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25 Cards in this Set
- Front
- Back
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NANDA
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North American Nursing Diagnosis Association
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Diagnosis
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statement or conclusion reguarding RN Dx
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Types of Diagnosis:
WARPS |
Wellness
Actual Risk Possible Syndrome |
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Wellness
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i.e Readiness to enhance
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Actual
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problem is present at time of assesment
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Risk
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problem does not exist yet but has the potential unless RN intervenes
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Possible
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evidence about health problem but incomplete or unclear
i.e Possible Social Isolation (single, elderly widow) |
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Syndrome
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associated with a cluster of other diagnoses
i.s. Bedridden: Risk for injury, fall, constipation |
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RN Dx:
PES |
problem define
etiology(related to) signs and symptoms |
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Qualifiers:
Words with meaning for Dx |
Deficient
Impaired Decreased Ineffective Compromised |
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RN Dx Example
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Acute pain related to tissue distention and edema AEB verbal reports, guarding behavior, and change in vital signs.
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Nursing vs Medical Diagnoses
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Nursing: judgement
Medical: disease process |
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Independent functions
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RN based
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Dependent functions
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MD gives orders for RN to follow
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Collaborative problems
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potential problem managed by RN and MD
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Collaborative problems Example
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RN Dx: Activity Intolerance
MD Dx: Myocardial Infarction Coll: Potential Complication of MI: CHF |
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Dx Process:
AIF |
Analyze Data
Identify health Problem Form Dx Statement |
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Analyze Data
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compare with norms
cluster data id inconsistancies |
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Identify Health Problem
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gather data and conclude a statement
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Types of Statements:
2 part: P. E(related to) 3 part: P.E(related to). S(AEB) |
2-part: P problem E etiology
3-part: P problem E etiology S sign/symptom |
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Two Part Example
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Constipation related to prolonged laxative
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Three Part Example
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Situational Low Self-Esteem related to feeling of rejection by husbands AEB hypersensitivity to criticism; states"I don't know if I can manage by myself."
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Collaborative Problems
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Disease/Situation
Complication Related to |
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Collaborative Problems Example
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Potential complication of childbirth: hemorrhage related to bladder distention, retained placental fragments
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Guidelines for RN dx
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state problem
legally advisable nonjudgemental cause/effect are related RN terminology |