Focus on Students: Anatomy of a Nursing Diagnosis

**J.Adderton**, BSN, MSN

As a student, you will often read and hear the acronym for The North American Nursing Diagnosis Association, or NANDA. NANDA is an organization of professional nurses that publishes approved nursing diagnosis to standardize terminology. Nursing diagnosis communicate nursing judgments to patients and the interdisciplinary team. Most likely, you purchased a NANDA reference book as a requirement for the first semester. Hopefully this article will bring new light to this reference book.

Are you confused by the difference in a medical diagnosis and nursing diagnosis? If so, you are just like many nursing students. A physician diagnosis a disease or disorder- this is a medical diagnosis. A physician will order medications and treatments to address the disease or disorder. A nursing diagnosis is a problem identified in the nursing assessment and is caused by the disease or disorder. A nursing diagnosis is a problem that can be addressed by a nurse and within the nurse's scope of practice. NANDA publishes a list of all approved nursing diagnosis and this helps keep the language standardized. Once you (the nurse) have assessed the patient and identified the nursing problem, you will reference a NANDA resource to identify the appropriate nursing diagnosis. Confused? Let's look at a case study to help with understanding.

Case Study

An adult patient presents to the emergency department with shortness of breath with respirations at 28. The patient has a history of asthma and used a rescue inhaler three separate times earlier in the day while cutting grass. The patient is wheezing and O2 saturation of 93%. No report of fever, chills or additional symptoms. The patient demonstrates use of rescue inhaler and patient does not use the inhaler properly.

The physician's assessment leads to a medical diagnosis of Asthma Exacerbation. A breathing treatment and IV steroids are ordered by the physician.

The nursing assessment reveals the patient is not using the rescue inhaler properly, therefore, not receiving needed medication- contributing to exacerbation. This is a problem the nurse can address through educating the patient on correct use of the inhaler. Therefore, an appropriate nursing diagnosis would be- Knowledge deficit, related to use of metered dose inhaler. Teaching a patient the correct use of an inhaler is a nursing intervention based on nursing judgment.

3 Types of Nursing Diagnosis

This article will focus on 3 types of nursing diagnosis- actual, risk and wellness/health promotion. The types often confuse students and to help turn on your nursing diagnosis light bulb- an example will be provided with each type description.

An actual nursing diagnosis has 3 parts: (1) The NANDA diagnosis, (2) the processes causing the symptoms and (3) the assessed or observed physiology or behavior. These three parts are connected by standard phases.

Quote

Ineffective breathing pattern (the NANDA diagnosis) related to (standardized phrase to connect) bronchoconstriction (the process causing the knowledge deficit) as evidenced by (standardized phrase to connect) wheezing and elevated respirations.

Risk diagnosis has 2 parts: (1) the NANDA diagnosis and (2) the observed physiology or behavior. Risk diagnosis do not include a "related to" because the problem has not yet occurred.

Quote

Risk for infection (the NANDA diagnosis) as evidenced by (standardized phrase to connect) increased mucus production (risk factor).

Wellness or health promotion diagnosis has only one part and is written a little differently. It begins "readiness for enhanced _________".

Quote

Readiness for enhanced management of therapeutic regimen (one part statement)

Is it becoming clearer? Let's take a closer look at the three types:

Actual

When assessing the patient, the nurse identifies current health problems that would benefit from nursing care. Based on the case study, the nurse assessed the patient with a respiratory rate of 28 and shallow. A NANDA actual nursing diagnosis of Ineffective breathing pattern is appropriate based on the nurse's assessment. The altered breathing pattern is related to bronchoconstriction that occurs with asthma exacerbations. The nurse assessed the following symptoms as evidence to support the nursing diagnosis of ineffective breathing pattern; wheezing, respiratory rate of 28, and shallow respirations. Example:

Quote

Ineffective breathing pattern related to bronchoconstriction as evidenced by wheezing, respiratory rate of 28 and shallow respirations.

Risk

A risk nursing diagnosis identifies a health problem that does not yet exist, but the patient, family, or community are at a higher risk of developing the problem than others. Because the problem has not yet occurred, risk diagnosis statements do not include "related to" data. A NANDA risk nursing diagnoses of risk for activity intolerance is appropriate based on the nurse assessment. Individuals with asthma are at a higher risk for activity intolerance due to inflammation and constriction of airways. The nurse assessed symptoms as evidence to support the at-risk diagnosis; imbalance between oxygen supply and demand. Example:

Quote

Risk for activity intolerance as evidenced by imbalance between oxygen supply and demand.

**Light bulb take-away: Risk diagnosis statements do not include "related to" data

Wellness or Health Promotion Diagnosis

A wellness diagnosis identifies the patient's readiness to achieve a higher level of wellness. Based on the case study, the nurse identified the patient's improper use of an inhaler. A NANDA wellness nursing diagnosis of Readiness for enhanced knowledge is appropriate based on the nursing assessment. The patient is ready to learn the correct use of the rescue inhaler for improved self-care of asthma.

Quote

Readiness for enhanced knowledge of medical self-administration.

**Light bulb take-away: Wellness diagnosis statements are written in a one part Statement.

Are you feeling more confident in the purpose and process of identifying a nursing diagnosis(s) for your patient care? Remember, a nursing diagnosis is determined by the nursing assessment and addresses a patient need that can be met by the nurse

What about nursing diagnosis would you, the reader, like to explore through additional articles? What part of the nursing process do you struggle with?

Additional Read

peachtreednurse, RN · Aug 29, 2018

In the late 80's a greater than 1000 page text on Nursing Diagnosis and Intervention proved very useful in the care plan process at a skilled nursing facility where I worked as Care Plan Coordinator. By relating nursing assessments pertinent to medical diagnoses and identifying problems and risk factors, we were able to generate a cohesiveness of language and practice;which in some cases and only after review and approval of the Administrator and Medical Director, modified or added to Policy and Procedure.

**J.Adderton, BSN, MSN** · Sep 21, 2018

It does help! The electronic medical record is sometimes a barrier for nursing students in obtaining information.

Focus on Students: Anatomy of a Nursing Diagnosis

Case Study

3 Types of Nursing Diagnosis

Actual

Risk

About J.Adderton, BSN, MSN

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