Anyone have any suggestions for nursing diagnoses???

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Help!!! I was just wondering if anyone has any earth shattering advice on how to write a nursing dx that my instructor won't rip up into tiny pieces when grading my clinical prep-work.... I'm just waiting for this critical thinking thing to hit me..... (will probably render me unconscious....:p )


124 Posts


I think the most important thing to look at is why your instructor feels your nursing dx is incorrect. When writing careplans or doing pt research I ask myself the following questions:

1. Does it make sense given the pt's current state of health.

2. Is this intervention within nursing's scope of practice.

3. How will I evaluate this effectiveness of the intervention (based on the nursing dx).



hoolahan, ASN, RN

1 Article; 1,721 Posts

Specializes in Home Health.

3-part diagnosis


P=Problem=The alteration/dysfunction/condition

E=Etiology=what is the cause of the problem

S=Symptoms="as evidenced by" list the symptom(s)

Eg. Decub

Altered skin integrity (=problem) related to immobility (=etiology) as evidenced by loss of epidermal tissue (or stage II pressure ulcer, =symptom)

Is it amenable to nursing care? You betcha, turn q 2, assess nutrition and hydration, maintain aseptic technique w dressing changes, etc...

Always try to use the PES diagnoses, but a 2 parter w/o listed symptoms is OK too.

Hope that helps.


408 Posts

Specifically, what part of dx are you having problems with? Definately ask your instructor what you can do to improve.

In our careplans we have to use only NANDA approved dx. Hoolahans example is much like ours. The NANDA dx, "related to"..., "as evidenced by".... If it is an at risk for dx, then we skip the "as evidenced by" part, since the pt is at risk for, and wouldn't have specific symptoms.

Ex. Fluid volume deficit, related to decreased fluid intake due to nausea and vomiting, as evidenced by: pt states "I can not eat or drink because I feel nauseous", pt vomited 100 cc clear liquid after attempting to drink water, pt dry heaving when food is brought into room, pt has poor skin turgor - skin tents when pinched lightly between two fingers, urine is dark amber colored.

The outcome/goal has to be measurable, have a specified time limit and be classified as long or short term. Ex. Short term: Pt will display adequate fluid intake within two days as evidenced by pt drinking at least 1 glass (8oz) fluid per hour 10 times/day and voiding light yellow urine at a rate of at least 30ml/hr.

Actions or implementation and rationales (for our class) have to be found in a published reference and cited. The first action is usually some type of assesssment, so you have a baseline to measure the interventions against. We usually use actions that are diagnostic, educative, therapeutic, or referrals with docs or to other depts.

Ex. Assess causitive/precipitating factors, and evaluate degree of fluid volume deficit: (in this case) nausea and vomiting may be causative, skin tenting and concentrated urine are physical indicators.

Then what actions can you take to correct these factors and deficits:

Ex. Referral: Collaborate with MD to get IV order for fluid replacement, order for antiemitics. Rationale: to assist in rehydration and decrease s/s of nausea.

Diagnostic: maintain accurate I&O, monitor urine specific gravity. Rationale: Accurate I&O shows hydration status by measuring total daily intake and output, specific gravity determines hydration.

Therapeutic: Note pt preferences re fluids and foods with high fluid content and encourage intake. Rationale: Pt may be more cooperative if provided with fluids and foods that are appealing to sense of taste.

Educative: Discuss factors related to fluid deficit, identify actions pt may take to correct deficiencies (sucking on ice chips or taking sips of water instead of large amount of fluid at one time). Rationale: Educating pt on problem/treatment empowers pt to maintain healthy behaviors.

(Usually our actions are more specific and basically spell out exactly what we are going to do)

Then we document responses to the actions, and at the end of the time limit, evaluate the outcome. Evaluation should include whether the goal was met, partially met, or not met. Include the evidence documented in the outcome, like: Goal met, pt drinks 10 eight oz glasses of fluid per day and voids light straw colored urine, amt 100ml/hr. Then we can also say, continue with actions #1 to #5 (if they have been effective) or we can revise actions if needed.

Sorry this is so lengthy, hope it helps!


131 Posts

Wow,thanks for the help!!! Those are exactly like formula we use P-E-S, the outcomes must be measurable witha time frame... Thanks for your help... I think seeing someone else explaining them helped! thanks again..........


26 Posts

Don't take my advice if you don't want a F. Care plans are usless items of beuracacy and from the nursing philosophy of -paper work before patients. Tell your instructor to read the credentials of the folks who come up with that nursing theory crap. They do the minimum 1 to 2 years med surg before they enter a masters program then sit bhind a desk philosophizing and creating this BS. It is my opinion that care plans are just part of the codependency of nursing.


84 Posts

okihusker: what are nurses codependent on?


1,244 Posts

Originally posted by NurseExplorer

okihusker: what are nurses codependent on?

Aministrators......who run the payroll.....who all have chronic cases of Paperrhea.

Paperrhea: [n]autoimmune disease caused by generation of huge mounds of bureaucratic bs

s/s: no trees, lotsa paper, nurses c/o carpal tunnel syndrome

Tx: 1) teach student nurses early on that this is part of the job; 2) plant a tree :kiss 3) become an administrator and hope you don't catch it. :p


408 Posts

Okihusker - I don't know of anyone who really likes care plans! But I do have to admit that they have been a great learning tool for me. They help me focus in on what problems the pt has, what I am doing for the patient, and why I am doing it. It helps to measure whether or not the actions we are taking are helping, or whether we need to try something else.

Yes, it is a pain to have to do all the research and writing, and it is not realistic to imagine that a nurse would have time to write an indepth plan for each pt on each shift, but as far as being in school to learn about patient care I feel it is very useful. Most of the nurses I have come across have told me that after I graduate, I will never have to write one of those things again! (Big sigh of relief!)


223 Posts

Hi all

Thought I would reply- Careplans extra paper work or vital tool for continuity of care?

In our unit we are a stroke unit so many of our patients will have very simular needs so the staff devised core care plans that address things like immobility, communication, diet etc

I am fairly new to the unit and had never used core care plans before

I had concerns about their validity and value. I suggested to my staff that if they wished to continue to use them they would have to show that they were evidence based. So we each took a care plan and performed a literature search,looked at current papers to validate that the care that we are providing was in fact the correct care that had aready been researched.

On the back of each care plan the papers are referenced.

So not only are they vital teaching tools if we needed to respond to a complaint the work has already been done

Care plans enable nurses to assess plan provide care and then evaluate the care in a systematic way

Best of luck



26 Posts

In response to what is codependence of nursing: The general exagerated feeling, belief, and action of being needed, and I underline the word exagerated. Care plans are NANDA's attempt to make Nursing an independent profession and practice. Nurses are needed we all know that, MDs know that, and hospital administrators know that. Just as much as I hate to admit the reverse. Do care plans benefit the patient? More than likely not. Did they benefit me in college? Not has much as having a fundamental grasp on Anatomy, Physiology, Chemistry, Microbilogy, Pathophysiology, Nutrition, and Pharmacology. What makes Nursing an independent profession is that we are at the bedside, assessing and reassing our patients. Identifying failure, S3 heart sounds, St seg depresion or elevation, and providing early recognition and intervention through theory we learned from fundamental science. Not writting Altered tissue profision crap ect. If you need a care plan to tell you what to do then I guess you are screwed as a nurse. But you have to play the game in college to get through the course. Like shining toliets in Boot Camp in the military.

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