How to Write a Nursing Differential Diagnosis
A nursing differential diagnosis is a list of possible conditions that could be causing a patient’s symptoms. It is a theory based on clinical reasoning, the patient’s medical history, and the results of physical exams and tests rather than a final diagnosis. Since many conditions can exhibit similar symptoms, a nursing differential diagnosis is necessary when multiple potential causes are considered. For example, fatigue can result from anemia, depression, heart disease, thyroid disease, sleep disorders, and other conditions.
A nursing differential diagnosis is not an official diagnosis; it is a step toward determining the underlying cause of the symptoms.
A nursing diagnosis forms the foundation for selecting nursing interventions to achieve outcomes for which the nurse is accountable. Developed from data gathered during the nursing assessment, nursing diagnoses enable the nurse to create a care plan.
Features of a Healthcare Provider’s Diagnostic Process
Your healthcare provider follows several steps to make an accurate diagnosis:
- Asking questions about your symptoms.
- Reviewing your medical history.
- Performing a physical examination.
- Creating a nursing differential diagnosis.
- Ordering additional tests.
- Reviewing test results and symptoms.
- Making a nursing differential diagnosis.
When Is a Nursing Differential Diagnosis Performed?
A nursing differential diagnosis is necessary when your symptoms match multiple conditions. Additional tests help narrow down the potential conditions on the nursing differential diagnosis list.
Test Details
How Does a Nursing Differential Diagnosis Work?
To make a diagnosis, your healthcare provider will gather as much information about your symptoms as possible. The process begins with an examination where they ask questions like:
- What are your symptoms?
- How long have you had these symptoms?
- What is the severity of your symptoms?
Next, they will review your medical history to see if the symptoms relate to any previous health concerns or diagnosed conditions. Questions about your medical history might include:
- Have you experienced these symptoms before?
- Have you noticed anything that might trigger or worsen your symptoms?
- Have you experienced any significant changes in your life?
- What medications, vitamins, and supplements are you taking?
Finally, your healthcare provider will perform a physical examination, checking your blood pressure heart rate, and listening to your lungs.
Based on this information, your provider will compile a list of potential conditions related to your symptoms. To confirm your diagnosis, they may order additional tests, such as:
- Laboratory tests (blood or urine).
- Imaging tests (X-ray, ultrasound).
After reviewing your symptoms, medical history, and test results, your healthcare provider will pinpoint the exact cause of your symptoms, make a final diagnosis, and recommend treatment.
What Can I Expect Before a Diagnostic Evaluation?
Before diagnosing, your healthcare provider will evaluate your symptoms by asking about your health and medical history. It’s essential to bring a list of any medications, vitamins, or supplements you take so your provider can ensure they are not influencing your symptoms.
What Can I Expect During a Diagnostic Evaluation?
During a nursing differential diagnosis, it might be overwhelming to see a list of possible conditions that could be causing your symptoms. At this stage, your healthcare provider will order tests to eliminate conditions and narrow down your specific diagnosis.
What Can I Expect After a Diagnostic Evaluation?
It’s important to understand that a nursing differential diagnosis is not a final diagnosis but a step toward it. Making an accurate diagnosis, especially for complex conditions, can take time.
Following the evaluation, your healthcare provider might order laboratory or imaging tests to confirm their diagnostic theories and pinpoint the most accurate condition. After the official diagnosis, your healthcare provider will recommend treatment options.
What Are the Risks of a Nursing Differential Diagnosis?
A nursing differential diagnosis is part of the diagnostic process aimed at eliminating errors. The goal is to treat the correct condition without endangering you. By forming a nursing differential diagnosis, additional testing is necessary to ensure the proper diagnosis rather than treating symptoms without understanding the cause. Only complete steps in the diagnostic process can lead to accurate diagnoses. However, additional testing significantly reduces the likelihood of error.
Results and Follow-Up
What Type of Results Do You Get with a Nursing Differential Diagnosis, and What Do They Mean?
A nursing differential diagnosis lists possible conditions that share the symptoms you described. This list is not your final diagnosis but a theory of what might be causing your symptoms. Your healthcare provider will order tests to eliminate conditions from this list, leading to your final diagnosis.
When Should I Know the Results of a Nursing Differential Diagnosis?
The timeline for receiving your results depends on the symptoms and complexity of the potential condition. Stay in contact with your healthcare provider during the diagnostic process, especially if you experience any changes in symptoms or medical history that could affect your diagnosis.
When Should I Call My Healthcare Provider?
You should contact your healthcare provider if:
- Your symptoms increase in severity or disappear.
- You develop new symptoms.
- You are hospitalized for any reason.
- Your current medications change.
Additional Common Questions
What Are Examples of Nursing Differential Diagnoses?
Several conditions can share similar symptoms. Your healthcare provider will evaluate your symptoms to make a nursing differential diagnosis and recommend treatment. If the initial treatment fails, they may reassess your symptoms and consider other potential conditions. Here are some examples:
Abdominal Pain
Symptoms: Ache, cramps, or sharp pains in the stomach region.
Possible Diagnoses:
- Appendicitis
- Gastritis
- Inflammatory bowel disease
- Intestinal or bowel blockage
- Pancreatitis
Asthma
Symptoms: Shortness of breath, wheezing, chest tightness, and coughing.
Possible Diagnoses:
- Allergic rhinitis
- Bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Pneumonia
Back Pain
Symptoms: Aching, burning, or sharp pain that worsens with movement.
Possible Diagnoses:
- Arthritis
- Disk hernia
- Fibromyalgia
- Osteoporosis
Chest Pain
Symptoms: Aching, sharp pain, burning, tightness, or pressure in the chest.
Possible Diagnoses:
- Angina
- Anxiety
- Muscle strain
- Pneumonia
- Viral infection
Cough
Symptoms: Clearing mucus or fluids from the throat, irritation, or tickle in the back of the throat.
Possible Diagnoses:
- Asthma
- Bronchitis
- Pneumonia
- Reflux
- Seasonal allergies
Depression
Symptoms: Fatigue, low energy, anxiety, mood, and appetite changes.
Possible Diagnoses:
- Anxiety
- Bipolar disorder
- Dementia
- Hypothyroidism
Elevated Alkaline Phosphatase
Symptoms: Abdominal pain, nausea, vomiting, and jaundice.
Possible Diagnoses:
- Liver, gall bladder, or bile duct blockage
- Gallstones
- Liver disease
Fatigue
Symptoms: Persistent tiredness, lack of energy, poor sleep, and weakness.
Possible Diagnoses:
- Anemia
- Depression
- Insomnia
- Thyroid disease
Headache
Symptoms: Head pain, throbbing, light, and sound sensitivity, lasting from hours to days.
- Hypertension
Hypertension
Symptoms: Chest pain, headaches, dizziness, shortness of breath, and fatigue.
Possible Diagnoses:
- Kidney disease
- Sleep apnea
- Thyroid disease
Knee Pain
Symptoms: Swelling, instability, stiffness, and popping noises in the knee.
Possible Diagnoses:
- Arthritis
- Cartilage tear
- Osteoarthritis
- Strained ligaments
- Tendonitis
Urinary Tract Infection (UTI)
Symptoms: Frequent urination, burning sensation while urinating, and a persistent urge to urinate.
Possible Diagnoses:
- Chlamydia
- Gonorrhea
- Interstitial cystitis
- Vaginal yeast infection
A nursing differential diagnosis is a crucial step in your healthcare provider’s process of making a final diagnosis. While seeing a list of possible conditions may seem overwhelming, remember that this is not the final nursing differential diagnosis. Your healthcare provider will recommend additional tests to confirm the diagnosis and provide appropriate treatment to alleviate your symptoms.
Types of Nursing Diagnoses
The four types of nursing diagnosis are Actual (Problem-Focused), Risk, Health Promotion, and Syndrome. Here are the four categories of nursing diagnoses:
Nursing Process
The nursing process consists of five stages: assessment, diagnosis, planning, implementation, and evaluation. Each step requires the nurse to use critical thinking. Understanding nursing diagnoses and their definitions is crucial. Nurses must be aware of defining characteristics, behaviors of the diagnoses, related factors, and appropriate interventions.
Problem-Focused Nursing Diagnosis
A problem-focused diagnosis (also known as actual diagnosis) identifies a client’s problem present at the time of assessment based on associated signs and symptoms. These diagnoses should not be seen as more important than risk diagnoses, as risk diagnoses can sometimes be the highest priority.
Problem-focused nursing diagnoses have three components: (1) nursing diagnosis, (2) related factors, and (3) defining characteristics. Examples include:
- Anxiety related to stress, evidenced by increased tension, apprehension, and concern about upcoming surgery.
- Acute pain related to decreased myocardial flow, evidenced by grimacing, expression of pain, and guarding behavior.
Risk Nursing Diagnosis
A risk nursing diagnosis identifies potential problems that could develop unless nurses intervene. It is based on the patient’s current health status, past health history, and risk factors that may increase the likelihood of a health problem. These diagnoses help in early identification and prevention of potential issues.
Risk diagnoses do not have etiological factors. Instead, they identify individuals or groups more susceptible to developing problems due to risk factors. For example, an elderly client with diabetes and vertigo who refuses assistance during ambulation may be diagnosed with a risk for injury or risk for falls.
Components of a risk nursing diagnosis include (1) risk diagnostic label and (2) risk factors. Examples include:
- Risk for injury
- Risk for infection
Health Promotion Diagnosis
A health promotion or wellness diagnosis is a clinical judgment about an individual’s motivation and desire to increase well-being. It identifies the patient’s readiness to engage in activities promoting health. For example, a first-time mother showing interest in breastfeeding may be diagnosed with “Readiness for Enhanced Breastfeeding,” guiding interventions to support proper breastfeeding.
This diagnosis focuses on transitioning an individual, family, or community to a higher level of wellness. It generally includes only the diagnostic label. Examples include:
- Readiness for enhanced health literacy
Syndrome Diagnosis
A syndrome diagnosis is a clinical judgment about a cluster of problems or risk nursing diagnoses expected to occur due to a particular situation or event. It is written as a one-part statement with only the diagnostic label. Examples include:
Possible Nursing Diagnosis
A possible nursing diagnosis is not a definitive diagnosis but a statement describing a suspected problem needing further data for confirmation. It allows communication among nurses about a potential diagnosis that requires additional data collection. Examples include:
- Possible chronic low self-esteem
- Possible social isolation
Components of a Nursing Diagnosis
A nursing diagnosis typically has three components: (1) the problem and its definition, (2) the etiology, and (3) the defining characteristics or risk factors (for risk diagnosis).
Problem and Definition
The problem statement, or diagnostic label, concisely describes the client’s health problem or response to which nursing therapy is given. A diagnostic label usually has two parts: qualifier and focus of the diagnosis. Qualifiers (modifiers) add meaning, limit, or specify the diagnostic statement. One-word nursing diagnoses (e.g., Anxiety, Constipation, Diarrhea, Nausea) inherently include the qualifier and focus in the term.
Etiology
The etiology, or related factors, component of a nursing diagnosis identifies one or more probable causes of the health problem. It involves the conditions contributing to the development of the problem, guiding the necessary nursing interventions, and allowing the nurse to tailor care to the individual patient. Nursing interventions should target etiological factors to address the root cause of the nursing diagnosis. Etiology is connected to the problem statement using the phrase “related to.” For example:
- Activity intolerance related to generalized weakness.
- Decreased cardiac output related to abnormality in blood profile.
Risk Factors
Risk factors replace etiological factors in risk nursing diagnoses. These elements increase an individual’s (or group’s) vulnerability to an unhealthy condition. Risk factors are specified in the diagnostic statement following the phrase “as evidenced by.”
- Risk for falls as evidenced by old age and use of a walker.
- Risk for infection as evidenced by a break in skin integrity.
Defining Characteristics
Defining characteristics are clusters of signs and symptoms indicating the presence of a specific diagnostic label. Defining characteristics in an actual nursing diagnosis are the observed signs and symptoms. For risk nursing diagnoses, since no signs and symptoms are present, the factors making the client more susceptible to the problem form the etiology. Defining characteristics are included in the diagnostic statement using the phrases “as evidenced by” or “as manifested by.”
Diagnostic Process: How to Diagnose
The diagnostic process includes three phases: (1) data analysis, (2) identification of the client’s health problems, health risks, and strengths, and (3) formulation of diagnostic statements.
Analyzing Data
Data analysis involves comparing patient data against standards, clustering cues, and identifying gaps and inconsistencies.
Identifying Health Problems, Risks, and Strengths
After data analysis, the nurse and the client identify problems that support tentative actual, risk, and possible diagnoses. This step involves determining whether a problem is a nursing diagnosis, a medical diagnosis, or a collaborative problem. Additionally, the nurse and the client identify the client’s strengths, resources, and coping abilities.
Formulating Diagnostic Statements
The final step of the diagnostic process is the formulation of diagnostic statements. This involves creating detailed and specific diagnostic statements based on the identified health problems, risks, and strengths.
One-Part Nursing Diagnosis Statement
Health promotion nursing diagnoses are typically written as one-part statements because the related factors are always the same: the individual is motivated to achieve a higher level of wellness. Syndrome diagnoses also lack associated factors. Examples include:
- Readiness for enhanced coping
- Rape Trauma Syndrome
Two-Part Nursing Diagnosis Statement
Risk and possible nursing diagnoses are written as two-part statements. The first part is the diagnostic label, and the second part provides the validation or the presence of risk factors. There is no third party for risk or possible diagnoses because signs and symptoms do not exist. Examples include:
- Risk for infection as evidenced by weakened immune system response
- Risk for injury as evidenced by unstable hemodynamic profile
Three-Part Nursing Diagnosis Statement
An actual or problem-focused nursing diagnosis uses a three-part statement: the diagnostic label, contributing factors (“related to”), and signs and symptoms (“as evidenced by” or “as manifested by”). This format, known as PES (Problem, Etiology, and Signs and Symptoms), includes examples such as:
- Acute pain related to tissue ischemia as evidenced by the statement, “I feel severe pain in my chest!”
Variations on Basic Statement Formats
Variations in writing nursing diagnosis statements include:
- Using “secondary to” to divide the etiology into two parts, making the diagnostic statement more descriptive. For example, there is a Risk for Decreased Cardiac Output related to reduced preload secondary to myocardial infarction.
- Using “complex factors” when there are too many etiologic factors or when they are too complex to state briefly. For example, Chronic Low Self-Esteem is related to complex factors.
- Using “unknown etiology” when defining characteristics are present, but the cause or contributing factors are unknown. For example, ineffective coping is related to unknown etiology.
- Specifying a second part of the general response or diagnostic label for precision. For example, impaired skin integrity (right anterior chest) is related to skin surface disruption secondary to burn injury.
Nursing Diagnosis for Care Plans
Below is a list of common nursing diagnoses that can be used to develop nursing care plans:
- Acute Pain
- Anxiety
- Chronic Pain
- Constipation
- Decreased Cardiac Output
- Diarrhea
- Fatigue
- Fear
- Grieving
- Hopelessness
- Hyperthermia
- Hypothermia
Purposes of Nursing Diagnosis
The purposes of a nursing diagnosis include:
- Nursing diagnoses are an effective teaching tool for nursing students to enhance problem-solving and critical-thinking skills.
- They help identify nursing priorities and guide nursing interventions based on those priorities.
- They aid in formulating expected outcomes to meet the quality assurance requirements of third-party payers.
- Nursing diagnoses help identify how a client or group responds to actual or potential health and life processes, as well as their available resources and strengths that can be utilized to prevent or resolve problems.
- They provide a common language and form a basis for communication and understanding among nursing professionals and the healthcare team.
- They provide a basis for evaluating whether nursing care is beneficial to the client and cost-effective.
Differentiating Nursing Diagnoses, Medical Diagnoses, and Collaborative Problems
The term “nursing diagnosis” encompasses several concepts. It refers to the distinct second step in the nursing process, represented by “D” in the acronym “ADPIE.” Additionally, it applies to the label nurses assign to data collected during the assessment, appropriately categorized as a nursing diagnosis. For instance, if a nurse identifies that a patient feels anxious, fearful, and has trouble sleeping, these issues are labeled as Anxiety, Fear, and Disturbed Sleep Patterns, respectively. A nursing diagnosis focuses on the patient’s response to a medical condition and includes aspects that nurses can address, covering physical, mental, and spiritual responses. Thus, a nursing diagnosis is centered on patient care.
In contrast, a medical diagnosis is made by a physician or advanced healthcare practitioner and pertains to diseases, medical conditions, or pathological states only a practitioner can treat. Through expertise and clinical experience, the practitioner identifies the specific cause of the illness and prescribes appropriate medication or treatment. Examples of medical diagnoses include Diabetes Mellitus, Tuberculosis, Amputation, Hepatitis, and Chronic Kidney Disease. Typically, a medical diagnosis does not change, and nurses are responsible for following the physician’s orders and administering prescribed treatments and therapies.
Collaborative problems are potential issues that nurses manage through both independent and physician-prescribed interventions. These problems or conditions require a combination of medical and nursing interventions, with the nursing role focusing on monitoring the patient’s condition and preventing potential complications.
| Nursing Diagnosis | Medical Diagnosis | Collaborative |
| Ineffective Airway Clearance | Pneumonia | Potential complication of head injury: increased intracranial pressure |
| Disturbed body image | Amputation | |
| Risk for unstable blood glucose | Type 2 diabetes mellitus | Potential complication of myocardial infarction: congestive heart failure |
| Impaired urinary elimination | Post-op prostatectomy | |
| Self-care deficit: dressing | Cerebrovascular accident |
Compared. Nursing diagnoses vs. medical diagnoses vs. collaborative problems
A nursing diagnosis addresses the patient’s physiological and psychological responses, whereas a medical diagnosis focuses on the specific illness or medical condition.
