Diagnosing

Learning Outcomes
1. Differentiate various types of nursing
diagnoses.
2. Identify the components of a nursing
diagnosis.
3. Compare nursing diagnoses, medical
diagnoses, and collaborative problems.
4. Identify basic steps in the diagnostic process.
5. Describe various formats for writing nursing
diagnoses.

Learning Outcomes
6. Describe the characteristics of a nursing
diagnosis.
7. List guidelines for writing a nursing
diagnosis statement.
8. Describe the evolution of the nursing
diagnosis movement, including work
currently in progress.
9. List advantages of a taxonomy of nursing
diagnoses.

DIAGNOSING

DIAGNOSING
In this phase, nurses use critical thinking
skills to interpret assessment data and
identify client strengths and problems.
Diagnosing is a pivotal step in the nursing
process.

DIAGNOSING

DIAGNOSING HISTORY
Began formally in 1973
Two faculty members of Saint Louis
University: Kristine Gebbie and Mary Ann
Lavin
The first national conference to identify
nursing diagnoses was sponsored by the
Saint Louis University School of Nursing
and Allied Health Professions in 1973.
Subsequent national conferences occurred in
1975, in 1980, and every 2 years thereafter.

DIAGNOSING
The purpose of NANDA International:
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 based on a single
principle or set of principles..
The group has currently approved more
than 200 nursing diagnosis labels for
clinical use and testing.

NANDA Nursing
Diagnoses

Definitions
DIAGNOSING
refers to the reasoning process
DIAGNOSIS
is a statement or conclusion regarding the
nature of a phenomenon.
DIAGNOSTIC LABELS
The standardized NANDA names for the
diagnoses
NURSING DIAGNOS
The clients problem statement, consisting
of the diagnostic label plus etiology
(causal relationship between a problem and
its related or risk factors).

NURSING DIAGNOSIS
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 (1990, NANDA)

This definition is consistent

with the following:
1. Professional nurses (registered nurses)
are responsible for making nursing
diagnoses
nurses are accountable for analyzing data
to determine diagnoses or issues.
The standard also specifies that nurses
should use standardized classification
systems when naming diagnoses
2. The domain of nursing diagnosis
includes only those health states that
nurses are educated and licensed to
treat..

This definition is consistent

with the following:
3. A nursing diagnosis is a
judgment made only after
thorough, systematic data
collection.
4. Nursing diagnoses describe a
continuum of health states:
deviations from health, presence
of risk factors, and areas of
enhanced personal growth.

Status of the Nursing

Diagnoses

Status of the Nursing

Diagnoses
Status refers to the
actuality or potentiality of the
diagnosis or the
categorization of the
diagnosis.(NANDA
International)

The kinds of nursing

diagnoses according to
status are
Actual
Health promotion
Risk
Wellness

Types of Nursing Diagnoses

1.Actual Diagnosis
Problem presents at the time of
the assessment
Presence of associated signs and
symptoms..
Examples are:
Ineffective Breathing
Anxiety

Pattern

and

Types of Nursing Diagnoses

2. Health Promotion Diagnosis
relates to clients preparedness to
implement behaviors to improve their
health condition.
These diagnosis labels begin with the
phrase Readiness for Enhanced, as in
Readiness for Enhanced Nutrition.

Types of Nursing Diagnoses

3. Risk Diagnosis
is a clinical judgment that a
problem does not exist, but the
presence
of
risk
factors
indicates that a problem is likely
to
develop
unless
nurses
intervene..
Example:
Risk for Infection

Types of Nursing Diagnoses

4.

Wellness Diagnosis
describes human
responses to levels of
wellness in an individual,
family or community.
Readiness for Enhanced Spiritual
Well- Being or Readiness for
Enhanced Family Coping.

Types of Nursing Diagnoses

Possible Diagnosis
Evidence about a health
problem incomplete or unclear
Requires more data to either
support or to refute it
Syndrome Diagnosis
Associated with a cluster of
other diagnoses

Components of a
NANDA
Nursing Diagnosis

Components of a NANDA
Nursing Diagnosis
A nursing diagnosis has
three components:
(1) the problem and its
definition
(2) the etiology
(3) the defining characteristics
Each component serves a
specific purpose.

Components of a Nursing
Diagnosis
1. Problem (Diagnostic Label) and
Definition
The problem statement, or
diagnostic label, describes the clients
health problem or response for which
nursing therapy is given.
It describes the clients health status
clearly and concisely in a few words.
The purpose of the diagnostic label is to
direct the formation of client goals and
desired outcomes.

Components of a Nursing
Diagnosis
1. Problem (Diagnostic Label) and
Definition
To be clinically useful, diagnostic labels
need to be specific; when the word
Specify follows a NANDA label, the
nurse states the area in which the
problem occurs,
for example
Deficient Knowledge (Medications) or
Deficient Knowledge (Dietary
Adjustments).

Components of a Nursing
Diagnosis

1. Problem (Diagnostic Label) and Definition

QUALIFIERS - are words that have been added to
some NANDA labels to give additional meaning
to the diagnostic statement;
For example:
Deficient (inadequate in amount, quality, or
degree; not sufficient; incomplete)
Impaired (made worse, weakened, damaged,
reduced,
deteriorated)
Decreased (lesser in size, amount, or degree)
Ineffective (not producing the desired effect)
Compromised (to make vulnerable to threat).

 Each diagnostic label approved by NANDAcarries

a definition that clarifies its meaning. For
example, the definition of the diagnostic label
Activity Intolerance is shown in Table 121.

COMPONENTS OF NURSING
DIAGNOSIS
DIAGNOSIS AND
DEFINITION

Activity
Intolerance:
Insufficient
physiological
or
psychological
energy to
endure or
complete
required or
desired

RELATED FACTORS

DEFINING
CHARACTERISTICS

Bed rest or
immobility
Generalized
weakness
Imbalance
between
oxygen
supply/deman
d
Sedentary
lifestyle

Verbal report of
fatigue or
weakness
Abnormal heart
rate or blood
pressure
response to
activity
Electrocardiogra
phic changes
reflecting
arrhythmias or
ischemia

Components of a Nursing
Diagnosis

ETIOLOGY (RELATED
FACTORS AND RISK FACTORS)
The etiology component of a
nursing diagnosis identifies one
or more probable causes of the
health problem, gives direction
to the required nursing
therapy, and enables the nurse
to individualize the clients care
2.

DIAGNOSTIC
LABEL
(PROBLEM) CLIENT
ETIOLOGY
Constipation Al
Martinez Long-term
laxative use
Jerry Wong Inactivity
and insufficient fluid
Intake
Anxiety

CLIENT

ETIOLOGY

Al Martinez
Jerry Wong

Long-term laxative use

Jerry Wong Inactivity
and insufficient fluid
Intake

Tanya Brown

Threat to physiological
integrity:
possible cancer
diagnosis
Caitlin Shea Effects of
aging (reduced
hearing, vision,
mobility)

Components of a Nursing
Diagnosis
3. Defining characteristics
Cluster of signs and symptoms
indicating the presence of a particular
diagnostic label (actual diagnoses)
Factors that cause the client to be more
vulnerable to the problem (risk
diagnoses)

Differentiating Nursing
Diagnoses
from Medical Diagnoses

Differentiating Nursing
Diagnoses
from Medical Diagnoses

NURSING DIAGNOSIS
is a statement of nursing judgment and
refers to a condition that nurses, by virtue of
their education, experience, and expertise,
are licensed to treat.
MEDICAL DIAGNOSIS IS
made by a physician and refers to a
condition that only a physician can treat.
Medical diagnoses refer to disease
processes specific pathophysiologic
responses that are fairly uniform from one
client to another.

 Nurses have responsibilities related to both

medical and nursing diagnoses.
Nursing diagnoses relate primarily to the nurses
independent functions, that is, the areas of
health care that are unique to nursing and
separate and distinct from medical management.
However, the nurse is still responsible for
identifying and responding to data that indicate
real or potential medical problems.

Differentiating Nursing
Diagnoses
from Collaborative
A collaborative
problem is a type of
Problems
potential problem that nurses manage using

both independent and physicianprescribed interventions.

Independent nursing interventions for a
collaborative problem focus mainly on
monitoring the clients condition and
preventing development of the potential
complication.

 Collaborative problems are present when a

particular disease or treatment is present;
that is, each disease or treatment has
specific complications that are always
associated with it.
For example, a statement of collaborative
problems is Potential complications of
pneumonia: atelectasis, respiratory failure,
pleural effusion, pericarditis, and meningitis.

Nursing and Medical

Diagnosis, and Collaborative
Problems
Differences Based
on
Description
Orientation
Responsibility for diagnosing
Treatment orders
Nursing focus
Nursing actions
Duration
Classification system

Nursing Diagnoses
Describes human responses to disease
processes/health problems
Oriented to the client
Nurse responsible for diagnosing,
treatment orders, actions
May change frequently
Classification system in development

Medical Diagnoses

Describes disease and pathology

Does not consider human responses
Oriented to pathology
Physician responsible for diagnosing and
treatment orders
Nurse implements orders and monitors client
status
Nursing actions dependent
Diagnosis remains as long as disease present
Well-developed and accepted classification

Collaborative Problems
Physiologic complications of disease, tests,
treatments
Oriented to pathophysiology
Nurse and physician diagnose
Physician orders definitive treatment
Independent nursing action for monitoring
and preventing
Dependent nursing actions for treatment
Present when disease/situation present
No classification system

The Diagnostic Process

 critical thinking, a person reviews data and

considers explanations before forming an opinion
Analysis is the separation into components, that
is, the breaking down of the whole into its parts
(deductive reasoning).
Synthesis is the opposite, that is, the putting
together of parts into the whole (inductive
reasoning).

Steps in Diagnostic Process

Analyzing Data
Compare data against standards
Cluster cues
Identify gaps and inconsistencies
Identifying health problems, risks, and
strengths
Formulating diagnostic statements

1. Comparing Data with

Standards
Nurses draw on knowledge and

experience to compare client data

to standards and norms and identify
significant and relevant cues.
A standard or norm is a generally
accepted measure, rule, model, or
pattern.

2.2 Clustering Cues

Data clustering or grouping of cues is a
process of determining the relatedness
of facts and determining whether any
patterns are present, whether the data
represent isolated incidents, and
whether the data are significant.
This is the beginning of synthesis.

Identifying Gaps and

Inconsistencies in Data

Skillful assessment minimizes gaps and

inconsistencies in data. However, data
analysis should include a final check to
ensure that data are complete and correct.
Inconsistencies are conflicting data.
Possible sources of
conflicting data include measurement
error, expectations, and inconsistent or
unreliable reports.

Identifying Health Problems,

Risks, and Strengths

Determining Problems and

Risks
After grouping and clustering
the data, the nurse and client
together identify problems
that support tentative actual,
risk, and possible diagnoses.

Writing Nursing Diagnoses

Basic Two-Part Statement
Problem (P)
Etiology (E)
The two parts are joined by the
words related to rather than
due to. The phrase due to
implies that one part causes or is
responsible for the other part. By
contrast, the phrase related to
merely implies a relationship.

 For NANDA labels that contain the word

Specify, the nurse must add words to
indicate the problem more specifically.
The format is still a two-part statement.
For example, Noncompliance (Specify)
would be Noncompliance (Diabetic Diet)
related to denial of having disease.

Writing Nursing Diagnoses

Basic Two-Part Statement
Problem (P)
Etiology (E)
Basic Three-Part Statement
Problem (P)
Etiology (E)
Signs and symptoms (S)

Writing Nursing Diagnoses

One-Part Statement
Wellness (readiness for enhanced)
Syndrome
Variations
Unknown etiology
Complex factors
Possible
Secondary
Other additions for precision

Characteristics of a
Nursing Diagnosis
Have diagnostic labels
Consist of the diagnostic label plus
etiology
Professional nurses responsible for making
nursing diagnoses
A judgment made only after thorough,
systematic data collection
Describes a continuum of health states

Guidelines for Writing a

Diagnostic
State in terms Statement
of a problem, not a need.

Word the statement so that it is legally advisable.

Use nonjudgmental statements.
Make sure that both elements of the statement
do not say the same thing.
Be sure that cause and effect are correctly stated.
Word the diagnosis specifically and precisely
Use nursing terminology rather than medical
terminology to describe the clients response and
probable cause of clients response

Improve Diagnostic
Reasoning

Verify diagnoses by talking with the client

and family
Build a good knowledge base and acquire
clinical experience
Have a working knowledge of what is
normal
Consult resources
Base diagnoses on patterns
Improve critical-thinking skills

Evolution of Nursing
Diagnoses
First Taxonomy Alphabetical

Taxonomy II

Domains
Classes
Nursing diagnoses
Seven axes

Process for Acceptance on New Diagnosis

NIC
NOC

Taxonomy II

Taxonomy II

Advantages of a Taxonomy of
Nursing
Development
of a standardized nursing
Diagnoses
language
Nursing minimum data set

Post Test
Use your clickers to complete the following
post test.

Question 1
The nurse is conducting the diagnosing phases
(nursing diagnosis) for a client with a seizure
disorder. Which of the following elements exists
between data analysis and formulating the
diagnostic statement?
1.
2.
3.
4.

Assess the clients needs.

Delineate the clients problems and strengths.
Determine which interventions are most likely to
succeed.
Estimate the cost of several different approaches.

Rationales 1
1. This is assessment.
2. Correct. In diagnosing, data from assessment
(option 1) are analyzed and problems, risks,
and strengths are identified before diagnostic
statements can be established.
3. Interventions are more commonly part of the
planning and implementing phases of the
nursing process.
4. Cost is an important consideration but would
be estimated in the planning phase.

Question 2

1.
2.
3.
4.

In the diagnostic statement Excess fluid

volume related to decreased venous
return as manifested by lower extremity
edema (swelling), the etiology of the
problem is which of the following?
Excess fluid volume.
Decreased venous return.
Edema.
Unknown.

Rationales 2
1. Excess Fluid Volume is the nursing
diagnosis.
2. Correct. Because the venous return is
impaired, fluid is static, resulting in
swelling. Therefore, decreased venous
return is the cause (etiology) of the
problem.
3. Edema of the lower extremity is the
sign/symptom or critical attribute.
4. The cause is known.

Question 3
Which of the following nursing diagnoses
contains the proper components?
1. Risk for caregiver role strain related to
unpredictable illness course.
2. Risk for falls related to tendency to collapse
when having difficulty breathing.
3. Decreased communication related to stroke.
4. Sleep deprivation secondary to fatigue and
a noisy environment.

Rationales 3
1. Correct. States the relationship between the
stem (caregiver role strain) and the cause of
the problem.
2. The diagnostic statement says the same thing
as the related factor (falls and collapse).
3. It is inappropriate to use medical diagnoses
such as stroke within a nursing diagnosis
statement.
4. Option 4 is vague. The statement must be
specific and guide the plan of care (fatigue
may be a result of sleep deprivation and does
not direct intervention)

Question 4
One of the primary advantages of using a
three-part diagnostic statement such as
the problem-etiology-signs/symptoms (PES)
format includes which of the following?
1. Decreases the cost of health care.
2. Improves communication between nurse
and client.
3. Helps the nurse focus on health and
wellness elements.
4. Standardizes organization of client data.

Rationales 4
1. More efficient planning may or may not
reduce health care cost.
2. Nursing diagnostic statements should be
confirmed with the client but using PES does
not ensure this.
3. PES statements can be wellness or illness
focused.
4. Correct. The PES format assists with
comprehensive and accurate organization of
client data.

Question 5
A collaborative (multidisciplinary) problem is
indicated instead of a nursing or medical diagnosis:
1.
2.
3.
4.

If both medical and nursing interventions are

required to treat the problem.
When independent nursing actions can be utilized
to treat the problem.
In cases where nursing interventions are the
primary actions required to treat the problem.
When no medical diagnosis (disease) can be
determined.

Resources
Audio Glossary
NDEC
A research team from the University of Iowa
refined, extended, validated, and classified
nursing diagnoses in collaboration with North
American Nursing Diagnosis Association. Presents
information obtained through this study.
NANDA International
Official Web site of NANDA that offers information
and links on nursing diagnosis.

Resources
PDA cortex
Freeware offered for students to download nursing
diagnoses onto the computer
Michigan Nurses Association: Standardized Nursin
g Language
The MNA's statement on the incorporation of
nursing diagnoses into practice.
The University of Iowa's Nursing Classification
Overview and information on nursing classification
and outcomes
Guidelines for Composing a Nursing Diagnosis
Guidelines and educational links on the
development of nursing diagnosis

Question 1
The nurse is conducting the diagnosing phases
(nursing diagnosis) for a client with a seizure
disorder. Which of the following elements exists
between data analysis and formulating the
diagnostic statement?
1.
2.
3.
4.

Assess the clients needs.

Delineate the clients problems and strengths.
Determine which interventions are most likely to
succeed.
Estimate the cost of several different approaches.

Rationales 1
1. This is assessment.
2. Correct. In diagnosing, data from
assessment (option 1) are analyzed and
problems, risks, and strengths are identified
before diagnostic statements can be
established.
3. Interventions are more commonly part of the
planning and implementing phases of the
nursing process.
4. Cost is an important consideration but would
be estimated in the planning phase.

Question 2

1.
2.
3.
4.

In the diagnostic statement Excess fluid

volume related to decreased venous
return as manifested by lower extremity
edema (swelling), the etiology of the
problem is which of the following?
Excess fluid volume.
Decreased venous return.
Edema.
Unknown.

Rationales 2
1. Excess Fluid Volume is the nursing
diagnosis.
2. Correct. Because the venous return is
impaired, fluid is static, resulting in
swelling. Therefore, decreased venous
return is the cause (etiology) of the
problem.
3. Edema of the lower extremity is the
sign/symptom or critical attribute.
4. The cause is known.

Question 3
Which of the following nursing diagnoses
contains the proper components?
1. Risk for caregiver role strain related to
unpredictable illness course.
2. Risk for falls related to tendency to collapse
when having difficulty breathing.
3. Decreased communication related to stroke.
4. Sleep deprivation secondary to fatigue and
a noisy environment.

Rationales 3
1. Correct. States the relationship between the
stem (caregiver role strain) and the cause of
the problem.
2. The diagnostic statement says the same thing
as the related factor (falls and collapse).
3. It is inappropriate to use medical diagnoses
such as stroke within a nursing diagnosis
statement.
4. Option 4 is vague. The statement must be
specific and guide the plan of care (fatigue
may be a result of sleep deprivation and does
not direct intervention)

Question 4
One of the primary advantages of using a
three-part diagnostic statement such as
the problem-etiology-signs/symptoms (PES)
format includes which of the following?
1. Decreases the cost of health care.
2. Improves communication between nurse
and client.
3. Helps the nurse focus on health and
wellness elements.
4. Standardizes organization of client data.

Rationales 4
1. More efficient planning may or may not
reduce health care cost.
2. Nursing diagnostic statements should be
confirmed with the client but using PES does
not ensure this.
3. PES statements can be wellness or illness
focused.
4. Correct. The PES format assists with
comprehensive and accurate organization of
client data.

Question 5
A collaborative (multidisciplinary) problem is
indicated instead of a nursing or medical diagnosis:
1.
2.
3.
4.

If both medical and nursing interventions are

required to treat the problem.
When independent nursing actions can be utilized
to treat the problem.
In cases where nursing interventions are the
primary actions required to treat the problem.
When no medical diagnosis (disease) can be
determined.

Rationales 5
1. Correct. A collaborative (multidisciplinary)
problem is indicated when both medical and
nursing interventions are needed to prevent or
treat the problem.
2. If nursing care alone (whether that care involves
independent or dependent nursing actions) can
treat the problem, a nursing diagnosis is indicated.
3. If nursing care alone (whether that care involves
independent or dependent nursing actions) can
treat the problem, a nursing diagnosis is indicated.
4. If medical care alone can treat the problem, a
medical diagnosis is indicated.