Nursing Diagnosis

Tinker88 · Apr 28, 2013

[h=3]"The careplan consists of three parts: 1) definition of the problem; 2) interventions and/or solutions; and 3) evaluation of the relative success of the interventions and solutions."

"The diagnosis given by a doctor and the one acted on by a nurse are two different things. Example: A medical diagnosis is "Diabetes Mellitus," while a related nursing diagnosis would be "risk for unstable blood glucose." The first example is the doctor's diagnosis of the patient, the second suggests a course of action to the nurse; you must work to reduce the risk."[/h]http://owl.english.purdue.edu/owl/owlprint/922/

[h=3]I'm not a nurse, but start a BSNA program in August. I thought this was a very interesting topic.[/h]

nurseprnRN, BSN, RN · Apr 29, 2013

The nursing process that results in the nursing plan of care and its implementation includes assessment, analysis, diagnosis, prescription, implementation, and re-assessment and revision of the plan as necessary,

The fallacy here is the unspoken assumption that the (single) nursing diagnosis is related to the medical diagnosis or depends on it ("acted on"). When you look at the NANDA-I 2012-2014 nursing diagnosis, you find nothing in the definition that says, "... for a patient with the medical diagnosis of diabetes mellitus." I know you probably think this is splitting hairs, but you have to look at the broader derivation and application of nursing diagnosis to understand its meaning.

A better example of the difference between medical diagnosis and plan of care and nursing diagnosis and plan of care might be, say, the medical diagnosis of anemia, made by lab values and history, and the many nursing diagnoses that might, depending on individual patient assessment, apply to this person-- some of which have no physiological relationship to a low hematocrit. This is because the medical diagnosis is aimed at identifying the pathological condition, and the medical plan of care is aimed solely at its treatment. Nursing assessment, diagnosis, and planning goes far beyond this limited focus. I will leave it to you, prospective student, to obtain your own copy of the NANDA-I 2012-2014 (the most current edition, $29 and free two-day shipping for students at Amazon) and enrich yourself about that.

I also find it amusing that in a resource ostensibly aimed at making the nurse a better writer (and in truth, I love Purdue OWL), the authors make usage errors themselves, e.g., "...if the patient is unable to check their own blood sugar..." Patients may be unable to check their own blood sugars, or a patient may be unable to check his own blood sugar, but you can't mix singulars and plurals in one clause. :)

dandk1997RN, MSN, RN · Apr 30, 2013

I write care plans based on ND on a daily basis. I work cardiac tele in a good-sized hospital in a small city. The care plans I write are based on my assessment of the pt, and at our facility, they come with predefined interventions and outcomes- I choose the ones I want to use for each specific pt. Each shift, the RN reviews and updates the plan, adding or deleting any ND based upon assessment changes. This helps us resolve (and more often) prevent complications, most often from immobility.

When I was in school, I thought nursing dxs were a waste of time. As a practicing nurse, I find them very helpful in prioritizing/coordinating the focused assessment and care I give my pt (besides just pushing the meds the provider orders.)

Taking care of pts involves WAY more than just doing what the doc says for the pt. if you only do what the doc orders, you're doing a disservice to the pts and will likely end up in trouble as well.

Best of luck to you.

Lossea, RN · Jul 31, 2013

NurseDirtyBird, thank you very much! I am a pre-nursing student and knew that nurses do not diagnose the disease of the patient, like a doctor does, and neither may nurses prescribe treatment, as in medication or tests. I did read the nursing processes here on AN that included diagnosis and interventions and was confused as to what the nursing diagnosis and interventions exactly entail...Your definition made it very clear to me. Thank you everyone, too. :yeah:

nurseprnRN, BSN, RN · Aug 1, 2013

In very few, overly simplified words: We cannot diagnose disease or prescribe treatments, that is the MD's job. But we can "diagnose" (recognize) responses to disease processes and treatments and "prescribe" and implement interventions to assist in the patient's recovery. That's pretty much our whole job...

No quotes around prescribe at all. We do prescribe nursing interventions for nursing diagnoses. It's in the nurse practice act.

CalRNtoBe2013 · Aug 4, 2013

As a nursing student I really don't understand nursing diagnosis. Patients have a medical diagnosis already why must nurses create another one and usually something so silly it is phrased in such a way that a normal person would not speak in such terms. For example...Hypoxia which we can all understand but they have created a nursing diagnosis such as inadequate tissue perfusion...I just dont get it...If I have a pt in pain I will admin pain pills not write about it...

1) Nurses do speak in terms such as "inadequate tissue perfusion". I can't tell you how many times a day I hear to word "perfusion" at work. 2) From what I have learned, hypoxia an inadequate tissue perfusion are not the same thing. Hypoxia puts the patient at risk for inadequate perfusion. Therefore, if your patient were hypoxic, your Nsg dx would be 'risk for (nsg dx) inadequate tissue perfusion r/t (medical dx) hypoxia.

CalRNtoBe2013 · Aug 4, 2013

And pain is a nsg dx as well. "Pain r/t hip fracture AEB (s&s of pain)". The unit I work in requires nurses to document nsg dx in the SBAR. No, it's not a full care plan, but those dx allow the nurses to determine their plan of care. For example, if the night shift nurse documents a dx of pain, the nurse on the next shift will know to administer pain meds before ADLs, etc.

nurseprnRN, BSN, RN · Aug 5, 2013

1) Nurses do speak in terms such as "inadequate tissue perfusion". I can't tell you how many times a day I hear to word "perfusion" at work. 2) From what I have learned, hypoxia an inadequate tissue perfusion are not the same thing. Hypoxia puts the patient at risk for inadequate perfusion. Therefore, if your patient were hypoxic, your Nsg dx would be 'risk for (nsg dx) inadequate tissue perfusion r/t (medical dx) hypoxia.

Not so. You can have perfectly wonderful perfusion (which refers only to blood flow) and lousy tissue oxygenation (the result of hypoxia/hypoxemia).

CalRNtoBe2013 · Aug 5, 2013

Not so. You can have perfectly wonderful perfusion (which refers only to blood flow) and lousy tissue oxygenation (the result of hypoxia/hypoxemia).

I know. I was pointing out that the OP was implying that inadequate perfusion is a fancier term for hypoxia, which isn't the case.

allnurses Guide · Aug 6, 2013

Hypoxia puts the patient at risk for inadequate perfusion.

You said you understand, but to clarify for the OP, the above statement is not true. Inadequate tissue perfusion can put you at risk for hypoxia, not the way it's written above.

You are correct they are two separate things. There can be many causes of hypoxia and hypoxemia that are unrelated to tissue perfusion.

CalRNtoBe2013 · Aug 6, 2013

I realize now that I stated it backwards. My whole intent was to show that they are not the same thing simply reworded for a care plan like the OP claimed. I despise writing care plans, too, but I've accepted the fact that they are used to piece things together. The first time I had to do a concept map, I wanted to pull my hair out. Now I catch myself making them to help study.

nurseprnRN, BSN, RN · Aug 7, 2013

See? That's the point. The people who tell you what sounds so good to a student ("I never use care plans in the REAL world!") have forgotten, or maybe never knew, that the point of having students do care plans and learn about nursing diagnosis is to teach them how to think like nurses. That's why you need to do them.