| Course | NR 226 Fundamentals: Patient Care |
|---|---|
| Week | 3 |
| Paper type | Nursing diagnosis exercise |
| Length | About 1,100 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 226 Week 3
Nursing Diagnosis Exercise: Five Statements for an 81-Year-Old Man With Pneumonia, Each With a Cause a Nurse Can Work On and a Defense Beside It
Student Name
College of Nursing, Chamberlain University
NR 226: Fundamentals: Patient Care
Instructor Name
Month Day, Year
Nursing Diagnosis Exercise: Five Statements for an 81-Year-Old Man With Pneumonia, Each With a Cause a Nurse Can Work On and a Defense Beside It
How the Statements Were Built
The statements below are built from the assessment of Mr. W., 81, on the third day of treatment for pneumonia, described in last week's write-up. Each actual diagnosis is one sentence in three parts: a label naming a human response, a related-to cause that nursing can work on without a provider's order, and the evidence, taken only from the assessment. The risk diagnosis is built differently, because a risk has not happened yet and so has no evidence of itself, only risk factors. Labels follow the NANDA International classification (Herdman et al., 2021). Beside each statement is a short defense of the choices in it.
The rule that shaped every cause was that the illness itself cannot be the cause. "Related to pneumonia" names something nursing cannot treat; the antibiotics do that. A cause has to be something a nurse can change: a weak cough, a position, a taste, a habit.
The Five Statements
Table 1 gives each statement with its reasoning.
Table 1
Nursing Diagnosis Statements With Reasoning
| Statement | Reasoning |
|---|---|
| Ineffective airway clearance related to a weak cough and thick secretions, as evidenced by coarse crackles at the right base, a cough too weak to bring up more than scant, thick yellow sputum, and 24 breaths a minute | The cause is the cough and the thickness of secretions, both of which nursing can work on through positioning, deep breathing, coughing and fluids. Pneumonia is the reason for the secretions, but it is not the cause the plan will target. |
| Impaired skin integrity related to sustained pressure over the sacrum and inadequate nutritional intake, as evidenced by a 2 by 3 centimeter open, shallow area over the sacrum and the patient's report that "my backside is sore" | The label is the response, not the wound's name. Two causes are given because both are in the data and both are nursing's to address: pressure, by turning and support surfaces, and intake, by the plan in the next statement. |
| Imbalanced nutrition: less than body requirements, developing over four months and related to altered taste and fatigue at mealtimes, as evidenced by intake of about a quarter of each meal, a weight loss of 5 kilograms (about 7%) in four months, and the statement "food tastes like metal" | Altered taste and fatigue are causes nursing can work around, through food choices, timing and rest before meals. The weight loss is the strongest evidence; a quarter of meals alone could be one bad day. |
| Deficient fluid volume related to insufficient oral intake, as evidenced by dark yellow urine of 700 mL in 24 hours, dry lips and tongue, and a fluid intake of 900 mL | His blood pressure is normal, so the deficit is mild. The label is still actual rather than risk, because three findings show it has already happened. |
| Risk for falls; risk factors: generalized weakness, unsteady gait without an assistive device, a Morse Fall Scale score of 55, and getting up to the bathroom alone at night | No "as evidenced by," because no fall has occurred. The risk factor that nursing can most directly change is the last: he gets up alone because he does not want to bother anyone. |
Note. Evidence is taken only from the Week 2 assessment of Mr. W.
Defining Characteristics, Pruned
The classification lists more defining characteristics for each label than I used. For ineffective airway clearance, it includes changes in respiratory rate, adventitious breath sounds, ineffective cough and excessive sputum, among others. I used only the ones present in Mr. W.'s data, and I did not add "dyspnea" because he did not say he was short of breath and I did not observe him struggling. Adding a characteristic because it usually appears would make the statement look stronger while making it less accurate.
The same pruning removed a diagnosis I first drafted: acute confusion. The only evidence was that he did not know the date and that his wife said he was "a bit muddled" one night. That is not enough to state an actual diagnosis, and a risk diagnosis did not yet feel justified either, so it stays as a finding to reassess tonight rather than as a label that would follow him into every handover.
Why the Risk Statement Looks Different
A risk diagnosis names a problem that has not occurred, so it cannot be evidenced by signs of the problem. Instead, it lists the factors that make it likely. Writing "risk for falls as evidenced by" anything would be a mistake in form and in logic, since there is nothing yet to be evident. The risk factors I chose are the ones that the care plan can act on or must work around: his weakness and gait, which physical therapy and a walker can address, and his reluctance to call, which teaching can address. His age is a risk factor too, but not one any plan can change, so it is noted in the assessment rather than repeated here.
The risk statement also has the most direct link to something the patient said. "I didn't want to bother anyone" is a risk factor in his own words, and it points to an intervention no equipment can supply: making sure he believes that calling for help at night is expected, not an imposition. That is teaching, and it belongs to nursing. It is also the part of the plan most likely to fail if it is done once and not repeated, because a polite, independent man who has always managed on his own will need to hear it more than once, from more than one nurse.
The Order the Statements Are Written In
The statements are listed in the order of the groups from last week, with airway clearance first because it could change fastest, and because improving it will ease his fatigue and help the others. Next week's care plan will take two or three of these forward, not all five, and the ranking here is the first draft of that choice. The fluid deficit is the one most likely to be folded into another problem, since a plan to improve his eating will also address his drinking.
References
Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2021). NANDA International nursing diagnoses: Definitions and classification 2021-2023 (12th ed.). Thieme.
What the NR 226 Week 3 assignment asks for
The Week 3 exercise asks you to write nursing diagnosis statements from the assessment data you organized last week. Expect the instructions to require approved labels, usually from NANDA International, written in the problem, etiology and signs and symptoms format, with risk diagnoses written with risk factors instead. Most sections want several statements and a written rationale for each. The key test is whether the cause is something nursing can treat, not the medical diagnosis. Evidence should come only from your assessment. Use labels from the list your section requires rather than inventing new ones. Many prompts also ask you to prioritize the statements or explain how they relate to one another.
Inside the NR 226 Week 3 example
The paper opens by explaining how each statement was built: a label for a human response, a related-to cause nursing can change and evidence from the Week 2 data. It states the rule that pneumonia cannot be a cause because antibiotics treat it. Table 1 then gives five statements, each beside a reasoning column, starting with ineffective airway clearance tied to a cough too weak to move thick sputum. A pruning section shows which defining characteristics were left out and removes acute confusion. A section explains why the fall risk statement lists factors, including the patient's words about not wanting to bother anyone. The close orders the statements for the care plan.
Where the points sit in the NR 226 Week 3 rubric
Diagnosis exercises are usually graded on correct labels, appropriate etiologies, accurate evidence, correct format for actual and risk statements and the quality of the rationale. The etiology row decides most grades, so every cause in this sample is something a nurse can change, such as position or cough strength. Evidence counts only when it came from the assessment, which the table note confirms. Format points depend on writing the risk statement with risk factors and no signs. The rationale earns credit when it defends the statement instead of repeating it. Citing NANDA International's classification supports the labels. Removing an under-supported diagnosis shows the judgment this exercise is designed to build.
Common NR 226 Week 3 mistakes, and how to avoid them
The most expensive mistake is a nursing label with the medical diagnosis as its cause, which leaves nurses nothing to do. Another is an etiology no nurse can touch, technically correct but useless for planning. Adding evidence that was never in the assessment to make a label sound better costs points quickly. Risk statements written with as evidenced by, invented labels, two statements sharing a cause without explanation and a reasoning column that just restates the diagnosis all lose marks. Each statement usually needs two to four pieces of evidence. Send your Week 2 data and your section's label list, and the statements can be drafted from them.
Get a NR 226 Week 3 example written to your instructions
Send the Week 3 worksheet, the approved label list if your section uses one, and the findings you are working from. A custom set of statements comes back inside 24 to 48 hours with the reasoning column filled in, free on a first request. Tell us how many statements the assignment asks for and whether risk statements are included.
More NR 226 papers and pre-licensure samples
- NR 226 Week 1: Nursing Action Discussion Post
- NR 226 Week 2: Assessment Data Clustering Write-Up
- NR 226 Week 4: Care Plan
- NR 226 Week 5: Concept Map
- NR 226 Week 6: Priority-setting Case
- NR 226 Week 7: Discharge Teaching Plan
- NR 226 Week 8: Reflection
- NR 228 Week 3: Nutrient Report
- NR 224 Week 3: Urinary Catheter Procedure Rationale
- NR 283 Week 3: System Case Study
- NR 222 Week 3: Family Assessment Paper
NR 226 Week 3 questions, answered
What is wrong with using the disease as the cause?
Nothing can be done about it without an order, so the plan built underneath collapses immediately. Write the cause as the mechanism the patient is living with instead: not the fracture but the immobility it produced, not the surgery but the pain that stops somebody moving. That version hands you interventions you can perform yourself and a goal somebody could actually reach inside a shift.
How much evidence should each statement carry?
Enough that the label becomes hard to argue with, which is usually two or three findings rather than a long list. Choose the ones that would be missing if the problem were not there, since those are the ones doing work. Anything still true under a different label is padding, and padding tends to invite the one question you would rather not be asked.
Can I use a label my section has not listed?
Check the instructions first, because many sections mark against a set list and an invented phrase loses points even when the reasoning under it is sound. Where the list is open, keep the wording to a recognized response rather than a description of the patient, and make sure the cause and evidence attached would survive somebody looking that label up.
Where can I find a free NR 226 Week 3 sample paper?
The whole Week 3 exercise, with five diagnostic statements for Mr. W., the reasoning table and the pruned confusion diagnosis, is posted on this page.
Why does the NR 226 Week 3 example drop acute confusion?
The only evidence was not knowing the date and his wife saying he was a bit muddled one night, which is too thin for an actual diagnosis, so the night nurse is asked to screen instead.