Source for Nursing Diagnosis NANDA

  1. Hello everyone,
    I am very new to but it has helped out a lot for so many different things. I am making my first post because i am having trouble with nursing diagnosis. I have searched to forum many times with different terms and i have still not come up with what i need. I know this subject has been beating the dead horse but everytime a member posts a link to a helpful page of source its either out of date and no longer available or if its on allnurses then for some reason it takes me to the home page only. What I am really looking for is a guide or a source for up to date and accepted NANDA Nursing Diagnosis. I am using a Prentice Hall Nursing Diagnosis handbook but it seems limited and out or date. For example my instructors will tell me electrolyte imbalance is an acceptable diagnosis, but I can't find it anywhere in any shape or form in my handbook. I am going to purchase the Elsevier Nursing Diagnosis Handbook but I have an assignment due in 2 days so an online source would be really helpful to me right now.
    My main issue right now is making a care plan for a patient admitted for DKA. I have found "Risk for unstable blood glucose" but what if they were admitted for DKA and several times during my clinical shift i checked a blood sugar and was getting levels in the 250-350 range. Is there a "management of" or maybe a "Readiness for". Thanks for anyones help or suggestions i really appreciate it.
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    About Asadel

    Joined: Mar '13; Posts: 3
    ER Tech; from US


  3. by   mo1222
    I have Ackley nursing diagnosis book it's very helpful!
  4. by   Asadel
    Awesome. Thanks I think I will buy it tonight from Amazon.
  5. by   StudentOfHealing
    Our school made us buy ackley.... Pretty good book!
  6. by   AgentBeast
    Think about this. How can someone be at "Risk for" something when that something is already going on. Your patient can't be at "Risk for unstable blood glucose" when her blood glucose levels are already all out of whack. Put another way you can't be at "risk for falling" when you are laying on the floor after falling down trying to get to the bathroom.

    Fluid volume deficit would be my #1 priority.
  7. by   Esme12
    Unfortunately.......many of the resources were once free from the internet.....since then like everyone else they saw a cash cow and took advantage of this.

    here is a current list from VickyRN asst admin..... nursing diagnoses 2012 - 2014.pdf‎

    Do a search on this site for DKA as well (upper right hand corner).

  8. by   Esme12
    The electrolyte imbalance diagnosis is an at risk diagnosis.....

    At risk for change in serum electrolyte levels that may compromise health
    Risk Factors

    Diarrhea; endocrine dysfunction; fluid imbalance (e.g., dehydration, water intoxication); impaired regulatory mechanisms (e.g., diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone); renal dysfunction; treatment-related side effects (e.g., medications, drains); vomiting
    What semester are you?
  9. by   nurseprnRN
    See, you are falling into the classic nursing student trap of trying to find a nursing diagnosis for a medical diagnosis without really looking at your assignment as a nursing assignment. You are not being asked to find an auxiliary medical diagnosis-- nursing diagnoses are not dependent on medical ones. You are not being asked to supplement the medical plan of care-- you are being asked to develop your skills to determine a nursing plan of care. This is complementary but not dependent on the medical diagnosis or plan of care.

    Sure, you have to know about the medical diagnosis and its implications for care, because you, the nurse, are legally obligated to implement some parts of the medical plan of care. Not all, of course-- you aren't responsible for lab, radiology, PT, dietary, or a host of other things.

    You are responsible for some of those components of the medical plan of care but that is not all you are responsible for. You are responsible for looking at your patient as a person who requires nursing expertise, expertise in nursing care, a wholly different scientific field with a wholly separate body of knowledge about assessment and diagnosis and treatment in it. That's where nursing assessment and subsequent diagnosis and treatment plan comes in.

    This is one of the hardest things for students to learn-- how to think like a nurse, and not like a physician appendage. Some people never do move beyond including things like "assess/monitor give meds and IVs as ordered," and they completely miss the point of nursing its own self. I know it's hard to wrap your head around when so much of what we have to know overlaps the medical diagnostic process and the medical treatment plan, and that's why nursing is so critically important to patients.

    You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

    There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

    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."

    To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and related factor. 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!

    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. This book will save your bacon no matter what other "care planning" book you have.
  10. by   nurseprnRN
    Just knowing the nursing diagnosis off a list does not do much good if you just pick one for which you can demonstrate no approved defining characteristics or approved related factors. You will only find those in the NANDA-I, not in Ackley or anywhere else. Why? Because NANDA-I, understandably, does not issue other books blanket permission to copy their entire work wholesale. Get your own, it's only $29 or $25 for your Kindle or iPad.

    Remember: You don't "pick" or "choose" a nursing diagnosis. You make a nursing diagnosis based on defined criteria, just like a physician diagnoses a medical condition using approved criteria. So ... you need to know what they are.
  11. by   Episteme
    What Grntea said. Students make a couple of mistakes that are very, very common.

    1. They try to pick the diagnosis and not MAKE the diagnosis.

    2. They look at the patient and focus on the most obvious problem... not the actual priority problem. I'll give you an example:

    You have a patient with 60% 2nd and 3rd degree burns. He's in excruciating pain. Typically, the nursing student stops right there and starts trying to articulate a nursing diagnosis of which one is always "acute pain". The other is the icky, horrible looking, bloody, draining, burns. So the typical student would maybe go with something in the skin integrity direction. Both are wrong. This patient's most urgent problem is the massive insensible loss of fluid he's experiencing because his skin is gone and he is literally evaporating into thin air.

    This is similar to why students start with the medical diagnosis. DKA. There you go. That's what's wrong. No... that's what's obvious.

    99% of the time... when you find yourself going in circles and cannot think of a priority diagnosis... it's because you have not done a thorough, rich, assessment.

    You told us what the pt's glucose was. What is her intake and output? What fluids are hanging and how fast are they going? What were her latest ABG's? When were her last serum chemistries drawn and what were they (especially K+ and HCO3-)... Is this her first episode of DKA? Has she been well controlled in the past? What precipitated this one? Did someone give her steroids? Does she have an infection? (BTW: What is her white count?) Did she run out of money and fail to buy insulin or testing strips?

    All the references in the world... (and yes, the book published by NANDA-I is the best and it's well written and not hard to understand) nothing, will help you if you do not assess your patient COMPLETELY.