Question About Nursing Diagnosis

[Apple-Core, ASN, BSN, RN]

OK - I think I have the nursing diagnosis versus the medical diagnosis this down, but when do we incorporate the medical diagnosis? And which comes first...? Do we (nurses) perform the nursing diagnosis and that forms the basis of information for the physician to make their medical diagnosis? Or are there independent assessments made by the nurse and the physician? Once the nurse does their assessment and draws up the care-plan, at what point do they include the physician's orders?

No - it's not homework, just interested =0)

Thanks

[jodispamodi]

I think you're a little bit confused.... and the terms are confusing. MD does not use nursing dx to diagnosis disease. To try to explain: the medical dx is the disease or condition the patient has, ie appendicitis, influenza, fractured femur, etc. The Nursing dx are basically assessing for problems (hopefully preventing) problems from those diseases/conditions, for example: the doctor diagnoses appendicitis, doctors tx would include, surgery, abx, pain medication etc; The nurse gets a patient with appendicitis, nursing dx would include: skin integrity, assessing for s/sx of infection, return to baseline bowel function, risk of electrolyte imbalance, maintain o2 sat above 90%(if had anesthesia), etc. (I'm doing this off the top of my head so hope its not confusing)

[student_B, ADN, RN]

OK - I think I have the nursing diagnosis versus the medical diagnosis this down, but when do we incorporate the medical diagnosis? And which comes first...? Do we (nurses) perform the nursing diagnosis and that forms the basis of information for the physician to make their medical diagnosis? Or are there independent assessments made by the nurse and the physician? Once the nurse does their assessment and draws up the care-plan, at what point do they include the physician's orders?

No - it's not homework, just interested =0)

Thanks

I may be oversimplifying, but:

Medical diagnosis is related to disease process, usually doesn't change over time.

Nursing diagnosis is the body's response to the disease process.

A nursing diagnosis can be related to a medical diagnosis, or independently based on an assessment.

E.g, Colectomy (medical diagnosis) could have a Nursing diagnosis of Risk for Infection r/t invasive surgical procedure. An independent diagnosis could be that an immobile patient has Risk for VTE r/t impaired mobility. In other words, what jodi said :)

[Apple-Core, ASN, BSN, RN]

Thanks so much for the replies! So, to clarify in my mind, the nursing diagnosis is more, really, of a list of objective and subjective presenting responses to the said disease. The patient will already have had the disease DX from the doctor BEFORE the nurse does the nursing DX....correct?

[jodispamodi]

Haha, so just to confuse you further... No the patient does not always have a medical diagnosis before the nurse writes the nursing care plan. Going back to my appendicitis case, the patient may have right sided abdominal pain but not the typical sx of appendiicitis. So the patient may be admitted with abdominal pain (which is really a symptom not a diagnosis)the patient could in fact have gas, constipation, appendicitis, colon cancer, so on so forth and in that case where the patient does not have a clear cut diagnosis yet you would work your nursing care plan for the symptoms/potential problems they have, and if they do have a medical diagnosis you still do the same thing. Does that make sense? Hope so.

[Apple-Core, ASN, BSN, RN]

Haha, so just to confuse you further... No the patient does not always have a medical diagnosis before the nurse writes the nursing care plan. Going back to my appendicitis case, the patient may have right sided abdominal pain but not the typical sx of appendiicitis. So the patient may be admitted with abdominal pain (which is really a symptom not a diagnosis)the patient could in fact have gas, constipation, appendicitis, colon cancer, so on so forth and in that case where the patient does not have a clear cut diagnosis yet you would work your nursing care plan for the symptoms/potential problems they have, and if they do have a medical diagnosis you still do the same thing. Does that make sense? Hope so.

So, technically, a nurse could strongly suspect appendicitis but would never actually say, "this is appendicitis" or even, "I suspect this appendicitis"...the only time they would refer to the fact it is appendicitis is after the DX by the doc? Even if it was a situation where the patient was displaying classic symptoms and the nurse was 99.999999999% sure their (private, in their mind medical diagnosis) was accurate.

I think, personally, the term "nursing diagnosis" is confusing and possibly misleading, at least in the case of students such as myself. Not that I am going to attempt to "reinvent the wheel" but I do feel a different term would really help eliminate the confusion!! Such as "nursing list of objective and subjective issues", or something???

Anyway, who am I in the field of nursing but a mere poop in the bottom of a bed-pan....LOL!!!

[jodispamodi]

Yes and no, and I was purposefully giving an easy example with appendicitis. Nurses don't diagnose; doctors do BUT we can put a bug in a doctor's ear, theres nothing that prevents you if you feel strongly from saying "hey doc, do you think this could be appendicitis?" Remember the patient is also going to be having labs and scans and physical assessment to pin down a diagnosis, say for example our same suspected appy case, but while you are chatting with the patient they happen to mention that a large number of family members have had colon cancer, but the doc hasnt been privy to this new piece of info, you can absolutely contact the doc and say, he's got a big family hx of colon cancer.

Yes, the term is confusing and it may be helpful to think of the two like this: Doctors treat disease, nurses treat patients. Hope this is helpful.

[Apple-Core, ASN, BSN, RN]

Very helpful, yes - and I so appreciate the time you've put into answering this! Thank you!!!