Professional Documents
Culture Documents
NUR 4115P
Mrs. Digges
6 West Concept Map
Legend:
Red = Nursing Diagnosis
Blue = Nursing Intervention
Green = Evaluation of nursing diagnosis/interventions
Orange = Assessment data
Purple = Medications
Teal = Rationales
Yellow = Developmental
Intervention:
Elevate HOB
to 30 degrees
Reduce
mechanical
pressure on
airway
clearance
Hx of
GERD
Intervention:
Maintain
proper
medication
regimen
Reduce
exacerbation
of asthma
GERD
can lead
to airway
problems
Break up
secretion and
promote clear
airway
Intervention:
Use CPT vest
for 10 mins, 30
mins after neb
tx.
Zantac
PO-soln
60 mg
BID
S/S improving.
Child was able to
sleep without drop
in pulse ox.
Zyrtec
PO soln
10 mg
daily
Coarse
crackles
auscultated
bilaterally
Need to teach
Nursing Dx #1:
child about
Ineffective airway clearance r/t
when tx is
airway constriction aeb coarse
needed
crackles auscultated bilaterally.
Outcome: Patient will
continue meds, to maintain
open/patent/clear airway.
Need to teach
child about
when tx is
Pulse Ox
needed
drops to
2mg/kg/day
in 2 doses =
2*32=64mg/2
= 32 mg BID
Albuterol
neb 5mg
q3hours
88% when
D.D. sleeps
Orapred
PO soln
32mg
(1mg/kg)
Atrovent
neb 0.5
mg
q6hours
Flonase 1
spray
5mcg/spray
q6hours
Allergy
to
peanuts
Improper med
management has
led to 7 ED visits
in 2 years. Should
be able to manage
with proper med
administration.
Weight:
32 kg
Need to teach
child about
when tx is
needed
Nursing Dx #2:
Ineffective therapeutic regimen
r/t excessive demands made on
mother aeb increased illness
symptoms.
Outcome: Mother will be able
to verbalize therapeutic
regiment of child and establish
one support person.
Eczema
present on
skin.
Intervention:
Assist mother in
setting realistic
goals during
hospitalization
Partially
completed
goal; Mother
verbalizes
need to care
for other
children
Reduce stress
and form a
plan of action
Aid in
formulating
proper
teaching
Help to
understand
why/what med is
important
Intervention:
Assess prior
efforts to follow
regimen
Intervention:
Keep child busy
so mother can go
home for two
hours
Nursing Dx #3:
Interupted family process r/t
changes in family roles aeb
mothers report of hardship with
caring for two other children.
Outcome: Provide child and
mother support so mother can go
care for two other children for two
hours.
Lack of support
(single mother)
does not allow for
proper care of all
3 children. Oldest
son also has
asthma but not as
severe.
Intervention:
Assess knowledge
of how regimen
helps prevent
symptoms
Intervention:
Assess childs
ability to explain
use of regimen
Promote
understanding of
disease progression;
prevent
hospitalizations
Intervention:
Provide education
on disease to
prevent further
hospitalizations (7
in past 2 yrs)