Briefly describe objectives of 3rd chapter of fundamental of nursing for generic bsn students

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Unit # 1- Nursing Process
Nursing Diagnosis
Fundamental Of Nursing
2nd
Semester – BSN Generic
Lecture # 3
Ms . Farhana
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Nursing process - component # 2 Nursing
Diagnosis
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1. Define diagnosis in relation to the nursing process.
2. State the meaning of nursing diagnosis
3. Describe the components of a nursing diagnosis
4. Differentiate between a nursing diagnosis and
medical diagnosis.
5. Identify the clinical skills needed to make nursing
diagnoses.
6. Formulate nursing diagnoses according to NANDA
list.

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Nursing Diagnosis
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Diagnosis is the second phase of the nursing process.
In this phase, nurses use critical thinking skills to
interpret assessment data to identify client problems.

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North American Nursing Diagnosis Association
(NANDA)
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 The purpose of NANDA is to define, refine and
promote a taxonomy of nursing diagnostic
terminology of general use to professional nurses.
 Taxonomy: A taxonomy is a classification system or
set of categories arranged based on a single
principle or set of principles.
 In 2000, taxonomy 1 revised to as taxonomy 2.
 Currently, approved,13 domains and 47 classes,
247 nursing diagnosis.

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13 Domains
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1. Health promotion
2. Nutrition
3. Elimination exchange
4. Activity /rest
5. Perception or cognition
6. Self perception
7. Role relationships
8. Sexuality
9. Coping or stress
tolerance
10. Life principle
11. Safety /protection
12. Comfort
13. Growth and
development

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NANDA Nursing Diagnosis
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Definitions:
Diagnosis: Diagnosis is a statement or conclusion
regarding the nature of phenomenon.
Diagnostic label: the standardized NANDA names
for the diagnoses are diagnostic label.
 In 1990 ,NANDA adopted an official working
definition of nursing diagnosis,

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1. Define Diagnosis In Relation To The Nursing Process.
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 •“A clinical judgment about individual, family, or community
responses to actual and potential health problems / life
processes. A nursing diagnosis provides the basis for selection
of nursing interventions to achieve outcomes for which the
nurse is accountable”
 (NANDA international, 2005, p.277)
OR
 The official NANDA definition of a nursing diagnosis is: “a
clinical judgment concerning a human response to health
conditions / life processes, or a vulnerability for that
response, by an individual, family, group, or community.”

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2. State The Meaning Of Nursing Diagnosis
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 1. Nursing diagnosis foster the nurses independent practice
(e.g. patient comfort or relief) compared to dependent
interventions driven by physician’s orders ( e.g. medication
administration).
 2. Nursing diagnosis are developed based on data
obtained during the nursing assessment. A problem - based
nursing diagnosis presents a problem response present at
time of assessment.
 3. The nursing diagnostic process is unique among others. A
nursing diagnosis integrates patient involvement, when
possible, throughout the process.

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 4. NANDA international is body of professionals
that develops, researches and refines an official
taxonomy of nursing diagnosis.
 5. All nurses must be familiar with the steps of the
nursing process in order to gain the most efficiency
from their positions.

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Characteristics Of Nursing Diagnosis
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 It states clear and concise health problem
 It derived from existing evidences about the client
 It is potentially amenable to nursing therapy
 It is the basis for planning and carrying out nursing
care.

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Types Of Nursing Diagnosis
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The five types of nursing diagnosis are actual, risk,
wellness, possible and syndrome.
1. Actual Diagnosis:
Is a client problem that is present at the time of the
nursing assessment.
Examples: Ineffective breathing pattern and anxiety.
 An actual nursing diagnosis is based on the
presence of associated signs and symptoms.

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2. Risk Nursing Diagnosis
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 Is a clinical judgement that a problem does not exist,
but the presence of risk factors indicates that a
problem is likely to develop unless nurses intervene.
 For example; risk for infection in hospitalized patient.
 A client with diabetes or compromised immune system
is at higher risk than others.
 Therefore the nurse would appropriately use the label
Risk for infection, Risk for injury to describe the clients
health status.

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3. Wellness Diagnosis
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Health promotion nursing diagnosis…
 “Describes human responses to levels of wellness in an individual, family or
community that have a readiness for enhancement”.
(NANDA international 2005, p. 277)
 A diagnosis representing healthy response of client who desires to achieve a
higher level of wellness.
Or
 Clinical judgment about a person’s, families or communities motivation and
desire to increase well being
 Example: potential for enhanced nutrition.
 E.g. Readiness for enhanced spiritual well-being or Readiness for enhanced
family coping.
 Readiness for enhanced self esteem.

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4. Possible Nursing Diagnosis
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 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.
 E.g. An elderly widow who lives alone is admitted to the
hospital. Nurses notices that she has no visitors and is pleased
with attention and conversation form the nursing staff. Until
more data are collected, the nurses may write a nursing
diagnosis of,
 Possible social isolation related to unknown etiology.
 Potential risk of constipation as a result of enforced bed rest.

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5. Syndrome Diagnosis
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 Is a diagnosis that is associated with a cluster of other
diagnosis.
(carpenito – Moyet, 2006).
 Risk for disuse syndrome, for example, may
experienced by long-term bedridden clients.
 Clusters of diagnosis 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.

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3. Describe The Components of a NANDA Nursing
Diagnosis
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A nursing diagnosis has three components:
1. The problem and its definition
2. The etiology
3. The defining characteristics

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1. Problem (Diagnostic Label) And Definition
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 The problem statement, or diagnostic label,
describes the client’s health problem or response for
which nursing therapy is given.
 Purpose:
 The purpose of diagnostic label is to direct the
information of client and desired outcomes. It may
also suggest some nursing intervention.

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Characteristics Of Diagnostic Label Or Problem
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 To be clinically useful, diagnostic labels need to be
specific; Each diagnostic label approved by
NANDA carries a definition that clarifies its
meaning.
 The nurse states the area in which the problem
occurs, E.g. Deficient Knowledge (Medication) or
Deficient Knowledge (Dietary adjustments).

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Continue…….
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 Qualifiers; Are words that have been added to
some NANDA labels to give additional meaning to
the diagnostic statement;
For example;
1. Deficient ( inadequate in amount, quality, or
degree; not sufficient; incomplete)
2. Impaired (weekend, damaged, reduced)
3. Decreased ( lesser in size, amount, or degree)

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Continue….
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4. Ineffective ( not producing the desired effect)
5. Compromised ( to make vulnerable to threat)
6. Acute (severe or of short duration)
7. Chronic ( lasting for a long time)
8. Imbalanced, Interrupted

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2. Etiology (Related Factors and Risk Factors)
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 The etiology component of a nursing diagnosis
identifies one or more probable causes of the
health problem, gives directions to the required
nursing therapy.
 Enables the nurses to individualized client care.

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PROBLEM ETIOLOGY
1. Activity intolerance
2. Constipation
3. Anxiety
Bed rest or immobility ,
generalized weakness,
imbalance between oxygen
supply and demand, sedentary
life style
Long term laxative use,
inactivity and insufficient fluid
intake
Threat to physiologic integrity:
Possible cancer diagnosis causes
of the health problem.

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3. Defining Characteristics
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 Defining characteristics are the cluster of signs and
symptoms that indicate the presence of a particular
diagnostic label / health problem.
 For Actual Nursing diagnosis: The defining
characteristics are the client signs and symptoms.
 For Risk Nursing diagnosis: No subjective and
objective signs are present.

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 Major Defining Characteristics: Must be present
for valid diagnosis.
 Minor Defining Characteristics: May or may not be
present.
 Example: For a nurse to make diagnosis of Activity
intolerance, client would need to exhibit the
defining characters of altered response to activity,
which may be dyspnoea or tachypnoea etc.

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4. Differentiate Between A Nursing
Diagnosis And Medical Diagnosis
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Category Nursing diagnosis Medical diagnosis
1. Formulation Formulated by a registered
nurse on the basis of
knowledge, experience
and according to need of
the patient.
Formulated by the
physician on the basis of
subjective and objective
data and describes a
disease only.
2. Description Describe human response to
disease process or health
problem; consist of a one,
two or three part
statement, usually including
problem & etiology.
Describe disease &
pathology; do not consider
other human responses;
usually consist of not more
than three words.
3. Orientation and
responsibility for
diagnosing
Oriented to the individual;
nurses responsible for
diagnosing.
Oriented to pathology;
physician responsible for
diagnosing.

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Continue….
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Category Nursing diagnosis Medical diagnosis
4. Treatment orders Nurse orders most
interventions to prevent and
treat.
Physician orders primary
interventions to prevent
and treat.
5. Nursing focus Treat and prevent Implement medical orders
for treatment and monitor
status of condition.
6. Nursing actions Independent Dependent

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Continue….
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Category Nursing diagnosis Medical diagnosis
7. Duration Can change frequently. Remains the same while
disease is present.
8. Classification system Classification system is
developed and being used
but is not universally
accepted.
Well-developed
classification system and
accepted universally by the
medical profession.
9. Example Activity intolerance related
to decreased cardiac out
put.
Myocardial infarction.

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Differentiate Between A Nursing Diagnosis And Medical
Diagnosis
 A nursing diagnosis is a
statement of nursing
judgment that made by
nurse, by their education,
experience, and expertise,
are licensed to treat.
 Nursing diagnoses describe
the human response to an
illness or a health problem.
 A medical diagnosis is
made by a physician and
refers to a condition that
only a physician can treat
 Medical diagnoses refer
to disease processes.
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Nursing Diagnosis Medical Diagnosis

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 Nursing diagnoses may
change as the client’s
responses change.
 Nursing diagnosis
 Ineffective breathing
pattern;
 Activity intolerance;
 Acute pain;
 Disturbed body image;
 Medical diagnosis remains
the same for as long as
the disease is present.
 Medical diagnosis
 Asthma
 Cerebrovascular accident
 Appendicitis
 Amputation
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Nursing Diagnosis Medical Diagnosis

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5. Identify The Clinical Skills Needed
To Make Nursing Diagnoses
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 The diagnostic process uses the critical -thinking
skills of analysis and synthesis.
 Critical thinking: It is a cognitive process during
which a person reviews data and considers
explanations before forming an opinion.
 Analysis: it is the separation into components, that
is, the breaking down of the whole into its parts.

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Continue…
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 Synthesis: It is just opposite to the analysis, that is
putting together of parts into the whole.
 An experienced nurse may enter a client’s room and
immediately observe significant data to form
diagnostic statement while a novice nurse needs
guidelines to understand and formulate nursing
diagnosis.

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The Diagnostic Process
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The diagnostic process has three steps.
Steps of diagnostic process
1. Analysing data
2. Identify health problems, risks, and strengths
3. Formulating diagnostic statements
1. Analyzing data;
 Compare data against standards (Identify significant cues).
 Cluster cues (generate tentative hypothesis)
 Identifies gaps and inconsistencies

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Analyzing Data: 1- Comparing data against
standards (Identify significant cues)
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 A standard or norm is generally accepted measure, rule, model
or pattern. The nurses uses a wide range of standards, such as
growth and development patterns, normal vital signs, and
laboratory values.
 A cue is considered significant if it does any of the following.
 1. Points to negative or positive change in a client’s health status
or pattern. E.g. the client states that “I have recently experienced
shortness of breath.
 2. The cue varies from norms of the client population. The client’s
pattern may fit within cultural norms but vary from norms of the
general society.
 3. The cue indicates a developmental delay

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Analyzing Data: 2- Clustering cues
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 To determine the relatedness of facts and
determining whether any pattern is present among
cues.
 The nurse may cluster data inductively by combining
data from different assessment areas to form a
pattern. ( Gordon’s pattern).
 Data clustering also involves making inferences
about the data. An inference is nurse’s judgment or
interpretation of cues.

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Analyzing Data: 3- Identifies gaps and inconsistencies
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 Inconsistencies are conflicting data.
 Skilled assessment minimizes gaps and
inconsistencies in analysis of data.
 For example if a client reports not having seen a
doctor in 15 years. Yet during the physical
examination he states, “My doctor takes my B.P.
every year”.

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Identifying Health Problems, Risks And Strengths
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The nurse and client can together identify strengths
and problems.
 Primarily decision making process
 Determining problems and risks:
 The nurse and client can together identify problem
that support tentative actual, risk and possible
diagnoses. It is also determine whether the client’s
problem is Nursing diagnosis, Medical diagnosis or
Collaborative problem.

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 Determining strengths:
 The nurse and client also establish the client’s
strengths, resources, and abilities to cope. A client’s
strength might be his weight that is with in the
normal range for age and height. Might be his
ability to cope, might be his state of nonsmoking.

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Formulating Diagnostic Statements
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 Basic Two - part statements
 Basic Three - part statements
 One - part statement

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Formulating Diagnostic Statements
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Basic Two - part statements: PE format
1. Problem (P): Statement of the client’s responses
(NANDA label).
2. Etiology (E): Factors contributing to or probable
causes of the responses.
 The two parts are joined by the words “related to”
rather than due to. “Related to” phrase implies a
relation ship.
 Structure: problem + related to + etiology

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Example:
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Problem Related to Etiology
Constipation Related to Insufficient Fluid Intake
Acute Pain Related to Presence Of Surgical Incision
Insomnia Related to Hospitalization

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Basic Three – Part Statements
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The basic three part nursing diagnosis statement is
called the PES format used for actual diagnosis and
includes the following:
1. Problem (P): statement of the client’s responses
(NANDA label)
2. Etiology (E): factors contributing to or probable
causes of the responses
3. Signs and symptoms (S): Defining characteristics
manifested by the client.

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Continue….
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 Actual nursing diagnoses can be documented by
using the three part statement because the signs
and symptoms have been identified.
 Not used for risk diagnosis because the client does
not have the signs and symptoms of the diagnosis.
 The PES format is especially recommended for
beginning diagnosticians because the signs and
symptoms validate why the diagnosis was chosen
and make the problem statement more descriptive.

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Continue……
structure: Problem + Related to + Etiology + as manifested by + signs and symptoms.
E.g.: Basic three - part Diagnostic statement:
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Problem Related to Etiology As manifested
by
Sign &
symptoms
Acute pain r/t surgical incision as manifested
by
Patient
discomfort and
pain scale.
Ineffective
airway
clearance
r/t accumulation of
pulmonary
secretions
as manifested
by
crackles on
auscultation
Hyperthermia r/t underlying
infectious
process
as manifesed
by
temperature
100 F

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 Acute pain related to abdominal surgery as
evidenced by patient discomfort and pain scale.
 Problem; Pain
 Etiology; Surgery of abdomen
 Signs and symptoms; Pain scale and discomfort of
patient

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One – Part statements
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 Some diagnostic statements consist of only one part,
such as wellness diagnoses and syndrome nursing
diagnoses, they consist of NANDA diagnostic label.
 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.

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 Example:
 Adding an etiology to Rape - Trauma Syndrome does
not make the any more descriptive or useful.
 Readiness for enhanced parenting.
 Currently NANDA list includes health seeking
behaviours, Anticipatory grieving, effective breast
feeding.

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Variation Of Basic Formats
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 Writing unknown etiology
 Using the phrase complex factors
 Using the word possible
 Using secondary to, to divide the etiology
 Adding a second part to the general response

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Avoiding Errors In Diagnostic Reasoning
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 Verify
 Build a good knowledge base and acquire clinical
experience
 Have a working knowledge of what is normal
 Consult resources
 Base diagnosis on patterns
 Improve critical thinking skills

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Assignment
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Formulate at least 5 nursing diagnosis of A patient
having fracture.

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