so that adequate care and interventions can be provided.
- Collaborate with health professionals and family members to ensure that the individual receives necessary resources and support to improve tissue perfusion.
- When initiating interventions, consider the cultural and spiritual values and beliefs of the individual in order to facilitate acceptance of activities, treatments and lifestyle modifications.
- Carefully monitor vital signs and intake & output as well as response to interventions.
- Encourage patient to practice relaxation techniques during treatment.
- Provide encouragement and support to the individual on ways to remain mobile so as to improve tissue perfusion.
NOC Results
- Cardiac Output: Ability of the heart to eject enough blood to meet metabolic demands.
- Nutrition: Satisfactory nutritional intake adequate to meet metabolic demands.
- Respiration: Volume of air inspired and expired during a given period of time.
- Skin Integrity: A structural and functional integrity of the skin intact.
- Tissue Perfusion: An adequate supply of oxygen and nutrients to the organs, tissues and cells of the body.
NIC Interventions
- Circulation Enhancement: Actions taken to improve tissue perfusion by promoting optimal cardiac output.
- Nutritional Monitoring: Tracking of nutritional intake to ensure adequate levels of energy and nutrients.
- Skin Surveillance: Assessment of skin integrity and identification of changes to skin integrity.
- Peripheral Sensory Stimulation: Practices used to promote adequate sensory function in limbs.
- Deep Breathing Exercise: Promote proper respiratory function through deep breathing exercises.
Conclusion
Inefficacious Peripheral Tissue Perfusion Risk is an important nursing diagnosis to consider when assessing individuals for potential tissue perfusion problems. By utilizing tools such as NOC results and NIC interventions, nurses can identify and provide appropriate interventions that target the risk factors of this diagnosis.
FAQ:
- What is Inefficacious Peripheral Tissue Perfusion Risk?
- What are defining characteristics of IPTP Risk?
Inefficacious Peripheral Tissue Perfusion Risk is a nursing diagnosis that identifies an individual’s risk for decreased peripheral tissue perfusion resulting in an inability to adequately meet metabolic needs.
Defining characteristics of Inefficacious Peripheral Tissue Perfusion Risk include agitation, altered circulation status, changes in respiration, decreased consciousness, fatigue, numbness or tingling sensations, pain, paleness of skin, paresthesia, abnormal cardiac output, abnormal capillary refill, abnormal color of extremities, altered peripheral pulses, altered peripheral skin temperature, diminished peripheral sensation, and ineffective tissue perfusion.
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