3 part Nursing diagnosis

Daytonite, BSN, RN · Mar 20, 2009

a nursing diagnostic statement follows this format:

p (problem) - e (etiology) - s (symptoms)

problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
etiology - also called the related factor by nanda, this is what is causing the problem and resulting in the symptoms. pathophysiologies need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. etiologies, if they are other than of a medical source, are often the focus of outcomes and long term goals.
symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they could be signs and symptoms of the medical disease the patient has, their responses to their disease, problems accomplishing their adls. they are evidence that prove the existence of the problem. if you are unsure that a symptom belongs with a problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

for "impaired swallowing, secondary to cva, aeb inability to swallow" you need to identify the etiology of the impaired swallowing and state it in nursing language (generically). if you have a nursing diagnosis reference it will actually list appropriate suggestions for each diagnosis for you (see online: impaired swallowing and look at the related factors near the top of the page).

problem (nursing diagnosis): impaired swallowing
etiology (cause): neuromuscular impairment (this is the damage, in nursing/medical language, that happens as a result of the cva)
symptoms (evidence, proof): choking, gagging, delayed swallowing

so, your final statement can look like this: impaired swallowing r/t neuromuscular impairment secondary to cva aeb inability to swallow. if you have more specific evidence of this "inability to swallow" i would list that instead of stating "inability to swallow". you want to impress your instructor and let them know that you understand that the aeb part of the statement calls for specific information from your assessment activity. the website above also lists specific symptoms (they are listed under defining characteristics on that webpage).

jothomas · Mar 20, 2009

Thank you very much Daytonite; as always, you explained it very clearly.