Diagnosing versus identifying symtpoms

Esme12, ASN, BSN, RN · Oct 30, 2013

As a pre-nursing student your focus needs to be on getting good grades to get into school. I hope this answered your questions.

twinkletoes53 · Oct 31, 2013

Those I understand. Perhaps I'll reiterate my question - what is criteria for determining the difference between diagnosis and symptom? Like I stated - a physician could diagnose a fracture, but it seems silly that I couldn't state someone has a fractured tibia if, let's say, the pt suffers of a compound fracture and the tibia is staring you in the face.

Without X Ray interpretation, you cannot state for certain which bone is fractured.

You might chart something like this:

"Patient presented with 10cmx10cm laceration on inner calf, with edges of bone protruding through skin. Diffuse edema around site of protruding bone. Foot and ankle are swollen. Posterior tibial pulses are present. Toes are dusky in color; capillary refill 10 seconds. Patient states that he is able to feel sensation in all toes."

You might also have documented "Per report of Dr. Smith, after viewing AP & lateral X Ray of affected extremity, patient has a compound fracture of tibia. Site immobilized with splint & patient prepped for surgery"etc.

NutmeggeRN, BSN · Oct 31, 2013

I'm a pre-nursing student (applying my second time this year) exploring concepts regarding nursing. I've recently began reading about the scope of practice with regards to CNAs, LPNs, and RNs. I'm trying to figure out a technical difference between identification of symptoms, and actual diagnosis. For example. I can easily identify an infected ear in my son, or a subconjunctival hemorrhage in a resident/patient I'm caring for. As a nurse, can I officially state, "patient has subconjunctival hemorrhage," or not? The difference between identifying dyspnea and diagnosing asthma is most apparent, but there seem to be grey areas in my understanding. What would be proper procedure if you believed your patient had a dissecting aortic aneurysm to state exactly what you believe it is, or that there's simply a cardiac event based on certain symptoms and activate the proper response?

Bottom line, we cannot diagnose. But, when you are on the phone with an MD you can certainly say it looks like____, sounds like____, smells like______and then get appropriate orders or interventions.

With family or friend or stranger, my standard answer is sounds like you are uncomfortable, wheezy, have a fever etc...... YOU need to call YOUR PCP, as I don't not have enough initials behind my name or enough malpractice insurance to practice medicine with a nursing license!

All said with a nice smile. :yes:

If the situation is emergent, I will call 911 and offer help to the best of my ability.

OwlieO.O · Oct 31, 2013

Get good at describing things. It takes practice. And it's not just for conditions like asthma, but also for charting generally. For instance, if you walk into a room and a patient seems to have fallen out of bed, you don't put "pt fell out of bed". You put "pt found on floor, alert and oriented to person, place, time, and events. Does not complain of any pain or discomfort at this time. no visual or palpable injuries or abnormalities noted. Vital signs as follows...bla bla bla....Dr. Smith Notified." ... or something like that.
You are not a CT-scanner, X-ray machine, video camera, walking Lab, or otherwise. just use subjective and objective info to describe what's going on :-)
It's fun to play the "what's their diagnosis!" game in your head and then see if you're right after everything is said and done. You'd be surprised how often you're wrong with ones you think are obvious.
For instance, man comes in complaining of terrible unilateral flank pain... I'm like... kidney stone? vitals reveal he has a fever, WBCs elevated... so... Pyelonephritis? urine comes back fine... x ray comes back - pneumonia in one lower lobe. no complaints of trouble breathing, had good sats, lungs sounded decent. Guess i should have listened a little better instead of thinking about kidney stones...!
You'll get it in time. Pay attention to how fellow students, nurses, and teachers chart things. Try to pick up on others' good habits or steal their phrases and stuff...I MEAN ... ahem... allow their linguistic habits to influence your work. :-)

That bolded phrase was very astute of you. It reminds me of a movie where an officer told his partner to refrain from using the phrase, "car accident," and instead stating, "vehicular collision," because one is an assumption, and the other is an affirmation based only on current evidence.

Thank you all so much for your time. This has helped my understanding a lot.

OwlieO.O · Oct 31, 2013

As a pre-nursing student your focus needs to be on getting good grades to get into school. I hope this answered your questions.

And learning about properly describing symptoms and avoiding diagnoses in official reports wouldn't help me? Think again.

nurseprnRN, BSN, RN · Oct 31, 2013

And learning about properly describing symptoms and avoiding diagnoses in official reports wouldn't help me? Think again.

You can and will do what you want. However, you came here asking for advice and opinion from people far more experienced and educated in these matters than you are, and you want to argue with us. OK. Fine. There's a reason why education for a clinical specialty is structured in sequence.

But hey. Pick up all you think you want to pick up. And when and if you get into a nursing program and start slinging around terminology with imprecision to make yourself "stand out" (oh, lordy, do we hear this a lot), do not be too offended when your faculty or clinical preceptors take your down several notches; do not cry "NETY!" or "they are being mean to me!" We did warn you.

LoriRNCM, ADN, ASN, RN · Oct 31, 2013

I'm halfway through my first semester and believe me, trying to figure out the whole nursing dx vs. medical dx. was a quandary at first. But they had us doing clinical analysis and careplans right away so we learned the difference is basically as already states by PPs here. Nurses treat symptoms, and doctors treat medical conditions.

nurseprnRN, BSN, RN · Oct 31, 2013

I'm halfway through my first semester and believe me, trying to figure out the whole nursing dx vs. medical dx. was a quandary at first. But they had us doing clinical analysis and careplans right away so we learned the difference is basically as already states by PPs here. Nurses treat symptoms, and doctors treat medical conditions.

Not exactly. Cute and memorable sound bite, but sooooo not correct.

Physicians diagnose and derive medical plans of care to treat medical conditions.

Nurses implement parts of the medical plan of care; nurses also diagnose and derive nursing plans of care to treat human response to illness or injury.

You can, and should, look that up in the ANA Scope and Standards of Nursing Practice, because when you are an RN, that will be the standard to which you will be held.

RNOTODAY, BSN, RN · Oct 31, 2013

Your a PRE nursing student? I missed that part. In that case, come back and post this same question after your clinical, month one. This will be the LEAST of your worries.