Towards a Greater Understanding of Nursing Diagnosis
and Care Planning
(How to think and prioritize like a nurse)
Once your care plan has been completed it is imperative to now look at the
reasons your client is in the hospital, the disease process that is most predominant and
the priorities these represent. When it comes to properly prioritizing your plan of care
you must first take a step back and begin with the A, B, C, D’s
AIRWAY/BREATHING/CIRCULATION/DISABILITY (Neuro). If any of these priorities are
reflected in your client, this is where you must lay the foundation and begin. Everything
else will be built from here. Refer to Doenges to ensure that the diagnostic statement
meets proper criteria to use for your client.
The following nursing diagnostic statements fall under this umbrella:
A/B: Airway-Breathing

Impaired gas exchange

Ineffective airway clearance

Ineffective breathing pattern

Impaired spontaneous ventilation

Risk for aspiration

Ineffective tissue perfusion (resp)…manifested by:
o
Altered RR outside parameters
o
Use of accessory muscles/chest retractions
o
Abnormal ABG’s
o
Bronchospasm
C: Circulation

Decreased cardiac output

Excess fluid volume

Deficient fluid volume

Risk for deficient fluid volume

Risk for imbalanced fluid volume
©2011 Keith Rischer/www.KeithRN.com

Ineffective tissue perfusion…manifested by:
o
o
o
Cardiopulmonary

Arrythmias

Weak/absent pulses

Edema

Altered BP outside parameters
Renal

Oliguria, anuria, hematuria

Elevation in creatinine

Hypoactive/absent bowel sounds

Abdominal distention
GI
D: Disability (Neuro)


Ineffective tissue perfusion…manifested by:
o
Altered mental status; speech abnormalities
o
Behaviorial changes (restlessness)
o
Changes in motor response, weakness, paralysis, papillary response
o
Difficulty swallowing
Acute confusion
o
Risk for falls
o
Risk for injury (trauma)

Chronic confusion

Anxiety
In addition to this initial sorting, nursing diagnosis statements can also be generally
sorted by the following body systems, activity impairments, education needs, and post
op surgical status:
GI/GU
©2011 Keith Rischer/www.KeithRN.com

Nausea

Bowel incontinence

Constipation

Risk for constipation

Diarrhea

Urinary retention
Integumentary

Impaired skin integrity

Impaired tissue integrity

Risk for impaired skin integrity
Activity Impairments

Activity intolerance

Impaired physical mobility

Impaired bed mobility

Impaired transfer ability

Impaired walking

Risk for activity intolerance

Fatigue
Client Education

Deficient knowledge (specify)

Noncompliance

Ineffective health maintenance
Surgical-post op: In addition to all the diagnostic statements under integumentary,
activity impairments and client education…the following also can apply:

Risk for infection

Delayed surgical recovery

Self care deficit (specify)

Acute pain
©2011 Keith Rischer/www.KeithRN.com
Once you have chosen the top nursing priorities, the following principles will help
guide you in the remainder of the care planning process of outcomes, interventions and
evaluation on the plan of care.
Nursing Diagnosis Statements: To state this correctly remember the following:

The related to must be the underlying problem or patho causing the problem, not
the disease process. For example in acute CHF client state: Decreased cardiac
output r/t altered contractility. NOT Decreased cardiac output r/t CHF.
Outcomes

Must flow from the nursing diagnosis statement and be specific and relevant to
your specific client, not just restating what is in Doenges. Use your concept map
data to make this connection.

Be specific and measurable to the day or context of your time in clinical. Do not
focus on discharge outcomes unless will be discharged in your time w/client.
Remember you need to be able to evaluate it.
Interventions

Make sure that your interventions flow directly from what the stated outcome is
reflecting.

Again must be relevant and specific to what is realistic and attainable for your
client. Adapt what is in Doenges to the data on your concept map.

Make the care plan tailored to your client by including as much specific data as
possible. For example do not state that you will “SN will give pain meds as
needed every 4 hours” but the specific meds that your client has available for
pain. “SN will give Percocet 1-2 tabs or Tylenol 650mg q4 hours as needed for
pain.”
Evaluation

Remember they must be dated and include the specific reasons why they were
met or not met
©2011 Keith Rischer/www.KeithRN.com
©2011 Keith Rischer/www.KeithRN.com