Transcript Concept Mapping

Concept Mapping
for Practical Nursing
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
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”
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
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)
Construction of a Concept Map
 Start
with client
 Client is center of map
Map #1: Client Information
 Placed
in center of
page
Patient initials
Age
Sex
Medical diagnosis
Admitted from
MJ
74, male
CHF
Admitted - Home
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
Map #1: Assessment/Data Clusters
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Review S&S on your diagnosis cards
See how data interrelates
Put similar data into groups
Give each group a simple name
DO NOT use systems
“How do all of these things affect my client?”
Data can be in more than one cluster
Data Clusters
Breathing Problems
Self-Concept
Elimination
Skin
Safety
Activity
Communication
Self Care
Nutrition/Fluid
Cognitive/Perceptual
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

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
Data Clusters
Breathing Problems
1 or 2
Fluid
1 or 2
Skin
5
Falls
9
Mobility
6
Nutrition
4
Elimination
7
Communication
10
Self Care
8
Mental status
3
 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
MJ
74, male
CHF
Home
500cc intake,
250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Map #1: Past Health History
 Client
may have past health history or
other health problems
 Make an additional box for this
information and place on concept map
 Map #1:
Past Medical History
2
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
Hypothyroidism
HTN
PVD
BPH
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
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
 Map #2:
Risk Problems
1
2
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
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Type 2 DM
Hypothyroidism
HTN
PVD
BPH
MJ
74, male
CHF
Admitted - Home
Risk for falls
R/T
weakness
and fatigue
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)
Activity intolerance R/T
imbalance
B/W O2 supply and demand
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
Excess Fluid volume R/T
water retention
AEB
MJ
74, male
CHF
Admitted - Home
Type 2 DM
Hypothyroidism
HTN
PVD, BPH
Risk for falls
R/T weakness
and fatigue
2
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Map #3: Goal/Plan
 Add client
goals
 Measurable and realistic
 What you want to accomplish with your
nursing care/interventions?
 It should be the client’ goals, not your
goals
 ONE goal for each problem
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
MJ
74, male
CHF
Admitted - Home
Pt will be able to ambulate 12 feet W/O
resting by ____
2
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Pt’s lungs will be clear to auscultation
by ________
Type 2 DM
Hypothyroidism
HTN, PVD, BPH
Risk for falls
R/T weakness
and fatigue
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
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
MJ
74, male
CHF
Admitted - Home
Pt will be able to ambulate 12 feet W/O
resting by ____
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Pt’s lungs will be clear to auscultation
by ________
Monitor O2 saturation QS
Assist OOB to chair TID
Provide periods of rest
Type 2 DM
Hypothyroidism
HTN, PVD, BPH
Risk for falls
R/T weakness
and fatigue
Monitor I & O QS
Monitor daily weight
Monitor lung sounds Q4 hr
Encourage C&DB
Map #5: Medications and Labs
 Add medications/treatments
 Add your laboratory/diagnostic data
 Place under nursing diagnosis
which they relate
to
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
MJ
74, male
CHF
Admitted - Home
Pt’s 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
Lasix
O2 2l NC
Titrate to Sat>93%
PaCo2 – 50
pH – 7.30
HCO3 – 28
CXR = Effusion
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Type 2 DM
Hypothyroidism
HTN , PVD, BPH
Risk for falls
R/T weakness
and fatigue
Monitor I & O QS
Monitor daily weight
Monitor lung sounds Q4 hr
Encourage C&DB
Lasix
potassium
BUN – 36mg/dL
Na – 130mEq/L
K – 3.0mmol/L
Map #5: 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

Map #5: Interconnections
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?
 If
Activity intolerance R/T
imbalance
B/W O2 supply and demand
Excess Fluid volume R/T
water retention
1
2
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
Pt will be able to ambulate 12 feet W/O
Resting by ____
Pt will maintain a Sat >93% by ___
Monitor O2 saturation QS
Assist OOB to chair TID
Provide periods of rest
Lasix
O2 2l NC
Titrate to Sat>93%
PaCo2 – 50
pH – 7.30
HCO3 – 28
CXR = Effusion
500cc intake, 250cc output
Crackles in bases
Pitting edema in BLE
HR 100
SOA with exertion
Pt output will equal intake by___
Pt’s lungs will be clear to auscultation
By ________
Type 2 DM
Hypothyroidism
HTN, PVD, BPH
Risk for Falls R/T
weakness & fatigue
Monitor I & O QS
Monitor daily weight
Monitor lung sounds Q4 hr
Lasix
potassium
BUN – 36mg/dL
Na – 130mEq/L
K – 3.0mmol/L
Evaluation
 If
you have opportunity to care for client
a second day, you may evaluate if plan of
care has worked for any short term goal
 It is good to practice evaluation, discuss
in post-conference
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
Past Health
History
High Risk
Problems
1
2
ND
RT
ND
RT
AEB
Goals
AEB
Meds
Treatments
Goals
Meds
Treatments
PMH
ND
1
RT
AEB
Meds
2
ND
RT
AEB
Risk Problems
Meds
Nursing Diagnosis
Meds
AEB
Goals
Treatments
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 client’s problems
 In long term care, we focus on actual
problems that require maintenance in order
to prevent further decline in condition

Impaired mobility R/T neurological
impairment
2
ROM (R arm contracture)
Strength (able to resist force with
L leg only)
Sara Lift to transfer
Resident will maintain ability to bear wt.
on LLeg and transfer with Sara Lift with
every transfer, ongoing
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
Risk for Falls R/T
decreased ROM and strength
Impaired Swallowing R/T
Neurological Impairment
MJ
74, male
CVA
Admitted - Home
1
Coughing and choking when eating
History of aspiration pneumonia
Pocketing food
Thickened liquids
Resident will swallow without coughing
or choking with all intake, ongoing.
Pt will maintain clear lungs to
auscultation, ongoing
Type 2 DM
Hyperlipidemia
HTN , CAD,
Pneumonia
1. Position resident upright at 90 degree
angle/head flexed 45 degrees for
all feedings
2. Place food on unaffected side of tongue.
3. Cue resident during feeding
WBC 18,000
CXR Infiltrates
Augmentin