ملتقى طلاب وطالبات جامعة الملك فيصل,جامعة الدمام - What is the nursing diagnosis?..مـاهـو التـشخيــص التـمريـضـي؟

Note: NANDA is an acronym for North American Nursing Diagnosis Association

From Kathy Quan,

What the heck is a nursing diagnosis?
I thought nurses weren't supposed to diagnose!

Nurses don't diagnose illnesses and injuries unless they have specifically trained to do so. Nurse Practitioners, for example, are trained to make a diagnosis and to prescribe treatment.

What is a Nursing Diagnosis?
A nursing diagnosis is different. It is part of the Nursing Process in which the nurse assesses the patient and develops a plan of care and evaluates the success of that plan and revises it as needed. The nursing diagnosis is a patient problem as identified by the nurse based on the nursing assessment. It is NOT a disease diagnosis.

So How Does This Work? For Example...
Mr. Smith is a fifty year old gentleman who was admitted to the hospital today for hyperglycemia (blood sugar was 530). He is lethargic and confused as to time and place, and complaining of blurry vision. His wife brought him to the hospital emergency room when he returned home from work and was acting "oddly".

His physician has suspected Type II Diabetes for awhile, but tests have been inconclusive. Mr. Smith vehemently objects to any insinuation that he has Diabetes. His wife states that his father had Diabetes and died from complications because of poor control. She says Mr. Smith has a tremendous fear of becoming diabetic and dying young like his father.

What Does the Nurse Do?
Your work as his nurse is cut out for you. The physician is taking a somewhat conservative approach and has ordered finger sticks every 2 hours until the blood sugar drops below 300. (Then every 4 hours.) He has prescribed a sliding scale insulin based on the glucose levels. Daily blood work will evaluate the accuracy of the finger sticks. A 2000 calorie ADA diet has also been ordered, and the dietician is to see the patient ASAP.

How the Nursing Process Works...
You will have to educate Mr. Smith in his new regimen. His fear, denial, and knowledge deficit about Diabetes present issues. Deficient knowledge, fear, ineffective coping, imbalanced nutrition and risk for injury would become your NANDA nursing diagnoses at this time. Your plan of care for Mr. Smith will revolve around diabetic assessment and education in relation to each of these diagnoses. Depending on how well he accepts and learns to cope with the situation will affect which nursing diagnosis becomes more primary than the others. They are all vital to his successful outcomes in learning to control his blood glucose and Diabetes as well as the long term prevention of complications.

Reassess

As Mr. Smith begins to learn about Diabetes and how his body is reacting, you will continually reassess his response to the nursing diagnoses and make necessary changes in your plan of care.
As his vision clears with lowering blood glucose levels his risk for injury is reduced. As he learns about his diet through the meal choices and a visit from the dietitian, his nutritional imbalance is reduced. As he learns the correlation to diet control and blood glucose levels his knowledge deficit is reduced. Hopefully as he learns about the ways he is controlling his blood glucose his fear will lessen and his coping will improve.

Things Don't Always Go So Smoothly...
If Mr. Smith refuses to participate in his care and has friends sneaking in junk food and sweets, his situation will worsen and your plan of care will need to be modified accordingly.

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Structure of diagnoses
The NANDA-International system of nursing diagnosis provides for five categories.

Actual diagnosis -
a statement about a health problem that the client has and the benefit from nursing care.

An example of an actual nursing diagnosis is:
Ineffective airway clearance related to decreased energy as manifested by an ineffective cough.

Risk diagnosis -
a statement about health problems that a client doesn't have yet, but is at a higher than normal risk of developing in the near future.

An example of a risk diagnosis is:
Risk for injury related to altered mobility and disorientation.

Possible diagnosis -
a statement about a health problem that the client might have now, but the nurse doesn't yet have enough information to make an actual diagnosis.

An example of a possible diagnosis is:
Possible fluid volume deficit related to frequent vomiting for three days as manifested by increased pulse rate.

Syndrome diagnosis -
used when a cluster of nursing diagnoses are seen together.

An example of a syndrome diagnosis is:
Rape-trauma syndrome related to anxiety about potential health problems as manifested by anger, genitourinary discomfort, and sleep pattern disturbance.

Wellness diagnosis
describes an aspect of the client that is at a high level of wellness.

An example of a wellness diagnosis is:
Potential for enhanced organized infant behaviour, related to prematurity and as manifested by response to visual and auditory stimuli.

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