Concept Mapping for Practical Nursing

1
Concept Mappingfor Practical Nursing
2
Concept Mapping

• Goals
• Apply care planning with a holistic view of
  individual clients
• Critically think about interconnections between
  data associated with client problems
• Encourage whole-brain thinking

3
What is Concept Mapping?

• Visual representation of your thinking processes
  as you plan and implement nursing care
• Use all elements of nursing process
• Help you to see big picture

4
What is Concept Mapping?

• Interconnect data from various sources
• Signs and symptoms/Assessment data
• Past medical history
• Laboratory and diagnostic data
• Medications and medical interventions
• Family/Psychosocial data

5
Getting Started

• Use a large piece of scratch paper then transfer
  data to your worksheet(s)
• Use pencil on scratch paper
• Can be messy at first
• Be prepared to do a lot of erasing
• Use ink for final copy on worksheet(s)

6
Construction of a Concept Map

• Start with client
• Client is center of map

7
Map 1 Client Information

• Placed in center of page
• Patient initials
• Age
• Sex
• Medical diagnosis
• Admitted from

MJ 74, male CHF Admitted - Home
8
Map 1 Assessment/Data Creating Clusters

• Assess your client (Be specific)
• Document ALL assessment data on front of your
  Nursing Worksheet
• Review data and underline or highlight all
  abnormal data
• Group data into data clusters based on
  interrelationships of data

9
Map 1 Assessment/Data Clusters

• Review SS on your diagnosis cards
• See how data interrelates
• Put similar data into groups
• Give each group a simple name
• DO NOT use systems
• Gordons Functional Health Patterns (Appendix B)
• Wellness-Oriented Diagnostic Categories (Appendix
  C)
• How do all of these things affect my client?
• Data can be in more than one cluster

10
Data Clusters
Breathing Problems
Self-Concept
Elimination
Skin
Safety
Self Care
Communication
Activity
Nutrition/Fluid
Cognitive/Perceptual
11
Map 1 Assessment/Data Clusters

• Use as many data clusters as you need
• Look at data clusters, does all of this data
  relate? Does label fit all data?
• Prioritize ALL data clusters. Base this on
  theory. Remember Maslow or Peplau.
• Pick your top 2 priority data clusters and place
  them on concept map
• Remember to number them on concept map

12
Map 1 Assessment/Data Clusters

• You will only list ACTUAL PROBLEMS
• Risk problems have a separate area
• Number actual problems by priority
• Then number risk problems

13
Data Clusters
Breathing Problems 1 or 2
Fluid 1 or 2
Elimination 7
Skin 5
Falls 9
Self Care 8
Communication 10
Mobility 6
Nutrition 4
Mental status 3
14

• Map 1
• Place top 2 priority data clusters around client

1 SOA with exertion Unable to walk 12 ft
without resting O2 sat ?from 94to 88 RR ? from
18 to 24 with activity O2 at 2L NC Crackles in
bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Home
15
Map 1 Past Health History

• Client may have past health history or other
  health problems
• May be receiving additional medications that do
  not fit into either of your problems
• Make an additional box for this information and
  place on concept map

16

• Map 1
• Past Medical History

2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
1 SOA with exertion Unable to walk 12 ft
without resting O2 sat ?from 94to 88 RR ? from
18 to 24 with activity O2 at 2L NC Crackles in
bases
MJ 74, male CHF Admitted - Home
Type 2 DM Insulin Hypothyroidism -
Synthroid HTN - Metoprolol
17
Map 2 Risk Problems

• Important issues are on your problem list that
  affect care, but are not existing problems at
  this time are risk problems
• List these, in proper diagnosis format, in an
  additional box on concept map
• Clients will have more than one risk problem

18

• Map 2
• Risk Problems

1 SOA with exertion Unable to walk 12 ft
without resting O2 sat ?from 94to 88 RR ? from
18 to 24 with activity O2 at 2L NC Crackles in
bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Type 2 DM Insulin Hypothyroidism -
Synthroid HTN - Metoprolol
Risk for falls R/T weakness and fatigue
19
Map 2 Nursing Diagnosis

• Look at each cluster of assessment data
• Pick Nursing Diagnosis that fits data cluster
• Make a new box and place it above data cluster
• Place Nursing Diagnosis in box
• Nursing Diagnosis ONLY from NANDA list
• Add your related to factors (R/T)

20
Activity intolerance R/T imbalance B/W O2
supply and demand AEB
Excess Fluid volume R/T water retention AEB
1 SOA with exertion Unable to walk 12 ft without
resting O2 sat ?from 94to 88 RR ? from 18 to 24
with activity O2 at 2L NC Crackles in bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Type 2 DM Insulin Hypothyroidism
Synthroid HTN - Metoprolol
Risk for falls R/T weakness and fatigue
21
Map 3 Goals

• Add client goals
• Measurable and realistic
• What you want to accomplish with your nursing
  care/interventions?
• They are clients goals, not your goals
• ONE goal for each problem

22
Activity intolerance R/T imbalance B/W O2
supply and demand AEB
Excess Fluid volume R/T water retention AEB
1 SOA with exertion Unable to walk 12 ft without
resting O2 sat ?from 94to 88 RR ? from 18 to 24
with activity O2 at 2L NC Crackles in bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Pt will be able to ambulate 12 feet W/O resting
by ____
Pts lungs will be clear to auscultation by
________
Type 2 DM Insulin Hypothyroidism
Synthroid HTN - Metoprolol
Risk for falls R/T weakness and fatigue
23
Map 4 Interventions

• Add nursing interventions for each nursing
  diagnosis
• Need AT LEAST 3 nursing interventions
• Write as many as you feel are necessary
• Make sure at least 1 or 2 are actions
• Remember to add anything you are currently doing

24
Activity intolerance R/T imbalance B/W O2
supply and demand AEB
Excess Fluid volume R/T water retention AEB
1 SOA with exertion Unable to walk 12 ft without
resting O2 sat ?from 94to 88 RR ? from 18 to 24
with activity O2 at 2L NC Crackles in bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Pts lungs will be clear to auscultation by
________
Pt will be able to ambulate 12 feet W/O resting
by ____
Monitor O2 saturation QS Assist OOB to chair
TID Provide periods of rest
Monitor I O QS Monitor daily weight Monitor
lung sounds Q4 hr Encourage CDB
Type 2 DM - Insulin Hypothyroidism -Synthroid HTN
- Metoprolol
Risk for falls R/T weakness and fatigue
25
Map 5 Medications and Labs

• Add medications/treatments
• Add your laboratory/diagnostic data
• Place under nursing diagnosis to which they relate

26
Activity intolerance R/T imbalance B/W O2
supply and demand AEB
Excess Fluid volume R/T water retention AEB
1 SOA with exertion Unable to walk 12 ft without
resting O2 sat ?from 94to 88 RR ? from 18 to 24
with activity O2 at 2L NC Crackles in bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Pts lungs will be clear to auscultation by
________
Pt will be able to ambulate 12 feet W/O resting
by ____
Monitor O2 saturation QS Assist OOB to chair
TID Provide periods of rest
Monitor I O QS Monitor daily weight Monitor
lung sounds Q4 hr Encourage CDB
Type 2 DM - Insulin Hypothyroidism -Synthroid HTN
- Metoprolol
Lasix O2 2l NC Titrate to Satgt93
Lasix potassium
Risk for falls R/T weakness and fatigue
PaCo2 50 pH 7.30 HCO3 28 CXR Effusion
BUN 36mg/dL Na 130mEq/L K 3.0mmol/L
27
Map 6 Interconnections

• Interconnections are linkages between problems
• These exist in a cause or effect relationship
• Begin to look for interconnections
• Client is connected to each and every problem in
  some way
• Help you to see actual connections in a very
  concrete manner

28
Map 6 Interconnections

• If one problem directly causes another problem,
  use a solid arrow from cause to effect
• If one problem indirectly causes another problem,
  use a dotted arrow from cause to effect
• Start at client
• How does past medical history interconnect?

29
Activity intolerance R/T imbalance B/W O2
supply and demand
Excess Fluid volume R/T water retention
1 SOA with exertion Unable to walk 12 ft without
resting O2 sat ?from 94to 88 RR ? from 18 to 24
with activity O2 at 2L NC Crackles in bases
2 500cc intake, 250cc output Crackles in
bases Pitting edema in BLE HR 100 SOA with
exertion
MJ 74, male CHF Admitted - Home
Pt output will equal intake by___ Pts lungs will
be clear to auscultation By ________
Pt will be able to ambulate 12 feet W/O Resting
by ____ Pt will maintain a Sat gt93 by ___
Monitor O2 saturation QS Assist OOB to chair
TID Provide periods of rest
Type 2 DM - Insulin Hypothyroidism -
Synthroid HTN - metoprolol
Monitor I O QS Monitor daily weight Monitor
lung sounds Q4 hr
Lasix O2 2l NC Titrate to Satgt93
Lasix potassium
Risk for Falls R/T weakness fatigue
PaCo2 50 pH 7.30 HCO3 28 CXR Effusion
BUN 36mg/dL Na 130mEq/L K 3.0mmol/L
30
Evaluation

• If you have opportunity to care for client a
  second day, you need to evaluate if plan of care
  has worked
• Determine if goals have been met
• Write met or not met on a line connecting goal
  and supporting data

31

• Please Feel Free To Be Creative
• You can write them, type them, use colors, or
  highlighter
• Use different shaped boxes
• You must keep basic components
• Presentation is up to you

32
High Risk Problems
Past Health History Other Medications
33
PMH
Risk Problems
34
Nursing Diagnosis
Meds
AEB
Treatments
Goals
35
Concept Mapping in Long Term Care

• Your concept map in long term care will look very
  different from your concept map in acute care
• In acute care, we focus on actual problems that
  require immediate intervention to correct
  clients problems
• In long term care, we focus on actual problems
  that require maintenance in order to prevent
  further decline in condition

36
Impaired mobility R/T neurological impairment
Impaired Swallowing R/T Neurological Impairment

• 2
• ?ROM (R arm contracture)
• Strength (able to resist force with
• L leg only)
• Sara Lift to transfer

1 Coughing and choking when eating History of
aspiration pneumonia Pocketing food Thickened
liquids
MJ 74, male CVA Admitted - Home
Resident will swallow without coughing or
choking with all intake, ongoing. Pt will
maintain clear lungs to auscultation, ongoing
Resident will maintain ability to bear wt. on
LLeg and transfer with Sara Lift with every
transfer, ongoing
Type 2 DM - Insulin Hypothyroidism
Synthroid HTN - Metoprolol
1. Perform ROM exercises to each extremity 2.
Use Sara Lift to transfer OOB and to reposition
q 2hr 3. Assess need for pain medication prior
to transfer

• 1. Position resident upright at 90 degree
• angle/head flexed 45 degrees for
• all feedings
• Place food on unaffected side of tongue.
• Cue resident during feeding

Risk for Falls R/T decreased ROM and strength
WBC 18,000 CXR Infiltrates
Augmentin