Nursing Diagnosis How to memorize?

Published

Im in my first year nursing school. ADN. Do you have to memorize the nursing dianoses NANDA? How do you know how to diagnose what when their are so many do you know each one by heart or look at the different domains? What kind of nursing diagnosis would be given to someone who smokes?

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

One helpful thing you can do is to tab and highlight your most commonly used Nsg Dxs in your book. It'll make things much easier for you by weeding out all those that aren't used for much.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

omg! this is, like, one of the most intelligent questions i've seen posted about nursing diagnoses!

how do you know how to diagnose what when there are so many?

there is a procedure to determining a nursing diagnosis. it is called the nursing process. the nursing process is an extrapolation of the scientific process. there are 5 steps to the nursing process, but the first step,
assessment
, is the most important in diagnosing anything, whether you are tying to figure out why your car won't start or why mr. smith can't walk. so, in your adn program you should be getting some kind of lectures on assessing your patients. these assessments take many forms: head to toe, body system, nursing needs and i'm sure there are others that some instructors want their students to use. assessment should also include a thorough investigation of the patient's written medical record as well if it is available to you. the bottom line is that you must know what a normal assessment is because what you are specifically looking for is what is
abnormal
in a patient. these abnormal things are what form the basis of the clues leading to the problems the patient is having. these clues, nanda calls them
defining characteristics
, form the backbone of the nursing diagnoses.

when you are first learning to work with nursing diagnoses you need to use a reference book of them to help you out. most students get care plan or nursing diagnosis books that have been expanded to include goals and nursing interventions. because i've been an
rn
for a long time, i don't need that much information. i just need the bare bones, so i have a nice little paperback book that is published by nanda called
nanda-i nursing diagnoses: definitions & classification 2007-2008
. you will often see me reference it when i answer care plan questions. all it contains is the current 188 nursing diagnoses, the definition of each, their defining characteristics (signs and symptoms), and the related factors (etiologies). most fit on one page and sometimes they run to two pages. i can fill in goals and nursing interventions myself.

there is a difference between medical diagnoses and nursing diagnoses. it is because they are based upon different types of criteria.

imbalanced nutrition: less than body requirements (nursing diagnosis):
abdominal cramping, diarrhea, excessive loss of hair, weight loss, poor muscle tone, aversion to eating, lack of food, lack of interest in food, reported altered taste sensation, satiety immediately after ingesting food.

contrast this with anorexia, a medical diagnosis

anorexia (medical diagnosis):
hypotension, bradycardia, emaciated appearance, skeletal muscle atrophy, loss of fatty tissue, blotchy or sallow skin, lanugo on the face and body, dryness or loss of scalp hair, dental carries, bowel distention, slowed reflexes.

the criteria (symptoms) used to define the condition are very different. they seem similar, but they are different because they were arrived at through different methods used to assess the patient.

while some of the same medical symptoms are commonly included in some of the nursing diagnoses, nursing diagnoses contain a lot more symptoms that relate to the patients
ability
to perform adls or accomplish some kind of activity. it is natural for nursing students to want to fall into using the same signs and symptoms that doctors use because you have seen them referred to in your previous studies of anatomy, physiology and pathophysiology already. that is often ok, but you can't forget to add your unique nursing assessment skills of the patient's ability to perform adls and function within their environment as well. nursing school is now adding that dimension to all of this and you have to keep in mind that you are being asked to include that. this new dimension of information is where most nursing students get confused. this new information must be included in choosing nursing diagnoses. it is what makes us nurses and defines our professional independent practice.

nursing diagnoses are not based, per se, on medical diagnoses. there are a handful that are, but most of the nursing diagnoses are based as well upon what you found out from your nursing assessment. two nursing diagnoses that do relate to medical diagnoses that i can name off the top of my head are
deficient fluid volume
which tells you right in it's definition "...this refers to dehydration..." and
decreased cardiac output
which is defined as "inadequate blood pumped by the heart to meet metabolic demands of the body" and there are only symptoms listed under it that point to that conclusion that is basically a medical conclusion.

do you know each nursing diagnosis by heart or do you have to look up the different domains?

when you are first learning to work with nursing diagnoses you need to look them up. you start by taking your abnormal assessment items and looking at the defining characteristics under likely nursing diagnoses that might apply. i call it shopping for a diagnosis. books like
nursing diagnosis handbook: a guide to planning care
, 7th edition, by betty j. ackley and gail b. ladwig have a cross referenced index of symptoms and diagnoses that will help narrow down the hunt for you. eventually, you will find that when you work with patients having the same kinds of symptoms you will be using the same nursing diagnoses. you get to know them by heart. still, as a student, i would use a nursing diagnosis reference to verify everything because your grade depends on it.

what kind of nursing diagnosis would be given to someone who smokes?

now that i've said all the above, let me ask you how you would go about determining the kind of nursing diagnosis to give this patient? first off, it won't involve anything to do with smoking because there is no nursing diagnosis about smoking. you would assess the patient. a respiratory assessment would be in order. long-term smokers can have symptoms of chronic bronchitis and productive coughing. so, i would look for those first. with productive coughing of gray, white or yellow sputum, wheezing, rhonchi and any cyanosis you go to a nursing diagnosis of
ineffective airway clearance.
for tachypnea, accessory respiratory muscle use or prolonged expiratory time you go to a nursing diagnosis of
ineffective breathing pattern.
if they've got weight gain, pedal edema and jugular vein distension then you would use
decreased cardiac output
but i would want to substantiate that with more assessment information or a medical diagnosis that indicates there is evidence of heart involvement at that point.

an assessment of their smoking habit would also be in order. i would question the patient about whether or not they had tried to quit or were they looking to quit. maybe that's not something they are interested in doing. you can't force a patient to do anything. what do they know about the effect of smoking on their health? now, this brings up patient education. if they want to quit smoking then
readiness for enhanced knowledge of smoking cessation
would be an appropriate nursing diagnosis to use; if not, then
ineffective health maintenance
would be the nursing diagnosis of choice.

i answer a lot of questions about care plans and how to choose a nursing diagnosis. in almost every one of them the underlying problem is always that the students never seem to know that it all builds upon your assessment of the patient. the assessment that you perform combined with matching the abnormal findings against a nursing diagnosis reference is how you decide on the nursing diagnoses for a patient. it has very little to do with their medical diagnoses although they can provide you with some clues as to what kind of symptoms (defining characteristics) you should be looking for in the patient. the nursing assessment is the foundation of every care plan. if you don't do a good thorough assessment then you won't have much to work with in determining a nursing diagnosis. or, you can start with a good assessment foundation, but if you don't match your defining characteristics to the right nursing diagnoses you end up with something that resembles the leaning tower of pisa--it looks ok, but it ain't quite right. you discover this when you have trouble with making nursing interventions try to fit with the nursing diagnosis and something isn't clicking like it should.

i am always open to questions on nursing diagnosis and care planning. anyone can always e-mail or pm me if they are looking for help and an understanding on this and don't want to post publicly. this is all at the heart of developing critical thinking skills. much of what i write is stated and restated and can be found in the posts on these stickys:

happy diagnosing!

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.
I wonder is nursing diagnosis just for school? That would be nice!

Wouldn't it be though! Actually the federal Medicare law mandates that any facility that accepts Medicare or Medicaid payments MUST have a written care plan included in each patient's medical record. They do not specify that nursing diagnoses must be used. In fact, when I learned to write care plans years and years ago, there was no such thing as a nursing diagnosis. We just listed the patient's symptoms and then our nursing interventions. Some clown (sorry, I should be more respectful of our nursing leaders/peers) came up with the nursing diagnosis idea. Nursing diagnosis amends well to computerized billing and they are used extensively by the nursing practitioners who must bill insurance companies and Medicare/Medicaid for the services they provide. So, there is a practical application to their use. Nursing instructors long ago saw the value in how care plans, and now nursing diagnoses, help to stimulate critical thinking. Although, since I learned to care plan without nursing diagnosis, I think that adding the element of nursing diagnoses just kind of confused up everyone. Simple is always better.

Can there be more than one diagnosis per patient. This might be a dumb question but Im trying to get a clear understanding.

You betcha. When I was going through my BSN program 20 years ago we were expected to thoroughly nursing diagnose our patients. It was not uncommon to have as many as 8 or 10 nursing diagnoses for a patient. Don't let this scare you. We had a complicated assessment process that included community, social and financial resources that might be available to the patient that we had to include in these things. I looked at my last history and physical exam that my doctor dictated for my hospital admission. It had 8 medical diagnoses on it and, unfortunately, they were all existing conditions. Wouldn't want to be a student nurse having to do a nursing care plan on me. I'd have to help you write it.

Up Vote Up Vote ×
Specializes in Peds, PICU, Home health, Dialysis.

Sorry if I misled with my posting. The hospital I am doing my clinicals at does not use nursing diagnoses, but they do have an area in the chart where the nurse plans the care. It is very informal though and they look nothing like a nursing diagnosis taught in nursing school.

Up Vote Up Vote ×
+ Join the Discussion