Nursing Diagnosis Guide:

All You Need to Know

Written by
Alex Lukey, MSN, RN

Reviewed by
Maegan Wagner, BSN, RN, CCM
The term “diagnosis” is defined as an agreed-upon clinical judgment.
When we think of a diagnosis, it is often thought of as a medical
diagnosis, such as high blood pressure. In its simplest form, a nursing
diagnosis is a diagnosis that nurses make based on their scope and
clinical judgment to guide patient care. Nursing diagnoses encompass
individuals, families, and communities and relate to health conditions
and life processes. Nursing diagnoses reflect the knowledge that is
fundamental to nursing practice. Nurses’ diagnoses also reflect the
systematic and scientific method of nursing.1

In this article:
 Purpose of a Nursing Diagnosis
 Nursing Diagnoses vs. Medical Diagnoses
 Purpose and Mission of NANDA-I
 Components of a Nursing Diagnosis
 Diagnosis
 Defining Characteristics
 Risk Factors
 Related Factors
 Types of Nursing Diagnoses
 Problem Focused
 Health Promotion
 Risk Focused
 Syndrome
  How to Write a Nursing Diagnosis
 Writing a Problem-Focused Nursing Diagnosis
 Writing a Risk-Focused Diagnosis
 Writing a Health Promotion-Based Diagnosis
 Writing a Syndrome Diagnosis
 List of Current Nursing Diagnoses and Domains
 List of Common Nursing Diagnoses
 References

Purpose of a Nursing Diagnosis

Nursing diagnoses are used in all care settings and support high
quality, evidence-based care. Here are a few ways nursing diagnoses
support nursing practice.

 Nursing diagnoses improve collaboration between team

members. Nursing diagnoses improve consistency and clarity of
communication between nurses and other members of the
patient’s care team. Nursing diagnoses can be revised, added,
or removed based on the patient’s outcomes.
 Nursing diagnoses are used as a teaching tool. For new
graduate nurses, familiarity with nursing diagnoses helps to
improve critical thinking confidence in practice. Nursing
diagnoses and supporting educational material can guide novice
nurses to direct interventions and goals for their patients.
Understanding how nursing diagnoses contribute to the nursing
process allows new nurses to become familiar with possible
interventions and care pathways for their patients.
 Nursing diagnoses may improve risk identification. Many
nursing diagnoses include diagnoses that alert the care team to
avoid a potential risk through intervention. For instance, the
nursing diagnosis “risk for bleeding” alerts a nurse that the
 patient may be receiving an anticoagulant and to monitor for
signs of bleeding.
 Nursing diagnoses can help establish care goals. Nursing
diagnoses illuminate care priorities, including current issues,
future risks, and health promotion opportunities. Once the
nursing diagnosis is identified, priorities, interventions, and goals
can be created in collaboration with the patient.
Nursing diagnoses are the foundation of care plans. Nursing
diagnoses drive actions and allow for continued assessment,
prioritization, organization, and effective health outcomes.

Nursing Diagnoses vs. Medical Diagnoses

Although there are some similarities between medical and nursing
diagnoses, such as clinical judgment and shared terminology, they are
distinct.2 the most apparent difference between nursing and medical
diagnoses is the healthcare practitioner deciding the diagnosis.
Nursing diagnoses are shared by all nursing designations, while
physicians create medical diagnoses. The exception is that nurse
practitioners in most states can also determine medical diagnoses and
prescribe medication. Therefore, a nurse practitioner could provide
both nursing and medical diagnoses.

There are also differences in each type of diagnosis. For example,

medical diagnoses focus on the disease or pathology that affects the
patient. In contrast, nursing diagnoses concentrate on the patient’s
response to the illness or life circumstance, which can be either a
physiological or psychological response. By focusing on the client’s
response, a nurse applies interventions to address or alter that
response.

To clarify this distinction, here are two examples of how medical and
nursing diagnoses can work together.

Example 1:
A patient with a medical diagnosis of cerebrovascular accident
(stroke) may lead to the complementary nursing diagnosis of unilateral
neglect. Without the medical diagnosis, the nurse would not know
what was causing unilateral neglect. The nursing diagnosis is a
jumping-off point to create goals to manage the deficit and improve
patient safety and quality of life.

Example 2:

With the medical diagnosis of dehydration, the nurse knows that the
patient is experiencing deficient fluid volume (nursing diagnosis).
Therefore, the nurse may implement the interventions of administering
IV fluids and recording intake and output for this patient.

Nursing and medical diagnoses are complementary and guide each

other to create a holistic clinical story.

Purpose and Mission of NANDA-I

NANDA International is an organization that supports the use and
development of standardized nursing terminology throughout clinical
settings.3 This organization’s mission is to use nursing diagnoses to
promote high-quality patient care through evidence-based care and
consistent terminology. Standardized nursing diagnoses inform
evidence-based terminology that improves clinical practice by
providing clear guidelines for communication and documentation.
NANDA International continually releases new editions with revised,
added, or retired nursing diagnoses with updates to criteria and
classifications.

The name NANDA originated as the acronym for the North American
Nursing Diagnosis Association. However, with the organization’s
global expansion, they no longer use NANDA as an acronym but as a
recognizable organizational name. If using the organization’s full
name, the correct use is NANDA International, Inc. (no hyphen), and
the abbreviation is NANDA-I (with a hyphen). The organization offers
networking and education and holds task forces on topics such as
diagnosis development, informatics, and nursing research.

Components of a Nursing Diagnosis

Diagnosis

Nursing diagnosis is the second step of the nursing process after

assessment.6 First, the nurse analyzes the assessment data they
collect, including quantitative and qualitative data. The nurse uses
critical thinking and understanding of the client’s context to perform
data analysis to determine what is expected or abnormal and what
information is relevant to the clinical picture. The nurse will use that
data and create clusters of pertinent information to form hypotheses
about the appropriate nursing diagnoses. At this stage, the nurse will
either write the nursing diagnosis or decide that they need additional
information to confirm or update their hypothesized diagnosis.

Defining Characteristics

Characteristics and risk factors are the evidence behind the nursing
diagnosis.4 However, they should not be used interchangeably.
Defining characteristics are observable characteristics to support a
problem-focused health promotion diagnosis or syndrome. Defining
characteristics are the signs or symptoms of clinical pathology.

Risk Factors

Risk factors are used primarily for risk-focused nursing diagnoses.

Risk factors replace the defining characteristics of problem-focused
nursing diagnoses. Similarly, they provide supporting evidence for the
nursing diagnosis. Unlike defining characteristics, risk factors describe
why the patient has increased chances of the undesirable health
outcome identified by the nurse. Risk factors can be biological,
psychological, family, or community-related. Patients may have one or
multiple risk factors supporting a risk diagnosis.

Related Factors

Related factors are described as the etiology of the nursing

diagnosis.4 Related factors are used in problem-focused, syndrome,
and sometimes health promotion nursing diagnoses. If the etiology of
the nursing diagnosis is known, it should be included in the diagnosis.
The nurse must then determine if other assessments are required to
understand the underlying etiology to form an accurate care plan to
address the issue. For example, a nurse may conclude the nursing
diagnosis of ineffective tissue perfusion. The nurse may conduct a
further respiratory assessment to find the patient hypoxic. Further
investigation would be required to find the clinical etiology of the
ineffective tissue perfusion if there is not a known cause in the
patient’s medical history.

Types of Nursing Diagnoses

Problem Focused

A problem-focused nursing diagnosis is a nursing diagnosis that

addresses a current health challenge.4 In contrast to other nursing
diagnoses that address potential problems or opportunities for health
improvement, a problem-focused diagnosis deals with a current,
known health challenge. To make this type of diagnosis, the defining
characteristics of the diagnosis must be present at the time of
evaluation. The defining characteristics include signs, symptoms, and
patient health history. Defining characteristics act as clues for the
nurse and, when grouped together, form patterns that allow a
diagnosis to be assigned. Related factors, also known as etiology,
should also be described as part of a problem-focused nursing
diagnosis.

Problem-focused nursing diagnosis example: The nurse notices

that the patient has a negative balance between their fluid intake and
output. The patient also has dry mucous membranes and weight loss.
The nurse makes the problem-based nursing diagnosis of “deficient
fluid volume.” The NANDA-I definition is “Decreased intravascular,
interstitial, and/or intracellular fluid. This refers to dehydration, water
loss alone without change in sodium.”5 Depending on the etiology and
the patient’s health condition, the care plan and interventions will aim
to increase fluid intake, identify the cause of the fluid deficit, and
maintain evidence of normovolemia.

Health Promotion

In contrast to problem-focused nursing diagnoses, health promotion

diagnoses require that the individual/family/community is already
functioning effectively in the health area, but there is an opportunity to
increase well-being. Another requirement of a health promotion
nursing diagnosis is that there is an expressed desire for
improvement. This is often expressed at the beginning of the nursing
diagnosis statement as “Readiness for enhanced…”. Therefore, the
defining characteristic of a health promotion diagnosis is the
client/family or community expressing a desire to improve or change
health behaviors. There is some similarity to risk-focused nursing
diagnoses; however, health promotion diagnoses are further upstream
than risk-focused nursing diagnoses, as they aim to improve and
actualize health potential in contrast to preventing an undesirable
outcome.

Health promotion nursing diagnosis example: At a prenatal

screening visit with a nurse, a patient expresses the desire to
breastfeed exclusively. The nurse recognizes the opportunity for
health promotion with the nursing diagnosis of “Readiness for
Enhanced Breastfeeding.” The NANDA-I definition is “A pattern of
providing milk to an infant or young child directly from the breasts
which may be strengthened.”5 Based on this assessment, the nurse
may refer the client to trusted online sources of information or refer
them to group education sessions if available.

Risk Focused
As stated previously, a risk-based nursing diagnosis falls between a
problem-based nursing diagnosis and a health promotion nursing
diagnosis. In a risk-based diagnosis, the nurse uses their clinical
judgment to determine that the patient is at risk for health
consequences if preventative measures are not implemented.
Otherwise stated, the problem has not yet manifested for the
client/family/community, but there is a vulnerability related to risk
factors that the nurse identifies. Care plans will focus on preventing
undesirable health outcomes.

Risk-focused nursing diagnosis example: In an inpatient surgical

unit, a nurse is assigned to a patient postoperative day 3 for Whipple
surgery. This nurse immediately recognizes that the patient meets the
criteria for the nursing diagnosis of “Risk for Infection.” The NANDA-I
definition is “At risk for being invaded by pathogenic organisms.” This
patient is at risk due to their diagnosis of pancreatic cancer and recent
surgery. For this reason, the nurse provides patient teaching on
handwashing and provides the patient with alcohol-based antiseptic
hand rub on their bedside table.

Syndrome

Nursing diagnosis syndromes are created when two or more

concurrent nursing diagnoses are related and can be treated using
similar interventions. Nursing syndrome diagnoses also cluster
problem and risk-focused nursing diagnoses that often accompany
specific health processes or life events.

Syndrome nursing diagnosis example: A patient shares that they

recently witnessed a motor vehicle accident resulting in multiple
injuries, including deaths. While not injured, they report difficulties
sleeping, increased alcohol use, and irritability, which are now
beginning to impact their ability to work. The nurse recognizes this
cluster of symptoms as consistent with the nursing diagnosis of “post-
trauma syndrome.” The NANDA-I definition of post-trauma syndrome
is “Sustained maladaptive response to a traumatic, overwhelming
event.” 5 Other nursing diagnoses that may cluster to form this
syndrome include nursing diagnoses related to sleep, anxiety, hope,
depression, substance use, and relationships. The nurse discusses
the goal of acknowledging the trauma and discusses options to
connect the patient to support resources.

How to Write a Nursing Diagnosis

Standardized methods of writing nursing diagnoses allow for clear
communication of a nursing diagnosis’s purpose and driving factors.
Writing a complete nursing diagnosis helps the nurse clarify their
reasoning for potential interventions and care goals.

Writing a Problem-Focused Nursing Diagnosis

Problem-focused nursing diagnoses are three-part statements that

include the problem, etiology, and symptoms (PES framework).

Problem

Nurses should use a NANDA-I label whenever possible to describe

the identified problem to ensure consistency in diagnoses. However, if
no NANDA-I label adequately represents the problem, the nurse
needs to describe the problem in a clear, concise, and useful way to
the care team. It is important to avoid judgmental language in the
problem statement.

Etiology

The second part of the problem-focused nursing diagnosis is the

etiology or the underlying cause or causes of the nursing diagnosis.
The etiology of the diagnosis is key to choosing appropriate
interventions, so the nurse should describe the etiology as precisely
as possible. For instance, what was the event’s timing, or how long
has the client had the disease? When describing an etiology linked to
a known pathophysiology or disease, the etiology should be stated as
“secondary to.” Otherwise, the etiology should be stated as “related to”
(R/T). “Related to” does not necessarily specify a direct cause-and-
effect relationship, which is preferred because there may be other
factors related to the nursing diagnosis that have not yet been
identified.

When various factors contribute to a nursing diagnosis that cannot be

summarized into a one-sentence statement, the etiology may be
written as “related to complex factors.” This should not be used as a
shortcut to finding the appropriate etiology but can be used when
there is not a clear primary etiology for the nursing diagnosis.

Signs/Symptoms

For a problem-focused nursing diagnosis, the described signs and

symptoms are the defining characteristics of the nursing diagnosis.
The nurse should link the etiology to the signs and symptoms by
stating “as manifested by” (AMB).

3-Part Nursing Diagnosis (P-E-S Format)

Problem (Label) + Etiology (Cause or Related Factors) +

Signs/Symptoms (Defining Characteristics)

Problem-Focused Diagnosis label ____________ related to

____________ (Etiology or Related Factors) as evidenced by
____________ (Defining Characteristics).

Example: Deficient fluid volume related to prolonged vomiting as

evidenced by increased pulse rate, increased urine concentration, and
poor skin turgor.

Writing a Risk-Focused Diagnosis

The risk-focused diagnosis is a two-part statement that includes

statements of the problem and risk factors. In this case, a vulnerability
rather than a present health problem.

Problem
Like a problem-focused diagnosis, the risk-focused statement should
also, if possible, use a NANDA-I approved diagnosis starting with
“Risk for…”. If a NANDA-I nursing diagnosis does not adequately
describe the vulnerability, the nurse should still begin their problem
statement with “Risk for…”.

Risk Factors

Rather than describing the etiology or related factors, risk-focused

diagnoses are supported by describing the risk factors related to the
diagnosis. The risk factor statement should follow the problem
statement with the nurse describing the problem “as evidenced by”
and then listing the risk factors.

2-Part Nursing Diagnoses

2-Part Nursing Diagnoses = Label + Risk Factors

Risk focused diagnosis label ____________ as evidenced by

____________ (Risk Factors).

Defining characteristics are not possible because the problem isn’t

“actual” yet.

Examples:

 Risk for infection as evidenced by a history of cancer and recent

surgery.
 Risk for falls as evidenced by a history of falls, use of an
assistive device, and visual difficulties.
Writing a Health Promotion-Based Diagnosis

A health promotion diagnosis is also described using a two-part

statement.

Problem
Rather than identifying a health problem, the problem when following
the PES framework here is an opportunity for health improvement.
When possible, the nurse should use an approved NANDA-I health
promotion diagnosis. If the nurse is formulating their own problem
statement for a health promotion diagnosis, they should start the
statement with “readiness for enhanced…”.

Signs/Symptoms

The signs and symptoms used to describe a health promotion

diagnosis are related to the patient, family, or community expressing
readiness or desire for health improvement. This may be a verbal
expression, actions, or other cues that alert the nurse to readiness for
health promotion.

2-Part Nursing Diagnoses

2-Part Nursing Diagnosis = Label + Defining Characteristics

Health promotion label ____________ as evidenced by

____________ (Defining characteristics).

Examples:

 Readiness for enhanced breastfeeding as evidenced by the

patient stating their desire to exclusively breastfeed and
requesting information on how to achieve this.
Writing a Syndrome Diagnosis

The syndrome diagnosis is a group of related nursing diagnoses and

should be written as a two-part statement.7

Problem

The nurse should use a recognized NANDA-I syndrome to diagnose a

nursing syndrome.

Etiology
For a syndrome diagnosis, the etiology is described as two or more
nursing diagnoses that form the evidence for the syndrome diagnosis.
There should be a minimum of two diagnoses, with no maximum of
nursing diagnoses to support a syndrome diagnosis. Each nursing
diagnosis should be written in its complete, appropriate form, either
including etiology, signs and symptoms, or risk factors.

2-Part Nursing Diagnoses

2-Part Statement = Label + Nursing Diagnoses that make up the

syndrome

Syndrome diagnosis label ____________ as evidenced by

____________ (2 or more nursing diagnoses that support the
syndrome diagnosis).

Examples:

 Post-trauma syndrome as evidenced by disturbed sleep pattern

and ineffective relationship functioning.
 Post-trauma syndrome as evidenced by insomnia and risk for
suicide.
List of Current Nursing Diagnoses and Domains
In the 2020 to 2023 edition of NANDA-I, there are 13 domains of
nursing diagnoses. Each domain has between three and six classes of
nursing diagnoses, that are then broken down into individual
diagnoses. Here we will list all 13 domains, related classes, and an
example nursing diagnosis. Please see NANDA International- Nursing
Diagnoses Definitions and Classification, 12th Edition, for the
complete list of diagnoses.

Domain 1: Health Promotion

Class 1: Health Awareness
Class 2: Health Management
Diagnosis: Risk for frail elderly syndrome
Domain 2: Nutrition
Class 1: Ingestion
Class 2: Digestion
Class 3: Absorption
Class 4: Metabolism
Class 5: Hydration
Diagnosis: Risk for unstable blood glucose level

Domain 3: Elimination and exchange

Class 1: Urinary function
Class 2: Gastrointestinal function
Class 3: Integumentary function
Class 4: Respiratory function
Diagnosis: Urinary retention

Domain 4: Activity/rest
Class 1: Sleep/Rest
Class 2: Activity/Exercise
Class 3: Energy balance
Class 4: Cardiovascular/pulmonary responses
Class 5: Self-care
Diagnosis: Bathing self-care deficit

Domain 5: Perception/cognition
Class 1: Attention
Class 2: Orientation
Class 3: Sensation/perception
Class 4: Cognition
Class 5: Communication
Diagnosis: Impaired memory

Domain 6: Self-perception
Class 1: Self-concept
Class 2: Self-esteem
Class 3: Body image
Diagnosis: Chronic low self-esteem
Domain 7: Role relationship
Class 1: Caregiving roles
Class 2: Family relationships
Class 3: Role performance
Diagnosis: Impaired social interaction

Domain 8: Sexuality
Class 1: Sexual identity
Class 2: Sexual function
Class 3: Reproduction
Diagnosis: Risk for disturbed maternal-fetal dyad

Domain 9: Coping/stress tolerance

Class 1: Post-trauma responses
Class 2: Coping responses
Class 3: Neurobehavioral stress
Diagnosis: Risk for post-trauma syndrome

Domain 10: Life principles

Class 1: Values
Class 2: Beliefs
Class 3: Value/belief/action congruence
Diagnosis: Moral distress

Domain 11: Safety/protection

Class 1: Infection
Class 2: Physical injury
Class 3: Violence
Class 4: Environmental hazards
Class 5: Defensive processes
Class 6: Thermoregulation
Diagnosis: Risk of surgical site infection

Domain 12: Comfort

Class 1: Physical comfort
Class 2: Environmental comfort
Class 3: Social comfort
Diagnosis: Impaired comfort

Domain 13: Growth/development

Class 1: Growth
Class 2: Development
Diagnosis: Delayed infant motor development
List of Common Nursing Diagnoses
In this section you will find common NANDA nursing diagnoses you
can use to create care plans.

 Activity Intolerance
 Acute Confusion
 Acute Pain
 Anxiety
 Chronic Pain
 Constipation
 Decreased Cardiac Output
 Diarrhea
 Disturbed Body Image
 Excess Fluid Volume
 Fatigue
 Fluid Volume Deficit (Dehydration)
 Hopelessness
 Hyperthermia
 Imbalanced Nutrition
 Impaired Comfort
 Impaired Gas Exchange
 Impaired Physical Mobility
 Impaired Skin Integrity
 Impaired Urinary Elimination
 Impaired Verbal Communication
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Ineffective Coping
  Ineffective Health Maintenance
 Ineffective Tissue Perfusion
 Insomnia
 Knowledge Deficit
 Noncompliance (Ineffective Adherence)
 Risk For Aspiration
 Risk for Bleeding
 Risk for Electrolyte Imbalance
 Risk for Falls
 Risk for Infection
 Risk for Injury
 Risk For Unstable Blood Glucose
 Self-Care Deficit
 Social Isolation
 Stress Overload
 Urinary Retention

References
1. Karaca T, Aslan S. Effect of ‘nursing terminologies and
classifications’ course on nursing students’ perception of nursing
diagnosis. Nurse education today. 2018;67(Journal Article):114-
117. doi:10.1016/j.nedt.2018.05.011
2. NANDA Internatioal. What is the difference between a medical
diagnosis and a nursing diagnosis? Accessed January 7,
2023. http://nanda.host4kb.com/article/AA-00266/0/What-is-the-
difference-between-a-medical-diagnosis-and-a-nursing-
diagnosis-.html
3. NANDA Internatioal. Our Story. Accessed January 7,
2023. https://nanda.org/who-we-are/our-story/
4. NANDA Internatioal. Glossary of Terms. Accessed January 3,
2023. https://nanda.org/publications-resources/resources/glossar
y-of-terms/
 5. Carpenito LJ, Books@Ovid Purchased eBooks. Handbook of
Nursing Diagnosis. 15th ed. Wolters Kluwer; 2017.
6. Open Resources for Nursing. DIAGNOSIS. In: Nursing
Fundamentals.
7. NANDA Internatioal. The Structure and Development of
Syndrome Diagnoses. Accessed January 7,
2023. https://nanda.org/publications-resources/resources/positio
n-statement/
Published on January 31, 2023

Alex Lukey, MSN, RN

Alex Lukey is a registered nurse and researcher. Alex earned her
bachelor's and master's degrees in nursing from the University of
British Columbia Okanagan. She is now working on a Ph.D. in Public
Health as a Killam Scholar at the University of British Columbia. Alex's
research has spanned health policy, patient education, and oncology.
She is currently working on ovarian cancer prevention using machine
learning. Her clinical practice experience includes cardiology, cardiac
surgery, and pediatric homecare. Alex is passionate about science
communication and education.
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