1. 12
Diagnosing

2. Directory Classroom Response System Questions
Lecture Note Presentation

3. Classroom Response System Questions

4. Question 1
The nurse is conducting the diagnosing phase (nursing diagnosis) of the nursing process for a client with a seizure disorder. Which step exists between data analysis and formulating the diagnostic statement?
Assess the client’s needs.
Delineate the client’s problems and strengths.
Determine which interventions are most likely to succeed.
Estimate the cost of several different approaches.

5. Question 1 Answer Assess the client’s needs.
Delineate the client’s problems and strengths.
Determine which interventions are most likely to succeed.
Estimate the cost of several different approaches.

6. Question 1 Rationales Gathering data about client needs is assessment.
Correct. In diagnosing, data from assessment are analyzed and problems, risks, and strengths are identified before diagnostic statements are established.
Interventions are established in the planning phase and carried out in the implementation phase of the nursing process.
Cost is an important consideration but would be estimated in the planning phase.

7. Question 2
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

8. Question 2 Answer Excess fluid volume Decreased venous return Edema
Unknown

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

10. Question 3
Which of the following nursing diagnoses contains the proper components?
Risk for Caregiver Role Strain related to unpredictable course of illness
Risk for Falls related to tendency to collapse when having difficulty breathing
Impaired Communication related to stroke
Sleep Deprivation secondary to fatigue and a noisy environment

11. Question 3 Answer
Risk for Caregiver Role Strain related to unpredictable course of illness
Risk for Falls related to tendency to collapse when having difficulty breathing
Impaired Communication related to stroke
Sleep Deprivation secondary to fatigue and a noisy environment

12. Question 3 Rationales
Correct. States the relationship between the stem (Caregiver Role Strain) and the cause of the problem.
The diagnostic statement here says the same thing as the related factor (falls and collapse).
It is inappropriate to use medical diagnoses such as stroke within a nursing diagnosis statement.
Option D 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).

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

14. Question 4 Answer Decreases the cost of health care
Improves communication between nurse and client
Helps the nurse focus on health and wellness elements
Standardizes organization of client data

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

16. Question 5
A collaborative (multidisciplinary) problem is indicated instead of a nursing or medical diagnosis:
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.

17. Question 5 Answer
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.

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

19. Lecture Note Presentation

20. Learning Outcomes Differentiate nursing diagnoses according to status.
Identify the components of a nursing diagnosis.
Compare nursing diagnoses, medical diagnoses, and collaborative problems.
Identify basic steps in the diagnostic process.

21. Learning Outcomes (cont'd)
Describe various formats for writing nursing diagnoses.
List guidelines for writing a nursing diagnosis statement.
Describe the evolution of the nursing diagnosis movement, including work currently in progress.

22. Nursing Diagnosis
Prior step of nursing process leads up to formation of nursing diagnoses
All other steps flow from nursing diagnoses
Problems nurses identify and treat
Taxonomy to categorize client problems or needs
NANDA

23. Figure 12-1 Diagnosing. The pivotal second phase of the nursing process.23

24. Diagnosing Diagnosing refers to the reasoning process
Diagnosis -a statement or conclusion regarding the nature of a phenomenon
Diagnostic labels are standardized NANDA names
Nursing diagnosis - problem statement consisting of diagnostic label plus etiology

25. Types of Nursing Diagnoses
Actual diagnosis
Problem presents at the time of assessment
Presence of associated signs and symptoms
Health promotion diagnosis
Preparedness to implement behaviors to improve their health condition
Example: Readiness for Enhanced Nutrition

26. Types of Nursing Diagnoses (cont'd)
Risk diagnosis
Problem does not exist
Presence of risk factors
Wellness diagnosis
Describes human responses to levels of wellness in individual, family, or community
Example: Readiness for Enhanced Family Coping

27. Components of a Nursing Diagnosis
Problem statement (diagnostic label)
Describes the client’s health problem or response
Qualifiers added to give additional meaning
Etiology (related factors and risk factors)
Identifies one or more probable causes of the health problem

28. Components of a Nursing Diagnosis (cont’d)
Defining characteristics
Cluster of existing signs and symptoms indicates “actual” diagnosis (clients have signs and symptoms).
Cluster of factors that cause client to be more vulnerable to a problem indicates “risk for” diagnosis (no subjective or objective data exist at present).

29. Nursing Diagnosis
A statement of nursing judgment based on education, experience, expertise and license to treat
Describes human response, the client’s physical, sociocultural, psychological, and spiritual responses to an illness or health problem
Changes when client’s responses change
Independent nursing functions

30. Medical Diagnosis Made by a physician Refers to a disease process
Remains the same as long as the disease process is present
Dependent nursing functions (physician-prescribed therapies and treatments)

31. Collaborative Problems
Use both independent and dependent (physician-prescribed) interventions
Require monitoring of client’s condition and prevention of potential complications
Occur when a particular disease or treatment is present

32. Figure Decision tree for differentiating among nursing diagnoses, collaborative problems, and medical diagnoses.

33. Table 12-3 Comparison of Nursing Diagnoses, Medical Diagnoses, and Collaborative Problems33

34. Steps in Diagnostic Process
Analyze data
Compare data against standards (standard, norm)
Cluster cues
Identify gaps and inconsistencies
Identify health problems, risks, and strengths
Formulate diagnostic statements

35. Writing Nursing Diagnoses
Basic Two-Part Statement
Problem (P)
Etiology (E)
Basic Three-Part Statement
Signs and symptoms (S)

36. Writing Nursing Diagnoses (cont’d)
One-Part Statement
Wellness (readiness for enhanced)
Syndrome
Variations
Unknown etiology
Complex factors
Possible
Secondary
Other additions for precision

37. Table 12-6 Guidelines for Writing a Nursing Diagnostic Statement37

38. Avoiding Errors in Diagnostic Reasoning
Verify data
Build a good knowledge base,acquire clinical experience
Have a working knowledge of what is “normal”
Consult resources
Base diagnoses on patterns
Improve critical-thinking skills

39. Evolution of Nursing Diagnoses
First taxonomy was alphabetical
Later version based on “human response patterns”
Taxonomy II has three levels
Domains
Classes
Nursing diagnoses

40. Evolution of Nursing Diagnoses (cont'd)
Process for acceptance of new and modified labels reviewed biannually
NIC (nursing interventions classification)
NOC (nursing outcomes classification)

41. Figure Taxonomy II. From NANDA Nursing Diagnoses: Definitions and Classifications, 2009–2011 (pp. 368–369), by NANDA International, 2009, Oxford, United Kingdom: Wiley-Blackwell. Reprinted with permission. 41

42. Figure 12-3 (continued) Taxonomy II
Figure 12-3 (continued) Taxonomy II.From NANDA Nursing Diagnoses: Definitions and Classifications, 2009–2011 (pp. 368–369), by NANDA International, 2009, Oxford, United Kingdom: Wiley-Blackwell. Reprinted with permission. 42

43. Advantages of a Taxonomy of Nursing Diagnoses
Development of standardized nursing language
Includes NANDA nursing diagnoses
Nursing interventions classification
Nursing outcomes classification
Nursing Minimum Data Set for computerized records