Comparison of nursing diagnoses,medical diagnoses,and colllaborative problems

Category

Nursing Diagnoses

Medical Diagnoses

Collaborative Problems

Example

Axtivity intolerence related to

decreased cardiac output
Describe human responses to
disease process or health
problem;consist of a
one-,two-,or three-part
statement,usually including
problem and etiology

Myocardial infarction

Potential complication of myocardial

infarction:congestive heart failure
Involve human responses-mainly
physiologic complications of
disease,tests,or treatment;consist of
a two-part statement of
situation/pathopisiology and the
potential complication
Oriented to pathopysiology; nurses
responsible for diagnosing

Description

Orientation and
responbility for
diagnosing

Oriented to the
individual;nurses responsible for
diagnosing

Treatment Orders
Nurse orders most interventions
to prevent and treat

Describe disease and

pathology; do not consider
other human
responses;usually consist of
not more than three words
Oriented to
pathology;physician
responsible for
diagnosing;diagnosis not
within the scope of nursing
pratice
Physician orders primary
interventions to prevent and
treat

Nursing focus

Prevent and monitor for onset or

status of condition

Treat and prevent

Nursing actions
Independent
Duration

Nurse collaborates with physician

and other health care professionals
to prevent and treat (require medical
orders) for definitive treatment

Implement medical orders for

treatment and monitor status
of condition

Some independent actions, but

primarily for monitoring and
preventing

Dependent (primarily)
Can change frequently

Present when diseasenor situation is

present

Classification system
Classification system is
developed and being used but
is not universally accepted

Remains the same while

disease is present
No universally accepted classification
Well-developed classification
system
system accepted by the
medical profession
Before forming an opinion. Analysis is the
For experienced nurses, these activities occur
separation into componets, that is, the breaking
continuously rather than sequentially.
down of the whole into its parts. Synthesis is the
opposite, that is, the putting together of parts into
the whole..
The diagnostic process is used continuously by
most nurses. An experienced nurse may enter a
clients room and immediately observe significant
data and draw conclusions about the client. As a
result of attaining knowledge, skill, and expertise in
the practice setting, the expert nurse may seem to
perform these mental processes automatically.
Novice nurses, however, need guidelines to
understand and formulate nursing diagnoses. The
diagnostic processnhas three steps:

Analyzing data
Identifying health problems, risks,, and
strengths
Formulating gaps and incosistencies

Comparing data with standarts

Nurses draw on knowledge and experience to
compare client data to standarts and norms and
identify significant and relevant cues. A standard or
norm is generally accepted measure, rule, model,
or pattern. The nurse usees a wide range of
standards, such as growth and development
patterns, normal vital signs,and laboratory values.
A cue is considered significant if it does any of thr
following (Gordon, 2002):

Analyzing Data
In the diagnostic process, analyzing involves the
following seps :
1.
2.
3.

Compare data againts standards (identify

significant cues)
Cluster cues (generate tentative
hypotheses)
Identify gaps and inconsistencies

Points to negative or positive change in a

clients health status or pattern. These
may be positive or nrgative. For example,
the client states: i have recently
experienced shortness of breath while
climbing stairs or i have not smoked for
3 months,
Varies from norms of the client population.
The clients patter may fit within cultural
norms but vary from norms of the general
society. The client may consider a patternfor example, eating very small meals and
having little appetite-to be normal. This

pattern, however,may not be productive

and may require further exploration.
Indicates a developmental delay. To
identifi significant cues the nurse must be
aware of the normal pattnerns and
changes that occur as the person grows
and develops. For example, by age 9

months an infant is usually able to sit

alone without support. The infant who has
not accomplished this task needs further
assesment for possible developmental
delays`

TABLE 17-5 Formulating Nursing Diagnoses for Amanda Aquilini

Functional
Health Pattern

Client Cue Clusters

Health
perception/he
althmanagem
ent
Nutritional
metabolic
(includes
hydration)

No appetite since
having cold
Has not eaten today; last
fuilds at noon today
Nauseated X 2 days.

Last fluids at noon today

Oral temp 39.4C (103F)
Skin hot and pale,
cheeks flushed Mucous
membranes dry
Poor skin turgor
Cues from elimination
pattern: Decreased
urinary frequency and
amount X 2 days

Elimination
Decreased urinary
frequency and amount X
2 days
Activity/exerci
se

Inferences (Tentative
Identification of Problems)

Imbalanced Nutrition: Less than

body requirements

Cognitive/perc
eptual

Roles/relations
hips

Selfperception/self
-concept

Husband out of town; will

be back tomorrow
afternoon

Expresses concern and

worry over leaving
daughter with neighbors

No problem Strength: Shows healthy

lifestyle understanding of and compliance
with treatment regimens
Imbalanced Nutrition: Less than body
nausea and increased metabolism
(secondary to disease process)

Deficient Fluid Volume

Strength: Normal weight for height
Deficient Fluid Volume related to intake loss
secondary to fever, diaphoresis, anorexia

No elimintaion problem

Cues consist of elimination data

but are actually symptoms of a
fluid volume problem in the
nutritional/ metabolic functional
health pattern
Disturbed Sleep Pattern

Difficulty sleeping
because of cough Cant
breathe lying down
States I feel weak
Short of breath on
exertion
Cues from
cognitive/perceptual
pattern:Responsive but
fatigued
I can think OK, just
weak
Cues from cardiovascular
pattern: Radial pulses
weak, regular
Pulse rate 92
Reports pain in chest,
especially when
coughing
Responsive but fatigued
I can think OK, just
weak

Formulating Diagnostic Statements

No elimination problem

Disturbed Sleep Pattern related to cough,

pain, orthopnea, fever, and diaphoresis

Acute Pain
These are cognitive/perceptual
data, but they reflect symptoms
of problems in the
activity/exercise pattern
Interrupted Family Processes
related to mothers illness and
temporary unavailability of
father to provide child care
Cues also related to a problem
in the coping/ stress pattern.
Cue is a symptom of a problem
in the coping/ stress pattern.

Acute Pain (chest) related to cough

secondary to pneumonia
Strength: No cognitive or sensory deficits

Risk for Interrupted Family Processes related

to mothers illness and temporary
unavailabilty of father to provide child care
Strength: Neighbors available and willing to
help.

No self-perception/self-concept problem

until husband returns

Functional Health
Pattern
Coping/stress

Medication/history
physical assesment

cardiovaskul
ar

oxygenation

skin

Client
Cue Clusters
Anxious;i cant breath
Expresses concerns about work;ill never
get caught up
Cues from role/relationship pattern:
husband out of town; will be back
tomorrow afternoon
Child with neighbor until husband returns
Cues from self-perception/self-concept
patterns;expressesconcernandworryo
ver leaving daughter with neighbors
No significant cues
Radial pulses weak,reguler pulse rate 92

Skin hot,pale,and moist respirations

shallow;chest expansion 3 cm cough
productive of small amounts of thick pale
pink sputum
Inspiratory crackles auscultated troughout
right upper and lower lungs
Diminished breath sounds on right side
muscous membranes pale,dry
Old surgical scars, anterior neck, RLQ
abdomen

Inferences (tentative
identification of problems)
Anxiety related to difficulty
breathing,inhability to
work,and child care

Formulating diagnostic
statements
Anxiety related to difficulty
breathing and parenting roles

No problem

No problem

Cues are symptoms only;

symptomps of exercise/rest
and oxygenation problems
Ineffection airway clearance
related to disease process

No cardiovaskular problem

No problem now

Old problem; resolved

Ineffection airway clearance

related to viscous secretions
and shallow chest expansion
secondary to pain,fluid
volume deficit, and fatigue

Nutrition Less than Body Requirements; Deficient

Fluid Volume; Disturbed Sleep Pattern; Activity
Intolerance; Acute Pain (Chest); Interrupted Family
Processes; Anxiety; and Ineffective Airway
Clearance.

A clients strengths might be weight that is within

the normal range for age and height, this enabling
the client to cope better with surgery. In another
instance, a clients strengths might be absence of
allergies and being a nonsmoker.

Not that some data may indicate a

possible problem but when clustered with other
data, the possible problem disappears. For
example, the following data for Amanda Aquilini,
Decreased urinary frequency and amount X 2
days, suggests a possible urinary elimination
problem. However, when these data are considered
along with data associated with Deficient Fluid
Volume, the nurse eliminates urinary elimination
as a problem.

A clients strengths can be found in the nursing

assessment record (health, home life, education,
recreation, exercise, work, family, and friends,
religious beliefs, and sense of humor, for example).
The health examination, and the clients records.
See table 17-5 for the strengths indentified for
Amanda Aquilini.

Determining Strengths
At this stage, the nurse and client also establish
the clients strengths, resources, and abilities to
cope. Most people have a clearer perception of
their problems or weaknesses than of their
strengths and assets, which they often take for
granted. By taking an inventory of strengths, the
client can develop a more well-rounded selfconcept and self-image. Strengths can be an aid to
mobilizing health and regenerative processes.

Formulating Diagnostic Statements

Most nursing diagnoses are written as two-part or
three-part statements, but three are variations of
these.
Basic Two-part Statements
The basic two-part statement includes the
following:
1.
2.

The two parts are joined by the words related to

rather than due to. The phrase due to implies that

Problem (P): statement of the clients

response (NANDA label)
Etiology (E): factors contributing to or
probable causes of the responses.

one part causes or is responsible for the other part.

By contrast, the phrase related to