Which of the following nursing diagnosis statements, using the three-part format (PES), are correct? Select all that apply
a. Chronic pain related to osteoarthritis AMB rates pain at 8 on a 0 to 10 pain scale and has difficulty with ambulation.
b. Ineffective airway clearance related to excessive mucus AMB cough, shortness of breath, change in respiratory rate and rhythm
c. Caregiver role strain related to increasing care needs AMB wife states, "He is just getting too heavy for me to lift"
d. Anxiety (moderate) related to cardiac catheterization AMB crying and yelling at family members
B, C
The ineffective airway clearance and caregiver role strain statements contain all components of a correctly written nursing diagnosis statement. The problems are stated in correct NANDA-I format and reflect a patient response to a health problem. The connecting "related to" statements reflect etiologies that cause or contribute to the health problem and can direct nursing interventions. The AMBs reflect signs and symptoms that have validated the patient response to the health problem.
The statement beginning with "Chronic pain" contains an etiology that is a medical diagnosis and cannot be used by the nurse to act on independently. The anxiety statement contains an etiology that describes a diagnostic procedure and cannot be independently acted on by a nurse.
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