Diagnosing versus identifying symtpoms

  1. 0 I'm a pre-nursing student (applying my second time this year) exploring concepts regarding nursing. I've recently began reading about the scope of practice with regards to CNAs, LPNs, and RNs. I'm trying to figure out a technical difference between identification of symptoms, and actual diagnosis. For example. I can easily identify an infected ear in my son, or a subconjunctival hemorrhage in a resident/patient I'm caring for. As a nurse, can I officially state, "patient has subconjunctival hemorrhage," or not? The difference between identifying dyspnea and diagnosing asthma is most apparent, but there seem to be grey areas in my understanding. What would be proper procedure if you believed your patient had a dissecting aortic aneurysm to state exactly what you believe it is, or that there's simply a cardiac event based on certain symptoms and activate the proper response?
  2. Visit  OwlieO.O profile page

    About OwlieO.O

    Joined Jan '12; Posts: 192; Likes: 118.

    32 Comments so far...

  3. Visit  RNOTODAY profile page
    16
    If you thought your patient had a dissecting aortic aneurysm, trust me, the last thing you would be doing is writing it down, or worrying about what to call it.
  4. Visit  SoldierNurse22 profile page
    10
    You would say, "Hey, this patient's going south, QUICK, based on the following signs/symptoms! Call an RRT and the doc and let's figure out what the **** is going on before it's too late!"
  5. Visit  RNOTODAY profile page
    8
    To answer your question , we as nurses can report SYMPTOMS. Of course, as we become more experienced, we will usually KNOW what the diagnoses is ,based on those symptoms, but we cannot declare it.... does that make sense?
  6. Visit  OwlieO.O profile page
    1
    Quote from RNOTODAY
    If you thought your patient had a dissecting aortic aneurysm, trust me, the last thing you would be doing is writing it down, or worrying about what to call it.
    Well, I should've clarified. I wouldn't write it down - but delivering the message to the surgical team, rescue personnel, etc. as they go into surgery.
    Akewataru likes this.
  7. Visit  SoldierNurse22 profile page
    1
    Often times, you can't make a definitive diagnosis such as a "dissecting aortic aneurysm" until you get to surgery, but they way you treat the patient is the same. Your basic lifesaving measures are going to be based on the symptoms until you get to the root of the issue.
    Akewataru likes this.
  8. Visit  OwlieO.O profile page
    1
    Quote from RNOTODAY
    To answer your question , we as nurses can report SYMPTOMS. Of course, as we become more experienced, we will usually KNOW what the diagnoses is ,based on those symptoms, but we cannot declare it.... does that make sense?
    Those I understand. Perhaps I'll reiterate my question - what is criteria for determining the difference between diagnosis and symptom? Like I stated - a physician could diagnose a fracture, but it seems silly that I couldn't state someone has a fractured tibia if, let's say, the pt suffers of a compound fracture and the tibia is staring you in the face.
    twinkletoes53 likes this.
  9. Visit  SoldierNurse22 profile page
    8
    Quote from OwlieO.O
    Those I understand. Perhaps I'll reiterate my question - what is criteria for determining the difference between diagnosis and symptom? Like I stated - a physician could diagnose a fracture, but it seems silly that I couldn't state someone has a fractured tibia if, let's say, the pt suffers of a compound fracture and the tibia is staring you in the face.
    Technically speaking, there are times when the diagnosis IS staring you in the face and you can't call it because that isn't what nurses do.
  10. Visit  OwlieO.O profile page
    1
    To quote a post from: http://allnurses.com/general-nursing...en-409037.html

    "Jul 19, '09 by swirlything
    The previous post is correct. I'd like to add that nursing diagnosis have to do with things that nurses have autonomy to take action about.

    For example, bacterial pneumonia is a medical diagnosis. A medical practitioner can diagnose and treat pneumonia with, for example, antibiotics.

    Altered airway clearance (inability to clear secretions from the airway) is a nursing diagnosis. It is a human response to the medical condition of pneumonia. It is a condition that an RN can treat autonomously (without need of an order from the doctor) through things like positioning and suctioning.

    As the previous poster said. Nurses do not treat diseases (though they carry out some treatments on behalf of the doctor). Nurses treat all the human response to those diseases... including physical, mental, and spiritual responses."

    Would a nurse have to, or be able to, make educated inferences based on symptoms in order to delineate a care plan for this "nursing diagnosis" (I don't like that phrase) of "altered airway clearance," or wait until a medical diagnosis is given. What if the situation is emergent and no medical diagnosis is possible?
    GrnTea likes this.
  11. Visit  SoldierNurse22 profile page
    7
    If the situation is emergent, you are going to follow your protocols and intervene to save the patient's life.

    For example, you obviously don't have to wait for a medical diagnosis of asthma to treat respiratory difficulty.

    I think you're really overthinking this. If a person is in distress, the nursing and medical teams act together to assist. You're not going to stop to delineate between a medical versus nursing diagnosis.
  12. Visit  SoldierNurse22 profile page
    0
    Quote from OwlieO.O
    As the previous poster said. Nurses do not treat diseases (though they carry out some treatments on behalf of the doctor). Nurses treat all the human response to those diseases... including physical, mental, and spiritual responses."
    I would respectfully disagree. When I was giving chemotherapy as an oncology nurse, I wasn't treating the symptoms of a disease. I was directly targeting the cancer that was causing those symptoms.

    If you aren't treating a disease itself, then you are in effect only treating the symptoms. That is not a wise, holistic or typically effective way to treat a disease process. Knowledge of that disease process allows both physicians and nurses to anticipate the course of the disease and other body systems that may be affected by the disease process, which makes the overall quality of care and the patient's quality of life higher.

    For example, you can give a cough drop for a cough. That'd be treating a symptom. But if you find out that the cough has been caused by asthma versus pneumonia, your treatment of that patient will be different. Of course, medications will be prescribed by the physician and not the RN based on the diagnosis, but that diagnosis guides your actions as a nurse. Patient education and suggesting treatments to the team based on the diagnosis is key. You wouldn't suggest an antibiotic or expectorant for a patient with asthma. And while bronchodilators can help a patient with pneumonia breathe easier, they ultimately do not treat the underlying disease process.
  13. Visit  OwlieO.O profile page
    0
    Quote from SoldierNurse22
    I would respectfully disagree. When I was giving chemotherapy as an oncology nurse, I wasn't treating the symptoms of a disease. I was directly targeting the cancer that was causing those symptoms.

    If you aren't treating a disease itself, then you are in effect only treating the symptoms. That is not a wise, holistic or typically effective way to treat a disease process. Knowledge of that disease process allows both physicians and nurses to anticipate the course of the disease and other body systems that may be affected by the disease process, which makes the overall quality of care and the patient's quality of life higher.

    For example, you can give a cough drop for a cough. That'd be treating a symptom. But if you find out that the cough has been caused by asthma versus pneumonia, your treatment of that patient will be different. Of course, medications will be prescribed by the physician and not the RN based on the diagnosis, but that diagnosis guides your actions as a nurse. Patient education and suggesting treatments to the team based on the diagnosis is key. You wouldn't suggest an antibiotic or expectorant for a patient with asthma. And while bronchodilators can help a patient with pneumonia breathe easier, they ultimately do not treat the underlying disease process.

    We have a misunderstanding. What I mean by treating is directing treatment, not carrying it out like you suggest. Thanks for your feedback. I'm understanding more-so now.
  14. Visit  hherrn profile page
    5
    Quote from OwlieO.O
    Those I understand. Perhaps I'll reiterate my question - what is criteria for determining the difference between diagnosis and symptom? Like I stated - a physician could diagnose a fracture, but it seems silly that I couldn't state someone has a fractured tibia if, let's say, the pt suffers of a compound fracture and the tibia is staring you in the face.
    Yup- You can state the patient has a fractured tibia. Why not? This is assuming your A and P skills are strong enough that you are sure it isn't the fibula.

    As far as documentation? You calling it a fractured tibia adds nothing. Documenting that "1 inch of bone protruding through the anterior lower lug, 6 inches below the inferior aspect of the patella" is descriptive, and helpful.

    And, to further make matters grey: Often, the chief complaint is the diagnosis, particularly in the ER. A pt whose chief complaint is shortness of breath, may, in fact, be diagnosed with shortness of breath.

    I wouldn't worry too much about this. It really isn't an issue. Document what you see, hear, and do, and be descriptive and accurate.
    Beekah20, dudette10, GrnTea, and 2 others like this.

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