Nursing diagnosis

Nursing Diagnosis Process

1. NURSINGDIAGNOSISBy:-DeveshwarP.D.

2. NURSINGDIAGNOSIS
Definition:NorthAmericanNursingDiagnosisAssociation(NANDA,1992)definesnursingdiagnosisasfollowing:-Aclinicaljudgementaboutindividual,familyorcommunityresponsestoactualandpotentialhealth/lifeprocesses.Nursingdiagnosisprovidesthebasisforselectionofnursinginterventionstoachieveoutcomesforwhichthenurseisaccountable.ORGordon(1976)definednursingdiagnosisasaActualorPotentialhealthproblemswhichnursesbyvirtueoftheireducationandexperiencesarecapableandlicensedtotreat.
PURPOSESOFNURSINGDIAGNOSISToanalyzecollecteddata.Toidentifyclient'snormalfunctional

3. levelstatement.Toidentifytheclient'sstrengthandweaknesses.Toformulateadiagnosticweaknesses.
CHARACTERISTICSOFNURSINGDIAGNOSISItstatesaclearandconcisehealthproblemItisderivedfromexistingevidencesabouttheclientItispotentiallyamenabletonursingtherapyItisthebasisforplanningandcarryingoutnursingcareIMPORTANCEOFNURSINGDIAGNOSISRememberingandwritingnursingdiagnosistaxonomyisnotaeasyjob.Itisareallyirksomework.Butifeverynursereads/understandstheimportanceofwritingdiagnosis,itissurethateverynursewillstart

4. labelingit.Nursingdiagnosistaxonomyprovidesacommonlanguageforcommunication.Ithelpstounderstandinbetterway.Example:Ifnursingdiagnosisforclientis:"Activityintolerancer/tprolongedbedrest"Whereverthenurseisresiding,everyonewillunderstanditbecauseallnursesarefollowingonetaxonomyi.e.NANDA.Itprovidesameansofcommunicatingtoothernurses,healthcareteam.Asnursingdiagnosisisframedbynurseandsheislicensedtotreatitindependently.ItfacilitatesdevelopmentofNurse'sautonomy.Ithelpsthenursestobeaccountablefortheirprofession.Makingaccuratenursingdiagnosishelpstoensurethatclientreceivesqualitynursingcare.Thus,itservesasafocusforqualityimprovement.

5. Nursingdiagnosisgivesdirectionforplanningnursingintervention.Nursingdiagnosistaxonomyhelpstobridgegapbetweenknowledgeandpractice•Ultimatleyenhancesthescopeofnursingpractice,whichisveryimportantfordevelopingnurse'sprofessionalroleinhealthcare.

6. DIFFERENCEINMEDICALDIAGNOSISANDNURSINGDIAGNOSIS

7. TYPESOFNURSINGDIAGNOSIS
a)Actualdiagnosisrepresentsaproblemwhichhasmanydefiningcharacteristics.Itisajudgementaboutaclient'sresponsetoahealthproblemthatispresentatthetimeofnursingassessment(Problem+Etiology+S/S).Itisbasedonthepresenceofsignsandsymptoms.Examples:ImbalancedNutrition:Lessthanbodyrequirementsr/tdecreasedappetitenausea

8. DisturbedSleepPatternr/tcough,feverandpainConstipationr/tlongtermuseoflaxativeIneffectiveairwayclearancer/ttoviscoussecretionsAcutePain(Chest)r/tcoughssecondarytopneumoniaActivityIntolerancer/tgeneralweaknessb)Highriskdiagnosisdescribesapotentialproblem.Itmeansclientisproneotdevelopaproblemthanotherproblemsif

9. leftinsimilarcondition.Itisaclinicaljudgmentthataproblemdoesnotexist,thereforenoS/Sarepresent,butthepresenceofriskfactorsisindicatesthataproblemisonlyislikelytodevelopunlessnurseinterveneordosomethingaboutit(Problem+RiskFactors).Nosubjectiveorobjectivecuesarepresentthereforethefactorsthatcausetheclienttobemorevulnerabletotheproblemaretheetiologyofarisknursingdiagnosis.Examples:Anobeseclientisundergoneforhipreplacementsurgery.Aspatientisimmobile/bedridden,nursemayfollownursingdiagnosisframe.

10. 1)"Riskforimpairedskinintegrityr/tsurgery.Presentlyclientdoesnothavepressureulcer,butifremainsbedriddenforlongtime,withoutchangingposition,heisathighrisktodeveloppressureulcer.2)"Highriskforinfectionr/thospitalizationimmunosuppressedmedication.
c)Wellnessdiagnosisisaclinical

11. judgementaboutanindividualfamilycommunityintransitionfromaspecificlevelofwellnesstoahigherlevelofwellness"(Carpenito1993)Example:Birthofnewborntwins.Wellnessnursingdiagnosis:PotentialforgrowthrelatedtoanunexpectedbirthOftwins.d)Syndromediagnosis:Clusterofactualorhighrisknursingdiagnosesthatarepredictedtobepresentbecauseofcertaineventorsituation.(Carpenito1993)Example:RapeTraumaSyndrome.STATEMENTOFNURSINGDIAGNOSISNursingdiagnosisgivedirectioninplanning

12. goalorientednursingcare.NursingDiagnosticstatementconsistsofthreeparts:problem,etiologyanddefiningcharacteristics.
I.Problem:Itdescribesclient'sresponseforwhichnursingcareisgiven.Nursestatesthe1,areaclearlyandconciselyinwhichtheproblemoccurs.Example:Knowledgedeficit,Acute,Chronic,Ineffective,andDecreasedetc.Knowledgedeficitindiet.II.Etiology:Etiologycomponentofdiagnosisidentifiesoneormorecausesofhealthproblem.Etiologyshouldgivedirectioninplanningnursinginterventions.

13. Ithelpsthenursetogiveindividualizedpatientcarebecausetwopatientsmayhavesameproblem.
III.Definingcharacteristicsarethesignsandsymptomsofproblemwhichhelpsinvalidatingthenursingdiagnosis.Itincludessubjectiveorobjectivedata.Example:Fluidvolumedeficitrelatedtodecreasedoralintakemanifestedbydryskinandmucous

14. membranes.Riskforimpairedskinintegrityrelatedtoimmobilitymanifestedbyrednessonsacralregion.NURSINGDIAGNOSISNew&ApprovedNANDANursingDiagnosisListfor2012-2014l.RiskforIneffectiveActivityPlanning2.RiskforAdverseReactiontoIodinatedContrastMedia3.RiskforAllergyResponse4.InsufficientBreastMilk5.IneffectiveChildbearingProcess6.RiskforIneffectiveChildBearing

15. Process7.RiskforDryEye8.DeficientCommunityHealth9.IneffectiveImpulseControl10.RiskforNeonatalJaundice11.RiskforDisturbedPersonalIdentity12.IneffectiveRelationship13.RiskforIneffectiveRelationship14.RiskforChronicLowSelf-Esteem15.RiskforThermalInjury16.RiskforIneffectivePeripheralTissuePerfusionSOURCESOFERRORINNURSINGDIAGNOSISA.Problemincollectingdatasuchas-

16. Lackofknowledge.Lackofskill.Inaccuratedata.Missingdata.Disorganizeddata.B.ProblemininterpretationofDatasuchas-Inaccurateinterpretationofcues.Failuretoconsiderconflictingcues.Useofinvaliddata.Givinglessconsiderationtoculturalinfluenceanddevelopmentstage.

17. C. ProbleminlabelingNursingdiagnosissuchas-Wrongselectionofdiagnosticlabel.Failuretovalidatenursingdiagnosiswithpatient.Failuretoseekguidance.
ROLEOFNURSE
Nursemusthaveuptodategoodknowledgebaseandclinicalexperience.Nurseshouldhaveknowledgeofnotonlynursingsubjectsbutalsoofothersubjects: chemistry, biochemistry,pharmacologyetc.

18. Itwillhelphertounderstandclient'sdata.Nurseshouldhaveuptodateclinicalknowledge.NormalvalueofBP,temperature,Bloodcount,ESR.Alongwiththis,sheshouldknowwhatisnormalforaparticularpersonkeepinginmindage,education,occupation,lifestyle,cultureandreligionetc.Insteadofproceedingwithmisseddata,nurseshouldinteractwithclientagainandshouldhavecompleteinformation.Nurse should verify theconflicting/ambiguousdata/cues.Shecan

19. consultherexpertcolleagues,recordsetc.Incaseofdoubtinlabelingnursingdiagnosis,nurseshouldberesourcefuli.e.consult/useanursingdiagnosishandbook.ShecankeeplistofNANDAdiagnosisinherpocketdiary.Asnurseisdealingwithhumanlife,sheshouldneverhesitatetotakeexpertopinion.Nurseshouldimprovecriticalthinkingskill.Nurseshouldstate/labeldiagnosisbriefly,specifically.Nurseshouldidentifyoneproblemineachnursingdiagnosis.

20. Nursingdiagnosismustbebasedonpatient'sdatabase.Nurseshouldkeepinmindthatproblemandcauseisnotsamething.Forexample:Alterationincomfortrelatedtofractureofrighthip.(Wrong)Alterationincomfortassociatedwithpaininrighthip.(Right)Alwaysstatenursingdiagnosisinawaythatdirectsnursinginterventions/strategies.Example:Anxietyrelatedtodiagnostictest.Sleeppatterndisturbancerelatedtohospitalization.