CONCEPT CARE MAPPING RESOURCE GUIDE

A Critical Thinking Approach to Care Planning

 CONCEPT MAPPING – A Critical –Thinking Approach to Care Planning

What are Concept Care Maps?

• Innovative approach to planning and organizing nursing care.

• Diagram of patient problems and treatments.
• Concepts mean Ideas.
• Developing clinical concepts will enhance your critical thinking skills and clinical
reasoning.
• Concept Care Maps are used for:
o Organizing patient data
o Analyzing relationships in the data
o Establishing priorities
o Building on previous knowledge
o Identifying what you do not understand
o Enabling you to take a holistic view of your patient

Concept Care Mapping and Critical Thinking

• Critical thinking as self-regulatory judgment.

• Critical thinking used to analyse relationship in clinical data.
• Critical thinking + Clinical Reasoning = Clinical Judgment
• Nonlinear and used to collect, interpret, analyse, present and evaluate patient data.
• Important to have room for “I don’t know how it fits here?”

Steps in Concept Care Mapping

• Nursing Process is a Foundation for Concept Care Mapping

• Step 1 - Develop a Basic Skeleton Diagram

§ Diagram of the reason your patient needs health care.
§ Reason in the centre with problems identified around the centre.
§ The general problem statements are written as nursing diagnosis.
§ It may not be easy to label the correct nursing diagnosis. Do not worry.
First look for the ‘big picture’ and later you can look up correct nursing
diagnosis. For example, if you recognize that your patient has a major
problem breathing, write it down. Later, you can decide what specifically
it should be: Impaired Gas Exchange or Ineffective Breathing Pattern.

• Step 2 - Analyze and Categorize Data

§ Gather all the information from your patient’s medical records, kardex or
your interaction with the patient.
§ When you categorize you will provide evidence to support the medical
diagnosis and nursing problem/diagnosis.
 § Identify:
o Important assessment data
o Clinical assessment data
o Pathophysiology
o Treatments
o Lab results
o Medications
o Medical history, data etc.
• Step 3 - Label and Analyze Nursing Diagnoses Relationships.
§ You may want to use NANDA
§ You will need to prioritize nursing diagnosis by numbering them.
§ You priorities will be what you think are most important problems.
§ You will also be drawing lines between nursing dx. to indicate
relationship.
§ Be prepared to explain why you have made these links.

• Step 4 - Identify Goal, Outcomes and Interventions.

§ The nursing interventions include key areas of assessment and monitoring
as well as procedures or other therapeutic interventions such as therapeutic
communication.
§ Be prepared to explain the identified rationales.

• Step 5 – Evaluate Patient’s Response.

§ It is a written evaluation of the patient’s physical and psychosocial
responses.
§ It may also include writing your clinical impression regarding patient
progress.

Gathering Clinical Data

• Patient Initials
• Age, growth, development
• Gender
• Admission Date
• Reason for Hospitalization
• Chronic Illnesses
• Surgical Procedures
• Advanced Directives
• Laboratory Data
• Diagnostic Test
• Medications/Allergies
• Pain Medication and Pain Assessment
 • Treatment and Relation to Medical and Nursing dx
• Support Services
• Consultation
• Diet
• IV fluids
• Elimination
• Activity
• VS
• Routine Physical Assessments
§ Neurological and Mental Status
§ Musculoskeletal Status
§ Cardiovascular System
§ Respiratory System
§ Gastrointestinal System
§ Integumentary System
§ Eyes, Ears, Nose, Throat
• Psychosocial and Cultural Assessment
§ Religious Preference
§ Marital Status
§ Occupation
§ Emotional State

Adopted from McHugh Schuster, Concept Mapping (2008) & Elsevier Canada.
 Lewis: Medical-Surgical Nursing in Canada, 3rd Edition
Concept Map
Mrs. Estrela, a 70-year-old Portuguese Canadian woman, was admitted to the medical unit with complaints of increasing dyspnea on exertion.

History of MI 12 yr ago
Respiratory tract infection 2 wk ago
Does not always remember to take
medications

Heart Failure

Key
Medical Nursing Clinical
Risk Psychosocial Collaborative Diagnostics/ Nursing Expected
Diagnosis Diagnosis Medications Manifestations
Factors Aspects Care Labs Interventions Outcome

Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

 Lewis: Medical-Surgical Nursing in Canada, 3rd Edition
Concept Map
Hector LeBlanc, a 34-year-old white man, was admitted to the emergency department after he was found unconscious in his apartment by his wife.
History of flu for 1 week
Stopped taking insulin
2 days ago
Blood glucose
40.5 mmol/L

Diabetic
48 Units insu lin daily
Ketoacidosis
Blood pH
7.26

Found unconscious Deep and rapid

Blood glucose 40 .5 mmol/L Vomiting breathing
Blood pH 7.26 Anorexia Flushed and dry skin
Acetone brea th smell Acetone breath smell

Ineffective self-health Imbalanced nutrition: less • Risk for deficient fluid volume
management than body requirements • Risk for electrolyte imbalance

Fluid Balance (NOC)

Knowledge: Diabetes Diabetes Self-
Electrolyte and Acid/Base
Management (NOC) Management (NOC)
Balance (NOC)

Teaching: Prescribed Diet (NIC) Hypovolemia Management (NIC)

• Determine feelings/attitude about prescribed diet. • Observe for indications of dehydration.
Teaching: Disease Process (NIC)
• Assist to accommodate food preferences into the prescribed diet. • Monitor fluid status, including intake and output.
• Assess level of knowledge of disease and treatment.
• Refer to dietitian to provide education and evaluation. • Monitor vital signs and weight.
• Discuss rationale behind treatment.
• Maintain a steady IV infusion flow rate to replace fluids and
• Discuss lifestyle changes to prevent future
Hyperglycemia Management (NIC) electrolytes.
complications.
• Monitor for signs and symptoms of hyperglycemia.
• Instruct on which signs and symptoms to report to Fluid/Electrolyte Management (NIC)
• Anticipate situations in which insulin requirements will increase
health care provider. • Monitor laboratory results re: fluid balance (e.g., hematocrit,
(e.g., flu).
• Facilitate adherence to regimen. serum osmolality).

Key
Medical Nursing Clinical
Risk Diagnostics/ Nursing Expected
Diagnosis Diagnosis Medications Manifestations
Factors Labs Interventions Outcome

Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

 Lewis: Medical-Surgical Nursing in Canada, 3rd Edition
Concept Map
Mrs. Hortense Putman, a 66-year-old woman, awoke in the middle of the night and fell when she tried to get up and go to the bathroom. She fell because she was not
able to control her left leg. Her husband took her to the hospital, where she was diagnosed with an acute ischemic stroke. Because she had awakened with symptoms,
the actual time of onset was unknown and she was not a candidate for tissue plasminogen activator (tPA).

Hx of left-sided Reports not taking

weakness and tingling Overweight high cholesterol
of face, arm, and hand drugs for weeks
3 months earlier

Acute
Ischemic
Stroke

Left-sided
Alert and oriented with Left-sided
numbness and
slow response time hemianopsia
weakness

Impaired physical Impaired verbal Unilateral neglect

mobility communication

Heedfulness of Affected
Mobility (NOC) Communication (NOC)
Side (NOC)

Unilateral Neglect Management (NIC)

Exercise Therapy: Muscle Control (NIC)
• Collaborate with PT, OT to develop exercise program.
• Determine readiness to engage in exercise program.
• Encourage to practice exercises independently.
• Provide restful environment after exercise.
Communication Enhancement: Speech Deficit (NIC)
• Instruct to scan from left to right to visualize entire environment.
• Use simple words and short sentences.
• Position bed so individuals approach patient on unaffected side.
• Listen attentively.
• Touch unaffected shoulder when initiating conversation.
• Provide verbal prompts/reminders.
• Position items, TV, reading materials within view on unaffected side.
• Provide positive reinforcement and praise.
• Gradually move personal items to affected side.

Key

Medical Risk Nursing Nursing Diagnosis Expected Clinical

Diagnosis Factors Interventions Outcome Manifestations

Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Clinical Data Collection

Neurological/Mental Status Pt Initials Respiratory System

Gender/Age

Musculoskeletal Status Diagnosis/Medical History

Medications:
Allergies:
Primary-

Secondary-

Medications: Advance Directives –

Pain Assessment
Report

Treatments/ Nursing Intervention

Medications:
VS
Eyes, Ears, Nose, Throat (EENT)
Diet

IV Fluids Gastrointestinal System

Elimination

Activity/Safety
Genitourinary System
Medications:

Laboratory Data

Medications:
Diagnostic Tests
Cardiovascular System
Medications

Medications

Integumentary System

Psychosocial/ Spiritual Endocrine/Reproductive System

Medications:
References

Neurological / Mental Status
Clinical Manifestations (CM):
• Alert
• Verbal
• Stroke
• Depression
Musculoskeletal Status
CM:
• Partially impaired mobility
• Uses walker to ambulate
long distances with
supervision
• Can ambulate short
distances (i.e., washroom
and shower) on own with
little to none supervision
• Falls Risk
Immune System/
CM:
• Capillary Blood Glucose of
7.0
• Chronic Hepatitis B
Eyes, Ears, Nose, Throat (EENT)
CM:
• Wears glasses
Genitourinary System
• No Catheter needed
• Regular output daily
• Approx.: 1L (1000ml)
Cardiovascular System
CM:
• Single Chamber Pacemaker
• BP= 176/81
• Pulse= 68
o Strength: Strong Radial
o Depth: Deep Pulses
o Pace: Regular
• Bruit and Slight Thrills at
AV Fistula
• Heparin prescribed
• Heparin Flush and then
ceftriaxone is given to
patient by IV Push through
PICC Line
• No evidence of edema
• No issues with peripheral
circulation
• Pedal pulse is regular
Patient Initials:
J. B
Gender/Age
Male/ 77 years old
Diagnosis/ Medication History
Primary:
• End stage Renal Failure
Secondary:
• Renal disease since 2003
Other Diagnosis:
• Allergies= Glyburide
o (causes neck swelling)
Advance Directives:
• Full Code
Laboratory Data:
Last Lab Test March 21st, 2016
• Urea= 21.6 (High)
• Creatinine= 938 (High)
• Sodium= 139
• Potassium= 5.3 (High)
• Chloride= 95
• Total CO2= 26
• Anion Gap= 18
• Ferritin= 552 (High)
• Iron= 12
• IBC= 39.9 (Low)
Diagnostic Tests:
• Urea
• CBC
• Electrolytes
• Creatinine
• Ferritin
• Iron and TIBC
Psychosocial/ Spiritual
• Married/ Widowed
• Wife was a nurse and was
one of the directors of
Credit Valley Trillium
Hospital
• Has a daughter and
granddaughter (2yrs) and
grandson (7yrs)
• Daughter is very involved
(visits almost every day)
• Ex-policeman
• From Croatia
• Loves playing Candy Crush
on his phone but admits
he’s not that good at it
Respiratory System
CM:
• Resp= 16 breaths/min
• O2Sat= 98% on room air
• Chest Sounds
o No adventitious
sounds
o Regular
• SOB= None
• Mucus= No
• Sleep Apnea
• Uses CPAP machine at
night for Sleep Apnea
Gastrointestinal System
CM:
• Self-Feed
• Liver Cirrhosis
• GI Bleed
• Ileus
• Bowel Sounds in LRQ,
ULQ and LLQ
• Regular bowel movements
• 2 bowel movements
Medication:
• No vomiting
• Docusate Sodium (PRN)
• Lactulose (PRN)
• Sennosides (PRN)
Integumentary System
CM:
• Skin= normal and intact
• Temp= 36.3
• Multiple Failed AV
Access- scar tissue present
• Itchiness, redness, and
swelling near AV Fistula
site
• Slight redness near PICC
Line site, but skin is dry
and intact with no swelling
• Uses Emla cream prior to
hemodialysis on AV
Fistula exit sites
Endocrine/ Reproductive System
CM:
• Hemodialysis needed
• Type 2 Diabetes
o Sliding Scale for
Insulin Lispro
o Insulin Glargine
prescribed
 References

Lewis, S., Heitkemper, M., Dirksen, S., Bucher, L., & Camera, I. (2014). Medical-Surgical Nursing: Assessment and
Management of Clinical Problems (3rd ed., pp. 1- 2060). St. Louis: Elsevier Mosby Canada.
 References

Lewis: Medical-Surgical Nursing in Canada. Toronto: Elsevier.

McHugh Schuster, P. (2008). Concept Mapping: A Critical-Thinking Approach to Care Planning. (2nd
edition). Philadelphia: F. A. Davis Company.