nursing diagnosis

BBFRN, BSN, PhD · Feb 16, 2009

Thread moved to Nursing Student Assistance Forum, as you'll find our most resourceful care planning experts here.

Daytonite, BSN, RN · Feb 16, 2009

i'm trying to figure out exactly what you mean by this question. do you mean: how do you construct the 3-part nursing diagnostic statement or, how do you choose a nursing diagnosis? i guess i'll answer both and you can tell me if i answered your question or not.

how do you construct the 3-part nursing diagnostic statement?

the 3-part diagnostic statement consists of 3 elements that can be represented by the mnemonic pes:

p (problem) - this is the nursing problem--the nursing diagnosis. the nursing diagnosis is actually a label, or phrase, that gives a short description of the problem. a much longer explanation of the problem can be found in a nursing diagnosis reference book.
e (etiology) - this is what is causing the p (problem) to occur. it is often the underlying pathophysiology of the patient's medical condition but it can be psychosocial and risk factors depending on the type of problem being addressed
s (symptom) - also called defining characteristics, these are the bits of evidence that you find during your assessment of the patient. it is abnormal data that prove the existence of the p (problem).

once you have the information for these 3 elements it is a matter of putting it together in the correct order. the words "related to" or the abbreviation "r/t" are inserted between the p (problem) and the e (etiology). and the words "as evidenced by" or "as manifested by" or the abbreviations "aeb" or "amb" are inserted between the e (etiology) and the s (symptom). the final 3-part nursing diagnostic statement follows the formula of p - e - s. some examples are:

ineffective airway clearance r/t retained secretions aeb diminished breath sounds bilaterally, crackles over upper lobes and persistent coughing
- problem: ineffective airway clearance (definition: inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway)
- etiology: retained secretions
- symptoms (the evidence): diminished breath sounds bilaterally, crackles over upper lobes and persistent coughing
[*]deficient knowledge, tobacco cessation r/t lack of interest in learning aeb statements of refusal to accept the health risks associated with smoking
- problem: deficient knowledge, tobacco cessation (definition: absence or deficiency of cognitive information related to a specific topic)
- etiology: lack of interest in learning
- symptoms (the evidence): statements of refusal to accept the health risks associated with smoking
[*]imbalanced nutrition: less than body requirements r/t illness and homelessness aeb lost 50 pounds in the past 3 months and not eating regular meals
- problem: imbalanced nutrition: less than body requirements (definition: intake of nutrients insufficient to meet metabolic needs)
- etiology: illness and homelessness
- symptoms (the evidence): lost 50 pounds in the past 3 months and not eating regular meals
[*]risk for infection r/t possible exposure to communicable disease
- problem: risk for infection (definition: at increased risk for being invaded by pathogenic organisms)
- etiology (risk factor): possible exposure to communicable disease

how do you choose a nursing diagnosis?

i like to use some analogy here. how does a doctor diagnose someone? they do a history (ros - review of systems), physical exam and often diagnostic tests. then they analyze this data and make a decision: the medical diagnosis. when you take your car to a mechanic you tell him what symptoms your car has been having. the mechanic also does an inspection first in order to determine what the problem in. you expect him to give you a report and estimate of what the repair will be. this is diagnosing. a plumber does the same. many other types of repairmen do similar types of diagnostic and repair work. what they all have in common with us is this problem solving. assessment is always done at the beginning of problem solving. for us nurses, assessment consists of:

a health history (review of systems)
performing a physical exam
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
reviewing the pathophysiology, signs and symptoms and complications of their medical condition
reviewing the signs, symptoms and side effects of the medications they are taking

during all that assessment activity we are constantly on the lookout for what isn't normal. anything that is abnormal (like rhonchi in the lungs, edema in the legs, bruises on the body, bleeding from anywhere, spots where there shouldn't be spots) are automatic symptoms of something. the frustration for us is to figure out what they are a symptom of! what confuses many is separating the difference between symptoms of a nursing diagnosis and the symptoms of a medical diagnosis. medical diagnoses and nursing diagnoses are as different as apples and oranges. every nursing diagnosis has a list of signs and symptoms. yes, it does. they can be found in a nursing diagnosis reference book or a care plan book that includes the nanda (north american nursing diagnosis association) taxonomy. the taxonomy includes the definition, related factors (etiologies) and defining characteristics (signs and symptoms) for each nursing diagnosis. to diagnose someone with a nursing diagnosis we must have done some degree of assessment and found some signs/symptoms to support the existence of that diagnosis. if you can satisfy the p-e-s elements, then you have yourself a problem.