[Solved] Nursing Map

Assignment Prompt & Instructions

– 2 years ago

**files (3)**

– ## ConceptMapTemplate.docx

– ## ConceptMapExample.pdf

– barcode.jpeg

**## ConceptMapTemplate.docx**

### NIGHTINGALE COLLEGE

### DIRECT-FOCUSED CARE: **CONCEPT MAPPING ASSIGNMENT WORKSHEET**

**_You may use this document to complete your Concept Map and submit it to Canvas, or you may use the template provided within the instructions in Canvas. You don’t need to do both. This is just an alternative if you are having trouble manipulating the original template in Canvas._**

**NURSING PROCESS TEMPLATE:**

**Assessment (Recognizing Cues)**

Which patient information is relevant? What patient data is most important? Which patient information is of immediate concern? Consider signs and symptoms, lab work, patient statements, H & P, and others. Consider subjective and objective data.

**Analysis (Analyzing Cues)**

Which patient conditions are consistent with the cues? Do the cues support a particular patient condition? What cues are a cause for concern? What other information would help to establish the significance of a cue?

**Analysis (Prioritizing Hypotheses)**

What explanations are most likely? What is the most serious explanation? What is the priority order for safe and effective care?

**Planning (Generate Solutions)**

What are the desirable outcomes? What interventions can achieve these outcomes? What should be avoided? (SMART Planning- specific, measurable, attainable, realistic/relevant, time-restricted- Goal setting)

**Implementation (Take actions)**

How should the intervention or combination of interventions be performed, requested, communicated, taught, etc.? What are the priority interventions? (Mark with asterisk)

**Evaluation (Evaluating Outcomes)**

What signs point to improving/declining/unchanged status? What interventions were effective? Are there other interventions that could be more effective? Did the patient’s care outlook or status improve?

**CONCEPT MAP TEMPLATE:**

**Nursing Process Template**

**(All 6 areas of the Nursing Process Template should be thoroughly completed. The SBAR information below is correctly and thoroughly identified, and in the right format. The chosen concept is clearly identified below.)**

**Patient Information (SBAR)**

**(Use SBAR format. See ELO for proper SBAR format.)**

**S:**

**B:**

**A:**

**R:**

**Main Concept (Should be focus of below map)**

**(You may only use a concept ONCE per semester. The Giddens text lists concepts. No medical or nursing diagnoses.)**

**Concept:**

**Recognizing Cues (S&S)**

**(Identify at least 4 critical cues that are significant and could impact the patient condition. May consider both subjective and objective data.)**

**1.**

**2.**

**3.**

**4.**

**Disease Process/Pathophysiology/Risk Factors**

**(Thorough review of the disease process pathophysiology and identify risk factors)**

**Disease Process and Pathophysiology:**

**Risk Factors:**

**Analyzing Cues/Conditions**

**(Based on identified cues, create 3 to 4 supporting connections between the relevant cues and client conditions/problems.)**

**1.**

**2.**

**3.**

**4.**

**Prioritizing Hypotheses**

**(Based on identified connections between cues and patient conditions/problems, identify and RANK 3 client conditions/problems critical to positive patient outcomes, with the most urgent problem first.)**

**1.**

**2.**

**3.**

**SMART PLANNING: Generate Solutions/Outcomes/Interventions**

**(List 5 solutions/outcomes with appropriate nursing interventions that will positively impact client outcomes and are appropriate to the care of the client. Outcomes/goals are listed in SMART format.)**

(ex: Within 30 minutes of breathing treatment and application of supplemental oxygen via nasal cannula, client will obtain and maintain oxygen saturation levels >95%.)

**1.**

**2.**

**3.**

**4.**

**5.**

**Taking Action – (How To)**

**(Describe how each of the 5 identified nursing interventions will be performed, implemented, administered, communicated, or taught.)**

**1.**

**2.**

**3.**

**4.**

**5.**

**Evaluating Outcomes**

**(Describe how you will determine the effectiveness of the 5 priority nursing interventions you implemented. How will you know if your interventions are effective or not?)**

**1.**

**2.**

**3.**

**4.**

**5.**

**## ConceptMapExample.pdf**

NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET

NURSING PROCESS TEMPLATE:

Assessment (Recognizing Cues)

Which patient information is relevant? What patient data is most

important? Which patient information is of immediate concern?

Consider signs and symptoms, lab work, patient statements, H & P,

and others. Consider subjective and objective data.

Vital signs: Fevers can indicate infection and/or
inflammation. Low oxygen saturation levels (< 90%) can
indicate inflammation in the airways. Heart rate and
respirations: Tachycardia and tachypnea are both signs of
an inflammatory response in the airways, or asthma.

Lung sounds: Wheezing can indicate a partially blocked
airway or swollen bronchiole tubes from inflammation
(Cleveland Clinic, 2020b). This client had inspiratory and
expiratory wheezes, telling us that he had inflammation
in his bronchiole tubes.

Medical History: 5-year-old boy with a history of asthma
and currently has a fever. Caregiver reports that inhaler
has not been helping.

Analysis (Analyzing Cues)

Which patient conditions are consistent with the cues? Do the cues
support a particular patient condition? What cues are a cause for
concern? What other information would help to establish the
significance of a cue?

One condition that is consistent with the cues is severe
acute asthma exacerbation. Another is that the client
may have a respiratory tract infection. Because of these
conditions, the bronchioles have become inflamed, and
the client has classic symptoms of an asthma
exacerbation: tachypnea, tachycardia, diaphoresis,
wheezing, shortness of breath, and chest tightness
(Jafarnejad & Khoshnezhad, 2020).

Analysis (Prioritizing Hypotheses)

What explanations are most likely? What is the most serious
explanation? What is the priority order for safe and effective care?

The client is most likely suffering from an asthma attack,
which includes inflammation and narrowing of airways.
This could be related to a respiratory infection affecting
the airways. The most serious explanation at this time
would be a severe asthma attack affecting the client’s
ability to breathe. The priority for safe and effective care
for this client would include maintaining patent airways
and an adequate oxygen saturation level.

Planning (Generate Solutions)

What are the desirable outcomes? What interventions can achieve
these outcomes? What should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-restricted- Goal
setting)

Achieve and maintain control of symptoms: medications,
fluids, oxygen.

Prevent respiratory decline: monitor client for any
indication of decline and treat as necessary.

Avoid dehydration, respiratory irritants, missing
medications, excessive physical activity during acute
exacerbation.

Implementation (Take actions)

How should the intervention or combination of interventions be
performed, requested, communicated, taught, etc.? What are the
priority interventions? (Mark with asterisk)

Positioning the client in a high-fowlers or semi-fowlers
can help with dyspnea while undergoing nebulizer
therapy (Chanif & Prastika, 2019).

Offer the client water to help thin secretions and hydrate.
Some clients may experience a dry mouth from
corticosteroids (Hira et al., 2015). Water can also be

Page 2 of 5

soothing since the client has a slight fever and is feeling
warm.

Client (and caregiver) education. This client is only 5 years
old so it can be helpful to show him how to properly use
his inhaler (with a chamber) by demonstrating on a
stuffed animal or inanimate object (LaRue & Kelly, 2015).
The caregiver should be educated on the medication
regimen, as well as how to use the inhalers and nebulizer
treatments. We should teach her the importance of the
treatments and when to call the provider. It is important
to inform her of common irritants such as being exposed
to smoke, dust, and pets (National Asthma Council,
2022).

Therapeutic communication: Since this is a pediatric
client, earning his trust can be tough but very important
so that he will feel safe with us and be more likely to
comply with the treatment. We must ask permission
before performing examinations and explain the process
as well as what he can expect.

Offer to turn on a movie or music for him. We want the
client to stay calm, comfortable, and happy. The
distraction of the television may help him rest and feel
more comfortable in such a stressful situation and
setting, being away from home (Children’s Hospital of
Pittsburgh, 2022).

Evaluation (Evaluating Outcomes)

What signs point to improving/declining/unchanged status? What
interventions were effective? Are there other interventions that
could be more effective? Did the patient’s care outlook or status
improve?

Before the assessment in the ED the client was not using
the spacer and was inhaling too fast (the client should
take a slow, deep breath). The nurse identified lack of
coordination between activating the inhaler and initiating
the deep breath, angling the inhaler to spray the tongue
or side of the mouth, and the client failing to hold his
breath for 10 seconds after inhalation. If this kind of
management continues, client will not get the necessary
medication he needs when another attack occurs.

Client’s cough has subsided and has been able to relax
without breathing difficulty. Oxygen saturation improved
to 96%. Client’s heart rate and respiratory rate have
dropped to WNL. Intermittent expiratory wheezes still
present but diminishing.

Page 3 of 5

Patient Information (SBAR)

Main Concept

(Should be focus of below map)

Disease Process/Pathophysiology/Risk Factors

Recognizing Cues, (S&S)

Analyzing Cues/Concerns

Prioritizing Hypotheses

Asthma is an airflow obstruction due to bronchial

hyperresponsiveness and underlying inflammation. The

bronchoconstriction quickly occurs to narrow the

airways due to stimuli such as irritants, allergens, or

infection. During an exacerbation, the epithelial cells

that line the airway initiate an inflammatory response,

causing the airways to become inflamed and begin to

swell and narrow. The muscles around the airway

contract and produce more mucus which leads to

further narrowing of the bronchial tubes.

• Step 1 – Mild intermittent asthma. Symptoms
fewer than two times a week.

• Step 2 – Mild persistent asthma. Symptoms
more than two times a week, but no more
than once a day.

• Step 3 – Moderate persistent asthma.
Symptoms every day.

• Step 4 – Severe persistent asthma. Constant
symptoms.

Risk Factors: Allergies, family history,
secondhand smoke, environmental exposures,
more prevalent in children

S: 5-year-old boy with an apparent acute

severe exacerbation of asthma.

B: The client was alert and speaking in short

sentences due to shortness of breath.

Inspiratory and expiratory wheezes audible

without the use of a stethoscope. Fever of

100.4 F, HR of 130 bpm, RR 40 bpm, O2 sat

of 90%. Patient has NKDA and no significant

past medical history other than diagnosis of

asthma.

A: I think the patient is experiencing asthma

exacerbation possibly due to respiratory

illness.

R: I recommend starting nebulizer

treatments and would like you to come place

orders as soon as possible, please.

INFLAMMATION

Prioritize client conditions and care:

1. Wheezing/dyspnea

2. Hypoxia

3. Fever

• Respiratory rate – 40 bpm

• Low oxygen saturation – 90%

• Fever – 100.4 F

• Chest tightness

• Inspiratory and expiratory wheezes

• Rapid heart rate – 130 bpm

Supporting connections between the cues

(S&S) and the client condition:

• Wheezing indicates bronchiole

inflammation causing airway

constriction.

• Dyspnea (shortness of breath)

causes tachypnea and tachycardia.

• Hypoxia (low oxygen saturation) is

related to the impaired gas

exchange due to the airway

constriction.

• Fever is related to suspected

respiratory infection.

Page 4 of 5

Generate Solutions/Outcomes/Interventions

SMART Planning Taking Action – (How To)

Evaluating Outcomes

1. Apply nasal cannula and titrate oxygen to

maintain oxygen saturation >95%.

2. Administer medications/breathing treatments

as directed to decrease inflammation and

wheezing. Listen to lungs every 30 minutes x2

hours to assess for wheezing.

3. Position the client in a high-fowlers or semi-

fowlers position to maintain airway clearance.

4. Administer antipyretic medication as need to

decrease fever and provide comfort.

5. Educate the client and caregiver regarding plan

of care, medications, and inhaler use. Verbalize

and demonstrate correct spacer use and

educate on importance of proper use.

1. The client’s O2 saturation was 98% on room air without evidence of dyspnea or chest tightness following

oxygen therapy.

2. Client’s respiratory rate decreased to 24 bpm and heart rate decreased to 100 bpm. Client verbalized ease of

breathing. Mild intermittent expiratory wheezes audible only with stethoscope.

3. Client able to sit upright to expectorate mucus and maintain airway clearance. Lungs clear with intermittent

expiratory wheezes.

4. Client’s temperature decreased from 100.4 F to 98.9 F by end of shift.

5. Caregiver and client demonstrated the appropriate use of inhaler with spacer, ensuring client inhales the

amount of medication needed, optimizing the effectiveness of the medication.

6.

4.

5.

1. Within 30 minutes of breathing treatment

and application of supplemental oxygen via

nasal cannula, client will obtain and maintain

oxygen saturation levels >95%.

2. Within 30 minutes of breathing treatment,

respiratory rate will be within 20-30 bpm and

heart rate will be within 75-115 bpm.

3. Client will have improved airway clearance

related to repositioning as evidenced by clear

lung sounds in all four lung fields anteriorly and

posteriorly by the end of the shift.

4. By end of the shift, client’s temperature will

be decreased from 100.4 F down to <99 F

following antipyretic medication administration.

5. By end of shift, client will correctly

demonstrate the use of inhaler spacer three

times, as a result of proper client and caregiver

education.

Page 5 of 5

References

Children’s Hospital of Pittsburgh. (2022). Distraction techniques | Children’s Hospital Pittsburgh.

https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques

Cleveland Clinic. (2020b). Wheezing: Definition, causes & treatment.

https://my.clevelandclinic.org/health/symptoms/15203-wheezing

Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.). Elsevier.

Jafarnejad, S., & Khoshnezhad Ebrahimi, H. (2020). Clinical guidelines on pediatric asthma exacerbation in emergency

department, a narrative review. European journal of translational myology, 30(1), 8682.

https://doi.org/10.4081/ejtm.2019.8682

National Asthma Council. (2022). The National Asthma Council Australia. https://www.nationalasthma.org.au/living-

with-asthma/resources/patientscarers/factsheets/pets-and-allergies

[https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques](https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques)

[https://my.clevelandclinic.org/health/symptoms/15203-wheezing](https://my.clevelandclinic.org/health/symptoms/15203-wheezing)

[https://doi.org/10.4081/ejtm.2019.8682](https://doi.org/10.4081/ejtm.2019.8682)

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**## ConceptMapTemplate.docx**

### NIGHTINGALE COLLEGE

### DIRECT-FOCUSED CARE: **CONCEPT MAPPING ASSIGNMENT WORKSHEET**

**_You may use this document to complete your Concept Map and submit it to Canvas, or you may use the template provided within the instructions in Canvas. You don’t need to do both. This is just an alternative if you are having trouble manipulating the original template in Canvas._**

**NURSING PROCESS TEMPLATE:**

**Assessment (Recognizing Cues)**

Which patient information is relevant? What patient data is most important? Which patient information is of immediate concern? Consider signs and symptoms, lab work, patient statements, H & P, and others. Consider subjective and objective data.

**Analysis (Analyzing Cues)**

Which patient conditions are consistent with the cues? Do the cues support a particular patient condition? What cues are a cause for concern? What other information would help to establish the significance of a cue?

**Analysis (Prioritizing Hypotheses)**

What explanations are most likely? What is the most serious explanation? What is the priority order for safe and effective care?

**Planning (Generate Solutions)**

What are the desirable outcomes? What interventions can achieve these outcomes? What should be avoided? (SMART Planning- specific, measurable, attainable, realistic/relevant, time-restricted- Goal setting)

**Implementation (Take actions)**

How should the intervention or combination of interventions be performed, requested, communicated, taught, etc.? What are the priority interventions? (Mark with asterisk)

**Evaluation (Evaluating Outcomes)**

What signs point to improving/declining/unchanged status? What interventions were effective? Are there other interventions that could be more effective? Did the patient’s care outlook or status improve?

**CONCEPT MAP TEMPLATE:**

**Nursing Process Template**

**(All 6 areas of the Nursing Process Template should be thoroughly completed. The SBAR information below is correctly and thoroughly identified, and in the right format. The chosen concept is clearly identified below.)**

**Patient Information (SBAR)**

**(Use SBAR format. See ELO for proper SBAR format.)**

**S:**

**B:**

**A:**

**R:**

**Main Concept (Should be focus of below map)**

**(You may only use a concept ONCE per semester. The Giddens text lists concepts. No medical or nursing diagnoses.)**

**Concept:**

**Recognizing Cues (S&S)**

**(Identify at least 4 critical cues that are significant and could impact the patient condition. May consider both subjective and objective data.)**

**1.**

**2.**

**3.**

**4.**

**Disease Process/Pathophysiology/Risk Factors**

**(Thorough review of the disease process pathophysiology and identify risk factors)**

**Disease Process and Pathophysiology:**

**Risk Factors:**

**Analyzing Cues/Conditions**

**(Based on identified cues, create 3 to 4 supporting connections between the relevant cues and client conditions/problems.)**

**1.**

**2.**

**3.**

**4.**

**Prioritizing Hypotheses**

**(Based on identified connections between cues and patient conditions/problems, identify and RANK 3 client conditions/problems critical to positive patient outcomes, with the most urgent problem first.)**

**1.**

**2.**

**3.**

**SMART PLANNING: Generate Solutions/Outcomes/Interventions**

**(List 5 solutions/outcomes with appropriate nursing interventions that will positively impact client outcomes and are appropriate to the care of the client. Outcomes/goals are listed in SMART format.)**

(ex: Within 30 minutes of breathing treatment and application of supplemental oxygen via nasal cannula, client will obtain and maintain oxygen saturation levels >95%.)

**1.**

**2.**

**3.**

**4.**

**5.**

**Taking Action – (How To)**

**(Describe how each of the 5 identified nursing interventions will be performed, implemented, administered, communicated, or taught.)**

**1.**

**2.**

**3.**

**4.**

**5.**

**Evaluating Outcomes**

**(Describe how you will determine the effectiveness of the 5 priority nursing interventions you implemented. How will you know if your interventions are effective or not?)**

**1.**

**2.**

**3.**

**4.**

**5.**

**## ConceptMapExample.pdf**

NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET

NURSING PROCESS TEMPLATE:

Assessment (Recognizing Cues)

Which patient information is relevant? What patient data is most

important? Which patient information is of immediate concern?

Consider signs and symptoms, lab work, patient statements, H & P,

and others. Consider subjective and objective data.

Vital signs: Fevers can indicate infection and/or
inflammation. Low oxygen saturation levels (< 90%) can
indicate inflammation in the airways. Heart rate and
respirations: Tachycardia and tachypnea are both signs of
an inflammatory response in the airways, or asthma.

Lung sounds: Wheezing can indicate a partially blocked
airway or swollen bronchiole tubes from inflammation
(Cleveland Clinic, 2020b). This client had inspiratory and
expiratory wheezes, telling us that he had inflammation
in his bronchiole tubes.

Medical History: 5-year-old boy with a history of asthma
and currently has a fever. Caregiver reports that inhaler
has not been helping.

Analysis (Analyzing Cues)

Which patient conditions are consistent with the cues? Do the cues
support a particular patient condition? What cues are a cause for
concern? What other information would help to establish the
significance of a cue?

One condition that is consistent with the cues is severe
acute asthma exacerbation. Another is that the client
may have a respiratory tract infection. Because of these
conditions, the bronchioles have become inflamed, and
the client has classic symptoms of an asthma
exacerbation: tachypnea, tachycardia, diaphoresis,
wheezing, shortness of breath, and chest tightness
(Jafarnejad & Khoshnezhad, 2020).

Analysis (Prioritizing Hypotheses)

What explanations are most likely? What is the most serious
explanation? What is the priority order for safe and effective care?

The client is most likely suffering from an asthma attack,
which includes inflammation and narrowing of airways.
This could be related to a respiratory infection affecting
the airways. The most serious explanation at this time
would be a severe asthma attack affecting the client’s
ability to breathe. The priority for safe and effective care
for this client would include maintaining patent airways
and an adequate oxygen saturation level.

Planning (Generate Solutions)

What are the desirable outcomes? What interventions can achieve
these outcomes? What should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-restricted- Goal
setting)

Achieve and maintain control of symptoms: medications,
fluids, oxygen.

Prevent respiratory decline: monitor client for any
indication of decline and treat as necessary.

Avoid dehydration, respiratory irritants, missing
medications, excessive physical activity during acute
exacerbation.

Implementation (Take actions)

How should the intervention or combination of interventions be
performed, requested, communicated, taught, etc.? What are the
priority interventions? (Mark with asterisk)

Positioning the client in a high-fowlers or semi-fowlers
can help with dyspnea while undergoing nebulizer
therapy (Chanif & Prastika, 2019).

Offer the client water to help thin secretions and hydrate.
Some clients may experience a dry mouth from
corticosteroids (Hira et al., 2015). Water can also be

Page 2 of 5

soothing since the client has a slight fever and is feeling
warm.

Client (and caregiver) education. This client is only 5 years
old so it can be helpful to show him how to properly use
his inhaler (with a chamber) by demonstrating on a
stuffed animal or inanimate object (LaRue & Kelly, 2015).
The caregiver should be educated on the medication
regimen, as well as how to use the inhalers and nebulizer
treatments. We should teach her the importance of the
treatments and when to call the provider. It is important
to inform her of common irritants such as being exposed
to smoke, dust, and pets (National Asthma Council,
2022).

Therapeutic communication: Since this is a pediatric
client, earning his trust can be tough but very important
so that he will feel safe with us and be more likely to
comply with the treatment. We must ask permission
before performing examinations and explain the process
as well as what he can expect.

Offer to turn on a movie or music for him. We want the
client to stay calm, comfortable, and happy. The
distraction of the television may help him rest and feel
more comfortable in such a stressful situation and
setting, being away from home (Children’s Hospital of
Pittsburgh, 2022).

Evaluation (Evaluating Outcomes)

What signs point to improving/declining/unchanged status? What
interventions were effective? Are there other interventions that
could be more effective? Did the patient’s care outlook or status
improve?

Before the assessment in the ED the client was not using
the spacer and was inhaling too fast (the client should
take a slow, deep breath). The nurse identified lack of
coordination between activating the inhaler and initiating
the deep breath, angling the inhaler to spray the tongue
or side of the mouth, and the client failing to hold his
breath for 10 seconds after inhalation. If this kind of
management continues, client will not get the necessary
medication he needs when another attack occurs.

Client’s cough has subsided and has been able to relax
without breathing difficulty. Oxygen saturation improved
to 96%. Client’s heart rate and respiratory rate have
dropped to WNL. Intermittent expiratory wheezes still
present but diminishing.

Page 3 of 5

Patient Information (SBAR)

Main Concept

(Should be focus of below map)

Disease Process/Pathophysiology/Risk Factors

Recognizing Cues, (S&S)

Analyzing Cues/Concerns

Prioritizing Hypotheses

Asthma is an airflow obstruction due to bronchial

hyperresponsiveness and underlying inflammation. The

bronchoconstriction quickly occurs to narrow the

airways due to stimuli such as irritants, allergens, or

infection. During an exacerbation, the epithelial cells

that line the airway initiate an inflammatory response,

causing the airways to become inflamed and begin to

swell and narrow. The muscles around the airway

contract and produce more mucus which leads to

further narrowing of the bronchial tubes.

• Step 1 – Mild intermittent asthma. Symptoms
fewer than two times a week.

• Step 2 – Mild persistent asthma. Symptoms
more than two times a week, but no more
than once a day.

• Step 3 – Moderate persistent asthma.
Symptoms every day.

• Step 4 – Severe persistent asthma. Constant
symptoms.

Risk Factors: Allergies, family history,
secondhand smoke, environmental exposures,
more prevalent in children

S: 5-year-old boy with an apparent acute

severe exacerbation of asthma.

B: The client was alert and speaking in short

sentences due to shortness of breath.

Inspiratory and expiratory wheezes audible

without the use of a stethoscope. Fever of

100.4 F, HR of 130 bpm, RR 40 bpm, O2 sat

of 90%. Patient has NKDA and no significant

past medical history other than diagnosis of

asthma.

A: I think the patient is experiencing asthma

exacerbation possibly due to respiratory

illness.

R: I recommend starting nebulizer

treatments and would like you to come place

orders as soon as possible, please.

INFLAMMATION

Prioritize client conditions and care:

1. Wheezing/dyspnea

2. Hypoxia

3. Fever

• Respiratory rate – 40 bpm

• Low oxygen saturation – 90%

• Fever – 100.4 F

• Chest tightness

• Inspiratory and expiratory wheezes

• Rapid heart rate – 130 bpm

Supporting connections between the cues

(S&S) and the client condition:

• Wheezing indicates bronchiole

inflammation causing airway

constriction.

• Dyspnea (shortness of breath)

causes tachypnea and tachycardia.

• Hypoxia (low oxygen saturation) is

related to the impaired gas

exchange due to the airway

constriction.

• Fever is related to suspected

respiratory infection.

Page 4 of 5

Generate Solutions/Outcomes/Interventions

SMART Planning Taking Action – (How To)

Evaluating Outcomes

1. Apply nasal cannula and titrate oxygen to

maintain oxygen saturation >95%.

2. Administer medications/breathing treatments

as directed to decrease inflammation and

wheezing. Listen to lungs every 30 minutes x2

hours to assess for wheezing.

3. Position the client in a high-fowlers or semi-

fowlers position to maintain airway clearance.

4. Administer antipyretic medication as need to

decrease fever and provide comfort.

5. Educate the client and caregiver regarding plan

of care, medications, and inhaler use. Verbalize

and demonstrate correct spacer use and

educate on importance of proper use.

1. The client’s O2 saturation was 98% on room air without evidence of dyspnea or chest tightness following

oxygen therapy.

2. Client’s respiratory rate decreased to 24 bpm and heart rate decreased to 100 bpm. Client verbalized ease of

breathing. Mild intermittent expiratory wheezes audible only with stethoscope.

3. Client able to sit upright to expectorate mucus and maintain airway clearance. Lungs clear with intermittent

expiratory wheezes.

4. Client’s temperature decreased from 100.4 F to 98.9 F by end of shift.

5. Caregiver and client demonstrated the appropriate use of inhaler with spacer, ensuring client inhales the

amount of medication needed, optimizing the effectiveness of the medication.

6.

4.

5.

1. Within 30 minutes of breathing treatment

and application of supplemental oxygen via

nasal cannula, client will obtain and maintain

oxygen saturation levels >95%.

2. Within 30 minutes of breathing treatment,

respiratory rate will be within 20-30 bpm and

heart rate will be within 75-115 bpm.

3. Client will have improved airway clearance

related to repositioning as evidenced by clear

lung sounds in all four lung fields anteriorly and

posteriorly by the end of the shift.

4. By end of the shift, client’s temperature will

be decreased from 100.4 F down to <99 F

following antipyretic medication administration.

5. By end of shift, client will correctly

demonstrate the use of inhaler spacer three

times, as a result of proper client and caregiver

education.

Page 5 of 5

References

Children’s Hospital of Pittsburgh. (2022). Distraction techniques | Children’s Hospital Pittsburgh.

https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques

Cleveland Clinic. (2020b). Wheezing: Definition, causes & treatment.

https://my.clevelandclinic.org/health/symptoms/15203-wheezing

Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.). Elsevier.

Jafarnejad, S., & Khoshnezhad Ebrahimi, H. (2020). Clinical guidelines on pediatric asthma exacerbation in emergency

department, a narrative review. European journal of translational myology, 30(1), 8682.

https://doi.org/10.4081/ejtm.2019.8682

National Asthma Council. (2022). The National Asthma Council Australia. https://www.nationalasthma.org.au/living-

with-asthma/resources/patientscarers/factsheets/pets-and-allergies

[https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques](https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques)

[https://my.clevelandclinic.org/health/symptoms/15203-wheezing](https://my.clevelandclinic.org/health/symptoms/15203-wheezing)

[https://doi.org/10.4081/ejtm.2019.8682](https://doi.org/10.4081/ejtm.2019.8682)

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**## ConceptMapTemplate.docx**

### NIGHTINGALE COLLEGE

### DIRECT-FOCUSED CARE: **CONCEPT MAPPING ASSIGNMENT WORKSHEET**

**_You may use this document to complete your Concept Map and submit it to Canvas, or you may use the template provided within the instructions in Canvas. You don’t need to do both. This is just an alternative if you are having trouble manipulating the original template in Canvas._**

**NURSING PROCESS TEMPLATE:**

**Assessment (Recognizing Cues)**

Which patient information is relevant? What patient data is most important? Which patient information is of immediate concern? Consider signs and symptoms, lab work, patient statements, H & P, and others. Consider subjective and objective data.

**Analysis (Analyzing Cues)**

Which patient conditions are consistent with the cues? Do the cues support a particular patient condition? What cues are a cause for concern? What other information would help to establish the significance of a cue?

**Analysis (Prioritizing Hypotheses)**

What explanations are most likely? What is the most serious explanation? What is the priority order for safe and effective care?

**Planning (Generate Solutions)**

What are the desirable outcomes? What interventions can achieve these outcomes? What should be avoided? (SMART Planning- specific, measurable, attainable, realistic/relevant, time-restricted- Goal setting)

**Implementation (Take actions)**

How should the intervention or combination of interventions be performed, requested, communicated, taught, etc.? What are the priority interventions? (Mark with asterisk)

**Evaluation (Evaluating Outcomes)**

What signs point to improving/declining/unchanged status? What interventions were effective? Are there other interventions that could be more effective? Did the patient’s care outlook or status improve?

**CONCEPT MAP TEMPLATE:**

**Nursing Process Template**

**(All 6 areas of the Nursing Process Template should be thoroughly completed. The SBAR information below is correctly and thoroughly identified, and in the right format. The chosen concept is clearly identified below.)**

**Patient Information (SBAR)**

**(Use SBAR format. See ELO for proper SBAR format.)**

**S:**

**B:**

**A:**

**R:**

**Main Concept (Should be focus of below map)**

**(You may only use a concept ONCE per semester. The Giddens text lists concepts. No medical or nursing diagnoses.)**

**Concept:**

**Recognizing Cues (S&S)**

**(Identify at least 4 critical cues that are significant and could impact the patient condition. May consider both subjective and objective data.)**

**1.**

**2.**

**3.**

**4.**

**Disease Process/Pathophysiology/Risk Factors**

**(Thorough review of the disease process pathophysiology and identify risk factors)**

**Disease Process and Pathophysiology:**

**Risk Factors:**

**Analyzing Cues/Conditions**

**(Based on identified cues, create 3 to 4 supporting connections between the relevant cues and client conditions/problems.)**

**1.**

**2.**

**3.**

**4.**

**Prioritizing Hypotheses**

**(Based on identified connections between cues and patient conditions/problems, identify and RANK 3 client conditions/problems critical to positive patient outcomes, with the most urgent problem first.)**

**1.**

**2.**

**3.**

**SMART PLANNING: Generate Solutions/Outcomes/Interventions**

**(List 5 solutions/outcomes with appropriate nursing interventions that will positively impact client outcomes and are appropriate to the care of the client. Outcomes/goals are listed in SMART format.)**

(ex: Within 30 minutes of breathing treatment and application of supplemental oxygen via nasal cannula, client will obtain and maintain oxygen saturation levels >95%.)

**1.**

**2.**

**3.**

**4.**

**5.**

**Taking Action – (How To)**

**(Describe how each of the 5 identified nursing interventions will be performed, implemented, administered, communicated, or taught.)**

**1.**

**2.**

**3.**

**4.**

**5.**

**Evaluating Outcomes**

**(Describe how you will determine the effectiveness of the 5 priority nursing interventions you implemented. How will you know if your interventions are effective or not?)**

**1.**

**2.**

**3.**

**4.**

**5.**

**## ConceptMapExample.pdf**

NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET

NURSING PROCESS TEMPLATE:

Assessment (Recognizing Cues)

Which patient information is relevant? What patient data is most

important? Which patient information is of immediate concern?

Consider signs and symptoms, lab work, patient statements, H & P,

and others. Consider subjective and objective data.

Vital signs: Fevers can indicate infection and/or
inflammation. Low oxygen saturation levels (< 90%) can
indicate inflammation in the airways. Heart rate and
respirations: Tachycardia and tachypnea are both signs of
an inflammatory response in the airways, or asthma.

Lung sounds: Wheezing can indicate a partially blocked
airway or swollen bronchiole tubes from inflammation
(Cleveland Clinic, 2020b). This client had inspiratory and
expiratory wheezes, telling us that he had inflammation
in his bronchiole tubes.

Medical History: 5-year-old boy with a history of asthma
and currently has a fever. Caregiver reports that inhaler
has not been helping.

Analysis (Analyzing Cues)

Which patient conditions are consistent with the cues? Do the cues
support a particular patient condition? What cues are a cause for
concern? What other information would help to establish the
significance of a cue?

One condition that is consistent with the cues is severe
acute asthma exacerbation. Another is that the client
may have a respiratory tract infection. Because of these
conditions, the bronchioles have become inflamed, and
the client has classic symptoms of an asthma
exacerbation: tachypnea, tachycardia, diaphoresis,
wheezing, shortness of breath, and chest tightness
(Jafarnejad & Khoshnezhad, 2020).

Analysis (Prioritizing Hypotheses)

What explanations are most likely? What is the most serious
explanation? What is the priority order for safe and effective care?

The client is most likely suffering from an asthma attack,
which includes inflammation and narrowing of airways.
This could be related to a respiratory infection affecting
the airways. The most serious explanation at this time
would be a severe asthma attack affecting the client’s
ability to breathe. The priority for safe and effective care
for this client would include maintaining patent airways
and an adequate oxygen saturation level.

Planning (Generate Solutions)

What are the desirable outcomes? What interventions can achieve
these outcomes? What should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-restricted- Goal
setting)

Achieve and maintain control of symptoms: medications,
fluids, oxygen.

Prevent respiratory decline: monitor client for any
indication of decline and treat as necessary.

Avoid dehydration, respiratory irritants, missing
medications, excessive physical activity during acute
exacerbation.

Implementation (Take actions)

How should the intervention or combination of interventions be
performed, requested, communicated, taught, etc.? What are the
priority interventions? (Mark with asterisk)

Positioning the client in a high-fowlers or semi-fowlers
can help with dyspnea while undergoing nebulizer
therapy (Chanif & Prastika, 2019).

Offer the client water to help thin secretions and hydrate.
Some clients may experience a dry mouth from
corticosteroids (Hira et al., 2015). Water can also be

Page 2 of 5

soothing since the client has a slight fever and is feeling
warm.

Client (and caregiver) education. This client is only 5 years
old so it can be helpful to show him how to properly use
his inhaler (with a chamber) by demonstrating on a
stuffed animal or inanimate object (LaRue & Kelly, 2015).
The caregiver should be educated on the medication
regimen, as well as how to use the inhalers and nebulizer
treatments. We should teach her the importance of the
treatments and when to call the provider. It is important
to inform her of common irritants such as being exposed
to smoke, dust, and pets (National Asthma Council,
2022).

Therapeutic communication: Since this is a pediatric
client, earning his trust can be tough but very important
so that he will feel safe with us and be more likely to
comply with the treatment. We must ask permission
before performing examinations and explain the process
as well as what he can expect.

Offer to turn on a movie or music for him. We want the
client to stay calm, comfortable, and happy. The
distraction of the television may help him rest and feel
more comfortable in such a stressful situation and
setting, being away from home (Children’s Hospital of
Pittsburgh, 2022).

Evaluation (Evaluating Outcomes)

What signs point to improving/declining/unchanged status? What
interventions were effective? Are there other interventions that
could be more effective? Did the patient’s care outlook or status
improve?

Before the assessment in the ED the client was not using
the spacer and was inhaling too fast (the client should
take a slow, deep breath). The nurse identified lack of
coordination between activating the inhaler and initiating
the deep breath, angling the inhaler to spray the tongue
or side of the mouth, and the client failing to hold his
breath for 10 seconds after inhalation. If this kind of
management continues, client will not get the necessary
medication he needs when another attack occurs.

Client’s cough has subsided and has been able to relax
without breathing difficulty. Oxygen saturation improved
to 96%. Client’s heart rate and respiratory rate have
dropped to WNL. Intermittent expiratory wheezes still
present but diminishing.

Page 3 of 5

Patient Information (SBAR)

Main Concept

(Should be focus of below map)

Disease Process/Pathophysiology/Risk Factors

Recognizing Cues, (S&S)

Analyzing Cues/Concerns

Prioritizing Hypotheses

Asthma is an airflow obstruction due to bronchial

hyperresponsiveness and underlying inflammation. The

bronchoconstriction quickly occurs to narrow the

airways due to stimuli such as irritants, allergens, or

infection. During an exacerbation, the epithelial cells

that line the airway initiate an inflammatory response,

causing the airways to become inflamed and begin to

swell and narrow. The muscles around the airway

contract and produce more mucus which leads to

further narrowing of the bronchial tubes.

• Step 1 – Mild intermittent asthma. Symptoms
fewer than two times a week.

• Step 2 – Mild persistent asthma. Symptoms
more than two times a week, but no more
than once a day.

• Step 3 – Moderate persistent asthma.
Symptoms every day.

• Step 4 – Severe persistent asthma. Constant
symptoms.

Risk Factors: Allergies, family history,
secondhand smoke, environmental exposures,
more prevalent in children

S: 5-year-old boy with an apparent acute

severe exacerbation of asthma.

B: The client was alert and speaking in short

sentences due to shortness of breath.

Inspiratory and expiratory wheezes audible

without the use of a stethoscope. Fever of

100.4 F, HR of 130 bpm, RR 40 bpm, O2 sat

of 90%. Patient has NKDA and no significant

past medical history other than diagnosis of

asthma.

A: I think the patient is experiencing asthma

exacerbation possibly due to respiratory

illness.

R: I recommend starting nebulizer

treatments and would like you to come place

orders as soon as possible, please.

INFLAMMATION

Prioritize client conditions and care:

1. Wheezing/dyspnea

2. Hypoxia

3. Fever

• Respiratory rate – 40 bpm

• Low oxygen saturation – 90%

• Fever – 100.4 F

• Chest tightness

• Inspiratory and expiratory wheezes

• Rapid heart rate – 130 bpm

Supporting connections between the cues

(S&S) and the client condition:

• Wheezing indicates bronchiole

inflammation causing airway

constriction.

• Dyspnea (shortness of breath)

causes tachypnea and tachycardia.

• Hypoxia (low oxygen saturation) is

related to the impaired gas

exchange due to the airway

constriction.

• Fever is related to suspected

respiratory infection.

Page 4 of 5

Generate Solutions/Outcomes/Interventions

SMART Planning Taking Action – (How To)

Evaluating Outcomes

1. Apply nasal cannula and titrate oxygen to

maintain oxygen saturation >95%.

2. Administer medications/breathing treatments

as directed to decrease inflammation and

wheezing. Listen to lungs every 30 minutes x2

hours to assess for wheezing.

3. Position the client in a high-fowlers or semi-

fowlers position to maintain airway clearance.

4. Administer antipyretic medication as need to

decrease fever and provide comfort.

5. Educate the client and caregiver regarding plan

of care, medications, and inhaler use. Verbalize

and demonstrate correct spacer use and

educate on importance of proper use.

1. The client’s O2 saturation was 98% on room air without evidence of dyspnea or chest tightness following

oxygen therapy.

2. Client’s respiratory rate decreased to 24 bpm and heart rate decreased to 100 bpm. Client verbalized ease of

breathing. Mild intermittent expiratory wheezes audible only with stethoscope.

3. Client able to sit upright to expectorate mucus and maintain airway clearance. Lungs clear with intermittent

expiratory wheezes.

4. Client’s temperature decreased from 100.4 F to 98.9 F by end of shift.

5. Caregiver and client demonstrated the appropriate use of inhaler with spacer, ensuring client inhales the

amount of medication needed, optimizing the effectiveness of the medication.

6.

4.

5.

1. Within 30 minutes of breathing treatment

and application of supplemental oxygen via

nasal cannula, client will obtain and maintain

oxygen saturation levels >95%.

2. Within 30 minutes of breathing treatment,

respiratory rate will be within 20-30 bpm and

heart rate will be within 75-115 bpm.

3. Client will have improved airway clearance

related to repositioning as evidenced by clear

lung sounds in all four lung fields anteriorly and

posteriorly by the end of the shift.

4. By end of the shift, client’s temperature will

be decreased from 100.4 F down to <99 F

following antipyretic medication administration.

5. By end of shift, client will correctly

demonstrate the use of inhaler spacer three

times, as a result of proper client and caregiver

education.

Page 5 of 5

References

Children’s Hospital of Pittsburgh. (2022). Distraction techniques | Children’s Hospital Pittsburgh.

https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques

Cleveland Clinic. (2020b). Wheezing: Definition, causes & treatment.

https://my.clevelandclinic.org/health/symptoms/15203-wheezing

Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.). Elsevier.

Jafarnejad, S., & Khoshnezhad Ebrahimi, H. (2020). Clinical guidelines on pediatric asthma exacerbation in emergency

department, a narrative review. European journal of translational myology, 30(1), 8682.

https://doi.org/10.4081/ejtm.2019.8682

National Asthma Council. (2022). The National Asthma Council Australia. https://www.nationalasthma.org.au/living-

with-asthma/resources/patientscarers/factsheets/pets-and-allergies

[https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques](https://www.chp.edu/our-services/radiology/our-approach/distractiontechniques)

[https://my.clevelandclinic.org/health/symptoms/15203-wheezing](https://my.clevelandclinic.org/health/symptoms/15203-wheezing)

[https://doi.org/10.4081/ejtm.2019.8682](https://doi.org/10.4081/ejtm.2019.8682)

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