CH12 Diagnosing

KOZIER & ERB’S
Fundamentals of NURSING
NINTH EDITION Concepts, Process, and Practice
CHAPTER 12
Diagnosing
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Diagnosing
• Is the second phase of the nursing process.
• Nurses use critical thinking skills to interpret
assessment data and identify client strengths
and problems
• Diagnosing is a pivotal step in the nursing
process
• Activities in this phase are directed toward
formulating the nursing diagnoses;
• The care planning activities following this
phase are based on the nursing diagnoses
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
• NANDA (North American Nursing

Diagnosis Association)
• To use the concept of nursing diagnoses

effectively in generating and completing a
nursing care plan, the nurse must be
familiar with the definitions of terms used
and the components of nursing diagnoses
Figure 12-1 Diagnosing. The pivotal second phase of the nursing process.
Diagnosing
• Diagnosing refers to the reasoning

process
• Diagnosis -a statement or conclusion
regarding the nature of a phenomenon
• Nursing diagnosis - problem statement

consisting of diagnostic label plus etiology
• Nursing diagnosis:
diagnostic label(statement ) ‫العالمات‬
‫ واالعراض‬+ etiology ‫السبب‬
Characteristics
• The standardized NANDA names for the
diagnoses are called diagnostic labels.
• The client’s problem statement (the

nursing diagnosis ), consisting of
The diagnostic label
Etiology (causal relationship between a
problem and its related or risk factors
• The official NANDA definition of a nursing
diagnosis is:
• “. . . a clinical judgment concerning a human
response to health conditions/ life
processes, or a vulnerability for that
response, by an individual, family, group, or
community
• “A nursing diagnosis provides the basis for
selection of nursing interventions to achieve
outcomes for which the nurse has
accountability”
• This definition is consistent with the
following:
Professional nurses (registered nurses) are
responsible for making nursing diagnoses.
The domain of nursing diagnosis includes only those
health states that nurses are educated and licensed to
treat.
A nursing diagnosis is a judgment made only after
thorough, systematic data collection.
Nursing diagnoses describe a continuum of health
states: deviations from health, presence of risk factors,
and areas of enhanced personal growth.
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
Types of Nursing Diagnoses
(cont'd)
• Risk diagnosis
– Problem does not exist
– Presence of risk factors
– the nurse would appropriately use the label Risk
for Infection to describe the client’s health status
• Syndrome diagnosis
– Is assigned by the nurses' clinical judgment to
describe a cluster of nursing diagnosis that have
similar interventions
Components of a Nursing Diagnosis
• Problem statement (diagnostic label)
– Describes the client’s health problem or response
– It describes the client’s health status clearly and
concisely in a few words.
– Diagnostic labels need to be specific
– Qualifiers( words added to give additional meaning)
are used such as :
• Deficient (inadequate) Impaired (made worse),
Decreased (lesser in size) Ineffective (not producing
the desired effect)
• Etiology (related factors and risk factors)
– Identifies one or more probable causes of the
health problem
Components of a Nursing Diagnosis
(cont’d)
• Defining characteristics
– Cluster of existing signs and symptoms indicates
“actual” diagnosis (clients have signs and
symptoms).
– For actual nursing diagnoses, the defining
characteristics are the client’s signs and symptoms.
– For risk nursing diagnoses, no subjective and
objective signs are present.
Differentiating Nursing Diagnoses
from Medical Diagnoses
• Nursing diagnosis ------- nurse

• Medical diagnosis -------- doctor \physician
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
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)
Steps in Diagnostic Process
• The diagnostic process has three steps:
Analyzing data
Identifying health problems, risks, and
strengths
Formulating diagnostic statements.
Steps in Diagnostic Process
I. Analyze data
• In the diagnostic process, analyzing involves
the following steps:
1. Compare data against standard .
• Nurses draw on knowledge and experience to compare client
data to standards and norms.
• A standard or norm is a generally accepted measure, rule,
model, or pattern.
• The nurse uses a wide range of standards, such as growth and
development patterns, normal vital signs, and laboratory
values.
2. Cluster the cues.
• Data clustering or grouping of cues is a process of
determining the relatedness of facts and determining whether
any patterns are present,
3. Identify gaps and inconsistencies
• 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 .
II . Identifying Health Problems, Risks, and
Strengths
• After data are analyzed, the nurse and client
can 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.
• III . Formulating Diagnostic Statements
• Most nursing diagnoses are written as two-part
or three-part statements, but there are
variations of these.
Writing Nursing Diagnoses
• Basic Two-Part Statement includes the

following:
• 1. Problem (P): statement of the client’s
response (NANDA label)
• 2. Etiology (E): factors contributing to or
probable causes of the response.
• The two parts are joined by the words related
to.
• Some examples of two-part nursing diagnoses
are shown in Box 12–1.
Problem Related to Etiology
Constipation Related to Prolonged laxatives use

R\T
Anxiety Related to Threat the physiological
R\T integrity ; possible
cancer diagnosis .
• Basic Three-Part Statement it is called the
.
PES format and includes the following:

• 1. Problem (P): statement of the client’s
response (NANDA label)
• 2. Etiology (E): factors contributing to or
probable causes of the response
• 3. Signs and symptoms (S): defining
characteristics manifested by the client
• Actual nursing diagnoses can be documented
by using the three-part statement because the
signs and symptoms have been identified.
• This format cannot be used for risk diagnoses
because the client does not have signs and
symptoms
Problem of the diagnosis.
Related Etiology As manifested by Signs and
to \as evidence by Symptoms
Situatio Related feelings of As manifested by( hypersensitivity to
nal Low to rejection AMB) criticism; states “I
Self- R\T by \as evidence by don’t
Esteem husband (AEB) know if I can
manage by myself”
and rejects
positive feedback
Table 12-6 Guidelines for
Writing a Nursing Diagnostic
Statement
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
• Stress Urinary Incontinence related to
degenerative changes in pelvic muscles and
structural supports associated with advanced
age, obesity, gravid uterus
• Acute pain related to surgical trauma and
inflammation, as evidenced by grimacing and
verbal reports of pain.
Risk for infection related to surgery and
immunosuppression.
Risk for aspiration related to reduced level of
consciousness

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KOZIER & ERB’S

• NANDA (North American Nursing

• To use the concept of nursing diagnoses

• Diagnosing refers to the reasoning

• Nursing diagnosis - problem statement

• The client’s problem statement (the

• Nursing diagnosis ------- nurse

• The diagnostic process has three steps:

• Basic Two-Part Statement includes the

Problem Related to Etiology

Constipation Related to Prolonged laxatives use

PES format and includes the following:

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