It would be more like altered thought process related to confusion. Basically, the "related to" draws from the symptom. You can think of it in terms of "as evidenced by". Confusion isn't a medical diagnoses because something causes confusion. But you can conclude that altered thought process as evidenced by you witnessing confusion is your assessment. Another example would be impaired skin integrity. You wouldn't pick impaired skin integrity related to decub ulcers, but you can say impaired skin integrity related immobility. That is b/c immobility isn't a medical diagnoses (well, it can be argued is it if a doctor is describing it as a limitation with the disease), however there's a medical reason that immobility is occurring..like paraplegia or a stroke. Another would be imbalanced nutrition. Malnutrition is a medical diagnosis, but someone who is NPO would be at risk for imbalanced nutrition. Being NPO puts them at risk. One great way to think of a nursing diagnosis is to think of things pts are "at risk for". (Risk for this, risk for that). Look for things you can prevent or or help with nursing actions (ambulation, bathing, education, monitoring this or watching for that, etc).