Concept Map

Student Name: Erickson’s Developmental Stage Related to pt. & Cite

Instructor: References (1)
The patient is 39 years old which means she is in the 6th group
based on the staging of Erik Erickson's. The psychosocial crisis is
Patient Education (In Pt.) & Discharge Planning (home needs) represented by intimacy vs isolation while the basic virtue is love.
During this period, people focus on creating a loving relationship
1. Inform the patient about the importance of adhering to blood-thinning and tend to share more intimately with others. Based on the fact that
treatment. Teach her about the possible complications, how to use it and our patient is married for the last 8 years and already has children History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite
when to stop taking them. we can state that on a physiological level she is doing well and there References) Medical, Surgical, Social History (1).
2. Teach the patient about monitoring her anticoagulant treatment should be no difficulties in her mental evolution. (McLeod,2018)
3. Teach the patient about determining d-dimers level periodically to ensure The patient started having difficulties breathing for the last 4 days. Things got
that there is no risk for other pulmonary thromboembolism even worse. In the beginning, she found it hard to do any physical work
4. Teach the patient about DVT prevention ( fluid intake, physical activity) because of her incapacity to breath correctly. When admitted to the hospital
5. Instruct the patient to quit smoking and provide information on the she was already suffering from dyspnea. More than this she confirmed she
correlation between cigarette smoking and thrombosis. started coughing severely in the last hours and felt like she was not getting
6. Instruct the patient to monitor her health status and attend regularly the enough oxygen.
meetings with the cardiologist.
7. Teach the patient about possible signs of bleeding such as urine in the Cultural considerations, ethnicity, occupation, religion,
family support, insurance. (1) (14) Pathophysiology:
stool or blood, or nose and gum bleeding. Pulmonary thromboembolism is a frequent disease and potentially fatal. It is
(Corrigan,Prucnal,2016) Socioeconomic/Cultural/Spiritual Orientation &
Psychosocial Considerations/Concerns, to include the the second cause of sudden death after that of cardiac origin. PE is
following Social Determinants of Health characterized by high frequency, gravity related to massive thrombus
The patient is married and has one child. She has an active social life migration, relapses, impaired right ventricular function, and an extreme
but she declines any physical activity. She works as a school symptomatic polymorphism, responsible for a large number of errors
professor so she spends a lot of time sitting. Based on ethnicity, she diagnosis. Three main causes predispose the patient to the formation of
is caucasian. She has no strong religion beliefes that could interfere thrombi. They form its so-called triad Virchow: Venous endothelium injury,
with the treatment. She also has full insurance. blood stasis, and hypercoagulability. The most common causes described in
the literature are venous stasis, hypercoagulation, immobilization, surgery and
Diagnostic Test/ Lab Results with dates and trauma, pregnancy, oral contraceptives and substitution estrogens,
Normal Ranges (3) malignancies, hereditary factors, various acute medical conditions, and HIV
infection. Individuals with HIV have a risk of developing TEP and DVT by
40% higher than the uninfected population.
Test Norms Date Current (Morrone,2018)
Value Patient Information Chief Complaint
Troponin 0 7/18/19 0.1 (1) Medical History
Glucose 80- 7/18/19 124 Name: A.M Sudden dyspnea with chest pain, continuous
100 Age: 39 coughing, wheezing.
Creatinine 0.5- 7/18/19 1.1 Gender: F Admitting Diagnosis The patient denies any medical history. Other than the usual pathologies such
1.3 Code Status: Full Status Pulmonary Thromboembolism as viral colds and recurrent streptococcal tonsilitis, nothing is important for
RBC 4.2- 7/18/19 5.33 DPOA: N/A
5.4 the given pathology.
Living Will: N/A
HGB 12-16 7/18/19 14.3
Tonsilitis:
HCT 38- 7/18/19 44
Streptococcal infections are caused by one of many streptococcal species
47%
WBC 5.000- 7/18/19 1000 (Streptococcus). These gram-positive bacteria spheres can cause many
10.000 Medical Management/ Orders/ Medications & Allergies (2) diseases, including streptococcal pharyngitis, pneumonia, skin infections,
D-Dimers <0.5 7/18/19 1.4 wounds, heart and blood valves.
Name Dose RT Freq. MOA RN Onset/Peak
ESR <20 7/18/19 44
Considerations /Duration
LDH 140- 7/18/19 260 (Insulin) Surgical History
200 Rivaroxaban 20 mg P,O Q.D Factor Xa inhibitors *Risk for bleeding
U/L *Does not require
INR determination
The patient denies any medical interventions.
Electrogardiogram : S1Q3T3 , right bundle
*Drug Interactions
branch block with other blood Social History
thining medication
Atorvastatin 40mg P.O Q.D Antilipemic Agent *Monitor the
The patient admits she is a smoker for the last 10 years. She never stopped
Cardiac ultrasound = regional kinetic disorder, smoking and tends to smoke approximately 1 pack per day. She is also
therapeutic effect
remodeling of the LV. *Assess for muscle overweight because she enjoys eating food high in fats and does not engage in
pain
*Avoid
physical activity. She also admits she is drinking a cup of coffee per day and
Pulmonary angiography: thrombus at the level like salty food.
administrating
of the segmentary branches of the pulmonary together with
artery (this is the method which confirmed the digoxin.
diagnosis) *Avoid this
medication during
(Yamamoto,2018) pregnancy
 Priority nursing diagnosis #1 Vital Signs (4) Neurological (5) Cardiovascular (6) Respiratory (7) Priority nursing diagnosis #2
Temperature: 98.9 F Shortness of Breath Ineffective breathing patter as
Pain as r/t by the decreased Heart Rate = 120 bpm Anxiety Present Pulse, Hyperventilation r/t by the increasing respirators
pulmonary tissue perfusion which is Respiratory Rate =30 Dizziness due to Chest Pain, Tachypnea
also associated with obstructed rate. (Herdman,Kamitsuru,2017)
cycles/min hyperventilation Tachycardia, Cough is present
pulmonary blood flow. O2 Sat = 90% Otherwise awake and alert High Blood Pressure, Wheezing
(Herdman,Kamitsuru,2017) Cranial Nerves Intact No signs of atrial fibillation
Blood Pressure : 140/88

Nutrition/Hydration GI (9) GU (10) Rest/ Exercise (11)

(8)
Signs of Dehydration. The
patient has dry skin, admits
she drinks les fluids than
required. She also enjoys
Outcome/Goal #1 eating salty food.
By the end of the shift, I expect
the patient to be pain-free or have
her pain level under control and
proving that she can breathe
Integumentary (12)
effectively
Peripheral Edema
(Herdman,Kamitsuru,2017)
Cyanosis
Pallor
Sweating due to anxiety
Interventions #1
1. Assess for s/s of pain
Normal Bower Sound Clear urine. Chronic Fatigue.
Abdomen is painless and Absent Dysuria The patient declines any
soft. Absent hematuria physical activity .
There are no evident signs Normal Renal Function
of obstruction or any GI
pathology Outcome/Goal #2
By the end of the shift, I expect the
patient to no longer be in a state of
tachypnea. Her blood saturation level
will be within the normal range.
Endocrine (13) Psychosocial (14) Misc. (Ht/Wt)
No palpable nodules at the Anxious patient and stated Height - 5'3"
level of the thyroid. that she was afraid of dying. Weight - 168 lbs
No signs of diabetes Even so, she was able to BMI -29.8
( polyuria,polydipsia,polyph communicate with the
agia ). medical staff and The patient is overweight
No heat or cold intolerance understood the message. (25-29.9) Interventions # 2
1. Assess the respiratory rhythm, depth,
and rate.

2. Administered pain medication as 2. Implement the measures needed to

instructed
3. Ude additional measure to relieve
the pain as a relaxation technique and
different body positions
4. Provide reassurance to reduce the
anxiety level (Herdman,Kamitsuru,2017)
Assessment/ Evaluation #1 Assessment/ Evaluation #2
improve the breathing pattern such as
1. It is known that early intervention for pain management can reduce improve
putting the patient in a high fowler
impaired gas exchange. Monitor gas exchange after treatment1,toTachypnea
evaluate the is frequent during PE. Evaluating the respiratory rate
response. can ensure that we can avoid any type of complications. position.
2. Pain medication allows the patient to breathe effectively. This will pulse
2. The be oximetry evaluation can help us detect any early 3. Assess lung for the presence of any
reflected by the fact that the patient will no longer be in a state of tachypnea.3.
changes in terms of blood oxygenation. abnormal sounds
Continuously evaluating the patient will ensure that the pain level is kept
under control. 4.Monitor pulse oximetry to ensure that the
3. Pain tends to get worse with breathing which can result in
ineffective breathing pattern. By assessing we can also promote a o2 saturation is within a normal range.
4. Anxiety can also lead to shallow respiration and increasing dyspnea. (Herdman,Kamitsuru,2017)
healthy
By reducing the stress level we should see that the patient breathing pattern that would avoid the accumulation of
is feeling
better carbon dioxide in the body. (Herdman,Kamitsuru,2017)

PC Outcomes/Goal PC Interventions PC Evaluation Plan

By the end of the shift, the patient will be stable. The patient will understand the importance of the given medication
The patient will show signs of perfusion She will no longer have difficulties breathing. and will closely follow the physician’s opinion.
Potential Complications/ at risk She will feel less anxious. The patient will meet her appointments and keep under control her
without accusing any pain or shortness of
for (Herdman,Kamitsuru,2017) lipid levels and will also prevent future PE.
breath.
Pulmonary Arterial Hypertension The patient will no longer have any pain and will be able to breath
The patient will have no signs of
due to ineffective vascularization normally.
arrhythmia
Cor Pulmonale due to the effect of The patient will engage in a salt-free diet to reduce the risk of
No long term complications.
ineffective respiratory rate on the recurrence. (Herdman,Kamitsuru,2017)
heart
Severe hypoxemia due to lack of
oxygenation of the blood.
 References
Corrigan, D., Prucnal, C., & Kabrhel, C. (2016). Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of
emergency department patients. Clinical and experimental emergency medicine, 3(3), 117–125. doi:10.15441/ceem.16.146

Morrone, D., & Morrone, V. (2018). Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean circulation journal, 48(5),
365–381. doi:10.4070/kcj.2017.0314

Saul McLeod,(2018),Erik Erikson's Stages of Psychosocial Development, Simply Psychology,Retrieved on 6/18/2019 from:
https://www.simplypsychology.org/Erik-Erikson.html

T. Heather Herdman ,Shigemi Kamitsuru,(2017),NANDA International Nursing Diagnoses,Thieme,ISBN-10:9781626239296

Yamamoto T. (2018). Management of patients with high-risk pulmonary embolism: a narrative review. Journal of intensive care, 6, 16.
doi:10.1186/s40560-018-0286-8