Types of NANDA-I Nursing Diagnosis

TYPES OF NANDA-I NURSING DIAGNOSIS

1. TYPES OF NANDA–I NURSING
DIAGNOSIS

2. Types of Nursing Diagnosis
Thereare4typesofnursingdiagnosis
accordingtoNANDA-I.Theyare:
•Problem-focused (Actual)
•Risk (Potential)
•Health promotion–Wellness
•Syndrome

3. Problem-focused (Actual)
•Aproblem-focusednursingdiagnosisis
a“clinicaljudgmentconcerningan
undesirablehumanresponsetohealth
condition/lifeprocessesthatexistinan
individual,family,group,orcommunity.

4. Cont..,
•Apatientproblempresentduringanursing
assessmentisknownasaproblem-focused
diagnosis.
•Generally,theproblemisseenthroughout
severalshiftsorapatient’sentire
hospitalization.However,itmaybe
resolvedduringashiftdependingonthe
nursingandmedicalcare.

5. •Aproblem-focusednursingdiagnosis
containsallthreecomponentsofthePES
format:
•Problem(P)–statementofthepatient
response(nursingdiagnosis).
•Etiology(E)–relatedfactorscontributingto
thenursingdiagnosis.
•SignsandSymptoms (S)–defining
characteristicsmanifestedbythatpatient.

6. Example.
•Thecomponentsofaproblemfocused
nursingdiagnosisstatementwouldbe:
•(P)FluidVolumeExcess
•(E)Relatedtocompromisedregulatory
mechanismssecondarytoRenalfailure
(acuteorchronic)
•(S)Asmanifestedbybilateral2+pitting
edemaoftheanklesandfeet,increased
weightof10pounds,andthepatient
reports,“Myanklesaresoswollen.”

7. •Acorrectlywrittenproblemfocused
nursingdiagnosisstatementwouldlook
likethis:
•FluidVolumeExcessrelatedto
compromisedregulatorymechanisms
secondarytoRenalfailure(acuteor
chronic)asmanifestedbybilateral2+
pittingedemaoftheanklesandfeet,an
increaseweightof10pounds,andthe
patientreports,“Myanklesareso
swollen.”

8. •Anxietyrelatedtounpredictablenatureof
asthmaticepisodesasevidentby
statementsof“I’mafraidIwon’tbeableto
breathe”

9. Risk Nursing Diagnosis
•Arisknursingdiagnosisshouldbe
supportedbyevidenceofthepatient’s
vulnerabilityfordevelopingaproblem.
Differentexpertsrecommenddifferent
phrasing. NANDA-I 2018-2020
recommends usingthephrase“as
evidencedby”torefertotheriskfactors
fordevelopingthatproblem.

10. A risk nursing diagnosisapplies when risk
factors require intervention from the nurse
and healthcare team prior to a real
problem developing.

11. •Ariskdiagnosisconsistsofthefollowing:
•Problem(P)–statementofthepatient
response(nursingdiagnosis)
•SignsandSymptoms(S)–riskfactors
indicatingthevulnerabilityfordeveloping
theproblem

12. Example.
•The components of a risk diagnosis
statement would be:
•Problem (P)–Risk for Falls
•Signs and Symptoms (S)–Dizziness
and decreased lower extremity strength

13. •A correctly written risk nursing diagnosis
statement would look like this:
•Risk for Falls as evidenced by dizziness
and decreased lower extremity strength.
•Risk for Impaired Skin Integrity related to
immobility secondary to fractured hip

14. Health-Promotion Nursing
Diagnosis
•Ahealth-promotionnursingdiagnosis
statementcontainstheproblem(P)and
thedefiningcharacteristics(S).The
definingcharacteristicscomponentofa
health-promotionnursingdiagnosis
statementshouldbeginwiththephrase
“expressesdesiretoenhance’’.

15. •Thegoalofahealthpromotionnursing
diagnosisistoimprovetheoverallwell-
beingofanindividual,familyor
community.
•Problem (P)–statement of the patient
response (nursing diagnosis)
•Signs and Symptoms (S)–the patient’s
expressed desire

16. Example.
•Thecomponentsofahealthpromotion
nursingdiagnosiswouldbe:
•(P)ReadinessforEnhancedHealth
Management
•(S)Expresseddesireto“learnmoreabout
myhealthsoIcantakebettercareof
myself.”

17. •Acorrectlywrittenhealthpromotion
nursingdiagnosisstatementwouldlook
likethis:
•EnhancedReadinessforHealthPromotion
asmanifestedbyexpresseddesireto
“learnmoreaboutmyhealthsoIcantake
bettercareofmyself.”

18. Syndrome
•Asyndromeisaclusterofnursing
diagnosesthatoccurtogetherandarebest
addressedtogetherandthroughsimilar
interventions.”Tomakeasyndrome
diagnosis,twoormorenursingdiagnoses
mustbeusedasdefiningcharacteristics(S)
thatcreateasyndrome.Relatedfactors
maybeusediftheyaddclaritytothe
definition,butarenotrequired.

19. •A syndrome statement consists of these
items:
•Problem (P)–the syndrome
•Signs and Symptoms (S)–the defining
characteristics are two or more similar
nursing diagnoses

20. •A syndrome diagnosisrefers to a cluster
of nursing diagnoses that occur in a
pattern or can all be addressed through
the same or similar nursing interventions.
Examples of this diagnosis include:
•Decreased cardiac output
•Decreased cardiac tissue perfusion
•Ineffective cerebral tissue perfusion
•Ineffective peripheral tissue perfusion

21. •Possiblenursingdiagnosisisnotatypeof
diagnosisasareactual,risk,and
syndrome.
•Possiblenursingdiagnosesarea
diagnostician’soptiontoindicatethat
somedataarepresenttoconfirma
diagnosisbutareinsufficientatthistime.

22. THANK YOU ALL