nursing diagnosis

[bexinan]

Hi this is my first time posting. I'm excited.

I'm a first year student. I have recently asked to make a nursing diagnosis on a case study: the patient has Alzheimer's disease and is wandering around all the time, wanting to "look for his wife".

I made a nursing dx:

Chronic confusion related to Alzheimer's disease

My instructor said it's wrong in the related factor and ask me to correct that. What's wrong?

I know it's a stupid question, but I found myself struggling in the r/t part all the time. Please help me.

[halkogirl]

You shouldn't have a medical diagnosis as your related to.... Alzheimer's is a medical diagnosis.

[MunoRN, RN]

Medical Diagnoses are allowed as a related to: From NANDA "A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis".

http://www.nanda.org/NursingDiagnosisFAQ.aspx

I've heard others claim that their teachers told them they couldn't use a medical diagnosis anywhere, which is pushing our intentional ignorance of medical diagnoses way too far.

[bexinan]

Munorn, what do you think is wrong with my r/t part?

[halkogirl]

Medical Diagnoses are allowed as a related to: From NANDA "A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis".

http://www.nanda.org/NursingDiagnosisFAQ.aspx

I've heard others claim that their teachers told them they couldn't use a medical diagnosis anywhere, which is pushing our intentional ignorance of medical diagnoses way too far.

I get what you are saying, but I think that the reason that nursing programs push the non-medical diagnosis is because we need to be able to back up our diagnosis with assessment data. By simply stating "Alzheimer's Disease" as our etiology, we are limiting the amount of data that we can use to support it. By making a statement such as "progressive cognitive impairment" in our etiology, we are often able to relate much more information from our assessment to our diagnosis, which possibly leads to better goals and outcomes, interventions and rationales, etc. We cannot be expected to know the pathology of every known disease, and if we assess our patients looking for data to support a medical diagnosis we may miss something that could be a priority diagnosis.

I know that this is not how nursing diagnoses work in the real world, but for school purposes I understand why they push the issue. Just my two cents.

[MunoRN, RN]

I get what you are saying, but I think that the reason that nursing programs push the non-medical diagnosis is because we need to be able to back up our diagnosis with assessment data. By simply stating "Alzheimer's Disease" as our etiology, we are limiting the amount of data that we can use to support it. By making a statement such as "progressive cognitive impairment" in our etiology, we are often able to relate much more information from our assessment to our diagnosis, which possibly leads to better goals and outcomes, interventions and rationales, etc. We cannot be expected to know the pathology of every known disease, and if we assess our patients looking for data to support a medical diagnosis we may miss something that could be a priority diagnosis.

I know that this is not how nursing diagnoses work in the real world, but for school purposes I understand why they push the issue. Just my two cents.

Using a medical diagnosis as your related to doesn't limit your assessment data since your assessment data should be in the "as evidenced by" section, not the related to. You could use "progressive cognitive impairment", the problem with that, is that it is far less accurate than the vast amount of specific information that the term "Alzheimer's Disease" includes. "Progressive cognitive impairment" could refer to Alzheimer's dementia, ICU delirium, hepatic encephalopathy, Hypercapnia, Uremia, Delirium Tremens, etc, all of which would have some shared nursing actions and goals, but for the most part each of these would include very different Nursing care plans.

[MunoRN, RN]

Munorn, what do you think is wrong with my r/t part?

I would guess she mistakenly believes that a related to cannot be a medical diagnosis, in which case you should refer to the NANDA website. (If she really believes Nursing Diagnoses serve any beneficial purpose at all, you should refer her to Patricia Benner's new book "Educating Nurses; A Call for Radical Transformation").

Anyway, you should include an 'as evidenced by' component to show that your assessment supports the medical diagnosis, maybe this will make your teacher happier.

[ImThatGuy, BSN, RN]

You can't make use the wording of a medical diagnosis in there. It's dumb, but that's how the chips landed.

[bexinan]

Thank you everyone for your reply. To be honest, I'm still confused how to get the r/t, how can you come up with "progressive cognitive impairment"? Is there a book or articles I should go to for these words? I'm overwhelmed, I have my first clinical next week, and I am frozen and have no idea about anything.

[halkogirl]

Thank you everyone for your reply. To be honest, I'm still confused how to get the r/t, how can you come up with "progressive cognitive impairment"? Is there a book or articles I should go to for these words? I'm overwhelmed, I have my first clinical next week, and I am frozen and have no idea about anything.

We use Sparks and Taylor's Nursing Diagnosis Reference Manual... it is a wonderful resource. Although each diagnosis needs to be tailored to the pt. it gives many suggestions as to possible etiologies, goals and outcomes, and interventions with rationales. Hope that helps :)

[halkogirl]

Also, if you google "chronic confusion nursing diagnosis" you can come up with a few websites that may help- r/t are often listed as defining characteristics.

[MunoRN, RN]

You can't make use the wording of a medical diagnosis in there. It's dumb, but that's how the chips landed.

Medical Diagnoses are allowed as a related to: From NANDA "A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis".

http://www.nanda.org/NursingDiagnosisFAQ.aspx