Trouble with relating medical dx to nursing dx

nurseprnRN, BSN, RN · Jun 20, 2014

hi, thank you for your response! i believe it is, i am just looking in my book and the other nursing diagnoses listed for thrombophlebitis are ineffective peripheral tissue perfusion, which doesnt really apply because they have no edema, normal cap refill, normal skin color.. the other ones are acute pain (they are not in pain), and risk for impaired physical mobility (not applicable because the thromboplhebitis is in their arm).

Dangitol, I am about to shout)

NURSING DIAGNOSES ARE NOT DERIVED FROM MEDICL DIAGNOSES. YOU CANNOT LOOK UP A MEDICAL DIAGNOSIS in some book or other AND THEN PICK A RELATED NURSING DIAGNOSIS LIKE THAT. You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data.

Off soapbox. Well, at least, not yelling anymore.

Ahem. You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts come first, diagnosis comes second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that. I dont care what kind of book they gave you that lists nursing diagnoses under medical ones. Wrong, wrong, wrong.

There is no magic list of medical diagnoses from which you can make a nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. As physicians make medical diagnoses based on evidence, so do nurses make nursing diagnoses based on evidence.

This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. CONGRATULATIONS! You made a nursing diagnosis! :anpom: If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

Two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current NANDA-I 2012-2014 nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

{{{sorry, I've been away for a few days :) }}}

Esme12, ASN, BSN, RN · Jun 20, 2014

I was too....LOL my baby graduated high school!

akulahawkRN, ADN, RN, EMT-P · Jun 20, 2014

Generally it's apples and oranges because nursing and medicine looks at the patient from completely different viewpoints.

There is absolutely one possible way I can think of that you could create a nursing diagnosis from a medical diagnosis... and firstly you'd need to intimately understand the medical diagnosis, specifically exactly the findings necessary to make that medical diagnosis. From that, you would have to determine exactly what findings there were to make that diagnosis, and then you could look at the labs, physical exam, and the like... and then you look at the NANDA descriptions to see where the matches are based on the findings. In effect, you're reverse engineering the medical diagnosis right back to the basis for the diagnosis and you're ultimately having to look at the data anyway!

But why do that when all you have to do is at least read the H&P and you'll get much of the data you'd need without really even looking at the medical diagnosis. You'd be looking at "the data" itself. You then at least have some idea where to start with making a preliminary nursing diagnosis. Once you have seen the patient and have gathered your own data, you can then revise your nursing diagnosis(es) to reflect the patient's true status and needs. There is no "Rosetta Stone" or "Google Translate" way to translate directly from a medical diagnosis to a nursing diagnosis and the reverse is also true. You can't go from a nursing diagnosis to a medical diagnosis, though in both cases, they may derive their end diagnosis from the same set of data.

In other words, don't try to make a nursing diagnosis from a medical diagnosis. After all, from a "simple" diagnosis of mid-shaft femur fracture, there's a dizzying number of nursing diagnoses that are possible. Without seeing the data, how would you know which of those nursing diagnoses to make?

Don't make it more difficult for yourself... look at the data and let the data drive your diagnosis.