Nanda nursing diagnosis 2018 pdf free download

The workbook features the nursing skills from the text, accompanied by an overview at the beginning of each skill set and supported by clinical skill competency check lists aligned with the National Competency Standards for the Registered Nurse. The Bondy rating scale has been incorporated to provide clearly defined levels of competency and an opportunity for reflection is included at the end of each skill to encourage meaningful learning. A suite of clinical skills videos are available online to support the workbook.

Ideal for viewing in class, the videos also provide students with a valuable tool for revision prior to assessment. Please note that this eBook does not include the DVD accompaniment. If you would like to have access to the DVD content, please purchase the print copy of this title.

The new edition builds on the strengths of the highly successful previous editions with greater authorship, increased local research, evidence and concepts particular to the health care systems of Australia and New Zealand.

Fully revised and updated by leading Australian and New Zealand nurse educators. It presents essential nursing skills in a clear format consistent with Australian and New Zealand practice, placing greater emphasis on critical thinking skill explanations, revised procedural recommendations, infection control considerations and updated medications information.

Health Care Delivery System Chapter 2 — now includes New Zealand content and walks the student through the evolution of health care delivery systems in our region. Engaging in Clinical Inquiry and Practice Development Chapter 5 written by Jackie Crisp and Professor Brendan McCormack provides a contemporary perspective on the processes underpinning nursing knowledge development, utilisation and their role in the ongoing advancement of nursing practice.

Managing Client Care Chapter 20 is an exciting newly revised chapter that engages the student in exploring nursing issues in managing client care within the context of contemporary health care systems. Students can take notes, highlight material and more. The e-book is included with this edition at no extra cost. New Resources for Students and Instructors on Evolve: Nursing Skills Online for Fundamentals of Nursing provides students with 17 interactive modules which expand on textbook concepts, through the use of media rich animations.

It encourages decision-making and critical-thinking skills through case-based and problem-oriented lessons. Clinical knowledge can be further tested through additional short answer and review questions. It strives to teach students how to think about each case in a meaningful, systematic way.

This book breathes life into theoretical principles and puts students in the mindset of a successful nurse. The framework approach gives students the tools to tackle real-life challenges in a clinical setting. The Nursing Process is the foundation of this book. By learning to identify normal function, assess risk or dysfunction, envision potential outcomes, plan and provide for interventions and evaluate the effectiveness of a treatment, students will be equipped to stay on track while customizing care for each patient.

Chapters open with a case study and include critical thinking questions, Apply Your Knowledge Boxes, and Ethical-Legal Boxes to build students' decision-making abilities and clinical judgment. Collaborating with the Healthcare Team Boxes and Patient Teaching Boxes demonstrate the importance of communication in these clinical scenarios.

While all books list critical thinking exercises as a feature, most books like Potter and Kozier include these questions at the end of the chapter. Craven weaves critical thinking into most activities throughout the chapter so students are constantly being challenged to think like a professional nurse.

There's a new fundamentals text in town. One that centers on simple language, active learning, and a fresh new way to help you truly understand, apply, and retain important nursing information and concepts. Introducing the brand new Fundamentals of Nursing text from Yoost and Crawford. Written in a warm and conversational style, this innovative text starts by guiding you towards a basic understanding of the nursing profession and then logically progresses through the nursing process and into the safe and systematic methods of applying care.

Each chapter features realistic case studies and critical thinking exercises woven throughout the content to help you continually apply what you've learned to actual patient care. Conceptual care maps further your ability to make clinical judgments and synthesize knowledge as you develop plans of care after analyzing and clustering related patient assessment data. All of this paired with a wealth of student-friendly learning features and clinically-focused content offers up a fundamentally different - and quite effective - way for you to easily master the fundamentals of nursing.

Active learning approach centers on case studies and critical thinking exercises that are woven throughout each chapter to ensure readers are able to apply chapter content to broader nursing concepts and realistic patient scenarios. Simple to complex progression of information starts by guiding readers towards a basic understanding of the nursing profession and then logically progressing through the nursing process and into the safe and systematic methods of applying care. Warm, conversational style devoid of repetitive discussions and unnecessary information slows down the pace of information to give readers time to critically think and master all fundamental concepts and skills.

Conceptual care maps require readers to develop a plan of care after analyzing and clustering related patient assessment data. This unique learning tool assists readers in recognizing the importance of each type of assessment data and furthers your ability to make clinical judgments and synthesize knowledge about the whole patient.

Learning objectives carried throughout the chapter features the objective being showcased at the start of the chapter, tied to headings throughout the chapter, and once again reinforced at the close of the chapter. Nursing Skills sections provide information on the purpose, procedures, evidence-based practice, special circumstances, and more for a variety of important nursing skills - all supported by rationales, photos, and illustrations.

Nursing Care Guidelines highlight information including background, procedural concerns, documentation concerns, and evidence-based practice and resources to reduce risk and ensure safety for the patient and nurse.

Diverse mix of clinically focused boxes are incorporated throughout each chapter. Collaboration and Delegation boxes stress the importance of effective and accurate communication between the healthcare team about a patient's condition and treatment, as well as the importance of assigning tasks appropriately. Ethical, Legal, and Professional Practice boxes address ethical and legal dilemmas commonly faced in nursing to prepare readers to act in a professional and nonjudgmental manner while protecting patient rights.

Patient Education and Health Literacy boxes stress the importance of patient education and how to deliver information in an understandable manner based on the patient's level of health literacy.

Health Assessment Questions boxes illustrate how to properly ask and use assessment questions while interviewing patients. Decreased diversional activity engagement Nursing Care Plan Readiness for enhanced health literacy Sedentary lifestyle Nursing care Plan.

Frail elderly syndrome Nursing care Plan Risk for frail elderly syndrome Deficient community health Risk-prone health behaviour Ineffective health maintenance Nursing care Plan Ineffective health management Readiness for enhanced health management Ineffective family health management Ineffective protection. Imbalanced nutrition: less than body requirements Nursing care Plan Readiness for enhanced nutrition Insufficient breast milk production Ineffective breastfeeding Nursing care Plan Interrupted breastfeeding Nursing care Plan Readiness for enhanced breastfeeding Ineffective adolescent eating dynamics Ineffective child eating dynamics Ineffective infant feeding dynamics Ineffective infant feeding pattern Nursing care Plan Obesity Overweight Risk for overweight Impaired swallowing Nursing care Plan.

Risk for unstable blood glucose level Nursing care Plan Neonatal hyperbilirubinemia Risk for neonatal hyperbilirubinemia Risk for impaired liver function Risk for metabolic imbalance syndrome. Risk for electrolyte imbalance Risk for imbalanced fluid volume Deficient fluid volume Nursing care Plan Risk for deficient fluid volume Excess fluid volume Nursing care Plan. Impaired urinary elimination Functional urinary incontinence Overflow urinary incontinence Reflex urinary incontinence Stress urinary incontinence Urge urinary incontinence Risk for urge urinary incontinence Urinary retention.

Constipation Nursing care Plan Risk for constipation Perceived constipation Chronic functional constipation Risk for chronic functional constipation Diarrhoea Dysfunctional gastrointestinal motility Risk for dysfunctional gastrointestinal motility Bowel incontinence.

Insomnia Sleep deprivation Readiness for enhanced sleep Disturbed sleep pattern. Risk for disuse syndrome Impaired bed mobility Impaired physical mobility Impaired wheelchair mobility Impaired sitting Impaired standing Impaired transfer ability Impaired walking.

Activity intolerance Risk for activity intolerance Ineffective breathing pattern Decreased cardiac output Risk for decreased cardiac output Impaired spontaneous ventilation Risk for unstable blood pressure Risk for decreased cardiac tissue perfusion Risk for ineffective cerebral tissue perfusion Ineffective peripheral tissue perfusion Risk for ineffective peripheral tissue perfusion Dysfunctional ventilatory weaning response.

Impaired home maintenance Bathing self-care deficit Dressing self-care deficit Feeding self-care deficit Toileting self-care deficit Readiness for enhanced self-care Self-neglect. Integumentary function the process of secretion and excretion through the skin None at this time Class 4.

Class 4. Cognition use of memory, learning, thinking, problem-solving, abstraction, judgment, insight, intellectual capacity, calculation, and language Code Diagnosis Code Diagnosis Acute confusion Ineffective impulse control Risk for acute confusion Deficient knowledge Chronic confusion Readiness for enhanced knowledge Labile emotional control Impaired memory Class 5.

Caregiving roles socially expected behavior patterns by people providing care who are not healthcare professionals Code Diagnosis Code Diagnosis Caregiver role strain Readiness for enhanced parenting Risk for caregiver role strain Risk for impaired parenting Impaired parenting Class 2. Family relationships associations of people who are biologically related or related by choice Code Diagnosis Code Diagnosis Risk for impaired attachment Interrupted family processes Dysfunctional family processes Readiness for enhanced family processes Class 3.

Coping responses the process of managing environmental stress Code Diagnosis Code Diagnosis Ineffective activity planning Fear Risk for ineffective activity planning grieving anxiety Complicated grieving Defensive coping Risk for complicated grieving Ineffective coping Impaired mood regulation Readiness for enhanced coping Readiness for enhanced power Ineffective community coping Powerlessness Readiness for enhanced community coping Risk for powerlessness Compromised family coping Impaired resilience Disabled family coping Readiness for enhanced resilience Readiness for enhanced family coping Risk for impaired resilience Death anxiety Chronic sorrow Ineffective denial stress overload Class 3.

Values the identification and ranking of preferred modes of conduct or end states None at this time Class 2. Beliefs opinions, expectations, or judgments about acts, customs, or institutions viewed as being true or having intrinsic worth Code Diagnosis Readiness for enhanced spiritual well-being Class 3.

Infection host responses following pathogenic invasion Code Diagnosis Risk for infection Class 2. Class 3. Violence the exertion of excessive force or power so as to cause injury or abuse Code Diagnosis Code Diagnosis Risk for other-directed violence Risk for self-mutilation Risk for self-directed violence Risk for suicide self-mutilation Class 4.

Defensive processes the processes by which the self protects itself from the nonself Code Diagnosis Code Diagnosis Risk for adverse reaction to iodinated latex allergy response contrast media Risk for allergy response Risk for latex allergy response Class 6. This happens for a variety of reasons. We are always learning more about our professional discipline, and perhaps we discover that what we thought belonged within one domain is really more accurately represented in two distinct domains.

New phenomena may be discovered that do not clearly fit within an existing structure. In addition, theoretical perspectives change, which leads professio- nals to view their knowledge from a different perspective. Gunn von Krogh. Work will be occurring over the next few years to test and possibly refine this taxonomy. It is important to emphasize that nanDa-I has not adopted this taxonomic structure, but that work will be ongoing over the next few years to examine its appropriateness as a taxonomic structure for nursing diagnoses, through worldwide discussion and research.

In Table 3. More information on the testing of this proposed taxonomy will be available as it occurs at our website, at www. Quammen, D. National Geographic Magazine.

Von Krogh, G. Sao Paulo, Brazil. May We can adapt the definition for a nursing diagnosis taxonomy; specifically, we are concerned with the orderly classification of diagnostic foci of concern to nursing, according to their presumed natural rela- tionships.

Taxonomy II has three levels: domains, classes, and nursing diagnoses. This structure provides for the stability, or growth and development, of the taxonomic structure by avoiding the need to change codes when new diagnoses, refinements, and revisions are added.

New codes are assigned to newly approved diagnoses. Retired codes are never reused. Taxonomy II has a code structure that is compliant with recommen- dations from the National Library of Medicine NLM concerning healthcare terminology codes. The NLM recommends that codes do not contain information about the classified concept, as did the Taxonomy I code structure, which included information about the location and the level of the diagnosis.

The benefit of using a recognized nursing language is the indication that it is accepted as supporting nursing practice by providing clinically useful terminology. The terminology is also registered with Health Level Seven International HL7 , a healthcare informatics standard, as a terminology to be used in identifying nursing diagnoses in electronic messages among clinical information systems www. This system consists of axes out of which components are combined to make the diagnoses substantially equal in form, and in coherence with the ISO model.

There are seven axes. In some cases, the axis is implicit, as is the case with the diagnosis Activity intolerance, in which the subject of the diagnosis Axis 2 is always the patient. In some instances an axis may not be pertinent to a particular diagnosis and therefore is not part of the nursing diagnostic label. For example, the time axis may not be relevant to every diagnosis. In some cases, however, the diagnostic focus contains the judgment for example, Nausea ; in these cases the judg- ment is not explicitly separated out in the diagnostic label.

Axis 2 subject of the diagnosis is also essential, although, as described above, it may be implied and therefore not included in the label. The Diagnosis Development Committee requires these axes for submission; the other axes may be used where relevant for clarity.

The focus may consist of one or more nouns. When more than one noun is used for example, Activity intolerance , each one contributes a unique meaning to the focus, as if the two were a single noun; the meaning of the combined term, however, is different from when the nouns are stated separately.

Frequently, an adjective spiritual may be used with a noun distress to denote the focus, Spiritual distress In some cases, the focus and the nursing diagnosis are one and the same, as is seen with the diagnosis of Nausea This occurs when the nursing diagnosis is stated at its most clinically useful level and the separation of the focus adds no meaningful level of abstraction. It can be very difficult to determine exactly what should be considered the focus of the diagnosis.

For example, using the diagnoses of bowel incontinence and stress urinary incontinence , the question becomes: Is the focus incontinence alone, or are there two foci, bowel incontinence and urinary incontinence?

In this instance, incontinence is the focus, and the location terms axis 4 of bowel and urinary provide more clarification about the focus. However, incontinence in and of itself is a judgment term that can stand alone, and so it becomes the focus, regard- less of location.

In some cases, however, removing the location axis 4 from the focus would prevent it from providing meaning to nursing practice. For example, if we look at the focus of the diagnosis, risk for imbalanced body temperature , is it body temperature or simply temperature? Or if you look at the diagnosis, disturbed personal identity , is the focus identity or personal identity?

Decisions about what constitutes the essence of the focus of the diagnosis, then, are made on the basis of what helps to identify the nursing practice implication, and whether or not the term indicates a human response.

Temperature could mean environ- mental temperature, which is not a human response, so it is important to identify body temperature as the nursing diagnosis. In some cases the focus may seem similar, but is in fact quite distinct: other-directed violence and self-directed violence are two different human responses, and therefore must be identified separately in terms of foci within Taxonomy II.

Examples include neighborhoods and cities When the subject of the diagnosis is not explicitly stated, it becomes the individual by default.

However, it is perfectly appropriate to consider such diagnoses for the other subjects of the diagnosis as well.

The diagnosis Grieving could be applied to an individual or family who has lost a loved one. It could also be appropriate for a community that has experienced a mass casualty, suffered the loss of an important community leader, devastation due to natural disasters, or even the loss of a symbolic structure within the community a school, religious structure, historic building, etc.

Axis 3 Judgment A judgment is a descriptor or modifier that limits or specifies the mean- ing of the diagnostic focus. All of the definitions used are found in the Oxford Dictionary On-Line The values in Axis 3 are found in Table 4. The values in Axis 4 are shown in Table 4. Thus you start with the diagnostic focus Axis 1 and add the judgment Axis 3 about it. Remember that these two axes are sometimes combined to form a nursing diagnosis label in which judg- ment is implicit, as can be seen with Fatigue Next, you specify the subject of the diagnosis Axis 2.

You can then use the remaining axes, if they are appropriate, to add more detail. Figures 4. NANDA-I does not support the random construction of nursing diagnoses that would occur by simply matching terms from one axis to another to create a diagnosis label to represent judgments based on a Figure 4.

It also makes it impossible to accurately research the incidence of nursing diagnoses, or to conduct outcome or intervention studies related to diagnoses, since, without clear component diagnostic parts definitions, defining characteristics, related or risk factors it is impossible to know if human response that are given the same label truly represent the same phenomena.

Therefore, when discussing the construction of nursing diagnoses in this chapter, the intent is to inform nurses about how nursing diagnoses are developed, and to provide clarity for individuals who are developing diagnoses for submission into the NANDA-I Taxonomy; it should not be interpreted to suggest that NANDA-I supports the creation of diagnoses by nurses at the point of patient care. Further Development A taxonomy and a multiaxial framework for developing nursing diagnoses allow clinicians to see where the nursing discipline lacks diag- noses, and provides the opportunity to develop clinically useful new diagnoses.

If you develop a new diagnosis that is useful to your practice, please submit it to NANDA-I so that others can share in the discovery. References Lundberg, C. Giarrizzo-Wilson Selecting a standardized terminology for the electronic health record that reveals the impact of nursing on patient care. Oxford University Press. Health promotion in nursing prac- tice 5th ed.

World Health Organization Health topics: Infant, newborn. Definition of key terms. Development of an instrument to evaluate diagnosis accuracy. Paans, W. B, Van der Schans, C. What factors influence the prevalence and accuracy of nursing diagnoses documentation in clinical practice? A systematic literature review. Journal of Clinical Nursing, 20, — We have decided to include some of the most common questions here, along with their answers, with the hope that it will help others who may have the same questions.

Standardized nursing language SNL is a commonly understood set of terms used to describe the clinical judgments involved in assessments nursing diagnoses , along with the interventions and outcomes related to the documentation of nursing care. How many standardized nursing languages are there? What are the differences among standardized nursing languages? Many nursing languages claim to be standardized; some are simply a list of terms, others provide definitions of those terms.

Is that correct? We are speaking about the diagnos- tic decision-making process, in which nurses diagnose. So, rather than using these simplistic terms selecting, choosing, picking , we should really describe the process of diagnosing.

What is taxonomy? Taxonomy is the practice and science of categorization and classifica- tion. In any field, development and maintenance of a research-based body of work require an investment of time and expertise, and dissemination of that work is an additional expense. As a volunteer organization, we sponsor committee meetings for the review of submitted diagnoses, to ensure they meet the level of evidence criteria.

We also provide educa- tional courses and offerings in English, Spanish, and Portuguese due to the high demand for this content. We have committee members from all over the world, and video conferencing and the occasional face-to-face meeting are expenses — as are our conferences and educational events. Our fees support this work on a break-even basis, and are quite modest in comparison to fees charged for a license to ICD medical diagnoses.

If we buy a book, and type the contents into software ourselves, do we still have to pay? The NANDA-I terminology is a copyrighted terminology, therefore no part of the nanDa-I publication, NANDA International Nursing Diagnoses: Definitions and Classification, can be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher.

This is true regardless of the language in which you intend to use the work. Use of this content requires that you apply for and receive permission from the publisher to reproduce our work in any format. Further information is available on our website www. Should the structure of Taxonomy II be used as a nursing assessment framework? It was never intended to serve as an assessment framework. The PES format was first published by Dr.

It is still used in several countries and in many publications. Formulating accurate diag- noses relies on assessing and documenting related factors and defining characteristics, and the PES format supports this, which is critical for accuracy in nursing diagnoses, a focus that NANDA-I strongly supports.

We are aware of the wide variety of electronic documentation systems in use and in develop- ment around the world, and it seems that there are as many ways of providing nursing documentation as there are systems. However, it is important that nurses are able to communicate the assess- ment data that support the diagnosis they make, so that others caring for the patient know why a diagnosis was selected.

The PES format remains a strong method for teaching clinical reason- ing and for supporting students and nurses as they learn the skill of diagnosis. Regardless of the requirements for documentation, it is important to remember that for safe patient care in clinical areas, it is crucial to survey or assess defining characteristics manifestations of diagnoses and related factors or causes of nursing diagnoses.

Choosing effective interventions is based on related factors and defining characteristics. How do I write the diagnostic statement for risk, problem-focused, and health promotion diagnoses? Documentation systems differ by organization, so in some cases you may write or select from a computerized list the diagnostic label that corre- sponds to the human response you have diagnosed. Here are some examples of PES charting. Problem-Focused Diagnosis To use the PES format, start with the diagnosis itself, followed by the etiological factors related factors in a problem-focused diagnosis.

There is no real use for simply providing a list of terms — to do so defeats the purpose of a SNL. Questions to ask to identify and validate the correct diagnosis include: 1.

Basic Questions about Nursing Diagnoses Can nursing diagnosis be used safely other than in an inpatient unit, such as in the operating room and outpatient clinics? Nursing diagnoses are used in operating rooms, ambulatory clinics, psychiatric facilities, home health, and hospice organizations, as well as in public health, school nursing, occupational health — and, of course, in hospitals. As diverse as nursing practice is, there are core diagnoses that seem to cross them all — acute pain , anxiety , deficient knowledge , readiness for enhanced health management , for example, can probably be found anywhere a nurse might practice.

That said, we know that there is a need for the development of diagnoses to further expand the terms we use to describe nursing knowledge across all of these areas of nursing. Work is underway in some areas, such as pediatrics and mental health, and across a great number of countries, and we are eagerly awaiting the results! Should nurses in a critical care unit use nursing diagnosis?

We are busy taking care of medical conditions. What an interesting question! Should nurses practice nursing? Yes, of course! Patients in critical condition are at risk for many complications that can be prevented by nurses: ventilator-related pneumonias risk for infection, , pres- sure ulcers risk for pressure ulcer, , corneal injury risk for corneal injury, They are often scared fear, , and families are stressed but need to know how to care for their loved one when he comes home: deficient knowledge , stress overload , risk for caregiver role strain If nurses only attend to the obvious medical condition, then, as the old adage says, they may win the battle, but still lose the war.

These patients may develop sequelae that could have been avoided, length of stay may be prolonged, or discharge home could result in untoward events and increased readmission rates. Attend to the medical conditions? And focus on the human responses? NANDA-I identifies three categories of nursing diagnosis: problem-focused, health promotion, and risk diagnoses. Within these categories, you can also find the use of syndromes. Definitions for each of these categories, and syndromes, can be found in the Glossary of Terms, on p.

What are nursing diagnoses, and why should I use them? It requires a nursing assessment to diagnose your patient correctly — you cannot safely standardize nursing diagnoses by using a medical diagnosis.

Although it is true that there are common nursing diagnoses that frequently occur in patients with various medical diagnoses, the fact is that you will not know if the nursing diagnosis is accurate unless you assess for defining characteristics and establish that key related factors exist.

A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability. This means that nursing diagnoses are used to determine the appropriate plan of care for the patient, driving patient outcomes and interventions. You cannot standardize a nursing diagnosis, but it is possible to standardize nursing interventions, once you have selected the appropriate outcome for the nursing diagnosis, as interventions should be evidence-based whenever possible.

What is the difference between a medical diagnosis and a nursing diagnosis? A medical diagnosis deals with a disease, illness or injury. A nursing diag- nosis deals with actual or potential human responses to health problems and life processes.

If nurses only focus on the stroke, they might miss the chronic pain the patient suffers, his sense of pow- erlessness, and even the interrupted family processes. All of these issues will have an impact on his potential discharge home, his ability to manage his new therapeutic regimen, and his overall quality of life. It is also important to remember that, while a medical diagnosis belongs only to the patient, nursing treats the patient and his family, so diagnoses regarding the family are critical because they have the potential to influence — positively or negatively — the out- comes you are trying to achieve with the patient.

What are the component parts of a diagnosis, and what do they mean for nurses in practice? There are several parts of a nursing diagnosis: the diagnostic label, definition, and the assessment criteria used to diagnose, the defining characteristics and related factors or risk factors. First, communication between healthcare team members must be clear, concise, and consistent. Secondly, how can we assess the validity of a diagnosis, or the diagnostic ability of a nurse, if we have no data to support the diagnosis?

Her condition is starting to stabilize, and you are assuming her care at the beginning of your shift. You notice in the chart that the nurse caring for her previously documented three nursing diagnoses: ineffective breathing pattern , anxiety , and deficient knowledge Based on that communica- tion, you form a picture in your mind of this patient and how you will want to approach her. The anxiety alerts you that you will want to be calming and reassuring in your approach, while the ineffective breathing pattern tells you that Ms.

Johansen is still having difficulty with ventilation. The diagnosis of deficient knowledge concerns you because you have a lot of teaching to do with the patient about her new medications, as well as nutritional changes to support her in losing weight, which can help to improve her breathing. A little while later, you complete your assessment and find that you have identified some differences from the previous nurse.

The diag- nosis of ineffective breathing pattern is clearly accurate — she has ortho- pnea, tachypnea, dyspnea, an increased anterior-posterior diameter; nasal flaring is evident, as is pursed-lip breathing, and she is using her intercostal muscles to breathe.

Her related factors include fatigue, obesity, and respiratory muscle fatigue. The anxiety, too, is obvious. She says that she lost her full-time job three months ago, and has only been able to find part-time, temporary work. She is barely able to pay her mortgage and buy groceries, and has no health insurance. She tells you that she has not been able to afford her medi- cations for her COPD for the past 6—7 weeks, and she canceled her routine appointment with her pulmonologist because she could not afford to pay for the visit.

She is knowledgeable about her disease, and clearly aware of the consequences of not taking the medication, but was unable to afford to continue with treatment. It is clear that the financial concern is affecting her anxiety, which in turn increases her breathing difficulties. Your assessment did not confirm any of the defining characteristics of deficient knowledge, nor did you identify any related factors.

The related factor is the cost of treatment, and her inability to afford medication and physician follow-up. Indeed, many patients with chronic disease often know as much or more about their health condition, their responses to it, and what improves or worsens their symptoms than the health professional. Focusing on deficient knowledge in Ms. Recognizing the financial barriers, the nurse can begin to work with the patient and the interdisciplinary team to identify potential sources of financial support for obtaining her medications, attending her follow-up visits, and possibly even sources to support her hospi- talization and follow-up care costs.

Which nursing diagnosis is most applicable to a patient with cerebral vascular accident? Nursing diagnoses are individual family, group, or community responses to health problems or life processes.

This means that one cannot standard- ize nursing diagnoses based on medical diagnoses or procedures. Without a nursing assessment, it is simply impossible to determine the correct diag- nosis — and it is does not contribute to safe, quality patient care. The care plan for each individual patient is based on assessment data. A thinking tool used by our colleagues in medicine can be useful as you determine your diagnoses: it uses the acronym SEA TOW Rencic, ; refer to Figure 2.

It is always a good idea to ask a colleague, or an expert, for a second opinion if you are unsure of the diagnosis. Can you confirm this pattern by reviewing the diagnostic indicators? Did you collect data that seem to oppose this diagnosis? Can you justify the diagnosis even with this data, or do this data suggest you need to look deeper? Think about your thinking — was it logical, reasoned, built on your knowledge of nursing science and the human response that you are diagnosing?

Finally, what other data might you need to collect or review in order to validate, confirm, or rule out a potential nursing diagnosis? How many diagnoses should my patient have? Students are often encouraged to identify every diagnosis that a patient has — this is a learning method to improve clinical reasoning and mastery of nursing science.

However, in practice it is important to prioritize nursing diagnoses, as these should form the basis for nursing interventions. Other diagnoses may require referral to other healthcare providers or settings, such as home healthcare, a different hos- pital unit, skilled nursing facility, etc. In a practical sense, having one diag- nosis per NANDA-I domain, or a minimum of 5 or 10 diagnoses, does not reflect reality. Although it is important to identify all diagnoses problem- focused, risk, and health promotion , nurses must focus on high-priority, high-risk diagnoses first; other diagnoses may be added later moved up on the priority list to replace those that are resolved, or for which inter- ventions are clearly being effective.

It is very important to continually evaluate your patient to determine if the diagnosis is still the most accurate for the patient at any particular point in time. Documentation rules vary by organization and by particular state and country requirements. However, the concept of family-based care is becoming quite standard, and certainly diagnoses that have an impact on the patient, and can contribute to patient outcomes, should be considered by nurses.

A review of the therapeutic regi- men, along with recommendations to simplify or organize care, may be very helpful. Physical examination : Mouth shape is not symmetrical. Looks an inflammation of the pharynx. Edema of the pharynx. Nursing Diagnosis and Nursing Interventions 1. Impaired swallowing related to muscle weakness due to swallowing paralise Outcomes : Patients can demonstrate the proper method of swallowing food without causing despair.

Intervention : a. Review the patient's ability to swallow , note the extent of facial paralysis. Increase efforts to be able to perform effective ingestion such as helping the patient hold his head. Tap the deepest part of the cheek with a spatula to know the weakness of the tongue.

Give eat slowly in a quiet environment. Start by giving a semi-liquid food orally , soft foods when patients can not swallow water. Help the patient to choose foods that are small or do not need to chew and easy to swallow. Instruct the patient to use a straw to drink liquids.

Suggest to participate in the exercise program. Imbalanced Nutrition Less than Body Requirements related to lack of adequate food intake. Outcomes : Adequate nutritional intake. Instruct the patient to eat slowly and chew food thoroughly.

Feeding little and often with foods that are not irritating. Serve food in interesting ways. Avoid eating or drinking foods that contain irritant substances.