Please Help: Can you explain how to get a nursing diagnosis?

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I am a first semester nursing student. I having trouble with trying to figure out how to come up with a nursing diagnosis. Can you explain a simple procedure to learn how to do this.

Thank you

My last patient had a diabetic foot ulcer. That was his diagnosis and that is why he was in the hospital. I suppose to make some nursing diagnosis from that patient. Like what can I do to figure some diagnosis out thou?

Nursing Dx: Impaired tissue integrity related to decreased circulation secondary to chronic disease processes as evidenced by draining wound on L foot.

Nursing Dx: Pain related to draining wound on L foot second to chronic disease processes as evidence by pt statement, "it hurts."

Nursing Dx: Altered lower extremity tissue perfusion related to interrupted blood flow secondary to chronic disease processes as evidenced by draining lesion on L foot.

Nursing Dx: Risk for infection related to hyperglycemia, poor circulation, and decreased sensation secondary to chronic disease processes.

Nursing Dx: Knowledge deficit of diabetes management related to lack of teaching as evidenced by draining foot ulcer and pt statement, "I guess I don't understand how to use insulin."

And many many more....

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Do you have a NANDA book?

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Specializes in Rehab.

Triage... you're SOO good at this... ever thought of going into education? :D

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Specializes in Critical Care, Cardiac Cath Lab.
"Impaired tissue integrity related to [skin breakdown??] secondary to diabetic foot ulcer as evidenced by [insert signs and symptoms]."

Okay..I tend to shy away from issues I can do nothing or little about at first...impaired tissue integrity is a good nursing diagnosis, but again..what is the underlying probelm that you can help with? It is the underlying probelms that we help that make good nurses GREAT nurses!

But lets see...hmmmm Impaired Tissue Integrity related to...okay this gets tricky...no MD diagnosis should be used...so we can't go diabetic..or neuropathy...hmmmmm..lets figure it out, why is the tissue damaged....well, most diabetics I know don't feel their injuries to their feet...so perhaps we should focus on that? Okay but how to term it without using doc speak...how about injury to foot secondary to decreased sensation to bilateral lower extemities...there we go!!!!! (secondary to is another wonderful term you can use in the related to section...we know there is a wound so go with that..but follow up with the reason for it by using seconary to! See, a little trick there!)

Now we can actually play a bit closer to doc speak in the AEB...so why do they have decreased sensation...um diabetes, well yes but too doc speak...but you can get away with it by saying "physician diagnosis of diabetic neuropathy, verbalization from patient stating lack of sensation, and visualized spreading of wound size without pain or realization by the client, and presence of necrotic tissue slough.

Wooooooohoooooooo..okay lets put it together and see if it meshes!

Impaired Tissue Integrity related to injury to foot secondary to decreased sensation to bilateral lower extemities, as evidenced by physician diagnosis of diabetic neuropathy, verbalization from patient stating lack of sensation, visualized spreading of wound size without pain or realization by the client, and presence of necrotic tissue slough.

How does that sound to you??? Now see the trick of this...the lack of sensation you may not be able to overcome, but you sure as heck can make a care plan focused on protection of the feet due to this risk factor...a lot easier to plan for than your original NDx!

Oh yeah..and if I get stuck for more than 10 minutes after a using a certain nursing diagnosis statement (the first one, and get stuck on the r/t)..I assume I have made it too complicated and I step back...if the NDx comes quicker and the r/t right there..hey, then I know I have it!!!! :)

You ROCK! I think I'll print this out and have it with me when I write my first care plan. :) Thanks for your help!

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Specializes in private duty/home health, med/surg.

I second the Ackley & Ladwig Nsg Dx Handbook. In the front, they have a list of medical dx or symptoms (such as "hypertension" or "itching") followed by a list of appropriate nursing diagnoses.

We didn't do a whole lot with nsg dx's in the first semester. I don't think I had developed enough of the "nurse's thinking" to be able to come up with a dx on my own until later on. Now, I am very good at coming up with them. Don't worry if it is tough for you now--you will eventually get it!

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Specializes in Education, Acute, Med/Surg, Tele, etc.
Triage... you're SOO good at this... ever thought of going into education? :D

HEY THANKS!!!! Yes, I would LOVE to be in the educational area of nursing..but I would have to advance a degree or two LOL! I am an ASN, and they normally don't use ASN's for Nursing School professors..LOL!

It was funny actually...I haven't used a NDx in years, but when I saw the question those little wheels in my head turned and I felt great using them again! It was like "wow..that stuff is still in my head!!! YEAH!!!!!".

Once my employer gets another nurse in to cover one that quit...I will be able to do more teaching for the facility! I have submitted a few key projects I would like to do, and the administration was stunned and very excited! So looks like I will get an opportunity someday..soon I hope!

But ohhhhhhhh how I would like to be a Nursing School teacher...that to me would be the best use of my skills, knowledge, and what I consider to be fun! When I see someone's lightbulb go on, and that look of "wow..so that is the connection..I can do that!!!!" I am on cloud nine!!!! :D

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My last patient had a diabetic foot ulcer. That was his diagnosis and that is why he was in the hospital. I suppose to make some nursing diagnosis from that patient. Like what can I do to figure some diagnosis out thou?

"Impaired skin integrity" is one obviously and then you gotta think of your nursing interventions :uhoh3:

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And many many more....

:uhoh3:

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Yes PHTLS is totally on the ball, thinking of the interventions comes with practice and I find myself actually writing my NDx backwards! I think of what I can do..then fill in the blanks to help solidify my interventions! :) Comes with practice as I said, and students will get the nack of it once connections are made and learned...it takes time, and a few reminders to make those connections.

My preceptor nurse in the ED told me something once that really helped me realize this when I was learning NDx and patient care..."you tend to look at a painting right now for its colors...how they are placed and what rules you think the painter used...this is what a student is all about...but once you get out, you will have to look at the entire painting and how those colors were used to create the whole...once you do that...you may just realize...there really aren't as many rules as there is ART! And Nursing my little student is an ART! No blacks without whites, and certainly many mixtures...and grey...lots of grey areas!!!"

From that moment on I tried to see the entire painting, or parts of the painting and start linking things...very deep I know, but it really helped me and I really took off after that! A painter doesn't just use one rule, but many...just like we do. They don't use one brush or one color, but diffent tools and different tones of color...weird analogy, but for me...it totally worked!!!

It is also how I teach others...knowing you may be looking for rules and separate colors when you start out, so I just try to link them up a bit using common things that invoke memory, add the idea of the whole, and a bit of the old humor and pull that creative mind out!

and PHTLS..LOL...rembember, be thankful you don't have to deal with this NANDA stuff...LOL:rolleyes: (and yes I roll my eyes all the time at what we have to do...:uhoh3: LOL!) But thanks to the fact I can't drive for anything...I chose nursing...I so wanted to go EMTP, and was basically trained by them, but I guess I will stick to it :imbar . My hubby is EMTP and laughs at me all the time when I have to figure this stuff out...LOL!!!!!!! He gets me by saying "don't you wish you would have gotten into EMT"..and I laugh and say "oh shut up, and enjoy my paycheck will ya!:kiss ;) " LOL!!!!! :chuckle

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I am a first semester nursing student. I having trouble with trying to figure out how to come up with a nursing diagnosis. Can you explain a simple procedure to learn how to do this.

Thank you

I so understand where you are coming from! I so disliked this part of nursing school - but I made it and you will too. I always looked through my charts a ton before deciding on the darn nursing dx. But ask yourself "why is the pt here?" "what is the pt. dx?" "what are barriers for this pts returning to his/her previous level of functioning?" etc. Can you use the good old "risk for" nursing dxs? Those can definately come in handy! Good lucK!

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I am probably way out in left field here, but have to say that I find the concept of nursing diagnoses helpful. This comes after years of working with 'medical diagnoses' alone. Not to say that all of the writing of care plans and all is very much fun or useful in and of itself - it's more like a way of thinking that is valuable. The hard part is thinking up all of the problems and then addressing them (nobody likes doing this) - but it is this same process that sharpens critical thinking and removes what we do from 'rote' practices.

I was taught in school that nursing diagnoses are meant to address problems or issues facing the patient that we as nurses can do something about.

That means that it doesn't have to directly apply to the specific disease process underway with the patient; it just has to be something that applies to the patient that the nurse can do something about.

I think that many many students have problems with care plans and nursing diagnoses mostly because no one ever explained "in English" (as it were) what the intent is.

In my opinion - Nursing process kind of boils down to three major steps: 1) What is wrong with the patient that (as a nurse) I can do something about or can help with? 2) What specifically can I do to help or change the situation? 3)What happened after I did whatever I said I would in #2?

Just my 0.02

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Specializes in M/S, Onc, PCU, ER, ICU, Nsg Sup., Neuro.

Hey SAD,

Alright your pt has a diabetic foot ulcer, how about:

Alteration in tissue perfusion related to complications from Diabetes Mellites

as evidenced by apparent diabetic ulcer(give location, note size and appearance, also what stage is this ulcer), and decreased peripheral circuation noted in affected extremity as evidenced by noted decrease in pedal and dorsalis pedis pulses compared with unaffected extremity, and possible skin discoloration(what is skin, warm vs cold; what is the capillary refill like bilaterally?).

Alteration in comfort related to pain secondary to apparent diabetic foot ulcer

and the complications of DM(ie; Diabetic neuropathy) as evidenced by complaints of pain for same, decreased physical mobility r/t ulcer etc.

Knowledge deficit(actual and potential) related to poor knowledge base of proper diabetic foot care, lack of regular followup with PMD or Podiatrist, lack of medical insurance or family support in care(if unable to care for themselves)

Infection related to foot ulcer secondary to complications of DM.

Haven't been in school for almost 20 yrs but these kinda jump up me right off the bat. Work them up from there....... flaerman

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