Nursing Diagnosis - Is this correct?

Esme12, ASN, BSN, RN · Oct 31, 2013

moved for best response

mer1227 · Oct 31, 2013

I don't quite understand what you mean

Esme12, ASN, BSN, RN · Oct 31, 2013

You were in general nursing.....nursing assistance is for homework and care plan questions.

nurseprnRN, BSN, RN · Oct 31, 2013

Briefly: No. Why is that? This is why:

1) There is no such nursing diagnosis as "ineffective tissue perfusion" in the NANDA-I 2012-2014 (current edition), which is the only authoritative source for approved nursing diagnoses.

2) When I look up the nursing diagnosis of ineffective peripheral tissue perfusion (page 240 in your NANDA-I 2012-2014, without which you are just making it up), I find that "gangrene," "ischemic wound," and "TM amputation" are not on the list of defining characteristics for this nursing diagnosis. Therefore you have made a diagnosis without the support you must have.

3) CAD does not appear in the (long) list of related (causative) factors. DM does, though, so you get partial (very partial) credit for that. :)

OK, now, let's step back a bit and regroup.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological." "Surgery" counts for a physical injury-- after all, it's only expensive trauma. :)

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and related (causative) factor. (Exceptions: "Risk for..." diagnoses do not have defining characteristics, they have risk factors.) Defining characteristics and related factors for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

I know that many people (and even some faculty, who should know better) think that a "care plan handbook" will take the place of this book. However, all nursing diagnoses, to be valid, must come from NANDA-I. The care plan books use them, but because NANDA-I understandably doesn't want to give blanket reprint permission to everybody who writes a care plan handbook, the info in the handbooks is incomplete. We see the results here all the time from students who are not clear on what criteria make for a valid defining characteristic and what make for a valid cause. Yes, we have to know a lot about medical diagnoses and physiology, you betcha we do. But we also need to know about NURSING, which is not subservient or of lesser importance, and is what you are in school for.

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

Esme12, ASN, BSN, RN · Nov 1, 2013

What I have in one of my books.....Gulanick: Nursing Care Plans, 7th Edition

Ineffective Tissue Perfusion: Peripheral, Cardiopulmonary, Cerebral

NANDA-I Definition: Decrease in oxygen resulting in failure to nourish the tissues at the capillary level

and the other.....Ackley: Nursing Diagnosis Handbook, 10th Edition

Ineffective peripheral Tissue Perfusion....Lorraine Duggan MSN, RN, ACNP, AHNP, Betty Ackley MSN, EdS, RN

NANDA-I Definition

Decrease in blood circulation to the periphery that may compromise health

JustBeachyNurse, LPN · Nov 1, 2013

Current NANDA-I has

Ineffective peripheral tissue perfusion

Risk for decreased cardiac tissue perfusion

Risk for ineffective cerebral tissue perfusion

Risk for ineffective peripheral tissue perfusion

As of 2012-14 ineffective tissue perfusion (specify type) is no longer a valid diagnosis as of current NANDA-I

Esme12, ASN, BSN, RN · Nov 1, 2013

Gulanick has recently published a new book...I have not purchased it as of yet....mine was published in 2011 I get it.....I have the new Ackley....which has the 2012-2014 NANDA ....which will be no good when the new list is published......and no the second diagnosis isn't on the NANDA I 2012-2014...I got it. I got it.

nurseprnRN, BSN, RN · Nov 1, 2013

What I have in one of my books.....Gulanick: Nursing Care Plans, 7th Edition
Ineffective Tissue Perfusion: Peripheral, Cardiopulmonary, Cerebral
NANDA-I Definition: Decrease in oxygen resulting in failure to nourish the tissues at the capillary level
and the other.....Ackley: Nursing Diagnosis Handbook, 10th Edition
Ineffective peripheral Tissue Perfusion....Lorraine Duggan MSN, RN, ACNP, AHNP, Betty Ackley MSN, EdS, RN
NANDA-I Definition
Decrease in blood circulation to the periphery that may compromise health

I don't know what the dates on the Ackley and Gulaanick are, but they appear to be based on an outdated NANDA-I edition. Both the last (2009-2011) and the current NANDA-I (2012-2014) have these broken down into more specific areas and replaced c:

Ineffective peripheral tissue perfusion

Risk for ineffective renal perfusion

Risk for ineffective cardiac tissue perfusion

Risk for ineffective cerebral tissue perfusion

Risk for ineffective gastrointestinal tissue perfusion

Risk for ineffective peripheral tissue perfusion

The NANDA-I is updated every three years, comparing favorably to many texts. (The last one I have in my possession is 2009-2011, and the next one will be 2015-2017, due out next Fall).

Esme12, ASN, BSN, RN · Nov 2, 2013

My Gulaneck is 2011 (I don't use it much) she just came out with the new one.....I am waiting to buy new when my daughter starts school...no we haven't heard early decision yet.....they say February!!! (we followed your thoughts) My Ackley is 2013....I use it. My NANDA is 2011...I don't use it for much right now..its out dated....again waiting for the newest next year...saving for fall...LOL