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Concept Mapping
4832 Nursing Care of Children and Families

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Step 1. Write the key problems the patient has based on the data collected. The key
problems are also known as the concepts. Start by centering the reason for seeking health
care (often a medical diagnosis). Next, list the major problems you have identified based
on the assessment data collected on the patient.

SLOPPY COPY

6. Key Problem 1. Key Problem 3. Key Problem

Anxiety Impaired oxygenation Risk for infection
Supporting data: Supporting data Supporting data
Patient has history of Non-productive cough Non-productive cough
anxiety Pain upon breathing Midline placed
Patient expressed being Cap refill of 4 seconds Wound on right forearm
anxious Supplemental oxygen Chest tube
Patient needed sitter due to Shallow breathing hospitalization
anxiety Decreased breath sounds
HR: 120 Respiratory rate: 26
BP: 134/84
02: 1L

4. Key Problem
7. Key Problem Reason For Needing Health Care Risk for bleeding
Risk Impaired immune Pleural Effusion Supporting data
system Key assessments: Midline placement
Supporting data Lung assessment Chest tube placed
Lupus Pulse ox TPA running
Hospitalization Respiratory rate Heparin 20 units
Increased antibiotic use Cap refill
Skin color

5. Key Problem 8. Key Problem 2. Key Problem

Impaired communication Caregiver role strain Pain
Supporting data Supporting data Supporting data
Autism Parent voices concern for Pain rated 8 on face scale
Impaired understanding patient Morphine prn
Use of face scales Parent is sole caregiver to Patient expresses a lot of
Developmental delay patient pain
Parent cannot work due to Grimaces upon inspiration
needing to take care of HR: 120
patient BP:134/84

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Step 2. Support problems with clinical patient data, including abnormal physical
assessment findings, treatments, medications, and IV’s, abnormal diagnostic and lab Data don’t
know where
tests, medical history, emotional state and pain. Also, identify key assessments that are
to put in
related to the reason for health care (chief medical diagnosis/surgical procedure) and put boxes:
these in the central box. If you do not know what box to put data in, then put it off to the
side of the map.
# Key Problem/ND # Key Problems/ND # Key Problem/ND
Alt. nutrition LBR/fluid Knowledge defit Caregiver role stratin
voloume deficit Supporting Data Supporting Data
Supporting Data Meds Single mom
breast fed 8 min q 3-4 h Pulse ox reading 3 siblings at home
poor skin tugor Disease process out of sick leave
sunken fontanel s/s resp distress no family near for support
no tears when seek medical advise
dry mucous membranes use of equipment – RT tx
wt loss treatments
ivf infusing at 20cc/hr isolation
#1
Key Problem/ND:
Impaired gas exhange/ineffective #
airwary clearance/ineffective
breathing patterns/risk for Reason For Needing Health Care Key Problem/ND
infection (others) (Medical Dx/ Surgery) Hyperthermia/alt comfort
Supporting Data RSV Supporting Data
O2 86 Key Assessments: Temp 102.8
Non-productive cough Lung sounds Flushed skin
Pale Pulse ox Tylenol 90 mg q 4=6 h prn
Head bobbing Resp. rate and effort Fussy continuously
Nasal flaring Skin color
Course lung sound Cap refill
O2 mist 35 % O2/mist tent
HOB elevated Heart rate
Heart rate 150 #
Respiratory rate 42
Intercostal/subcostal retractions – Key Problem/ND
increased with feeding
Blow-by 4 L.with feedings Supporting Data:
Albuterol q 2 hr and q 1 h prn # Key Problem/ND
Prednisone 3 cc (15 mg-5cc) Parental anxiety
Cpt w/ treatment Supporting Data:
# Deep/nasal suction prn Parents voice concern about
isolation resp status of infant/pulse ox
Copious clear nasal secrete readings
Crib grounded Anxious facial expression
Never leaves bedside

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Step 3. Draw lines between related problems. Number to prioritize problems. LAST-
label the problem with a nursing diagnosis.

Step 4: Identification of goals, outcomes and interventions.

Step 5: Evaluation of Outcomes
Problem # ____1___:
General Goal: patient’s oxygenation will improve

Predicted Behavioral Outcome Objective (s): The patient will…… be able to take 10 deep
breaths every hour on day of care.

on the day of care.

Nursing Interventions Patient Responses

1.teach patient to use incentive spirometry 1. Patient’s lung expansion will improve
2. Monitor spo2 levels 2. Keep pulse ox on,
3.teach caregiver and patient importance of taking deep breaths 3. Lung expansion will improve
4.raise head of bed 4. Patient’s lungs will be able to expand
5. encourage ambulation 5. Patient’s lungs will expand and help dislodge secretions
6. teach patient to lean forward when taking a deep breath 6. Patient will lean forward when having trouble breathing
7. administer supplemental oxygen 7. Patient’s o2 will stay above 95 cap refill will improved
8. encourage rest 8. Decrease workload on the body, decrease pulse and
BP

Evaluation of outcomes objectives: Patient’s oxygenation improved throughout the day, we were able to
decrease her oxygen to 0.5L

Problem # _______2__________:
General Goal: reduce patient’s pain to tolerable level

Predicted Behavioral Outcome Objective (s): The patient will…… express pain and receive
adequate pain management on day of care

on the day of care.

Nursing Interventions Patient Responses

1. administer morphine as prescribed
2. provide distraction activities
3. encourage patient to ambulate
4. use faces scale to assess pain
5. assess pain every 30 mins
6. assess vitals every 4 hours
7. assess what is tolerable level for patient
8. assess need for Tylenol
Evaluation of outcomes objectives: patient was able to get pain under control and was able to use distraction
and play with playdoh
1. Monitor pain, HR, Mental status, and BP for decrease
2. Monitor blood pressure and pulse with distraction
3. Encourage movement to increase lung expansion
4. Patient had impaired communication due to developmental delay
5. Allow patient to express pain for proper management
6. Assess BP and HR
7. Make sure pain medication lines up with plan
8. Give pain level and give as need

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Step 3. Draw lines between related problems. Number to prioritize problems. LAST-
label the problem with a nursing diagnosis.

Step 4: Identification of goals, outcomes and interventions.

Step 5: Evaluation of Outcomes
Problem # ____3__:
General Goal: reduce risk of infection for patient

Predicted Behavioral Outcome Objective (s): The patient will remain free of signs of infection
on day of care

on the day of care.

Nursing Interventions Patient Responses

1 avoid overuse of antibiotics 1. Review antibiotic use to make sure there is not to many
2.monitor white blood cell count 2. White blood cells elevated may be an infection
3. check chest tube site 3. Monitor for redness and drainage at site
4. check midline site 4. Monitor for redness and swelling
5. encourage ambulation 5. Assess lung sounds for fluid
6.encourage coughing 6. Assess sputum production
7. monitor vital signs 7. Monitor temperature for signs of Fahrenheit
8. change dressings 8. Change all dressing sites to avoid bacteria on wounds
Evaluation of outcomes objectives: patient showed no signs of infection on day of care

Problem # _______4_________:
General Goal: avoid excessive bleeding

Predicted Behavioral Outcome Objective (s): The patient will show no signs of internal bleeding
on day of care

on the day of care.

Nursing Interventions Patient Responses

1. monitor chest tube site 1. Monitor site for bleeding on gauze

2. monitor midline site
3. assess hemoglobin and hematocrit
4. conduct skin assessment
5. monitor sputum
6. monitor stool
7. assess mucosa
8. avoid risky behavior
2. Monitor insertion site
3. Low hemoglobin and hematocrit indicate bleeding
4. Look for signs of ecchymosis
5. Look for signs of blood in sputum
6. Monitor for signs of blood in stool
7. Dry mucosa can lead to nose bleeds
8. Teach patient to avoid falls due to risk for bleeding

Evaluation of outcomes objectives: patient remained free of excess bleeding during day of care

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Step 3. Draw lines between related problems. Number to prioritize problems. LAST-
label the problem with a nursing diagnosis.

Step 4: Identification of goals, outcomes and interventions.

Step 5: Evaluation of Outcomes
Problem # ____5__:
General Goal: find effective way for patient to communicate

Predicted Behavioral Outcome Objective (s): The patient will communicate needs during day of
care

on the day of care.

Nursing Interventions Patient Responses

1 use face scales when assessing pain 1. Face scale is most effective with patients with developmental delays
2. use simple commands 2. Evaluate patients ability to respond
3. ask yes and no questions 3. Patient is able to shake head yes or no
4 monitor nonverbal ques 4. Patient grimaces in relation to pain
5. ask family about care 5. Family knows what is best for patient
6.use lay terms 6. Use words easy for patient to understand
7. monitor vital signs 7. Vitals signs can que into problems
8. provide hygiene and basic needs 8. Allow patients things every patient needs
Evaluation of outcomes objectives: patient was able to communicate needs through words and family during
day of care

Problem # _______6_________:
General Goal: relieve patients’ anxiety during hospital stay

Predicted Behavioral Outcome Objective (s): The patient will show no signs of anxiety on day
of care

Nursing Interventions Patient Responses

1.assess patients’ anxiety on day of care 1. Allow patient to express concerns

2. monitor vital signs
3. teach relaxation techniques
4. provide distraction
5. provide hygiene
6. evaluate support system
7. seek community resources
8. provide education on anxiety
2. HR and BP can cause increase
3. Monitor HR and BP
4. Distraction can help relieve anxiety
5. Getting cleaned up can help relieve anxiety
6. Support systems can help relieve anxiety
7. Provide resources on community options
8. Education on disorder can help relieve anxiety

Evaluation of outcomes objectives: patient remained free of symptoms of anxiety on day of care

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Step 3. Draw lines between related problems. Number to prioritize problems. LAST-
label the problem with a nursing diagnosis.

Step 4: Identification of goals, outcomes and interventions.

Step 5: Evaluation of Outcomes
Problem # ____7__:
General Goal: provide patient with safety due to impaired immune system

Predicted Behavioral Outcome Objective (s): The patient will remain free of signs of infection
on day of care

on the day of care.

Nursing Interventions Patient Responses

1 avoid overuse of antibiotics 1. Review antibiotic use to make sure there is not to many
2.monitor white blood cell count 2. White blood cells elevated may be an infection
3. educate patient on immunity 3. Patient will remain free of contact with sick people
4. check ANA test 4. Patient will have a positive test
5. encourage hygiene 5. Prevent bacteria from entering system
6.encourage coughing 6. To decrease bacteria in sputum
7. teach good hand hygiene 7. Patient will demonstrate hand hygiene
8. monitor vital signs 8. Temperature will be in normal limits
Evaluation of outcomes objectives: patient showed no signs of infection on day of care

Problem # _______8________:
General Goal: caregiver will express any concerns

Predicted Behavioral Outcome Objective (s): The patient’s caregiver will express any concerns
patient has on day of care

on the day of care.

Nursing Interventions Patient Responses

1. provide support groups 1. Patient’s caregiver will concern support groups

2. provide information on finances
3. provide basic needs to patient
4. allow mother to talk about concerns
5. give mother resources on care for child
6. monitor vital signs
7. teach mother about medication
8. teach mother about disease process
2. Patient’s mother will remain free of concerns on finances
3. Help to relieve stress on caregiver
4. Mother will be able to express any needs
5. Give mother chance for break form caregiving
6. Give mother full report on vitals during time away
7. Teach about risk for bleeding with blood thinners
8. Teach mother about what is happening to help relieve stress

Evaluation of outcomes objectives: patient’s mother expressed any concerns on day of care

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P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis