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nursing diagnoses come from nursing assessments, the same way that medical diagn oses come from

medical assessments. you don't just pick a medical diagnosis and then start writing down nursing diagnoses. nursing diagnoses are derived from nursing assessments, not medical ones (althou gh some we use the same data for our diagnoses). so to make a nursing diagnosis, a nursing assessment has to occur. for that, well, you need to either examine t he patient yourself, or (if you're planning care ahead of time before you've see n the patient) find out about the usual presentation and usual nursing care for a given patient. medical diagnoses, when accurate, can be supporting documentation for a nursing diagnosis, for example, "activity intolerance related to (because the patient ha s) congestive heart failure/duchenne's muscular dystrophy/chronic pulmonary insu fficiency/amputation with leg prosthesis." however, your faculty will then ask y ou how you know. this is the dread (and often misunderstood) "as evidenced by." in the case of activity intolerance, how have you been able to make that diagnos is? you will likely have observed something like, "chest pain during physical ac tivity/inability to walk >25 feet due to fatigue/inability to complete am care w ithout frequent rest periods/shortness of breath at rest with desaturation to sp o2 85% with turning in bed." i hope this is helpful to you who are just starting out in this wonderful profes sion. it's got a great body of knowledge waiting out there to help you do well f or and by your patients, and you do need to understand its processes. it looks like your faculty is asking you for evidence that your goal has been ac hieved. in the case of activity intolerance, above, your goals might be that the "patient says s/he is less exhausted" due to your interventions (which would pr obably be...?). you can tell the patient is less exhausted by the activity s/he has to do because "s/he says so /has a lower pulse and respiration rate/ doesn't desaturate so much." in the case of this baby, you're not going to get a lot of subjective data (that 's a joke...babies aren't going to speak to you), so all your evidence is going to be objective things like temp, hr, rr, feeding ability, urine and fecal outpu t, crying, color. i'd say look at the baby's ability to regulate body temp (how good is that in a newborn?) and what would you assess, do, and evaluate for that ? does that help? your beginning text says circulation is physiological, and that's true. skin cou ld be safety, because broken skin is usually the result of an unsafe thing (even surgery is just expensive trauma:d); imo skin could also, in some circumstances , be seen in a physiological light, as in looking at its ability to regulate flu ids & temperature.

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