1. Concept Mapping...for the slightly confused Diana Benton RN - 2010

2. What’s a concept map anyway? ...an innovative approach to planning and organizing nursing care ...focused on a holistic nursing view of the patient, rather than a disease model

3. For the student ...helps with organizing the problems and care of patients in a logical fashion ...guides the student’s focus so he or she can learn to analyze relationships in clinical data and to prioritize the needs of a specific client

4. For the instructor ... a visual representation of the critical thinking ability of inexperienced nurses

5. A description we’ll expand upon is...

6. A concept map is adiagram of the sequential steps of the nursing process. 1. assessment 2. nursing diagnosis 3. goal 4. intervention 5. evaluation

7. Let’s get started... This is D.J. - he fractured his right femur when he jumped off the roof. You’d think a 42 year old guy woulda known better!

8. Although there are many different ways to make a concept maplet’sdo it my way  and... D.J. 42 year old male Admitting dx: Fx Right Femur ...start with a circle in the center of the paper identifying the patient.

9. Then, to plan the patient’s care, you’ll utilize... the nursing process

10. To begin.... ssess the patient and gather subjective and objective data

11. MY LEG HURTS ! I feel awful. When I sit up I get dizzy headed. Subjective Assessment Data (information that only the client feels and can describe) I’m depressed. I feel like I’m gonna throw up. Symptoms

12. Signs Concurrent Health Problems Weight 200# Xray: (R) femoral neck fracture Objective Assessment Data (observable or measurable facts) Pertinent Labs and Diagnostic Tests Vital Signs BP 150/68 - Pulse 96 Pallor Buck’s traction (R) leg Moaning Make 2 more circles. It will help you remember to check D.J.’s chart for additional objective data and besides, you could use the extra space!

13. Let’s see how this assessment data looks when added toyour concept map

14. Needs Further Assessment Subjective Assessment Data D.J. 42 year old male Admitting dx: Fx Right Femur c/o Pain (R) leg If you realize you need to get more information .. make a note here to remind yourself c/o nausea “depressed” “dizzy” Concurrent Health Problems None Objective Assessment Data Pertinent Labs and Diagnostic Tests BP = 150/68 Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Moaning

15. Now to come up with a... ursing iagnosis

16. Look at the assessment data. Identify patterns of related responsesto an actual or potential health problem. BP = 150/68 Moaning c/o Pain (R) leg Pulse = 98 Xray: (R) femoral neck fracture

17. ACUTE PAIN Based on the problem identified, chose an appropriate nursing diagnosis from the NANDA list.

18. Add this nursing diagnosis to your concept map. Nursing Diagnosis:ACUTE PAIN Subjective Assessment Data Needs Further Assessment c/o Pain (R) leg c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” Concurrent Health Problems None You must be able to show the relationship between each nursing diagnosis you chose and the assessment data upon which it was based. Objective Assessment Data Pertinent Labs and Diagnostic Tests BP = 150/68 Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Moaning

19. As you add more diagnoses... Another Diagnosis ACUTE PAIN Another Diagnosis ... your map can begin to look like a confusing mess. Skip the lines.

20. Instead... use a 3 part nursing diagnosis that includes: Nursing Diagnosis:ACUTE PAIN Diagnosis R/T (R) femoral neck fracture Cause “related to” AEB c/o Pain (R) leg / moaning / BP = 150/68 / pulse 98 Indicators “as evidenced by”

21. When added to your concept map it should look like this: Nursing Diagnosis:ACUTE PAIN R/T (R) femoral neck fracture AEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Subjective Assessment Data Needs Further Assessment c/o Pain (R) leg c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” Concurrent Health Problems None Objective Assessment Data Pertinent Labs and Diagnostic Tests BP = 150/68 You gotta admit...that looks a lot better! Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Moaning

22. After you have decided on a nursing diagnosis, set a patient-focused... oal specific measurable attainable realistic timely so you will be able to determine if desired outcomes of care are achieved

23. ACUTE PAIN So what’s gonna be your patient-focused goal The will... ...have no pain he just broke his leg...it’s gonna hurt! ...report pain controlled at a tolerable level this is more realistic but...

24. How are you gonna determine if the pain is tolerable specific “reports pain levels of < 5 on a scale of 0 to 10 within the next 24 hours” measurable attainable realistic timely Nowthat’sa smart goal

25. Put this goal on your concept map. Nursing Diagnosis:ACUTE PAINR/T (R) femoral neck fractureAEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Subjective Assessment Data Needs Further Assessment c/o Pain (R) leg Goal: The patient will report pain controlled at levels of < 5 on a scale of 0 to 10 within the next 24 hours c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” Concurrent Health Problems None Objective Assessment Data Pertinent Labs and Diagnostic Tests BP = 150/68 Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Moaning

26. Now you need to decide on nursing...nterventionsthat, when implemented, will enable the patient to achieve the stated goal

27. I know some! Explain 0 to 10 pain scale / need not wait until pain is severe Administer ordered pain meds prn / assess pain relief 30 min. after medicating Maintain Buck’s traction to  muscle spasms Refresh ice to right femur prn Provide periods of uninterrupted rest

28. Add your interventions. Nursing Diagnosis:ACUTE PAINR/T (R) femoral neck fractureAEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Subjective Assessment Data Goal: The patient will report pain controlled at levels of < 5 on a scale of 0 to 10 within the next 24 hours Needs Further Assessment c/o Pain (R) leg c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” Interventions: Explain 0 to 10 pain scale / need not wait until pain is severe. Administer ordered pain meds prn / assess pain relief 30 min. after medicating. Maintain Buck’s traction to  muscle spasms. Refresh ice to right femur prn. Provide periods of uninterrupted rest. “dizzy” Concurrent Health Problems None Objective Assessment Data Pertinent Labs and Diagnostic Tests BP = 150/68 Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Moaning

29. Following the same sequence of steps, you can develop additional nursing diagnoses along with goals and interventions. Nursing Diagnosis:ACUTE PAINR/T (R) femoral neck fractureAEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Goal: The patient will report pain controlled at levels of < 5 on a scale of 0 to 10 within the next 24 hours. Interventions: Explain 0 to 10 pain scale / need not wait until pain is severe. Administer ordered pain meds prn / assess pain relief 30 min. after medicating. Maintain Buck’s traction to  muscle spasms. Refresh ice to right femur prn. Provide periods of uninterrupted rest. Subjective Assessment Data c/o Pain (R) leg Needs Further Assessment c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” Nursing Diagnosis: Goal: Concurrent Health Problems None Objective Assessment Data Nursing Diagnosis: Interventions: BP = 150/68 Goal: Pulse = 98 Pertinent Labs and Diagnostic Tests Pallor Buck’s traction (R) leg Xray: (R) femoral neck fracture Interventions: Moaning

30. At this point...prioritize the needs of your patient based on Maslow’s Hierarchy of Needs.

31. Maslow’s Hierarchy of Needs Self-actualization Esteem feeling of accomplishment Love and belonging intimate relationships and acceptance Safety feel safe and avoid danger Physiological needs basic to human survival oxygen, water, food, shelter, and sleep

32. Nursing Diagnosis:ACUTE PAINR/T (R) femoral neck fractureAEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Number each nursing diagnosis on your concept map in order of priority. 1 Nursing Diagnosis:ACUTE PAIN Goal: The patient will report pain controlled at levels of < 5 on a scale of 0 to 10 within the next 24 hours. Subjective Assessment Data Interventions: Explain 0 to 10 pain scale / need not wait until pain is severe. Administer ordered pain meds prn / assess pain relief 30 min. after medicating. Maintain Buck’s traction to  muscle spasms. Refresh ice to right femur prn. Provide periods of uninterrupted rest. c/o Pain (R) leg Needs Further Assessment c/o nausea D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” 3 Nursing Diagnosis: Goal: 2 Concurrent Health Problems None Objective Assessment Data Nursing Diagnosis: Interventions: BP = 150/68 Pulse = 98 Pertinent Labs and Diagnostic Tests Goal: Pallor Buck’s traction (R) leg Xray: (R) femoral neck fracture Moaning Interventions:

33. Lastly, do an... valuation of the effectiveness of the interventions in relation to goal set if goal is not being met, what changes do you need to make?

34. 1 Nursing Diagnosis:ACUTE PAINR/T (R) femoral neck fractureAEBc/o Pain (R) leg / moaning / BP 150/68 / pulse 98 Subjective Assessment Data c/o Pain (R) leg Needs Further Assessment c/o nausea Goal: The patient will report pain controlled at levels of < 5 on a scale of 0 to 10 within the next 24 hours. D.J. 42 year old male Admitting dx: Fx Right Femur “depressed” “dizzy” Interventions: Explain 0 to 10 pain scale / need not wait until pain is severe. Administer ordered pain meds prn / assess pain relief 30 min. after medicating. Maintain Buck’s traction to  muscle spasms. Refresh ice to right femur prn. Provide periods of uninterrupted rest. Concurrent Health Problems None Objective Assessment Data BP = 150/68 Pertinent Labs and Diagnostic Tests Pulse = 98 Xray: (R) femoral neck fracture Pallor Buck’s traction (R) leg Evaluation: Goal met – patient reports pain controlled between levels 1 - 4 during past 24 hours Moaning

35. Yea, you just made a... ... concept map! Wasn’t that easy?