what you have to start doing is when you are told someone has a condition like angina pectoris (but understand that it can be any disease or condition) is to start asking yourself "what
is actually going on here?" and "why"
is this chest pain happening?" when i was first in nursing school
years ago we didn't have any formal lectures and were told to find information on our own. one of the things we were constantly guided to do was to ask ourselves and find the answer to "why" things were happening. that, i later learned, is one of the crucial components of critical thinking although i didn't understand it at the time. because, you see, these things (like chest pain or angina pectoris) don't just show up for unknown reasons. there is a rationale for everything that happens and everything that both the doctors and we are going to do for that patient. that is the critical thinking part in all this. get that and you've learned what you needed to about it.
chest pain is one of the most common reasons that people are seen in the er. that is all they come in complaining of and many times that is all you will know about them at first. but by exploring the symptom of chest pain and the diagnosis of angina pectoris you can learn so
much. there are other things to look for and ask about when these patients come in which is why we must do an assessment. assessment is critical to the determination of their problems. assessment for us nurses consists of:
- a health history (review of systems)
- performing a physical exam
- assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
- reviewing the pathophysiology, signs and symptoms and complications of their medical condition
- reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking
the nursing process in the simplest definition is the method we use to solve problems
. it has 5 steps. specific activity goes on in each step.
- problem determination
the nursing process comes from the scientific process and it is not used exclusively by us nurses. many other professions and disciplines use it, or some form of it, to solve questions they have. we actually use this rational process outside of nursing to solve problems. it's just that we never sat down and broke it into its component parts. a nursing diagnosis is a concept that came about while i was in nursing school years ago. it comes under step 2 of the nursing process, problem determination. the nursing diagnosis itself is merely a label, it is a tag like you would place on a cupboard or a drawer, associated with one or more signs and symptoms that refer to a certain nursing problem. every nursing diagnosis has a definition and that is what you really want to look at. these definitions are in the nanda taxonomy (such as the appendix of taber's cyclopedic medical dictionary
or it can be purchased from nanda). that is one of the reasons nanda came about--to organize and standardize the diagnostic information so everyone would know what we were talking about when we used each diagnosis. otherwise, there would be a lot of confusion and who would know what a diagnosis meant if it wasn't clearly defined? before nanda we merely listed signs and symptoms as the patient problems on care plans
. someone began to figure out that some of the signs and symptoms could be grouped together and nursing diagnoses were born. however, the remainder the care planning process (problem solving) didn't change. once the problem is identified we still need to do something about it. and that is step 3 and 4 of the nursing process. now, this is an analogy that i sometimes post that gives you an example of how the nursing process works in the real world:
you are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. you pull over to the side of the road. "what's wrong?" you're thinking. you look over the dashboard and none of the warning lights are blinking. you decide to get out of the car and take a look at the outside of the vehicle. you start walking around it. then, you see it. a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated. what you have just done is step #1 of the nursing process--performed an assessment. you determine that you have a flat tire. you have just done step #2 of the nursing process--made a diagnosis. the little squirrel starts running like crazy in the wheel up in your brain. "what do i do?" you are thinking. you could call aaa. no, you can save the money and do it yourself. you can replace the tire by changing out the flat one with the spare in the trunk. good thing you took that class in how to do simple maintenance and repairs on a car! you have just done step #3 of the nursing process--planning (developed a goal and intervention). you get the jack and spare tire out of the trunk, roll up your sleeves and get to work. you have just done step #4 of the nursing process--implementation of the plan. after the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. you begin slowly to test the feel as you drive. good. everything seems fine. the spare tire seems to be ok and off you go and on your way. you have just done step #5 of the nursing process--evaluation (determined if your goal was met).
there is nothing random about the way we do things. you just need to learn how to think like a nurse
nursing diagnoses are based upon a patient's response to what is happening to them. that is very different from how medical diagnoses are set up. just look at a taxonomy page for one diagnosis as a time and read the definition, related factors and defining characteristics. as you do, you will begin to see how they fit together. read some of the information that is there on the diagnostic pages of the care plan constructors.
eventually, you will begin to see the thinking process going on.
decreased cardiac output
is one of the more difficult nursing diagnoses to understand. it is one of the physiological ones. it is often confused with ineffective tissue perfusion
especially when issues of ischemia (oxygen deprivation to the tissues) come up. decreased cardiac output
takes in all problems of malfunctioning of the heart both electrical and mechanical and
includes ischemia of the heart. this year nanda has done away with ineffective tissue perfusion, cardiopulmonary
which i thought was only used for pulmonary emboli anyway and i would suggest that nurses diagnose according to the response and symptoms the patients exhibit as a result of the perfusion problem.