Nursing Field Notes / Nursing Core · Fundamentals of Nursing

ADPIE 🔁

The Nursing Process I — Assessment · Diagnosis · Planning · Implementation · Evaluation

NG-002 Nursing Core ADHD-friendly visual edition

The nursing process is the systematic approach used to guide client care. It is the skeleton under every care plan, every clinical-judgment question and a huge share of NCLEX items. It is a circle, not a list — you never stop at Evaluation, you loop back and assess again.

📄 Simple Nursing original — opens in Drive →

🔤 A · D · P · I · EAssess → Diagnose → Plan → Implement → Evaluate. In that order. Every time.

1️⃣ ASSESS is always firstUnless the client is in immediate danger, you gather data before you act.

🫁 Physical before psychologicalMaslow: airway beats anxiety. Ask “what kills fastest?”

🎯 SMART outcomesSpecific · Measurable · Attainable · Realistic · Timely

🔁

THE CYCLE

STEP 1 · THE FRAME

Five steps, one loop. Learn the wheel first and every care-plan question stops being scary.

🔁 The nursing process is a wheel — it never ends at step 5

EXAM TIP Evaluation feeds straight back into Assessment. If the outcome was not met, you do not invent a new intervention out of thin air — you re-assess, then re-diagnose, then re-plan.

🧠 “All Dogs Play In Evening.” Say it while you trace the wheel with your finger — clockwise, starting at 12 o'clock. The dog that stops playing gets walked back to the start. 🐕

📖 Say the definition the way the source says it

Nursing process = “the systematic approach used to guide client care.”

It shapes clinical judgment about a client's physical & psychological status, and it also folds in the client's social factors, family, and community experiences.

🧠 Systematic = same steps, same order, every client. That is the whole point — it stops you from “just doing something.”

⭐ The five steps in one line each

AAssessmentgather info & review history

DDiagnosisidentify the problem

PPlanninggoals, outcomes, action plan

IImplementationdo the interventions

EEvaluationdid it work?

🧠 Five steps = five fingers. Tap each finger as you say it; on the thumb (E) you fold the hand shut and open it again — back to A.

🚨 The #1 NCLEX trap: “what does the nurse do FIRST?”

Almost always ASSESS — A comes before D-P-I-E for a reason. You cannot diagnose or intervene on data you do not have.

The only exception: when the client is in immediate danger — an unwitnessed collapse, an active seizure, an obstructed airway, a disconnected ventilator. Then you act first (position, protect, call for help) and assess as you go.

❌ “Administer the PRN acetaminophen” — before you took a temperature? No.
❌ “Notify the provider” — before you have data to report? Usually no.
✅ “Auscultate lung sounds,” “Check the blood glucose,” “Ask the client to describe the pain” — these are assessments.

🧠 “Data before drama.” If two answer choices are both reasonable and one of them gathers information, that is usually the one.

🔤 ADPIE vs ADOPIE — why you may see six steps

Some texts (and the ANA Standards of Practice) split Planning in two and teach six steps:

Assessment
Diagnosis
Outcome identification ← the extra one
Planning
Implementation
Evaluation

Same process. ADOPIE just pulls “write the measurable outcome” out as its own step.

🧠 ADPIE + O = ADOPIE. The O is the Outcome — the sentence you will grade yourself against later.

🧭 Where this page sits in the batch

ADPIE is the spine. Two other pages are its arms and legs:

📎 NG-190 Head-to-Toe Assessment — how to actually do the A: the systematic head-to-toe sequence, inspection → palpation → percussion → auscultation.
📎 NG-180 Delegation & the 5 Rights — how the I gets shared: what you may hand to an LPN/UAP and what you may never delegate.

🧠 You may delegate TASKS, never the nursing PROCESS. Assessment, nursing diagnosis, planning, teaching and evaluation stay with the RN.

🩻

A + D · GATHER, THEN NAME IT

STEP 2 · THE DATA

Assessment collects it. Diagnosis names the human response you are going to treat.

🗣️ vs 👁️ Subjective = what they SAY · Objective = what you OBSERVE

Subjective data is what the client reports. Objective data is what can be observed or measured.

🧠 “Subjective = Spoken. Objective = Observed.” Both start with the same letter as their cue. If you had to put quotation marks around it, it is subjective.

🔎 Where the data comes from

Primary source = the client. Always. Their report outranks everyone else's.
Secondary sources = family, caregivers, the chart, old records, the previous nurse, other disciplines, diagnostic results.

Then validate (does the subjective match the objective?), cluster related findings, and document in the client's own words where possible.

🧠 The client is the PRIMARY source — even a confused client is still assessed; you just add corroboration.

🗂️ Four kinds of assessment

Initial / comprehensive — on admission, full database.
Focused / problem-focused — one system or one complaint, done constantly through the shift.
Emergency — ABCs during a crisis; rapid, life-threat only.
Time-lapsed / ongoing — compare to baseline later (clinic follow-up, next shift).

🧠 Every re-check is an assessment. Reassessing after an intervention is technically Evaluation — same skill, different step of the wheel.

🏷️ Diagnosis = identify the problem — the human response, not the disease

Using the assessment data you collected, the goal is to address both actual and potential health problems for the client.

🩺 MEDICAL diagnosis	👩‍⚕️ NURSING diagnosis
Made by the provider	Made by the RN
Names the disease — pneumonia, CHF, stroke	Names the human response to it — impaired gas exchange, activity intolerance, impaired swallowing
Stays the same until the disease resolves	Changes as the client changes — you rewrite it constantly
Treated with medicine & surgery	Treated with nursing interventions the RN can order independently

A medical diagnosis is never a nursing diagnosis. “Pneumonia” is not something you can write on the care plan as the problem.

🧠 The doctor names the disease; the nurse names the trouble it causes. Pneumonia (medical) → impaired gas exchange (nursing).

🧱 The three types of nursing diagnosis

Actual / problem-focused — it is happening now, and you have signs & symptoms to prove it.
Risk — not happening yet, but risk factors are present. “Risk for…” has no signs & symptoms — if it had them it would be actual.
Health-promotion — the client is ready to improve something. “Readiness for enhanced…”

Format (PES): Problem related to Etiology as evidenced by Signs & symptoms.

e.g. Impaired gas exchange r/t alveolar-capillary membrane changes AEB SpO₂ 89%, crackles, restlessness.

🧠 PES = Problem · Etiology · Signs. Risk diagnoses drop the S — no evidence yet, only risk factors.

🪜 Prioritizing the diagnosis: Maslow, then ABC

CAUTION Physical needs always come before psychological needs, as outlined by Maslow's hierarchy. “We are always going to prioritize an airway issue before we treat an emotional one.”

Ask the question the source gives you: “What is going to kill your client the fastest?” That is what goes first on the care plan.

🧠 “Breath before feelings.” A client who is anxious and hypoxic gets oxygen first — you cannot talk someone out of a saturation of 89%.

❓ Practice Q1 — the classic diagnosis question

A client with pneumonia has an oxygen saturation of 89%. Which nursing diagnosis is most appropriate?

✅ Impaired gas exchange. Pneumonia is the medical diagnosis; the human response you can treat is the failure to move oxygen across the alveolar–capillary membrane, and the SpO₂ is your AEB evidence.

🧠 Low SpO₂ + lung problem = impaired gas exchange. Airway secretions you can't clear = ineffective airway clearance. Poor effort/rate/depth = ineffective breathing pattern. Three different diagnoses — match the evidence.

❓ Practice Q2 — a SATA diagnosis question

A client with Crohn's disease feels overwhelmed and has had no outside support since a recent divorce. Which nursing diagnoses fit the plan of care? (Select all that apply.)

✅ Ineffective coping — “overwhelmed,” lost her support system.
✅ Imbalanced nutrition: less than body requirements — malabsorption is expected in Crohn's.
✅ Risk for deficient fluid volume — diarrhea is the hallmark.
⚠️ Hopelessness — only if the client has said something that supports it. Don't diagnose a feeling she never reported.

🧠 Every diagnosis you pick must be able to finish the sentence “…as evidenced by ___.” If you can't fill that blank from the stem, don't select it.

🛠️

P + I + E · PLAN, DO, CHECK

STEP 3 · THE ACTION

Write a goal you could grade. Carry it out. Then be honest about whether it worked.

🎯 Planning = goals, outcomes & an action plan — and it must be SMART

Develop an action plan with specific goals and the desired outcome of the plan — then always discuss the plan with the client to check that their perceived needs are being met.

❌ Poorly written outcome
“Client will walk without dizziness.”
No number, no distance, no deadline. Walk how far? By when? You cannot chart “met” or “not met.”

✅ SMART outcome
“Client will demonstrate improved activity tolerance as evidenced by walking 20 feet without dizziness by day 3 of hospitalization.”
Specific behavior, measurable distance, a deadline.

🧠 Every outcome starts “The CLIENT will…” — not “the nurse will.” Nurse actions are interventions; client behaviors are outcomes. That single swap fixes half of all care-plan mistakes.

🗣️ ATI-style question — checking the plan fits

What is the MOST appropriate way to assess whether the plan of care correlates with the client's perceived needs?

✅ Discuss the plan of care with the client.

Don't forget the client's opinion here — but make sure what they want is realistic.

🧠 “Perceived needs” = ask the person who is perceiving them. Not the chart, not the family, not the last shift.

🛠️ Implementation = carry it out (and reassess as you go)

Independent — RN-initiated: repositioning, HOB elevation, teaching, skin care, encouraging fluids.
Dependent — needs a provider order: medications, IV fluids, treatments, diets.
Collaborative / interdependent — with PT, RT, dietitian, social work, pharmacy.

⭐ Reassess immediately before you act. The blood pressure from two hours ago is not permission to give the antihypertensive now.

📎 NG-180 Delegation & the 5 Rights — you may delegate a task to an LPN/UAP, but never assessment, never the nursing diagnosis, never teaching, never evaluation, and never an unstable client.

🧠 “Do it, then document it.” If it isn't charted, it didn't happen — and charting is part of implementation, not an afterthought.

📊 Evaluation = did the OUTCOME happen? Three answers, three next moves

Evaluation is not “was the intervention done.” It is compare the client's actual response to the outcome criteria you wrote.

🧠 “Not met → go back to A.” The most common wrong answer is “change the intervention.” The right first move is to re-assess — the intervention may have been fine and the diagnosis wrong.

🚨 Five ADPIE traps that cost points

❌ Writing a medical diagnosis on the nursing care plan.
❌ Writing an outcome that starts “The nurse will…”
❌ Adding “as evidenced by” signs to a risk diagnosis.
❌ Choosing an intervention when an assessment option is available.
❌ Delegating assessment, teaching, or evaluation to a UAP.

🧠 “R.I.S.K. has no evidence.” Risk = no signs yet. If you can see it, it isn't a risk any more — it's actual.

✅ Putting one client through the whole wheel

A — 72-y-o post-op day 1, reports “I can't catch my breath,” SpO₂ 89%, RR 28, crackles at the bases, splinting the incision.
D — Impaired gas exchange r/t retained secretions and shallow splinted breathing AEB SpO₂ 89%, RR 28, crackles.
P — Client will maintain SpO₂ ≥ 94% on room air and use the incentive spirometer 10× per hour while awake by end of shift.
I — HOB up, splint pillow, coach incentive spirometry, pain control before deep breathing, ambulate, O₂ per order.
E — SpO₂ now 95%, spirometer used 8×/hr → partially met: keep the plan, extend the time frame.

🧠 Treat the pain so they can breathe. The intervention that unlocks the outcome is often one step upstream of it.

⚡

QUICK RECALL

SAY IT OUT LOUD

🔁 A D P I EAssess · Diagnose · Plan · Implement · Evaluate — and loop.

🗣️ vs 👁️Subjective = Spoken. Objective = Observed.

🪜 Maslow then ABCPhysical before psychological. “What kills fastest?”

🎯 “The CLIENT will…”SMART outcome, with a number and a deadline.

🎯 Cover & check — 6 rapid-fire questions

Q1: A client is anxious about surgery and has an SpO₂ of 88%. Which problem comes first?

The oxygenation. Maslow — physiological needs before psychological. Airway/breathing beats anxiety every time.

Q2: “Client reports 8/10 stabbing pain in the right lower quadrant.” Subjective or objective?

Subjective — it is what the client says. A rigid abdomen you palpate and a temp of 101.4 °F are the objective data that go with it.

Q3: Rewrite “Client will eat better” as a SMART outcome.

Something like: “Client will consume at least 75% of each meal for 3 consecutive days by discharge.” Specific behavior, measurable amount, a time frame.

Q4: What is the difference between a medical diagnosis and a nursing diagnosis?

The medical diagnosis names the disease (pneumonia) and is made by the provider. The nursing diagnosis names the human response the nurse can treat (impaired gas exchange) and changes as the client changes.

Q5: The outcome was not met. What is the nurse's FIRST action?

Reassess. Evaluation loops back to Assessment — the data or the diagnosis may have been wrong, not just the intervention.

Q6: A risk nursing diagnosis has which part missing?

The “as evidenced by” signs & symptoms. A risk diagnosis has risk factors only — if there were signs, it would be an actual problem.