The document discusses nursing diagnosis, providing information on its definition, evolution, purpose, types, components and how to formulate diagnoses. It defines nursing diagnosis as a clinical judgment about a patient's response to actual or potential health problems. Nursing diagnosis involves identifying problems, risks, and strengths to direct care. It discusses the various parts of a diagnostic statement and provides examples of common nursing diagnoses according to the North American Nursing Diagnosis Association.

1. NURSING DIAGNOSIS
Dr.Pauline Sharmila
Professor &HOD Pediatric
Department-FON, SGT University

3. Diagnosis
What is the problem?
The second step after Assessment is
formulation of Nursing Diagnosis.
Diagnosis involves judgement and critical
thinking to make the actual or potential
diagnosis. Usually more than one
diagnosis is made for a patient.

4. Evolution of Nursing Diagnosis
• Nursing Diagnosis was first mentioned in 1950’s
• Fry (1953) identified nursing diagnosis as a tool for
individualizing patient care.
• Kristine and Mary Ann were also important
pioneers.
• First National Conference for the Classification of
Nursing Diagnoses was in 1973.
• American Nurses Association (ANA) published
Standards of Nursing Practice (1973).
• North American Nursing Diagnosis Association
(NANDA)- 1982.

5. • NANDA is now known as NANDA – International
After 2002 because of its significant growth.
• NANDA has lots of Domains and each Domain has
some class - Eg:
Domain. Nutrition
– Class 1. Ingestion
– Class 2. Digestion
– Class 3. Absorption
– Class 4. Metabolism
– Class 5. Hydration

6. Definition of a Nursing Diagnosis
A nursing diagnosis is defined as “ a clinical
judgment about an individual, family or
community responses to actual and potential
health problems/life processes. Nursing
diagnosis provide the basis for selection of
nursing interventions to achieve outcomes
for which the nurse is
accountable.”(NANDA, 2009)

7. Purpose of NANDA
• To define, refine and promote a taxonomy
of Nursing diagnostic terminology of
general use to Professional Nurses.
(Taxonomy is a classification system or set
of categories arranged on the basis of
single principle or set of Principles).
• Members of NANDA:- Staff Nurses,
Clinical Specialists, Faculty, Directors of
Nursing, Deans, Theorists & Researchers.

8. Purpose of Nursing Diagnosis
• To identify nursing priorities
• Gives a direction to plan nursing
interventions
• It acts as a basis of communication for
better health outcomes in the patient
• It acts as a basis of evaluation
• It helps to sharpen the problem solving
and critical thinking skills.

9. Prioritizing Nursing Diagnosis
• Airway
• Breathing
• Circulation
Maslow’s
hierarchy
of needs

11. Actual Nursing Diagnosis
A clinical judgment about human
experience/responses to health conditions/life
processes that exist in an individual, family, or
community.

12. Examples
• Impaired physical mobility related to pain
in lower back as manifested by decreased
muscle strength.
• Impaired Skin Integrity related to pressure
over bony prominence as evidenced by
pain and redness.

13. Risk Nursing Diagnosis
Describes human responses to health
conditions that may develop in a vulnerable
individual. It is supported by risk factors that
contribute to increased vulnerability.
Problems that are likely to develop if proper
care is not taken.

14. • Risk for fall related to decreased physical
capability as manifested by weakness and
dizziness.
• Risk for injury as evidenced by altered
mobility.

15. Possible Nursing Diagnosis
•A type of diagnosis in which evidence about
a health problem is not clear and requires
more data either to support or refuse it.
•Suspected problem

16. Example
• Possible stress incontinence related to
tissue trauma during delivery.
• Possible anxiety related to loss of spouse.
• Possible decreased gastrointestinal
motility related to sedentary life style.

17. Wellness Nursing Diagnosis/
Health Promotion Diagnosis
A clinical judgment about a person’s, family’s
or community’s motivation and desire to
increase wellbeing and actualize human
health potential.

18. Example
•Readiness for enhanced parenting.
•Readiness for enhanced health
management.

19. Syndrome Nursing Diagnosis
A clinical judgment describing a specific
cluster of nursing diagnoses that occur
together, and are best addressed together
and through similar interventions.
An example of a syndrome diagnosis is:
Rape trauma syndrome.

20. Disuse syndrome includes cluster of
diagnosis as:
Impaired physical mobility, risk for ineffective
tissue integrity, risk for activity intolerance,
risk for infection, Risk for constipation, risk
for injury, risk for powerlessness, risk for
hopelessness.

21. Nanda Labels
• Altered: A change from baseline.
• Impaired: Made worse, weakened
damaged.
• Decreased: Smaller in size, amount or
degree.
• Ineffective: Not producing the desired
effects.
• Acute: Sever or short of duration.
• Chronic: Lasting a long time, recurrent.

24. Parts of the Diagnostic Statement
1. Two part statement includes:
• Problem
• Etiology
2. Three part statements:
• Problem
• Etiology
• Defining characteristics

25. Four Part Statement
These statement are the combination of
basic statement and has 4 parts
Eg:
1. High risk for impaired skin integrity
2. Pressure sore related to
3. Immobility
4. Secondary to presence of traction and
casts

26. S.No. Problem Related to Etiology
1 Clonic
Constipation
Related to Prolonged
laxative use
2 Ineffective
Breastfeeding
Related to Breast
Engorgement

27. Problem Statement (Diagnostic Label)
It describes the client’s health problem or
response for which nursing therapy is given
clearly and concisely in a few words.
Eg: Knowledge deficit (medications)
Some Qualifier are also added to give additional
meaning to the statement such as Impaired,
Decreased, Ineffective, Acute, Chronic.

28. Etiology (Related Factors & Risk
Factors)
This component identifies one or more
probable causes of health problem. It help
the nurse to give individualized patient care.
Eg: Anxiety related to hospitalization.

29. Defining Characteristics
These are the clusters of signs and
symptoms that indicate the presence of a
particular diagnostic label.
Eg: Fluid volume deficit related to decreased
oral intake manifested by dry skin and
mucus membranes.

30. Example of Nursing Diagnosis
Ineffective
Airway
Clearance
Ineffective Airway
Clearance RT fatigue
Ineffective Airway Clearance RT
fatigue AEB dyspnea at rest
Anxiety Anxiety RT change in
role functioning
Anxiety RT change in role
functioning AEB insomnia, poor eye
contact, and quivering voice
Deficient
Knowledge
Deficient Knowledge
RT misinterpretation of
information
Deficient Knowledge
RT misinterpretation of information
AEB inaccurate return
demonstration of self-injection
Spiritual Distress Spiritual Distress RT
separation from
religious ties
Spiritual Distress RT separation
from religious ties AEB crying and
withdrawal
(Data from American Nurses Association [1997] Standards of clinical nursing
practice [pp. 7-9], Washington, DC: Author).

31. How to formulate the ND
• Collect Data
• Analyse data
• Identify the patient’s
1. Problems
2. Risks
3. Strength
• Formulate the statement

34. Practice Session

35. Scenario:1
Mr. Woods is admitted with COPD. He is short
of breath, anxious, cyanosed, confused and has a
respiratory rate of 40. All of these symptoms
began yesterday when he suddenly found it
difficult to breath.
Medical diagnosis: COPD
Nursing Diagnosis?

36. Scenario:2
Subjective Data:
“I am suffering with the difficulty to eat and drink
due to sever throat pain associated with the pain and
fever”
Objective Data:
Temp: 101.2 F
Tonsils are swollen and skin is warm and poor
turgor.
Medical Diagnosis: Tonsilitis
Nursing Diagnosis?

37. Scenario :3
Mr. Nelson is 55 years old male admitted in the
hospital 24 hours ago, with the complain of sever
chest pain radiating to left arm and jaw, he has
shortness of breath and decreased pulse and
Blood pressure is 90/40 mmHg
Medical diagnosis: Myocardiatis.
Nursing diagnosis?

38. Thank You