Nursing Care Plan Writing Support Using NANDA-I, PES Format, and the ADPIE Framework

NANDA International publishes the official taxonomy of nursing diagnoses used in nursing education and clinical practice worldwide. The current edition, NANDA-I 13th edition (2024-2026), edited by T. Heather Herdman, Shigemi Kamitsuru, and Camila Takao Lopes and published by Thieme Medical Publishers, contains 277 nursing diagnoses organized into 13 domains and 47 classes. This edition added 56 new diagnoses.

Note: some secondary sources cite 267 diagnoses. The official count from the NANDA-I 13th edition publisher is 277.

Each nursing diagnosis falls into one of three types:

Problem-focused diagnosis: A clinical judgment about an existing health problem. Example: Impaired Gas Exchange.

Risk diagnosis: A clinical judgment about vulnerability to a health problem that has not yet occurred. Example: Risk for Falls.

Health promotion diagnosis: A clinical judgment about motivation and desire to increase well-being. Example: Readiness for Enhanced Nutrition.

The PES format structures every nursing diagnosis statement into three components:

P (Problem): The NANDA-I diagnosis label. This is the standardized name from the taxonomy (for example, "Impaired Gas Exchange" or "Acute Pain").

E (Etiology): The related factors or risk factors, phrased as "related to." This identifies the cause or contributing factor that the nurse can address through interventions. The etiology must be a treatable nursing concern, not a medical diagnosis. For example, "related to alveolar-capillary membrane changes" rather than "related to pneumonia."

S (Signs and Symptoms): The defining characteristics, phrased as "as evidenced by." These are the observable and measurable indicators that support the diagnosis. For example, "as evidenced by oxygen saturation of 88% and shortness of breath with exertion."

A complete PES statement reads: "Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by oxygen saturation of 88% and shortness of breath with exertion."

Risk diagnoses use a two-part format (Problem + Risk Factors) because the condition has not yet manifested and there are no signs and symptoms to report.

Every care plan follows the ADPIE framework, which is the standard nursing process recognized by the American Nurses Association (ANA):

Assessment: Collect subjective and objective data. Subjective data comes from the patient (symptoms, reported pain levels, medical history). Objective data comes from clinical measurements (vital signs, lab results, physical examination findings).

Diagnosis: Analyze the assessment data and identify applicable NANDA-I nursing diagnoses using the PES format. Prioritize diagnoses based on clinical urgency and patient safety.

Planning: Set measurable, time-bound outcomes using SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound). Example: "Patient will maintain oxygen saturation above 94% on room air within 48 hours."

Implementation: Identify evidence-based nursing interventions for each diagnosis. Each intervention must include a rationale supported by clinical evidence or professional standards. Interventions should address the etiology, not just the symptoms.

Evaluation: Assess whether the interventions achieved the planned outcomes. Document whether the goal was met, partially met, or not met, and revise the care plan accordingly.

These are the issues that most frequently cost marks on nursing care plans:

Vague or unmeasurable goals. "Patient will feel better" is not a SMART goal. "Patient will report pain at 3 or below on the Numeric Rating Scale within 4 hours of analgesic administration" is measurable and time-bound.

Interventions not tied to rationale or evidence. Every intervention must include a rationale explaining why it addresses the etiology. Strong care plans cite clinical guidelines or primary research to support each intervention.

Incorrect PES structure. The most common error is stating a medical diagnosis as the etiology. "Impaired Gas Exchange related to pneumonia" is incorrect because pneumonia is a medical diagnosis, not a treatable nursing concern. "Impaired Gas Exchange related to alveolar-capillary membrane changes" is correct because it identifies a factor the nurse can address.

Missing evaluation. A care plan without an evaluation step is incomplete. The evaluation must state whether each goal was met, partially met, or not met, and describe what the next nursing action should be.

Diagnoses not prioritized. When multiple diagnoses are present, they must be ordered by clinical urgency. Airway, breathing, and circulation concerns come before comfort or knowledge-deficit diagnoses.

These are among the most commonly assigned nursing diagnoses in care plan projects:

• Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by oxygen saturation below 92% and dyspnea on exertion
• Risk for Falls related to impaired mobility, medication side effects, and altered mental status
• Acute Pain related to tissue trauma as evidenced by patient-reported pain of 7 on the Numeric Rating Scale and guarding behavior
• Ineffective Breathing Pattern related to pain and anxiety as evidenced by tachypnea and use of accessory muscles
• Anxiety related to threat to health status as evidenced by restlessness, increased heart rate, and verbalized feelings of worry
• Deficient Knowledge related to unfamiliarity with disease process as evidenced by patient questions about medication management
• Impaired Skin Integrity related to prolonged immobility as evidenced by stage 2 pressure injury on the sacrum

Every care plan project includes:

• Nursing diagnoses selected from the NANDA-I 13th edition (2024-2026) taxonomy
• PES-formatted diagnosis statements with correct etiology and defining characteristics
• SMART goals for each diagnosis
• Evidence-based interventions with rationale citing clinical guidelines or primary research
• Complete ADPIE cycle from assessment through evaluation
• Formatted to your program's exact requirements and rubric
• APA 7th edition referencing
• Unlimited revisions until your instructor is satisfied