Nursing Diagnosis Process

1. NURSINGDIAGNOSIS
By:-
DeveshwarP.D.

2. NURSINGDIAGNOSIS
Definition: North American Nursing
Diagnosis Association (NANDA, 1992)
definesnursingdiagnosisasfollowing:-
Aclinicaljudgementaboutindividual,family
or community responses to actualand
potentialhealth/ life processes.Nursing
diagnosisprovidesthebasisforselectionof
nursing interventionsto achieveoutcomes
forwhichthenurseisaccountable.
OR
Gordon(1976)definednursingdiagnosisasa
ActualorPotentialhealthproblemswhich
nursesbyvirtueoftheireducationand
experiencesarecapableandlicensedtotreat.
PURPOSESOFNURSINGDIAGNOSIS
 Toanalyzecollecteddata.
 To identify client's normalfunctional

3. levelstatement.
 To identify the client's strength and
weaknesses.
 Toformulateadiagnosticweaknesses.
CHARACTERISTICSOFNURSINGDIAGNOSIS
 Itstatesaclearandconcisehealth
problem
 Itisderivedfrom existingevidences
abouttheclient
 Itispotentiallyamenabletonursing
therapy
 Itisthebasisforplanningandcarrying
outnursingcare
IMPORTANCEOFNURSINGDIAGNOSIS
Rememberingandwritingnursingdiagnosis
taxonomyis nota easyjob.Itis a really
irksome work. But if every nurse
reads/understandstheimportanceofwriting
diagnosis,itissurethateverynursewillstart

4. labelingit.
 Nursingdiagnosistaxonomyprovidesa
common languageforcommunication.It
helpstounderstandinbetterway.
Example:Ifnursingdiagnosisforclientis:
"Activityintolerancer/tprolongedbedrest"
Whereverthenurseisresiding,everyone
willunderstanditbecauseallnursesare
followingonetaxonomyi.e.NANDA.
 Itprovidesameansofcommunicating
toothernurses,healthcareteam.
 Asnursingdiagnosisisframedbynurse
andsheislicensedtotreatitindependently.
It facilitates development of Nurse's
autonomy.
 Ithelpsthenursestobeaccountablefor
theirprofession.
 Makingaccuratenursingdiagnosishelps
toensurethatclientreceivesqualitynursing
care.Thus,itservesasafocusforquality
improvement.

5.  Nursing diagnosis gives direction for
planningnursingintervention.
 Nursing diagnosis taxonomyhelps to
bridge gap between knowledge and
practice•Ultimatleyenhancesthescopeof
nursingpractice,whichisveryimportantfor
developing nurse's professionalrole in
healthcare.

6. DIFFERENCEINMEDICALDIAGNOSISAND
NURSINGDIAGNOSIS

7. TYPESOFNURSINGDIAGNOSIS
a) Actualdiagnosisrepresentsaproblem
whichhasmanydefiningcharacteristics.
Itisajudgementaboutaclient'sresponse
toahealthproblem thatispresentatthe
timeofnursing assessment(Problem +
Etiology+S/S).Itisbasedonthepresence
ofsignsandsymptoms.Examples:
 Imbalanced Nutrition:Lessthanbody
requirements r/t decreased appetite
nausea

8.  DisturbedSleepPatternr/tcough,fever
andpain
 Constipation r/ tlong term use of
laxative
 Ineffective airway clearance r/t to
viscoussecretions
 Acute Pain (Chest) r/ t coughs
secondarytopneumonia
 Activity Intolerance r/ t general
weakness
b) High risk diagnosis describes a
potentialproblem.Itmeansclientisprone
otdevelopaproblemthanotherproblemsif

9. leftin similarcondition.Itis a clinical
judgmentthataproblem doesnotexist,
therefore no S/S are present,butthe
presenceofriskfactorsisindicatesthata
problem isonlyislikelytodevelopunless
nurseinterveneordosomethingaboutit
(Problem +RiskFactors).Nosubjectiveor
objective cuesare presenttherefore the
factorsthatcausetheclienttobemore
vulnerabletotheproblem aretheetiology
ofarisknursingdiagnosis.Examples:
An obese client is undergone for hip
replacement surgery. As patient is
immobile/bed ridden,nurse may follow
nursingdiagnosisframe.

10. 1)"Risk for impaired skin integrity r/t
surgery.Presentlyclientdoesnothave
pressureulcer,butifremainsbedridden
forlongtime,withoutchangingposition,
heisathigh riskto develop pressure
ulcer.
2)"Highriskforinfectionr/thospitalization
immunosuppressedmedication.
c) Wellness diagnosis is a clinical

11. judgement about an individual family
communityin transition from a specific
levelofwellness to a higherlevelof
wellness"(Carpenito1993)Example:Birth
ofnewborntwins.
Wellnessnursing diagnosis:Potentialfor
growthrelatedtoanunexpectedbirthOf
twins.
d)Syndromediagnosis:Clusterofactual
orhigh risknursing diagnoses thatare
predictedtobepresentbecauseofcertain
event or situation. (Carpenito 1993)
Example:RapeTraumaSyndrome.
STATEMENTOFNURSINGDIAGNOSIS
Nursingdiagnosisgivedirectioninplanning

12. goal oriented nursing care. Nursing
Diagnosticstatementconsistsofthreeparts:
problem,etiologyanddefiningcharacteristics.
I.Problem:Itdescribesclient'sresponsefor
whichnursingcareisgiven.Nursestates
the1,areaclearlyandconciselyinwhich
theproblemoccurs.
Example: Knowledge deficit, Acute,
Chronic,Ineffective,and Decreased etc.
Knowledgedeficitindiet.
II. Etiology: Etiology component of
diagnosisidentifiesoneormorecausesof
health problem. Etiology should give
directioninplanningnursinginterventions.

13. Ithelpsthenurseto giveindividualized
patientcare because two patients may
havesameproblem.
III. Definingcharacteristicsarethesigns
andsymptomsofproblem whichhelpsin
validatingthenursingdiagnosis.Itincludes
subjectiveorobjectivedata.Example:
Fluidvolumedeficitrelatedtodecreasedoral
intakemanifestedbydryskinandmucous

14. membranes.
Riskforimpaired skin integrityrelated to
immobilitymanifestedbyrednessonsacral
region.
NURSINGDIAGNOSIS
New & Approved NANDA Nursing
DiagnosisListfor2012-2014
l.RiskforIneffectiveActivityPlanning
2.RiskforAdverseReactiontoIodinated
ContrastMedia
3.RiskforAllergyResponse
4.InsufficientBreastMilk
5.IneffectiveChildbearingProcess
6.Risk for Ineffective Child Bearing

15. Process
7.RiskforDryEye
8.DeficientCommunityHealth
9.IneffectiveImpulseControl
10.RiskforNeonatalJaundice
11.RiskforDisturbedPersonalIdentity
12.IneffectiveRelationship
13.RiskforIneffectiveRelationship
14.RiskforChronicLowSelf-Esteem
15.RiskforThermalInjury
16.Risk forIneffective PeripheralTissue
Perfusion
SOURCES OF ERROR IN NURSING
DIAGNOSIS
A. Problemincollectingdatasuchas-

16.  Lackofknowledge.
 Lackofskill.
 Inaccuratedata.
 Missingdata.
 Disorganizeddata.
B. Problem in interpretation ofData
suchas-
 Inaccurateinterpretationofcues.
 Failuretoconsiderconflictingcues.
 Useofinvaliddata.
 Givinglessconsiderationtocultural
influenceanddevelopmentstage.

17. C. Problem in labeling Nursing
diagnosissuchas-
 Wrongselectionofdiagnosticlabel.
 Failuretovalidatenursingdiagnosis
withpatient.
 Failuretoseekguidance.
ROLEOFNURSE
 Nurse musthave up to date good
knowledgebaseandclinicalexperience.
 Nurseshould haveknowledgeofnot
onlynursing subjects butalso ofother
subjects: chemistry, biochemistry,
pharmacologyetc.

18.  Itwillhelpherto understandclient's
data.
 Nurseshouldhaveuptodateclinical
knowledge.
NormalvalueofBP,temperature,Blood
count,ESR.
 Alongwiththis,sheshouldknow what
isnormalforaparticularpersonkeepingin
mindage,education,occupation,lifestyle,
cultureandreligionetc.
 Insteadofproceedingwithmisseddata,
nurseshouldinteractwithclientagainand
shouldhavecompleteinformation.
 Nurse should verify the
conflicting/ambiguousdata/cues.Shecan

19. consultherexpertcolleagues,recordsetc.
 In case ofdoubtin labeling nursing
diagnosis,nurseshouldberesourcefuli.e.
consult/useanursingdiagnosishandbook.
ShecankeeplistofNANDAdiagnosisin
herpocketdiary.
 Asnurseisdealingwithhumanlife,she
should never hesitate to take expert
opinion.
 Nurseshouldimprovecriticalthinking
skill.
 Nurse should state/ labeldiagnosis
briefly,specifically.
 Nurseshouldidentifyoneproblem in
eachnursingdiagnosis.

20.  Nursing diagnosismustbebased on
patient'sdatabase.
 Nurseshouldkeepinmindthatproblem
andcauseisnotsamething.Forexample:
Alterationincomfortrelatedtofractureof
righthip.(Wrong)
 Alterationincomfortassociatedwith
paininrighthip.(Right)
 Alwaysstatenursingdiagnosisinaway
thatdirectsnursing
interventions/strategies.
Example:Anxietyrelatedtodiagnostictest.
 Sleeppatterndisturbancerelatedto
hospitalization.