1. NURSING
PROCESS-
DIAGNOSING
PREPARED AND PRESENTED BY
MRS.S.ANUCHITHRA RADHAKRISHNAN,
VICE PRINCIPAL CUM HOD OBG NURSING,
P.D.BHARATESH COLLEGE OF NURSING,
HALAGA, BELGAUM.

2. INTRODUCTION
 Diagnosing is the 2nd phase of nursing process
 Nurse uses critical thinking skills to interpret assessment
data
 Pivotal step of Nursing process
 To diagnose in nursing means to analyze assessment
information and derive meaning from the analysis.
 All the activities preceding this phase are directed toward
formulating nursing diagnosis contd…

3. INTRODUCTION
 The use of the nursing process and nursing diagnoses is
rapidly becoming an integral part of an effective system of
nursing practice.
 Identification & Development of Nursing Diagnosis began
in year 1973
 It is derived from actual or potential problems.
 Derived from physiological, social, cultural,
developmental and spiritual dimensions of client.
contd…

4. INTRODUCTION
 Focus : Helping client to achieve a maximal level of
wellness and highest level of independence.
 Medical diagnosis deals with disease or medical condition
or pathology (treating or curing)
 Nursing deals with human response to bio-psycho-social
stressors and/or health problems that a nurse is licensed
and competent to treat. contd…

5. INTRODUCTION
 NANDA – North American Nursing Diagnosis
Association
 To promote a taxonomy of nursing diagnostic
terminology
 Taxonomy is the classification system
 Currently NANDA approved 206 Nursing Diagnosis
labels
 In 2000 Taxonomy I is revised & now referred to as
Taxonomy II contd…

6.  206 nursing diagnoses that are grouped
(classified) within 13 domains (categories) of
nursing practice. They are
1. Health Promotion;
2. Nutrition;
3. Elimination and Exchange;
4. Activity/Rest;

7. 5. Perception/Cognition;
6. Self-Perception;
7. Role Relationships;
8. Sexuality;
9. Coping/Stress Tolerance;
10. Life Principles;
11. Safety/Protection;
12. Comfort;
13.Growth/Development.

8. DEFINITION
A nursing diagnosis is a statement of the high risk or
actual problems in the client’s health status the nurse is
licensed competent to treat
 Note: It is not medical diagnosis
 Data Analysis + Problem Identification = Formulation
Of Nursing Diagnosis

9. DEFINITION
 “It is a clinical judgment about individual, family
or community responses to actual and potential
health problems/life processes. Nursing
diagnoses provide the basis for selection of
nursing interventions to achieve outcomes for
which the nurses are accountable”.

10. THE GENERAL USE/PURPOSE OF NURSING
DIAGNOSES
1. Gives Nurses a Common Language
2. Promotes Identification of Appropriate Goals
3. Provides Acuity Information
4. Can Create a Standard for Nursing Practice
5. Provides a Quality Improvement Base

11. THE SPECIFIC USE/PURPOSE OF NURSING DIAGNOSES
a. For client:
1. Individualization of care
2. Appropriate selection of interventions
3. Establishment of goal
b. For Nursing:
1. Facilitates communication, documentation
2. Continuity of care among health care providers

12. IV).CHARACTERISTICS OF NURSING DIAGNOSIS
1. It states a clear and concise health problem
2. It is derived from existing evidences about the
client
3. It is potentially amenable to nursing therapy
4. It is the basis for planning and carrying out
nursing care

13. V).TYPES OF NURSING DIAGNOSIS
1. Actual Nursing Diagnosis
2. Risk Nursing Diagnosis
3. Health-Promotion Nursing Diagnosis
4. Possible Nursing Diagnosis
5. Syndrome Diagnosis

14. 1. ACTUAL NURSING DIAGNOSIS
 Actual Nursing Diagnosis is a client problem
that is present at the time of Nursing Assessment
 It is based on the presence of associated signs &
symptoms
 Firm diagnosis supported by nurses findings
(validated)

15. DEFINITION OF ACTUAL NURSING
DIAGNOSIS
 “A clinical judgment about human
experience/responses to health conditions/life
processes that exist in an individual, family, or
community”.

16. EXAMPLES OF ACTUAL NURSING DIAGNOSIS
 Ineffective breathing pattern related to bacterial / viral
inflammatory Process.
 Ineffective breathing pattern related to Tracheo-bronchial
obstruction
 Anxiety related to changes in the environment and
routines, threat to socio economic status.
 Anxiety related to change in health status and situational
crisis.
 Body image disturbance related to temporary presence
of a visible drain/ tube.

17. 2.RISK NURSING DIAGNOSIS
 It is a clinical judgment that a problem doesn’t
exist, but the presence of risk factors
indicates that a problem is likely to develop
unless nurses intervene.
 Describes human responses to health
conditions / life processes that may develop in
a vulnerable individual / family / community.

18. 2.RISK NURSING DIAGNOSIS
 It is supported by risk factors that contribute to
increased vulnerability.
 Eg. A client with Diabetes Mellitus or a
compromised immune system is at high risk
than others.
 Therefore the nurse would appropriately use
the label risk for infection to describe the
client’s health status.

19. EXAMPLES OF RISK NURSING DIAGNOSIS
 Eg. Admission in hospital prone for acquiring infection-
compromised immune system
1. Risk for infection related to compromised immune
system.
2. Risk for injury related to altered mobility and
disorientation.
3. Risk for aspiration related to decreased cough and gag
reflex

20. EXAMPLES OF RISK NURSING DIAGNOSIS
1. Risk for impaired skin integrity related to immobility.
2. Risk for impaired skin integrity related to edema and
neuropathy
3. Risk for injury related to generalized weakness
4. Risk for Impaired skin integrity (left ankle) related to
decrease peripheral circulation in diabetes.
5. Risk for Impaired skin integrity related to loss of pain
perception

21. 3. HEALTH-PROMOTION NURSING DIAGNOSIS
A clinical judgment about a person’s, family’s
or community’s motivation and desire to
increase wellbeing and actualize human
health potential as expressed in the readiness
to enhance specific health behaviors, and can
be used in any health state.

22. 3. HEALTH-PROMOTION NURSING DIAGNOSIS
 Describes human responses to levels of
wellness in an individual, family or community
that have a readiness for enhancement.
 Health-promotion nursing diagnosis are one
part statement includes diagnostic label.

23. EXAMPLES OF HEALTH-PROMOTION
NURSING DIAGNOSIS
- Readiness for Enhanced Self-Esteem.
- Readiness for enhanced spiritual well being
- Readiness for enhanced family coping.

24. 4. POSSIBLE NURSING DIAGNOSIS
A possible nursing diagnosis is one in which evidence
about a health problem is incomplete or unclear.
 A possible diagnosis requires more data either to support
or to refuse it.
 Possible nursing diagnosis are suspected because of the
prescence of certain factors.
 Tentative-additional data needed to confirm or rule out
problem.

25. EXAMPLES SITUATION FOR FORMULATING
POSSIBLE NURSING DIAGNOSIS
 Eg. Elderly widow who lives alone admitted in
hospital no visitors and she is pleased with
attention and conversation from the nursing
staff. Until more data are collected, the nurse
may write a nursing diagnosis of
 Possible social isolation R/T unknown
etiology

26. EXAMPLES OF POSSIBLE NURSING
DIAGNOSIS
- Potential risk of constipation as a result of enforced bed
rest.
-Potential risk of pressure sore development from
enforced bed rest.

27. 5. A SYNDROME DIAGNOSIS
A clinical judgment describing a specific cluster of
nursing diagnoses that occur together, and are
best addressed together and through similar
interventions.

28. 5. A SYNDROME DIAGNOSIS
 Rape-trauma syndrome related to anxiety about
potential health problems and as manifested by anger,
genitourinary discomfort, and sleep pattern
disturbance.

29. Impaired physical mobility
Impaired gas exchange and
Risk for tissue
Impaired integrity
 Eg. Disuse syndrome Risk for activity intolerance
Includes Risk for constipation
Risk for infection
Risk for injury
Risk for powerlessness

30. COMPONENTS OF NANDA NURSING
DIAGNOSIS
 A Nursing Diagnosis has 5 components
A. Label
B. Definition
C. Etiology
D. The defining characteristics
E. Risk factors and Related factors
Each component serves a specific purpose

31. A. LABEL
 Provides a name for a diagnosis.
 It is a concise term or phrase that represents a
pattern of related clues.
 It may include modifiers.
 Describes the client’s health problem or response
for which nursing therapy is given

32. A. LABEL
 It describes the client’s health status clearly and
concisely in few words
Purpose:
 Is to direct the formation of client goals and
desired outcomes.
 It may also suggest some Nursing interventions

33. To be clinically useful,
 Diagnostic labels need to be specific; when the word
specify follows a NANDA label, the nurse states the
area in which the problem occurs,
For eg, Deficient knowledge (medication) or Deficient
knowledge (dietary adjustments)
 Each diagnostic label approved by NANDA carries a
definition that clarifies its meaning
contd…

34. Qualifiers are words that have been added to some NANDA
labels to give additional meaning to the diagnostic statement ;
for eg.
1. Deficient (inadequate in amt, quality, or degree, not
sufficient, Incomplete)
2. Impaired (made worse, weakened, damaged, reduced,
Deteriorated, Absent , lessened, either temporarily or
permanently )
3. Altered (distorted, changed)

35. 1. Risk for (chance of something going wrong, hazard,
damage, something likely to cause injury, something to
harm, danger, or loss)
2. Decreased (reduce, lessen, decline, diminution lesser
in size, amount or degree)
3. Ineffective (not producing the desired coping,
unproductive, unsuccessful, useless)
4. Compromised (to make vulnerable to threat)

36. NANDA MODIFIERS
1. Acute (sever, serious, intense, critical)
2. Chronic (constant, persisting, ever present)
3. Depleted (exhausted, tired, useless)
4. Disturbed ( troubled, uneasy, unbalanced, bothered)
5. Dysfunctional ( inability to function, organ or part
of body unable to function)

37. NANDA MODIFIERS
1. Enhanced (improved, better)
2. Excessive (extreme, too much, unnecessary,
disproportionate)
3. Increased (greater than before, improved)
4. Intermittent (irregular, alternating, discontinuous)
5. Potential for (likely to occur, may or might)

38. B. DEFINITION
 Provides a clear, precise description; delineates its
meaning and helps differentiate it from similar
diagnoses.
 Based on data collected
 Must be approved NANDA format begin with
modifiers contd..

39.  Use the exact NANDA wording to state the problem
 Examples
1.Poor sleep pattern / Sleep Pattern, disturbed
2.Poor circulation / Tissue perfusion, ineffective
(cardiopulmonary)

40. C. ETIOLOGY
 The factors contributing to or causing the problem
 It can’t be a medical diagnosis
 Must be modifiable by nursing intervention
 Nurse must be able and license to do something
about it. contd…

41. ETIOLOGY
 Will be one of five categories:
Pathophysical,
Environmental,
Situational,
Psychological, or Maturational
 The etiology component of a nursing diagnosis identifies
one or more probable cause of the health problem,
gives direction to the required nursing therapy, and enables
the nurse to individualize the client’s care. Contd…

42. PROBLEMS HAVING DIFFERENT ETIOLOGIES AND
DIFFERENT INTERVENTIONS
Problem Client Etiology Nursing Intervention
A Long term Gradual withdraw of
laxative laxatives
use Teach components of high
fiber diet.
B Inactivity -exercise information
Constipation
& about daily schedule
insufficient - types of fluid he likes
fluid - Plan to include sufficient
intake amount of fluid in his diet.

43. PROBLEMS HAVING DIFFERENT ETIOLOGIES AND
DIFFERENT INTERVENTIONS
Problem Client Etiology Nursing Intervention
Ineffective A Breast 1. Massage of breast before
breast engorge feeding
feeding ment 2. Use hot packs
3. Hot shower before nursing
infant
B Inexperie 1. Advice to feed infant on
nce and demand
lack of 2. Show her how infant is
knowled sucking & swallowing
ge 3. Demonstrate different
holding positions for
feedings.

44. D.DEFINING CHARACTERISTICS
Defining Characteristics are the cluster of signs and
symptoms that indicate the presence of a particular
diagnostic label
 For Actual Nursing Diagnosis- The Defining
Characteristics are the client’s signs and symptoms
 For Risk Nursing Diagnosis- No subjective and objective
signs are present Thus the factors that cause the client to be
more than “Normally” vulnerable

45. E. RISK FACTORS
Environmental factors and physiological,
psychological, genetic or chemical elements
that increase the vulnerability of an individual,
family or community to an unhealthful event.

46. E. RELATED FACTORS
 Factors that appear to show some type of
patterned relationship with the nursing
diagnosis.
 Such factors may be described as
antecedent to, associated with, related to,
contributing to or abetting. Only actual
nursing diagnoses have related factors.

47. DIFFERENCE BETWEEN MEDICAL &
NURSING DIAGNOSES
Sl Nursing Diagnoses Medical Diagnoses
No
1 It is a statement of Medical Diagnoses is
Nursing judgment made by physician
2 Refers to a condition Refers to a condition
that Nurses are licensed that only a physician
to treat can treat.

48. DIFFERENCE BETWEEN MEDICAL &
NURSING DIAGNOSES
Sl Nursing Diagnoses Medical Diagnoses
No.
3 Nursing Diagnoses Medical Diagnoses
describe a client’s refers to disease
physical, socio-cultural, processes
psychologic, and
spiritual responses to an
illness or health
problem.

49. DIFFERENCE BETWEEN MEDICAL &
NURSING DIAGNOSES
Sl Nursing Diagnoses Medical Diagnoses
No.
4 It changes depend Fairly uniform from
upon the response of one client to another
the client to an illness
& health problem.
5 Nursing Diagnoses Medical Diagnose
change as the client remains same for as
responses change. long as the disease
process is present.

50. THE DIAGNOSTIC PROCESS
 The Diagnostic Process uses critical thinking skills of
analysis and synthesis.
 Critical thinking is a cognitive process during which a
person reviews data and considers explanations before
forming an opinion.
 Analysis – is the separation into components that is
breaking down of the whole into its parts.
 Synthesis – is the opposite that is the putting together
of parts into the whole.

51.  The diagnostic process is used continuously by most
nurses.
 An experienced nurse may enter a client’s room and
immediately observe significant data and draw conclusions
about the client.
 As a result of attaining knowledge skill and expertise in the
practice setting, the expert nurse may seem to perform
these mental processes automatically.
 Novice nurses, however, need guidelines to understand and
formulate nursing diagnoses.

52. THE DIAGNOSTIC PROCESS
The diagnostic process has 3 steps:-
1] Analyzing data
2]Identifying health problems, risks and
strengths.
3] Formulating Diagnostic statements.

53. Assessing
a. Collect data
b. Organize data
c. Validate data
d. Document
data
DIAGNOSING
a.Analyze data
b.Identify health
problems, risks and
strength,
c.Formulating nursing
diagnosis

54. 1] ANALYZING DATA
 In analyzing data following steps are involved.
A. Compare data against standards (identify
significant cues)
B. Cluster cues (generate tentative hypotheses)
C. Identify gaps & inconsistencies.
 For experienced nurses, these activities occur
continuously rather than sequentially.

55. A. COMPARING DATA AGAINST STANDARDS
A Standard or Norm is generally accepted
measure, model rule, or pattern.
 Eg. of Standards
 Growth and Development patterns
 Normal vital signs
 Laboratory values

56. B. CLUSTER CUES
 It is a process of determining the relatedness of
facts and determining whether data are
significant.

57. C. IDENTIFY GAPS & INCONSISTENCIES
Skillful assessment minimizes the gaps & inconsistencies,
conflicting data's.
Possible sources are measurement error, expectation and
unreliable report.
It helps to have final check to ensure the data are complete and
correct.
 Eg. Patient reports not having seen a Doctor in 15 years, yet
during Physical Examination he states “My doctor takes my BP
every year”.
 All inconsistencies must be clarified before valid pattern
“Validating data”.

58. 2] IDENTIFYING HEALTH PROBLEMS, RISKS &
STRENGTHS
 After data are analyzed, the nurse and client
can together identify strengths & problems.
 That is after gaping and clustering the data, the
nurse and client together identify problems that
support tentative actual, risk, and possible
diagnoses.

59. EG. OF A CLIENT WITH PNEUMONIA
Sl
No. Client cue clusters
1 a) No appetite since Imbalanced Nutrition: Less that
having “Cold” Body Requirements related to
b) Has not eaten decreased appetite & Nausea, &
today, Last fluids increased metabolism
at noon today (Strength: - Normal Weight for
c) Nauseated x 2 Height.)
days

60. EG. OF A CLIENT WITH PNEUMONIA
Sl
No. Client cue clusters
2 a) Last fluids at noon
today Deficient fluid volume related to
b) Oral temperature intake insufficient to replace
39.40c (1030 F) fluid loss secondary to fever,
c) Skin lot & pale, diaphoresis, anorexia
checks flushed
d) Dry mucous
membrane
e) Poor skin turgor
f) Decreased Urinary
frequency x 2 days

61. EG. OF A CLIENT WITH PNEUMONIA
Sl
Client cue clusters
No.
3 Difficulty in Disturbed sleep pattern related to
sleeping because cough, pain, orthopnea, fever,
of cough, and diaphoresis.
“Can’t breathe
while lying down”

62. EG. OF A CLIENT WITH PNEUMONIA
Sl
No. Client cue clusters
4 a) States “I feel Weak”
b) Short of breath on Activity Intolerance related to
exertion general weakness imbalance between
c) Radial pulses weak, O2 supply / demand
regular Strength: - No musculoskeletal
d) Pulse rate – 92 bt/mt impairment, normal energy level is
e) States “I can think Satisfactory, exercises regularly.
ok, just weak”

63. EG. OF A CLIENT WITH PNEUMONIA
Sl
No. Client cue clusters
5 Reports pain in Acute pain related to cough
chest especially secondary to inflammation of
when coughing lung parenchyma.
Strength:-No cognitive or
sensory deficits.

64. EG. OF A CLIENT WITH PNEUMONIA
Sl
No. Client cue clusters
6 a) Husband out of Interrupted family processes
town; will be back related to mother’s illness &
tomorrow temporary unavailability of
afternoon father to provide child care.
b) Child with Strength :- Neighbors available
neighbor until & willing to help.
husband returns.

65. EG. OF A CLIENT WITH PNEUMONIA
Sl
Client cue clusters
No.
7 a) Anxious :- “I can’t
breathe” Anxiety related to difficulty breathing,
b) Facial muscles tense, inability to work, and child care.
c) Trembling
d) States “I’ll never get
caught up”
e) Husband out of town;
will be back tomorrow
afternoon.
f) Child with neighbor
house
g) Express “concern” &
“Worry”

66. EG. OF A CLIENT WITH PNEUMONIA
Sl
Client cue clusters
No.
8 a) Radial pulse weak, regular
pulse rate 92 Ineffective Airway clearance related to
b) Skin hot, pale, and moist viscous secretions & shallow chest
c) Respirations shallow, chest expansion secondary to pain, fluid
expansion, 3cm volume deficit & fatigue.
d) Productive cough
e) Thick pale pink sputum
f) Inspiratory crackles
auscultated through out. Right
upper & lower lungs.
g) Diminished breath sounds
an ® side
h) Mucous membranes pale,
dry

67. DETERMINING STRENGTHS
 Eg. of strengths
 Weight is with in normal as per age & Height – Enables
client to cope with surgery.
 Absence of allergies & Non smoker.
 It can be found in the nursing assessment record (health,
home life, Education, recreation, exercise, work, family &
friends religious beliefs, sense of humour)

68. 3] FORMULATING DIAGNOSTIC STATEMENTS
 Most Nursing Diagnoses are written as two part or three
part statements, but there are variations of these.
1. Basic two part statements
2. Basic three part statements
3. One part statements
4. Variations of Basic formats.
5. Collaborative problems.

69. BASIC TWO PART STATEMENTS
 The basic two part statement includes the following.
1] Problem (P) :- Statement of the client’s response (NANDA
Label)
2] Etiology (E) :- Factors contributing to or probable cause of
responses.
 The two parts are joined by the words related to rather than
due to.
 The phrase due to implies that one part causes or is
responsible for the other part.
 By contrast, the phrase related to merely implies a
relationship.

70. EG. OF TWO PART STATEMENTS
Problem Related to Etiology
Constipation Related to Prolonged
Laxative use
Ineffective Related to Breast
Breast Feeding engorgement

71.  Some NANDA Labels contain the word specify. For these the
nurse must add words to indicate the problem more
specifically.
 Eg. Noncompliance (specify)
 Noncompliance (Diabetic Diet) related to denial of having
disease.
 For ease in alphabetizing, many NANDA lists are arranged with
qualifying words after the main word (Eg. Infection, Risk For).
 Avoid writing Diagnostic statements in that manner instead,
write them as they would be stated in normal conversation (Eg.
Risk for infection)

72. BASIC THREE PART STATEMENTS
 The three part Diagnostic Statements called the PES
format and includes the following:
1] Problem (P) :- Statement of the client’s response
(NANDA Label)
2] Etiology (E) :- Factors contributing to or probable cause
of the response.
3] S/S (S) :- Defining characteristics manifested by the
client.

73.  Actual nursing diagnoses can be documented by using
the three part statement
 because the signs & symptoms have been identified.
 This format cannot be used for risk diagnoses
 because the client doesn’t have signs & symptoms of the
diagnosis.

74. EG. OF 3 PART STATEMENT
Problem Related Etiology As manifested Signs & symptoms
To by
Situational Related to Rejection by As manifested by States that “I don’t know if I can
Low Self husband
Esteem
manage by myself”
Rejects positive feed back.
Hyperthermia Related to Bacterial infection As manifested by Elevated body temperature. 1000F
Increased pulse rate 92bt/mt
Increased R.R 30br/mt
Dry lips . States Fatigue, tired.
Feels so Hot
Reduced Skin turgor.
Ineffective Related to Viscious secretions As manifested by Viscious secretions, shallow chest
breathing
pattern
expansion.

75. ONE PART STATEMENTS
 Wellness diagnoses and Syndrome nursing diagnoses.
 As the diagnostic labels are refined they tend to become
more specific, so that nursing interventions can be
derived from the label itself.
 Therefore an etiology may not be needed.
 The wellness diagnoses statement begins with words
Readiness for Enhanced (Parenting, Spiritual well
being, Effective breast feeding, Health seeking
behaviors, Anticipatory Grieving Low fat Diet.)

76. GUIDELINES FOR WRITING A NURSING DIAGNOSTIC
STATEMENT
Sl Correct statement Incorrect
No.
1 State in terms of Deficient fluid volume Fluid replacement
problem, not a related to fever (need) related to fever.
need.
2 Word the statement Impaired skin integrity Impaired skin integrity
so that it is legally related to immobility related to improper
advisable (legally acceptable) positioning (implies
legal liability)
3 Use nonjudgmental Spiritual distress related Spiritual distress
statements to inability to attend related to strict rules
church services necessitating church
secondary to immobility attendance
(Nonjudgmental)

77. GUIDELINES FOR WRITING A NURSING DIAGNOSTIC
STATEMENT
Sl Correct Incorrect
No. statement
4 Make sure that both Impaired skin Impaired skin
elements of the statement integrity (ulcer integrity
don’t say the same thing. in sacral area) related to
related to ulceration of
immobility. sacral area.
5 Be sure that cause and Pain severe Pain related to
effect are correctly stated head ache severe head
(that is the etiology related to fear ache.
causes the problem) of addiction to
narcotics

78. GUIDELINES FOR WRITING A NURSING DIAGNOSTIC
STATEMENT
Sl Correct statement Incorrect
No.
6 Word the diagnosis Impaired oral Impaired oral
specifically and mucus membrane mucus
precisely to provide related to membrane
direction for decreased related to
planning nursing salivation noxious agent
intervention secondary to (vague)
radiation of neck.
(specific)

79. GUIDELINES FOR WRITING A NURSING DIAGNOSTIC
STATEMENT
Sl Correct statement Incorrect
No.
7 Use nursing Risk for Risk for
terminology rather ineffective airway pneumonia
than medical clearance related (Medical
terminology to to accumulation Terminology)
describe the client of secretions in
response & its lungs (nursing
cause. terminology)

80. CONCLUSION
 Definition
 Types of Nursing Diagnoses –Actual, Risk, Wellness, Possible and Syndrome
 Components of NANDA nursing diagnosis- Problem, Etiology, Defining
characteristics
 Difference between medical and nursing diagnoses
 Diagnostic process-
 Analyzing data - Compare data against standards (identify significant cues),
Cluster cues (generate tentative hypotheses) , Identify gaps & inconsistencies.
 Identifying health problems risk and its strengths
 Formulating diagnostic statements - Basic two part, Basic three part, One part,
Variations of Basic formats, Collaborative problems.
 Guidelines for writing a nursing diagnostic statement

81. COMPONENTS OF NANDA NURSING
DIAGNOSIS
 A nursing Diagnosis has 3 components.
1. The problem and its definition
2. The etiology
3. The defining characteristics.
 Each component serves a specific purpose.

82. 1] THE PROBLEM (DIAGNOSTIC LABEL) AND ITS
DEFINITION
 Describes the clients health problem or response for
which nursing therapy is given.
 It describes the client’s health status clearly & concisely
in few words.
 Purpose is to direct the formation of client goals and
desired outcomes.
 It may also suggest some nursing interventions.

83.  To be clinically useful,
 diagnostic labels need to be specific;
 when the words specify follows a NANDA Label, the nurse states
the area in which the problem occurs.
 For eg.
Deficient knowledge (specify) Medication
Deficient knowledge (Dietary adjustments).

84.  Qualifiers are words that have been added to some NANDA
Labels to give additional meaning to the diagnostic
statement; for eg.
 Deficient (inadequate in amount quality or degree not sufficient,
incomplete)
 Impaired (Made worse, weakened, damaged, reduced,
deteriorated)
 Decreased (lesser in size amount or degree)
 Ineffective (not producing the desired coping)
 Compromised (to make Vulnerable to threat)
 Each Diagnostic label approved by NANDA carries a definition
that clarifies its meaning.

85. 2] ETIOLOGY
 The etiology component of a nursing diagnosis
 identifies one or more probable cause of the health problem,
 gives direction to the required nursing therapy and
 enables the nurse to individualize the client’s care.
 Eg. of problems having different etiologies and different
interventions

86. Problem Client Etiology Nursing Intervention
A Long term Gradual withdraw of laxatives
laxative use - teach components of high fiber diet.
Constipati
B Inactivity & - exercise information about daily schedule
on insufficient - types of fluid he likes
- Plan to include sufficient amount of fluid in
fluid intake his diet.
Ineffective A Breast -massage of breast before feeding
Breast engorgement - use hot packs
- hot shower before nursing infant
Feeding
B Inexperience - Advice to feed infant on demand
and lack of - Show her how infant is sucking &
swallowing
knowledge - demonstrate different holding positions for
feedings.

87. D. DEFINING CHARACTERISTICS
 Defining Characteristics are the client’s signs &
symptoms. That indicates the presence of a
particular diagnostic label.
 For Actual Nursing Diagnosis the defining
characteristics are the client’s signs &
symptoms.
 For Risk Nursing Diagnosis no subjective &
objective signs are present.