Student Resources: Nursing Diagnoses - page 2
A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and/or potential health problems or life processes. A medical diagnosis, on the other hand, is... Read More
Nov 30, '10Hey guys im doing my first care plan (group presentation, 1 ns diagnosis per person) and have to come up with a nursing diagnosis for a young jewish mother of 2 toddlers who has been diagnosed with hyperthyroidism. This is what i came up withe for the diagnosis part:
activity intolerance r/t generalized weakness and fatigue aeb inability to perform daily physical activities.
i was wondering if the related factors have to be listed in the nanda book or not because i used fatigue as a realted factor although it is not listed. also id like to know if my aeb is too broad ? should i make it more specific such as "aeb patient verbalization of weakness/ exhaustion?" all help is appreciated ... please let me know anything else im missing my teacher did explain this very well!!
Oct 26, '11I'm an old fart and I remember when nursing DX first came about. I remember the we'll be able to bill for our own nursing servicves arguments.
One path that I've taken when trying to teach nursing dx, especially to people who already have predjudice against them, is that it's a way of thinking. It's a way to teach yourself an organized, systomatic way to approach your patient. When you start, it takes thought, but after you get experience, you learn to do it on the fly. IF YOU"VE LEANED THE CONCEPTS.
When a patient comes into the unit, it really doesn't matter what their medical dx is. The nursing care is directed by their problem. IT really doesn't matter that much in the first few minutes or hours even if your DIB pt has pneumonia, CHF, ,COPD or whatever. it's the hypoxia and the recognition that it's a pulmonary cause and not a cardiac or whatever. (overly sipmlistic example alert)
The question I have, is this, and it's a question, because I don't know. Is nursing DX one of those things that need to be changed. Either how it's normally taught, or the importance it's given?
Dec 31, '11
nursing diagnoses 2012 - 2014
domain 1 - health promotion deficient diversional activity sedentary lifestyle deficient community health risk-prone health behavior ineffective health maintenance readiness for enhanced immunization status ineffective protection ineffective self-health management readiness for enhanced self-health management ineffective family therapeutic regimen management domain 2 - nutrition insufficient breast milk ineffective infant feeding pattern imbalanced nutrition: less than body requirements imbalanced nutrition: more than body requirements risk for imbalanced nutrition: more than body requirements readiness for enhanced nutrition impaired swallowing risk for unstable blood glucose level neonatal jaundice risk for neonatal jaundice risk for impaired liver function risk for electrolyte imbalance readiness for enhanced fluid balance deficient fluid volume excess fluid volume risk for deficient fluid volume risk for imbalanced fluid volume domain 3 - elimination and exchange functional urinary incontinence overflow urinary incontinence reflex urinary incontinence stress urinary incontinence urge urinary incontinence risk for urge urinary incontinence impaired urinary elimination readiness for enhanced urinary elimination urinary retention constipation perceived constipation risk for constipation diarrhea dysfunctional gastrointestinal motility risk for dysfunctional gastrointestinal motility bowel incontinence impaired gas exchange domain 4 - activity/ rest insomnia sleep deprivation readiness for enhanced sleep disturbed sleep pattern risk for disuse syndrome impaired bed mobility impaired physical mobility impaired wheelchair mobility impaired transfer ability impaired walking disturbed energy field fatigue wandering activity intolerance risk for activity intolerance ineffective breathing pattern decreased cardiac output risk for ineffective gastrointestinal perfusion risk for ineffective renal perfusion impaired spontaneous ventilation ineffective peripheral tissue perfusion risk for decreased cardiac tissue perfusion risk for ineffective cerebral tissue perfusion risk for ineffective peripheral tissue perfusion dysfunctional ventilatory weaning response impaired home maintenance readiness for enhanced self-care bathing self-care deficit dressing self-care deficit feeding self-care deficit toileting self-care deficit self-neglect domain 5 - perception/ cognition unilateral neglect impaired environmental interpretation syndrome acute confusion chronic confusion risk for acute confusion ineffective impulse control deficient knowledge readiness for enhanced knowledge impaired memory readiness for enhanced communication impaired verbal communication domain 6 - self-perception hopelessness risk for compromised human dignity risk for loneliness disturbed personal identity risk for disturbed personal identity readiness for enhanced self-control chronic low self-esteem risk for chronic low self-esteem risk for situational low self-esteem situational low self-esteem disturbed body image stress overload risk for disorganized infant behavior autonomic dysreflexia risk for autonomic dysreflexia disorganized infant behavior readiness for enhanced organized infant behavior decreased intracranial adaptive capacity domain 7 - role relationships ineffective breastfeeding interrupted breastfeeding readiness for enhanced breastfeeding caregiver role strain risk for caregiver role strain impaired parenting readiness for enhanced parenting risk for impaired parenting risk for impaired attachment dysfunctional family processes interrupted family processes readiness for enhanced family processes ineffective relationship readiness for enhanced relationship risk for ineffective relationship parental role conflict ineffective role performance impaired social interaction domain 8 - sexuality sexual dysfunction ineffective sexuality pattern ineffective childbearing process readiness for enhanced childbearing process risk for ineffective childbearing process risk for disturbed maternal-fetal dyad domain 9 - coping/ stress tolerance post-trauma syndrome risk for post-trauma syndrome rape-trauma syndrome relocation stress syndrome risk for relocation stress syndrome ineffective activity planning risk for ineffective activity planning anxiety compromised family coping defensive coping disabled family coping ineffective coping ineffective community coping readiness for enhanced coping readiness for enhanced family coping death anxiety ineffective denial adult failure to thrive fear grieving complicated grieving risk for complicated grieving readiness for enhanced power powerlessness risk for powerlessness impaired individual resilience readiness for enhanced resilience risk for compromised resilience chronic sorrow stress overload risk for disorganized infant behavior autonomic dysreflexia risk for autonomic dysreflexia disorganized infant behavior readiness for enhanced organized infant behavior decreased intracranial adaptive capacity domain 10 - life principles readiness for enhanced hope readiness for enhanced spiritual well-being readiness for enhanced decision-making decisional conflict moral distress noncompliance impaired religiosity readiness for enhanced religiosity risk for impaired religiosity spiritual distress risk for spiritual distress domain 11 - safety/ protection risk for infection ineffective airway clearance risk for aspiration risk for bleeding impaired dentition risk for dry eye risk for falls risk for injury impaired oral mucous membrane risk for perioperative positioning injury risk for peripheral neurovascular dysfunction risk for shock impaired skin integrity risk for impaired skin integrity risk for sudden infant death syndrome risk for suffocation delayed surgical recovery risk for thermal injury impaired tissue integrity risk for trauma risk for vascular trauma risk for other-directed violence risk for self-directed violence self-mutilation risk for self-mutilation risk for suicide contamination risk for contamination risk for poisoning risk for adverse reaction to iodinated contrast media risk for allergy response latex allergy response risk for latex allergy response risk for imbalanced body temperature hyperthermia hypothermia ineffective thermoregulation domain 12 - comfort impaired comfort readiness for enhanced comfort nausea acute pain chronic pain impaired comfort readiness for enhanced comfort social isolation
nanda nursing diagnosis home pageLast edit by VickyRN on Jan 11, '12
May 28, '14Personally, I think we do students a great disservice to give them that list and no guidance as to how to use it. It's important for them to know that you can't just look at that list and pick something you think sounds about right for your patient. You must must must have assessment data that indicate your diagnosis was made in agreement with the real, scientifically-based defining characteristics and approved causes for each. These criteria cannot be found in "nursing care plan handbooks." They are found only in the NANDA-I 2012-014 (as of the time of this writing, the current edition), because NANDA-I understandably doesn't give blanket permission to reprint their entire work to every handbook author that comes down the pike. Not to any of them, actually. $29 atwith free two-day delivery, or instant to your iPad or for $25.
Oct 23, '14How does one reconcile these 12 domains with Gordon's 11 functional health patterns? Some seem identical; though, I only just glanced.
Thanks for the great resource.
Aug 17, '15
You are in school to learn to be a nursing diagnostician and treat people for what you diagnose. Yes, you are. You think it's all about learning how to do stuff like injections and IVs and tubes, but those are just tasks. You are learning how assess human responses and prescribe nursing measures.
There is no magic list of medical diagnoses from which you can derive 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.
Facts first, diagnosis 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.
As an example: How does a physician make a medical diagnosis of anemia? The physician doesn't go to a list and say, "Gee, this guy looks pale, must be anemic, sounds pretty good to me," right? No- a diagnosis is made by obtaining a CBC. Then how does the physician know what caused it? Ah, then we collect more data-- renal failure (low erythropoietin), marrow malignancy (differential), occult GI beed (stool check), big bleeding with IV replacement (trauma record)... Then the physician can develop a medical plan of care to treat the causative (related-to) factors for the diagnosis made on data.
Nursing diagnosis is the same thing. A nurse can't just pick a diagnosis out of a list. And you can't make a diagnosis without data, either. So... my first suggestion is banishing the words "pick/find/choose" from any discussion of the NANDA-I list of approved nursing diagnoses. I think if students got this concept in their first week of school, that they will learn how to make nursing diagnoses, they'd have a better hook to hang their hat on, so to speak.
This is why you can't say, "My patient has diabetes. What are his nursing diagnoses?" Sure, when I admit somebody with diabetes I have some good ideas about possible nursing diagnoses based on my experience with caring for diabetics in many settings-- like, oh, knowledge deficit, fluid imbalance, impaired CV function, ineffective peripheral issue perfusion, pain, and many other things often seen in diabetics-- but I can't make one of them until I am sure the patient actually has defining characteristics. If I'm a smart person I will also keep my eyes and ears open for other nursing diagnoses for this patient -- maybe I see evidence of abuse, or sexual dysfunction, or death anxiety, or ineffective denial, or powerlessness, or risk for injury, or risk for self-directed violence, or contamination or .... You get the picture. This is why limiting your vision to "nursing diagnosis for diabetes" is so, well, limiting.
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.
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’m making the nursing diagnosis of/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." You can thumb through your NANDA-I 2015-2017 and find lots and lots of medical diagnoses as related factors. They are not the origins of nursing diagnoses, however.
To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and a related/caustive factor. (Exception: see "risk for" diagnoses) (Think of the physician who has to have some lab work to diagnose anemia...same thing.)Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2015-2017 (current edition). $39 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. This edition also includes an EXCELLENT FAQs section aimed at 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 2015-2017, 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 nursing diagnosis first from a medical one 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! 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.
About “Risk for” diagnoses:
First: "Risk for" nursing diagnoses are very often properly placed first, as safety ranks above all of the physiological needs in Maslow's hierarchy. What are nurses for if not to protect a patient’s safety?
Second: It is a fallacy that "risk for..." nursing diagnosis is somehow lesser or not "real." If you look in your NANDA-I 2015-2017, there is a whole section on Safety, and almost all of the nursing diagnoses in that section are "risk for..." diagnoses. However, because NANDA-I has learned that nursing faculty is often responsible for this fallacy, the language on these has recently been revisited and was changed to include "Vulnerable to ..." in the defining characteristics the current edition.
"Risk for.. " diagnoses do not have defining characteristics, they have risk factors.
Third: Setting priorities. This sort of assignment is often made not only to see if somebody can recite rote information but to elicit your thought processes and see how well you can defend your reasoning. There is often no single priority; defend yours. Your faculty will be gratified to see you try and make your case.
So, what is the reasoning you have applied to your ranking, as applied to a specific patient or to people in general?
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 2015-2017 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.