Anemia NANDA

1) There is no such thing as "a NANDA." Well, there is, but it's an organization and its proper name is NANDA-I. You have been asked to make a nursing diagnosis, the current list of which is to be found in the NANDA-I 2015-2017.1) And no handbook or other text has all of the NANDA-I approved nursing diagnoses with defining and related factors. (If they did, it would be a copyright violation).

2)All nursing diagnoses have-- must have-- defining characteristics and related/causative factors as defined by NANDA-I. (Exception: "Risk for.." diagnoses have risk factors.) This is nonnegotiable. You can't just make them up.

You must use the NANDA-I 2015-2017, the most current edition. I know that many people (and even some faculty, who should know better) think that a "care plan handbook" will take the place of this book. However, all nursing diagnoses, to be valid, must come from NANDA-I. The care plan books use them, but because NANDA-I understandably doesn't want to give blanket reprint permission to everybody who writes a care plan handbook, the info in the handbooks is incomplete. Sometimes they're out of date, too-- NANDA-I is reissued and updated q3 years, so if your "handbook" is before 2014, it may be using outdated diagnoses.Since it's clear that you didn't have a copy of the NANDA-I 2015-2017 when you were doing this assignment, you're in luck: It's Monday evening, and with the free 2-day shipping Amazon gives students you can have it by Thursday, and instantly if you have a Kindle or other electronic reader (I have a copy on an iPad). :)

I hate these imaginary patient things, and worse, I hate educational programs that imply or teach explicitly that nursing diagnosis derives from medical diagnosis, as in this question. You can't do it.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 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.

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.

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.

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."

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 2015-2017 (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 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 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 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.

OK. So anemia. Look in your textbook and see what the assessment findings for someone with anemia are apt to be. Weakness, shortness of breath, perhaps? What nursing diagnoses might go with those assessment parameters? If you look them up in a list of possible NDs, are there defining characteristics you might see in an anemic person and related factors which includes, say, ANEMIA? There you go. And that's the only way you can make a nursing diagnosis for a patient with anemia, based on your assessment. (For an imaginary patient, you say, "Someone with anemia might look like this..." and take it from there.)

Thank you and I absolutely agree with your thoughts regarding this assignment. Which is also why I am struggling with it because this is exactly opposite what we have been taught for the last 2 years...your symptoms will indicate your nanda not the other way around. I am beyond frustrated!

STOP CALLING IT "A NANDA." I have been shoveling snow and chipping ice for a week, no, more than a week, haven't been able to get out of the house for 8 days, and I am at the end of my tether. :)

A patient's assessment (symptoms and all) does dictate his nursing diagnosis. Nursing diagnosis is based on facts, and those are the facts. He doesn't have a nanda. >> He has defining characteristics and you have made a nursing diagnosis based on finding them.

Just do it right, and if they give you any stick about it, pull out your NANDA-I 2015-2017 and show it to them. UPS, bless them, are still delivering, and Amazon will have it to you in two days, or you can get an instant download.

LOL GrnTea, thanks for the chuckle.