2. 2
Learning Outcomes
After studying this chapter, you should be able to:
• Compare nursing diagnoses and medical
diagnoses.
• Differentiate nursing diagnoses according to
status.
• Identify the components of a nursing diagnosis.
• Describe various formats for writing nursing
diagnoses.
• List guidelines for writing a nursing diagnosis
statement.
3. Introduction
• Diagnosis is second phase of the nursing
process
• In this phase, nurses use critical thinking
skills to:
interpret assessment data and
identify client strengths and problems
3
4. • Diagnosing is critical step in nursing
process as the care planning activities
following this phase are based on the
nursing diagnoses
4
5. Diagnosing
• Nurses use NANDA (North American Nursing
Diagnosis Association International) to select
appropriate nursing diagnoses
• NANDA established 1982
• International convention held every 2 years to:
review existing nursing diagnoses and
propose new nursing diagnoses
• Currently, we are using NANDA list 2018-20
5
8. Differentiating medical from nursing
diagnosis
Medical diagnosis: refers to disease
processes – specific physiologic
responses that are fairly uniform from one
client to another. Client’s medical
diagnosis remains the same for as long as
the disease process is present.
Examples: diabetes mellitus, myocardial
infarction, COPD, arthritis, etc.
8
9. Nursing diagnosis:
• A clinical judgement concerning a human
response to health conditions/life processes, or
a vulnerability for that response, by an
individual, family, group, or community
9
10. Examples of nursing diagnoses:
• Imbalanced nutrition: less than body requirements
• Nausea
• Ineffective breathing pattern
• Hyperthermia
• Risk for falls
• Deficient fluid volume
• Disturbed sleep pattern
• Feeding self-care deficit
10
13. Types of Nursing Diagnoses
• Actual diagnosis
• A risk diagnosis
• A syndrome diagnosis
• A health promotion diagnosis
13
14. 1. Actual diagnosis
• Actual diagnosis: a client problem that is
present at time of nursing assessment; an
actual nursing diagnosis is based on
presence of associated signs and
symptoms
14
15. Examples of actual nursing
diagnoses
• Impaired verbal communication related to
language barrier as evidenced by
speaking and understanding only Urdu.
15
16. Examples of actual nursing
diagnoses
• Ineffective breathing pattern related to
chest pain as evidenced by
hyperventilation and shortness of breath
16
17. Examples of actual nursing
diagnoses
• Activity intolerance related to imbalance
between O2 supply and demand as
evidenced by verbal report of fatigue or
weakness and pulse oximetry reading
89% and exertional dyspnea
17
18. Examples of actual nursing
diagnoses
• Pain related to abdominal surgery as
evidenced by patient reporting 9/10 on
pain scale and guarding abdomen and
difficulty of being distracted
18
19. 2. A risk diagnosis
• Risk diagnosis: clinical judgement that a
problem does not exist, but presence of
risk factors indicates that a problem is
likely to develop unless nurses intervene
Example: (search NANDA for additional)
Risk for infection related to compromised immune status
(no signs or symptoms)
Risk for dry mouth related to dehydration (no signs or
symptoms) 19
20. 3. A health promotion diagnosis
• Health promotion diagnosis relates to client’s
preparedness to implement behaviors to
improve health conditions. These diagnosis
labels begin with the phrase Readiness for
Enhanced
Example: (search NANDA for additional)
Readiness for Enhanced coping
Readiness for Enhanced health literacy
Readiness for Enhanced nutrition
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21. 4. A syndrome diagnosis
• Syndrome diagnosis: assigned by a
nurse’s clinical judgement to describe a
cluster of nursing diagnoses that have
similar interventions
Example: (search NANDA for additional)
Frail elderly syndrome
Risk for disuse syndrome
21
23. 23
1. Analyzing data
2. Identifying health problems, risks, and strengths
3. Formulating diagnostic statements
Diagnosis
24. 1. Analyzing Data
• Compare data against standards (identify
significant cues)
• Cluster the cues
• Identify gaps and inconsistencies
24
25. 1. Analyzing data
A. Compare data against standards (identify
significant cues)
• Compare client data to standards and
norms and identify significant cues
Example growth charts, vital signs, and
laboratory values
25
26. 1. Analyzing data
A. Compare data against standards (identify
significant cues)
• A cue is considered significant if it:
1. Points to negative or positive change in a
client’s health status or pattern.
2. Varies from norms of client population.
3. Indicates a developmental delay
(pediatrics).
26
27. 1. Analyzing data
A. Compare data against standards (identify
significant cues)
1. Points to negative or positive change in a
client’s health status or pattern.
Example: Client states: “I have recently
experienced shortness of breath while
climbing stairs” or “I have not smoked for
three months.”
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28. 1. Analyzing data
A. Compare data against standards (identify
significant cues)
2. Varies from norms of client population.
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29. 1. Analyzing Data
Client Cues Standard/Norm Type of Cue
Woman with small
frame.
Height is 158 cm
Weighs 109 kg
Height and weight tables
indicate that the
“ideal” weight for a
woman 157 cm with a
small frame is 46–61 kg
Deviation from
population norms
States, “I’m just not
hungry these days.”
Ate only 15% of food on
breakfast tray.
Has lost 13 kg in past 3
months.
Client usually eats three
balanced meals per
day. Adults typically
maintain stable weight.
Changes in client’s
usual health status
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31. 1. Analyzing data
A. Compare data against standards (identify
significant cues)
3. Indicates a developmental delay (pediatrics).
Example: By age 9 months, infant is usually
able to sit alone without support. If infant has
not accomplished this task, this needs
further assessment for possible
developmental delays.
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33. 1. Analyzing data
C. Identifying Gaps and Inconsistencies in Data
• Data analysis should include a final check to
ensure that data are complete and correct
• Inconsistencies are conflicting data
• Possible sources of conflicting data include
measurement error, and inconsistent or
unreliable reports
Example: client says he has no hypertension and yet he
brings his antihypertensive medications to the clinic
33
34. 2. Identifying health problems,
risks, and strengths
Determining problems and risks
• After grouping and clustering the data,
nurse and client identify problems that
support actual and risk diagnoses
• Nurse must also determine if client’s
problem is nursing diagnosis or medical
diagnosis
34
35. 2. Identifying health problems,
risks, and strengths
Determining strengths
• Nurse and client also establish client’s
strengths, resources, and abilities to cope
• By identifying strengths, client can develop
a positive self-image
Examples: weight that is within normal range for age and
height, absence of allergies, being a nonsmoker, having
strong family ties, level of education
35
36. 3. Formulating diagnostic
statements
Components of nursing diagnosis
1. problem statement (diagnostic label)
2. etiology (related factors and risk factors)
3. defining characteristics (cluster of signs
and symptoms)
_1___ related to ___2__ as evidenced by
___3__.
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37. Components of NANDA nursing
diagnosis
1. problem (diagnostic label)
• describes client’s health problem or response for
which nursing therapy is given
• purpose of diagnostic label is to direct formation
of client goals and desired outcomes
• may also suggest some nursing interventions
37
38. • Qualifiers are words that have been added to
some NANDA labels to give additional meaning
to the diagnostic statement, for example:
Deficient (inadequate in amount, quality, or degree;
not sufficient)
Impaired (made worse, weakened, damaged)
Decreased (lesser in size, amount, or degree)
Ineffective (not producing desired effect)
Compromised (to make vulnerable to threat)
40
39. 2. Etiology (related factors and risk
factors)
• Identifies one or more probable causes of
the health problem
• Gives direction to required nursing
therapy, and
• Enables nurse to individualize client care .
39
40. Examples of nursing diagnoses
with different etiologies
Diagnostic Label
(Problem)
Client Etiology
Constipation Mr. Salem Long-term laxative use
Mr. Imad Inactivity and insufficient
fluid intake
Anxiety Ms. Danya Threat to physiological
integrity: possible cancer
diagnosis
Ms. Hessa Effects of aging (reduced
hearing, mobility, vision)
40
41. 3. Defining characteristics
• Cluster of signs and symptoms that
indicate the presence of a particular
diagnostic label (cues)
• For actual nursing diagnoses, defining
characteristics are client’s signs and
symptoms
• For risk nursing diagnoses, no cues
41
42. Components of Nursing Diagnosis
Diagnosis and
Definition
Related Factors Defining Characteristics
Activity intolerance:
insufficient physiological
or psychological energy
to endure or complete
required or desired daily
activities
• Bed rest or immobility
• Generalized weakness
• Imbalance between
oxygen supply/demand
• Sedentary lifestyle
• Verbal report of fatigue or
weakness
• Abnormal heart rate or blood
pressure response to activity
• Electrocardiographic changes
reflecting arrhythmias or ischemia
• Exertional discomfort or dyspnea
42
44. Formulating Diagnostic
Statements
• The three-part statement format cannot be
used for risk diagnoses because the client
does not have signs and symptoms of the
diagnosis; the health problem may
develop if preventive actions are not done
Example: Risk for injury related to poor
balance and history of frequent falls
44
45. Formulating Diagnostic
Statements
• Include the following:
1. Problem: statement of the client’s response (NANDA label)
2. Etiology: factors contributing to or probable causes of the
responses
3. Signs and symptoms: defining characteristics manifested by client
45
Problem Related to As Manifested by
Acute pain Tissue ischemia Pain rating of 8/10, grimacing,
guarding behavior
Ineffective airway clearance Tracheal bronchial
inflammation, edema
formation, increased sputum
production
Coughing, dyspnea, purulent
sputum
46. Formulating Diagnostic
Statements
One-part statements
• Health promotion diagnoses & syndrome nursing
diagnoses consist of a NANDA label only
• Health promotion diagnoses begin with the words
Readiness for Enhanced followed by the desired higher
level of wellness
Example:
Readiness for Enhanced self-care
Readiness for Enhanced health literacy
46
47. Formulating Diagnostic
Statements
One-part statements (cont.)
• A syndrome diagnosis is a diagnosis that
is associated with a cluster of other
diagnoses
Example: Risk for Disuse Syndrome may be experienced by long-term
bedridden clients. Clusters of diagnoses associated with this syndrome
include Impaired Physical Mobility, Risk for Impaired Tissue Integrity,
Risk for Activity Intolerance, Risk for Constipation, Risk for Infection,
Risk for Injury, Risk for Powerlessness, Impaired Gas Exchange, etc.
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48. Guidelines for Writing a Nursing Diagnostic
Statement
Guideline Correct Statement Incorrect or Ambiguous
Statement
1. State in terms of a
problem, not a need.
Deficient Fluid Volume
(problem) related to
fever
Fluid Replacement (need)
related to fever
2. Make sure that both
elements of the statement
do not say the same thing.
Risk for Impaired Skin
Integrity related to
immobility
Impaired Skin Integrity
related to ulceration
of sacral area (response
and probable
cause are the same)
3. Be sure that cause and
effect are correctly stated
(i.e., the etiology
causes the problem or puts
the client at
risk for the problem).
Pain: Severe Headache
related to avoidance
of narcotics due to fear of
addiction
Pain related to severe
headache
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49. Guidelines for Writing a Nursing Diagnostic
Statement
Guideline Correct Statement Incorrect or Ambiguous
Statement
4. Word the diagnosis
specifically and precisely
to provide direction for
planning nursing
intervention.
Impaired Oral Mucous
Membrane related
to decreased salivation
secondary to radiation
of neck (specific)
Impaired Oral Mucous
Membrane related
to noxious agent (vague)
5. Use nursing terminology
rather than
medical terminology to
describe the client’s
response.
Risk for Ineffective Airway
Clearance
related to accumulation of
secretions in lungs
(nursing terminology)
Risk for Pneumonia
(medical terminology)
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