Why This Matters
Nursing diagnoses are the foundation of the nursing process—they're what distinguish nursing care from medical treatment. While physicians diagnose diseases, nurses diagnose human responses to health conditions, which means you're being tested on your ability to identify how patients experience illness, not just what illness they have. Understanding these diagnoses connects directly to care planning, clinical judgment, and NCLEX-style questions that ask you to prioritize interventions.
Don't fall into the trap of memorizing definitions in isolation. The real exam skill is recognizing patterns: which diagnoses share similar interventions, which ones indicate higher priority, and how multiple diagnoses interact in a single patient. As you review these diagnoses, think about the underlying concepts—oxygenation, safety, mobility, psychosocial well-being—because that's how you'll apply them in clinical scenarios and on test day.
Physiological Integrity: Oxygenation and Circulation
These diagnoses address the body's most fundamental need: getting oxygen to tissues. When respiratory or circulatory function is compromised, it triggers a cascade of complications affecting every body system.
Ineffective Breathing Pattern
- Abnormal respiratory rate, rhythm, or depth—often secondary to pain, anxiety, opioid administration, or neuromuscular impairment
- Priority assessment includes respiratory rate, oxygen saturation, accessory muscle use, and patient positioning
- Key interventions focus on positioning (high Fowler's), breathing exercises, pain management, and anxiety reduction to restore effective ventilation
Deficient Fluid Volume
- Dehydration from inadequate intake or excessive loss—causes include vomiting, diarrhea, hemorrhage, fever, or NPO status
- Clinical indicators include decreased urine output, concentrated urine, tachycardia, hypotension, and poor skin turgor
- Electrolyte imbalances and acute kidney injury are serious complications requiring IV fluid replacement and strict intake/output monitoring
Compare: Ineffective Breathing Pattern vs. Deficient Fluid Volume—both threaten tissue perfusion, but through different mechanisms (oxygen delivery vs. circulatory volume). On an NCLEX question asking about priority assessment, remember: airway and breathing come before circulation in the ABCs.
Safety and Risk Prevention
Risk diagnoses identify patients who haven't yet developed a problem but are vulnerable. Your role shifts from treatment to prevention—a critical distinction for care planning questions.
Risk for Infection
- Increased susceptibility due to invasive lines, surgical incisions, immunosuppression, or chronic disease
- Chain of infection knowledge is essential—interventions target breaking links through hand hygiene, aseptic technique, and barrier precautions
- Patient education on wound care, signs of infection, and when to seek help is a primary nursing responsibility
Risk for Falls
- Multifactorial etiology including impaired mobility, medication effects (sedatives, antihypertensives), sensory deficits, and environmental hazards
- Fall risk assessment tools (Morse Fall Scale, Hendrich II) guide intervention intensity and documentation requirements
- Prevention strategies include bed alarms, non-slip footwear, clear pathways, and frequent rounding—these are never optional interventions
Impaired Skin Integrity
- Tissue damage from pressure, shear, friction, or moisture—staging of pressure injuries is a testable skill
- Risk factors include immobility, incontinence, malnutrition, and decreased sensation
- Prevention and treatment require repositioning schedules, moisture management, nutritional support, and appropriate wound care products
Compare: Risk for Infection vs. Impaired Skin Integrity—skin breakdown creates infection risk, making these diagnoses frequently co-occur. When you see impaired skin integrity, always assess for and document infection risk in your care plan.
Pain and Comfort
Pain diagnoses require you to understand both the physiological mechanisms and the subjective patient experience. Remember: pain is whatever the patient says it is.
Acute Pain
- Sudden onset with identifiable cause—typically from surgery, trauma, procedures, or acute illness; expected to resolve as healing occurs
- Physiological stress response includes elevated vital signs, diaphoresis, and guarding behaviors
- Multimodal management combines pharmacological interventions (analgesics) with non-pharmacological approaches (positioning, ice/heat, distraction)
Chronic Pain
- Persistent pain lasting beyond expected healing time—often defined as greater than 3-6 months duration
- Central sensitization means the nervous system has adapted, making pain management more complex than simply treating tissue damage
- Holistic approach required including physical therapy, psychological support, lifestyle modifications, and careful medication management to prevent dependence
Compare: Acute Pain vs. Chronic Pain—acute pain serves a protective function and responds well to opioids; chronic pain involves neurological changes and requires multimodal, long-term strategies. NCLEX questions often test whether you can distinguish appropriate interventions for each.
Mobility and Activity
Immobility is never just about movement—it's a systemic threat. These diagnoses connect to complications across every body system.
Impaired Physical Mobility
- Limited independent movement due to pain, weakness, neurological impairment, or medical restrictions (casts, traction)
- Complications cascade includes pressure injuries, DVT, pneumonia, constipation, and muscle atrophy—all preventable with nursing intervention
- Progressive mobilization and range-of-motion exercises are priority interventions, even when patients resist
Activity Intolerance
- Insufficient energy for daily activities—distinct from impaired mobility because the patient can move but lacks endurance
- Underlying causes include cardiac or respiratory disease, anemia, deconditioning, and prolonged bed rest
- Gradual activity progression with vital sign monitoring before, during, and after activity guides safe advancement
Compare: Impaired Physical Mobility vs. Activity Intolerance—mobility focuses on ability to move; activity intolerance focuses on energy to sustain movement. A post-surgical patient may have both: limited mobility from incisional pain AND activity intolerance from blood loss.
Elimination and Nutrition
These diagnoses address basic physiological needs that patients often find embarrassing to discuss. Your assessment skills and therapeutic communication are essential.
Constipation
- Infrequent, difficult, or incomplete bowel evacuation—common in hospitalized patients due to immobility, opioids, dehydration, and dietary changes
- Assessment includes bowel sound auscultation, abdominal palpation, and detailed history of normal bowel patterns
- Interventions progress from least invasive (fluids, fiber, ambulation) to more invasive (stool softeners, laxatives, enemas) as needed
Impaired Urinary Elimination
- Dysfunction in voiding pattern—includes retention, incontinence, urgency, or dysuria
- Causes range from catheter-related issues to neurogenic bladder, infection, prostatic enlargement, or medication effects
- Bladder scanning for post-void residual and strict intake/output monitoring guide intervention decisions
Imbalanced Nutrition: Less Than Body Requirements
- Inadequate nutrient intake relative to metabolic demands—evidenced by weight loss, muscle wasting, and lab abnormalities (albumin, prealbumin)
- Contributing factors include dysphagia, nausea, pain, depression, and inability to feed self
- Collaborative care involves dietary consults, calorie counts, modified textures, and possibly enteral or parenteral nutrition
Compare: Constipation vs. Impaired Urinary Elimination—both are elimination diagnoses, but constipation interventions focus on promoting motility while urinary interventions often address obstruction or retention. Both require detailed assessment before intervention.
Psychosocial Well-Being
Physical and psychological health are inseparable. These diagnoses often underlie or exacerbate physiological problems and are frequently undertreated.
Anxiety
- Emotional response to perceived threat—manifests with both psychological symptoms (worry, fear, irritability) and physical symptoms (tachycardia, diaphoresis, muscle tension)
- Assessment tools like the GAD-7 provide objective measurement, but therapeutic presence and active listening are your primary interventions
- Anxiety worsens other diagnoses—it increases pain perception, disrupts sleep, impairs breathing patterns, and interferes with learning
Ineffective Coping
- Inability to appraise or respond to stressors appropriately—may present as denial, withdrawal, substance use, or emotional outbursts
- Assessment focuses on identifying usual coping mechanisms, support systems, and current stressors overwhelming the patient's resources
- Nursing interventions include therapeutic communication, referrals to social work or counseling, and teaching adaptive coping strategies
Disturbed Sleep Pattern
- Disrupted sleep quantity or quality—caused by pain, anxiety, environmental factors (noise, lighting), or medication effects
- Sleep deprivation consequences include impaired healing, decreased immune function, cognitive dysfunction, and increased fall risk
- Sleep hygiene interventions address environment, routine, and contributing factors—cluster care to minimize nighttime interruptions
Compare: Anxiety vs. Ineffective Coping—anxiety is the emotional response to stress; ineffective coping is the behavioral pattern of managing stress poorly. A patient can have anxiety with effective coping (uses relaxation techniques) or ineffective coping without significant anxiety (denial of serious diagnosis).
Quick Reference Table
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| Oxygenation/Perfusion | Ineffective Breathing Pattern, Deficient Fluid Volume |
| Safety/Prevention | Risk for Infection, Risk for Falls, Impaired Skin Integrity |
| Pain Management | Acute Pain, Chronic Pain |
| Mobility | Impaired Physical Mobility, Activity Intolerance |
| Elimination | Constipation, Impaired Urinary Elimination |
| Nutrition | Imbalanced Nutrition: Less Than Body Requirements |
| Psychosocial | Anxiety, Ineffective Coping, Disturbed Sleep Pattern |
| Immobility Complications | Risk for Falls, Impaired Skin Integrity, Constipation, Risk for Infection |
Self-Check Questions
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Which two diagnoses both increase a patient's risk for deep vein thrombosis, and what shared factor explains this connection?
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A patient reports pain rated 7/10 that began after surgery yesterday. Which nursing diagnosis applies, and how would your approach differ if this same pain level persisted for eight months?
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Compare Risk for Infection and Impaired Skin Integrity: How does one diagnosis create conditions for the other, and what single intervention addresses both?
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You're prioritizing care for a patient with Ineffective Breathing Pattern, Anxiety, and Constipation. Using clinical judgment, which diagnosis requires intervention first, and why might addressing it improve the others?
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A patient with Impaired Physical Mobility refuses to ambulate due to fatigue. What additional nursing diagnosis should you consider, and how would confirming this change your intervention approach?