Nursing Diagnoses - What are they and what ones should I consider?

Nursing diagnoses are a unique kind of diagnosis in the medical world and should not be confused with medical diagnoses. NANDA (the North American Nursing Diagnosis Association) does an excellent job explaining what a nursing diagnosis is and what it is is not. A nursing diagnosis should not focus primarily on the patient's medical condition (because it is not a medical diagnosis) and it should not simply be a way to reword the medical diagnosis. A nursing diagnosis should not act as a specific label for a patient in an attempt to verbalize what you are seeing in the patient.

NANDA defines a nursing diagnosis as, "A clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability."

A nursing diagnosis should always be formulated after a comprehensive head-to-toe nursing assessment. When a nursing diagnosis is based off of a comprehensive assessment, more effective and safer patient care can occur which often leads to a improved patient outcome.

Below are some nursing diagnoses that commonly arise when working with a pediatric patient with medulloblastoma. It is important to remember that not all of these nursing diagnoses may apply and that a nurse should thoroughly assess the patient and their family members to determine the appropriate nursing diagnoses.

Nursing Diagnosis	Related to	Plan/Outcome	Interventions
Disturbed body image	Hair loss and other body changes	Short term: Patients express a change in body image Long term: Patient reports having an positive self-image	Facilitate therapeutic communication with the patient, educate patient on what kind of body changes to expect, education caregivers on coping strategies to discuss with their child, observe the patient in a social interaction
Impaired skin integrity	Chemotherapy and radiation	Short term: skin remains intact, no signs of redness/breakdown Long term: patient’s skin integrity is maintained	Assess skin integrity every 4 hours, keep skin clean and dry, turn the patient every 2 hours, encourage the patient to consume adequate amounts of liquids and nutrients
Acute pain	Side effects of treatment	Short term: Patient reports no discomfort (no visible grimace/cry if not able to self-report), vital signs are stable, patient is able to participate in activities Long term: pain management remains consistent with no peaks/troughs in pain levels	Assess characterisitics of pain (OLD CART = onset, location, duration, characterisitics, alleviating/aggravating factors, any radiating pain, treatment options), try to establish a set schedule for administering pain medications, provide comfort to patient (distraction, repositioning, etc.), anticipate pain with activity and pre-medicate patient before activity
Risk for fluid volume deficit	Chemotherapy and radiation	Short term: Intake and output is balanced, skin turgor is present and mucous membranes are intact/moist, electrolytes, Hb, HCT, and vital signs are all within normal range Long term: Patient understands risks associated with fluid volume deficit and maintains hydration status.	Continually assess: skin turgor, mucous membranes, patient’s thirst level, blood pressure, HR, serum electrolytes, albumin, and CBC Monitor intake and output, insure adequate intake of fluids (checking IV pumps, etc.),
Anxiety	Unknown future	Short term: patient will express willingness to discuss anxieties, patient will develop coping strategies to manage anxiety Long term: patient will report a reduction in overall anxiety	Suggest relaxation/distraction techniques to reduce anxiety, maintain a relationship of therapeutic communication with the patient, encourage the patient to verbalize his/her anxieties as they arise, allow the patient time alone to rest

Some other nursing diagnoses not mentioned above but that can be important to consider include: risk for infection, risk for caregiver role strain, risk for ineffective coping, and readiness for enhanced learning.


References:

http://www.nanda.org/What-is-Nursing-Diagnosis-And-Why-Should-I-Care_b_2.html

http://nandanursing.com/nursing-care-plan-for-brain-tumor-intracranial-tumor.
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http://wps.prenhall.com/wps/media/objects/737/755395/brain_tumor.pdf