University Of Duhok

College of Nursing
Academic Year 2024-2025
1st Semester/Second class
Adult Nursing

Session 2:
Nursing Diagnosis

LECTURER
SARA JAWAD KADHIM
BSC. MSC. IN ADULT NURSING
16 September 2024 Nursing Process : Nursing diagnosis 1
Nursing Diagnosis : Second phase of nursing process

❑Diagnosing :The nurse will analyze data, identifying health

problems, risks, and strengths, and formulating diagnostic
statements about a patient’s potential or actual health
problem.

❑More than one nursing diagnosis is sometimes made for

each patient.

❑Formulating a nursing diagnosis by nursing assists in the

planning & implementation of patient care.
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 Nursing Diagnosis
❑Diagnosis phase: Identification of the following two
types of patient health problems:
1. Nursing Diagnosis: A statement that describes a
specific client’s response to an actual or potential health
problem that requires independent nursing intervention.
2. Collaborative problems: Identify potential problems or
complications that require collaborative interventions. It
manage by physician-prescribed & nursing prescribed–
interventions.

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Establishing Nursing Diagnosis Statements
A nursing diagnosis statement consisted of three/or two
components: PES or PE format.

1. The Problem statement/diagnostic label (describes the patient

health problem & based on the (NANDA) category). =P

2. The Etiology/cause (related factors which contribute to

the problem/ probable causes of the health problem) =E
3. The Defining characteristics (signs and symptoms that
are associated with the problem /subjective & objective
data)=S
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 How to write Nursing diagnosis statement
❑Problem statement/A diagnostic label : 2 parts
1. Qualifier(modifiers): words that have been added to some
diagnostic labels to give additional meaning to the diagnostic
statement.
2. focus of the diagnosis.
Qualifier(modifiers) focus of the diagnosis.
▪ Impaired (made worse, weakened, Damaged) Physical mobility
▪ Ineffective (not producing the desired effect) Tissue Perfusion
▪ Acute (severe or of short duration) Pain
▪ Chronic (lasting a long time)
▪ Imbalanced Nutritional status : Less
Or altered (change from baseline) Than Body Requirements
▪ Risk for Injury
▪ Deficient (smaller in size, amount
16 September 2024 or degree)
Nursing Process Fluid volume
: Nursing diagnosis 5
 How to write Nursing diagnosis statement
▪ Etiology: is linked with the problem statement by the connecting
phrase as “related to”. Or “R/T”
▪ Defining characteristics: are written “as evidenced by” or “as
manifested by” in the diagnostic statement.

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 Formulating a Nursing Diagnosis

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 Examples of Nursing Diagnosis statements
Impaired Physical Mobility related to
decrease muscle control, loss of equilibrium
and coordination as evidenced by reduce
overall motor skill in the performance of
ADL.

Altered respiratory patterns related to

pneumonia as manifested by chest x-ray with
bilateral atelectasis.
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 Examples of Nursing Diagnosis statements
Acute Pain related to tissue ischemia as
evidenced by statement of “I feel severe pain
on my chest!”.

Ineffective Breathing Pattern R/T pain as

evidenced by a respiratory rate of less than
11 & use of accessory muscles.

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 Type Of Nursing Diagnosis
1. Problem-Focused Nursing Diagnosis (actual diagnosis):
Is a health problem present at the time of nursing
assessment. Also, presence of associated signs & symptoms
or defining characteristics
▪ Expressed by the use of a three-part (PES) statement
Problem(Diagnostic Label) related to ______________ (Related
Factors) as evidenced/or as manifested by _________________
(Defining Characteristics)

▪ Imbalanced Nutrition: Less than body requirements R/T

decreased appetite & nausea as manifested by decrease
body weight.
▪ Acute Pain related to decreased myocardial flow as
evidenced by expression of pain, guarding behavior.
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 Type Of Nursing Diagnosis
2. Risk Nursing diagnosis: It Is a clinical judgment that a
problem does not exist, but the presence of risk factors
indicates that a problem is likely to develop. No evidence of
sign & symptoms (defining characteristics) are present.
▪ Expressed by the use of a two -part (PE) statement
▪Problem (Diagnostic Label): Risk for _____________ related
to __________________________ (Risk Factors).

▪ Risk for falls R/T unsteady gait

▪ Risk for Impaired skin integrity R/T immobility &
decreased tissue perfusion.
▪ Risk for Constipation R/T inactivity and insufficient fluid
intake.
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 Type Of Nursing Diagnosis
3. Health Promotion Nursing Diagnosis or (wellness
diagnosis) : It is a clinical judgment about patients motivation
& desire to increase well-being.
▪ Do not require a related factor, there is no “related to”.
Instead, the defining characteristic(s) are provided patient
desire to improve his/her current health state.
▪ Expressed by the use of a two-part statement.
▪Health Promotion diagnosis: Readiness for Enhanced
_____________ ( defining characteristics)
Readiness for Enhanced family coping as evidenced by verbalization of
desire to information that will enhance health choices
Readiness for enhanced nutrition as evidenced by patient’s interest in
learning about healthy eating habits.
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 Type Of Nursing Diagnosis
4. Syndrome nursing diagnosis: used to describe a cluster of
related signs, symptoms, or risk factors that occur together&
are associated with a specific health condition or problem.

Expressed by the use of a one-part statement.

Problem (Diagnostic Label): _____________

▪ Chronic Pain Syndrome
▪ Disuse syndrome
▪ Post-trauma syndrome
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 Type Of Nursing Diagnosis
5. Possible Nursing Diagnosis: Are statements describing a
suspected problem for which additional data are needed to
confirm or rule out the suspected problem.

▪ Expressed by the use of a two-part statement

Problem (Diagnostic Label): possible _____________

▪ Possible chronic low self-esteem

▪ Possible social isolation.

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 Variations on Basic Statement Formats
❑Using “unknown etiology” when the defining
characteristics are present but the nurse does
not know the cause or contributing factors.
• Ineffective coping related to unknown
etiology.

❑Using “complex factors” when there are too many

etiologic factors or when they are too complex to
state in a brief phrase.
• Chronic Low Self-Esteem related to complex factors
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 Variations on Basic Statement Formats
❑Using “secondary to” to divide the etiology into
two parts, thereby making the statement more
descriptive & useful.
• Risk for Impaired Skin Integrity related to decreased
peripheral circulation secondary to diabetes.

❑Adding a second part to the general response or

diagnostic label to make it more precise.
• Impaired Skin Integrity (Right Lateral Ankle) related
to decreased peripheral circulation
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 PRIORITIZATION of NURSING DIAGNOSIS
❑Is the process that identifies the most significant
nursing problems, also the most important
interventions, in the nursing care plan.

❑Priorities are established using a number of

methods including:

➢The ABCs (airway, breathing & cardiovascular

status) of the patient as the highest of all priorities.

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➢ Maslow’s hierarchy of needs
❖Identifies the physiological or biological needs. Attention
being given first to physiological needs; once those lower-
level needs are met, higher-level needs can be addressed.

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 ➢ Alfaro-LeFevre (2008) suggests a three-level of
Prioritization :
▪ First-level priority problems (immediate): Airway
problems, Breathing problems, Signs (vital sign
problems)
▪ Second-level priority problems: Mental status
change, Acute pain, Acute urinary problems,
Untreated medical problems as (a diabetic who has
not had insulin), Abnormal lab values, Risks of
infection.
▪ Third-level priority problems:
Health problems that do not
fit in the above categories.
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 Nursing Diagnoses vs. Medical Diagnoses
❖Nursing diagnoses: focus on the human response to
health conditions & life processes that have been
identified independently by RNs .

❖Medical diagnoses: focus on diseases & medical

problems that have been identified by physician.
❖Example:
• A medical diagnosis: identified for Ms. Muna is Chronic
Obstructive Pulmonary Disease .
• Nursing diagnoses: “associated condition” is patient
may be experiencing ineffective of breathing patterns
& anxiety
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 Summery

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Recommended Resources: For
nursing diagnosis & nursing care plan books
❑Ackley and Ladwig’s Nursing Diagnosis Handbook:
An Evidence-Based Guide to Planning Care
❑Nursing Care Plans – Nursing Diagnosis &
Intervention (10th Edition)
❑Nurse’s Pocket Guide: Diagnoses, Prioritized
Interventions, and Rationales
❑Nursing Diagnosis Manual: Planning, Individualizing,
and Documenting Client Care

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