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Discussion

nursing diagnoses

Need advice on how to make nursing diagnoses! Every time I try to make one it turns out to be a medical diagnosis. The NANDA ones sort of help, but I could never figure out what goes after "related to" and how "manifested by" is different from "related to"....?

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Need advice on how to make nursing diagnoses! Every time I try to make one it turns out to be a medical diagnosis. The NANDA ones sort of help, but I could never figure out what goes after "related to" and how "manifested by" is different from "related to"....?

You can't really entirely fabricate your own. NANDA has a list of nursing diagnoses that you can pick from which are approved nursing diagnoses.

Pick a diagnosis you think you are seeing (i.e. acute pain, impaired physical mobility). This is usually the easiest part. In assignments you are typically given a case and you can figure out what the diagnosis is by reading the info.

The next step is the RT (related to) clause. This is what likely caused the problem in the patient. If you chose acute pain, you might say "related to tissue trauma (surgery)" or if you chose impaired physical mobility, you might say "related to fractures."

The last step is the AEB (as evidenced by), which may also be what you can manifested by. I've never heard of it that way, but I guess it works the same. It's the observable or recordable data indicating that the patient is suffering from the condition stated in your first part, the diagnosis. For acute pain, you may say "as evidenced by description of pain rated 8 out of possible 10" or for impaired physical mobility, you may say "as evidenced by inability to move left forearm."

It's really not that hard once you have it down. I'm only in my second month of nursing school and I feel confident about them already. We had tons of practice in our fundamentals class with them and it helped.

The mistake you're likely making that results in it being a medical diagnosis is the start of your statements. It should never be a medical condition. "Osteoarthritis related to..." is not a nursing diagnosis. Write out your nursing diagnosis and then read it over. If you see any medical conditions listed in it, you've likely wrote it wrong.

Remember, the nursing diagnosis is created so the nurse knows what they need to heal or aid the patient with. A nurse cannot fix osteoarthritis, but they can fix pain. If your diagnosis starts with something the nurse is unable to help with, it's either a non-NANDA diagnosis or you picked a medical condition.

Hope that helps some.

related to is the CAUSE/etiology of the dx. The AEB or AMB is the evidence signs/symptoms.

RISK for dx will have r/t but not AEB because there is no evidence yet..only risk factors.

I have Doenges Nursing Dx book which is great, lists a lot of the r/t factors and also what s/s you might see...highly recommend it.

Here are my two most recent from psych nursing:

Risk for suicide r/t suicidal thoughts, social isolation, past suicide attempts, family history of suicide; secondary to bipolar disorder & borderline personality disorder

Panic Anxiety r/t stress, ineffective coping skills, medication changes, fear of having panic attacks in public places secondary to Bipolar Disorder AEB pt reports of increasing anxiety, insomnia, increased social isolation, reports of “messed up thinking since taking Xanax”, reports of escalating anxiety at church & Walmart with palpitations, difficulty breathing, “no one can come near me except my husband or pastor until it passes”, states this has led to fear of leaving home for weeks prior to suicide attempt, has been unable to engage in normal productive activities such as youth group participation, shopping, & cleaning of church.

The last one was a little long..but hey the more evidence the better :)

Here are some others I've written:

Fluid volume deficit r/t decreased fluid intake and fever 2* Pyelonephritis AEB signs of dehydration on admission, mother reports “he hasn’t felt like eating or drinking”

Risk for Caregiver role strain r/t child’s hospitalization AEB statements of financial and job stress such as “we are still getting bills from the last time he was in the hospital” and “my husband doesn’t have any vacation time to take off work” and “We have new insurance, I hope they cover this”

Pain r/t inflammatory process in abdomen and recovery from surgery 2* appendicitis AEB report of pain 6 (0-10 pain scale); c/o abdominal & right shoulder pain; pt bent over when ambulating & guarding of abdominal area

I used to have the same issues thinking more like a medical student lol - but you have to think of what the nurse can do to help with the patients problems.

  • Expert

hi, galenne!

you can find help with composing diagnoses and writing care plans on these two threads on allnurses. be sure to review the information in them:

first, let me explain that nanda, the north american nursing diagnosis association, has been the foremost authority on developing and defining nursing diagnoses since the 1970's. along with research done by the university of utah on nursing outcomes and nursing interventions their mission is to standardize all these components of care plans so they can be coded and stored as numerical data in computerized systems. there are currently 172 nursing diagnoses. each one has a definition, specified causes (nanda refers to them as "related factors"), what i like to simply call symptoms (nanda refers to them as "defining characteristics"), nursing outcomes classification (outcomes), and nursing interventions classifications (nursing interventions).

what makes it somewhat confusing to new learners of this system is all the language and wording that nanda uses. i'll be the first to say that it sounds like a bunch of gobbledygook. it is. but, as with medical terminology, as you use and learn it, it becomes more familiar and it isn't long before all these terms are just rolling off your tongue.

for nursing school, most students are required to use nursing diagnostic statements on their care plans. schools do this to help you learn to put all the elements of a nursing diagnosis together so you learn them and learn how to use them. remember, as i said above, each nursing diagnosis has it's own set of causes and symptoms that has already been decided upon by nanda.

the easiest way to write a diagnostic statement is to follow this mnemonic: pes. it stands for p (problem), e (etiology) and s (symptoms).

p (problem). this is the nursing diagnosis. a nursing diagnosis is nothing more than a label that has been decided by nanda to belong with a group of related problems the patient has.

e (etiology). this is what is causing, or is a major contributing factor to, the problem. in nursing diagnostic statements it is the information that immediately follows the r/t (related to) part.

s (symptoms). this is the patient data, signs and symptoms that you discovered in your physical assessment and review of the patient's chart. this is the evidence that supports the p (problem). these are also the items that any nursing interventions you decide to use will be focused on. in nursing diagnostic statements these are the items that immediately follow the aeb (as evidenced by) part.

it's very natural to end up with some reference to medical diagnoses at first because we know and understand how that terminology works. you just have to be constantly on your toes to watch for those little slips when you write a nursing diagnosis. nanda wants us to never use any reference to medical diagnoses in our nursing diagnostic statements. there are a very few rare exceptions where they allow it. the only reason is because they haven't yet figured out the non-medical language to use in those specific cases--yet.

so, a nursing diagnostic statement is going to be put together like this:

  • problem r/t etiology aeb symptoms, or
  • nursing diagnosis r/t related factors aeb defining characteristics (using nanda terminology)

here are some examples of some nursing diagnostic statements. in each, you can clearly identify all three components:

  • activity intolerance r/t imbalance between oxygen supply and demand aeb dyspnea and the need for oxygen supplementation for an hour after physical therapy
  • activity intolerance r/t bedrest and weakness aeb restlessness
  • nausea r/t postsurgical effects of anesthesia and manipulation of bowel aeb increased salivation, tachycardia and patient statements of being nauseated
  • impaired skin integrity r/t surgical disruption of tissues aeb surgical incision
  • acute pain r/t surgical disruption of tissues aeb patient reports of pain, restlessness, guarding, and changes in vital signs
  • ineffective health maintenance r/t knowledge deficiency in caring for disease condition aeb inability (or refusal) to recognize symptoms of illness
  • ineffective breathing pattern r/t hyperventilation aeb dyspnea
  • ineffective tissue perfusion r/t reduction of arterial and venous blood flow aeb dysrhythmias, abnormal abgs, oliguria and anuria
  • acute confusion r/t ethylene glycol ingestion aeb confusion, slurred speech, and hallucinations
  • impaired urinary elimination r/t urinary tract infection aeb dysuria, urgency and frequency

the best thing you can do for yourself to help you with care plan writing is to get yourself a good book that explains each of the nursing diagnoses. there are a number of nursing diagnosis handbooks on the market that do this. this is the one of the ones that i have and find extremely useful: nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig. there is a shortened version of it (by shortened i mean it has about 300 less pages) printed under the title of mosby's handbook of nursing diagnosis. ackley and ladwig follow nanda terminology to the letter. you will not find any complete listing of nanda diagnoses on the internet because nanda owns the copyrights to them and will only sell the right to print them. so, the only way you can get your hands on them is to find one of these nursing diagnosis or nursing care plan books. lynda juall carpenito-moyet has written a number of care planning books with nursing diagnosis emphasis over the years. she has been a member of nanda for many years and knows how all this nursing diagnosis is supposed to be put together and work. some people find her books to be a bit difficult to understand at times, however. i, however, find things her her books that other authors don't address. if you do not already have some sort of supplement book to help you with nursing diagnosis, you can browse through choices that are available on the amazon and barnes and noble websites.

hope this helps you out and hasn't scared you more than you already might be. you can always post a new thread asking for help and assistance with a care plan or a nursing diagnosis you are working on. the nursing student forums have many of these kinds of threads. learning to choose nursing diagnoses and write care plans is a nursing skill like any other. it involves the use of your mind and some critical thinking rather than physical adeptness. like learning to tie your shoes when you were a kid, you have to make attempts at them again and again. the going is slow at first. i didn't really start to fully understand the written care plan process until i was well out of school and on the job. at that time (back in the 70's) nanda nursing diagnoses hadn't even been introduced to the general nursing staffs. i didn't learn about this stuff until the 80's when i went back to school for my bsn and, believe me, i struggled with it. i will help you with this if you only ask.

see you here on the forums. welcome to allnurses! :welcome:

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