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Concept Mapping
4832 Nursing Care of Children and Families
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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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.
#8 Impaired Family Processes
#1 Impaired Gas Exchange r/t hospitalization c#7 Knowledge Deficit
r/t bronchospasms - Child absence from r/t lack of knowledge of triggers and
- SOB school medication administration
- Pulse Ox checks - Parent absent from - Patient/ family teaching
- Increased respiratory work - Reinforce correct albuterol
effort - Sibling at home with administration
- HOB elevated other parent - Identify triggers
- Nasal flaring - Increased family stress - Asks frequent questions
- Listen to lung sounds
- Albuterol treatment
- Flonase treatment
#6 Patient and Parental Anxiety
#2 Ineffective Airway Clearance Reason For Needing Health Care r/t hospitalization
r/t bronchospasms - Ineffective breathing
- Increased pulmonary Medical diagnosis: ASTHMA - Increased respiratory
secretions Chief complaint: Respiratory Distress rate
- Crackles Key Assessments: - Voiced concerns
- Dyspnea - Respiratory effort - Emotional support
- Pulse Ox checks - Respiratory Rate
- Albuterol treatment - Lung Sounds
- Flonase treatment - O2 levels
- Suctioning - Skin Color
- Cough
- Mucus production/ color
- Capillary refill
#3 Ineffective Breathing Pattern r/t #5 Risk for Infection
- Effectiveness of treatments
spasm of airway r/t increase pulmonary
- Dyspnea secretions and immobility
- Coughing - Activity intolerance
- Accessory muscle use - Hospitalization
- Tachypnea - Inability to cough up
- Cyanosis #4 Activity Intolerance mucus
- Pulse Ox checks r/t airway constriction and imbalance - No prophylactic
between O2 demand and supply treatment
- Dyspnea - Vital signs
- Fatigue
- Decreased O2 upon exertion
- Chest tightness
- Inability to play
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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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
tests, medical history, emotional state and pain. Also, identify key assessments that are
related to the reason for health care (chief medical diagnosis/surgical procedure) and put
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.
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: Impaired Gas Exchange r/t bronchospasms evidenced by SOB, nasal flaring and
increased respiratory effort
General Goal: Patient maintains optimal gas exchange
Predicted Behavioral Outcome Objective (s): The patient will have unlabored respirations at 12-
20 breaths per minute and pulse Ox >95% on the day of care.
Nursing Interventions Patient Responses
1. Continuous O2 monitoring 1. Pt O2 level stayed above 97%
2. Check breath sounds 2. Inspiratory wheezes
3. Elevated HOB 3. Patient had no SOB while laying in bed
4. Monitor Vitals 4. Vitals remained WNL
5. Assess nail shape 5. No clubbing found
6. Assess capillary refill 6. Refill is < 3 seconds
7. Assess mental status 7. Mental status remained at baseline
8. Assess skin 8. No cyanosis
Evaluation of outcomes objectives: Pt goal to maintain optimal gas exchange was met
Problem #2: Ineffective Airway Clearance r/t bronchospasms as evidenced by SOB, nasal flaring
and increased respiratory effort
General Goal: Patient will have Effective Airway Clearance
Predicted Behavioral Outcome Objective (s): The patient will have no abnormal breath sounds,
respiratory rate between 12-20, and maintain pulse Ox >95% on the day of care.
Nursing Interventions Patient Responses
1. Albuterol administration 1. Pt tolerated administration well
2. Flonase administration 2. Pt tolerated administration well
3. Assess breath sounds 3. Inspiratory wheezing
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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4. Assess cough 4. Pt had a productive cough
5. Assess O2 5. Pt O2 level stayed above 97%
6. Assess vitals 6. Vital WNL
7. Assess for use of accessory muscles 7. Breathing was unlabored
8. Assess airway patency 8. Airways remained patent
Evaluation of outcomes objectives: After medication treatment, patient no abnormal breath sounds, RR was
16, and pulse ox stayed above 97%. Patient goals met.
Problem #3: Ineffective Breathing Pattern r/t spasm of airway as evidence by wheezing, SOB,
respiratory distress
General Goal: Pt will have effective breathing patterns
Predicted Behavioral Outcome Objective (s): The patient will have no use of accessory muscle,
nasal flaring, and respiratory rate between 12-20 on the day of care.
Nursing Interventions Patient Responses
1. Albuterol administration 1. Pt tolerated administration well
2. Flonase administration 2. Pt tolerated administration well
3. Assess breath sounds 3. Inspiratory wheezing
4. Assess respiratory rate 4. RR 16
5. Assess for use of accessory muscles 5. No use accessory muscle use
6. Observe for nasal flaring 6. No nasal flaring
7. Inquire about relieving factors 7. Pt states that resting help
8. Monitor pulse Ox 8. SpO2 >97%
Evaluation of outcomes objectives: Patient did not show signs of respiratory muscle use or nasal flaring, and
maintain a RR of 16. Goals were met
Problem #4: Activity Intolerance r/t airway constriction and imbalance between O2 demand and
supply as evidenced by fatigue, SOB, dyspnea upon exertion
General Goal: Pt will be able to tolerate activity
Predicted Behavioral Outcome Objective (s): The patient will be able to perform ADLs with no
episodes of dyspnea on the day of care.
Nursing Interventions Patient Responses
1. Albuterol administration 1. Pt tolerated administration well
2. Flonase administration 2. Pt tolerated administration well
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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3. Assess breath sounds 3. Inspiratory wheezing
4. Assess respiratory rate 4. RR 16
5. Assess for triggers 5. Pt states that dogs trigger her asthma
6. Encourage Activity with breaks 6. Pt took breaks when starting to feel SOB
7. Educate on triggers 7. Pt now understands the activity can exarate
her asthma
8. . Monitor pulse Ox 8. SpO2 >97%
Evaluation of outcomes objectives: Pt performed ADLs with two dyspnea episodes and took breaks. Goal was
not met.
Problem #5 Risk for Infection r/t increase pulmonary secretions and immobility as evidence by
activity intolerance and hospitalization
General Goal: Pt will not acquired infection
Predicted Behavioral Outcome Objective (s): The patient will have no fever
(above 37.5C) or increased WBC labs (above 1l thousand/microliter) on the day of care.
Nursing Interventions Patient Responses
1. Monitor vitals 1. Vitals WNL
2. Assess for fever 2. Pt temperature was 36.9C
3. Assess labs 3. All labs remained WNL
4. Perform standard precautions 4. Hand hygiene performed frequently
5. Assess mucus appearance 5. Mucus was thin and clear
6. Monitor appetite 6. Pt had no loss of appetite
7. Get Patient out of bed 7. Pt got out of bed to use bathroom
8. Assess immunization status 8. All immunization are up to date
Evaluation of outcomes objectives: Pt developed no infection on day of care. Temperature was 36.9 and WBC
were 5.6 thousand/microliter. Goal met.
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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Problem #6 Patient and Parental Anxiety r/t hospitalization as evidence by voiced concerned.
General Goal: Parents and Patient will have no Anxiety.
Predicted Behavioral Outcome Objective (s): The patient will have all answered met and no
anxiety on the day of care.
Nursing Interventions Patient Responses
1. Assess for signs of anxiety 1. No anxiety found
2. Check for understanding of 2. Patient understands asthma diagnoses.
diagnoses
3. Assess vitals 3. Vital WNL
4. Administer antianxiety meds 4. Medication no needed
5. Assess overall appearance 5. Pt was content and in no distress
6. Monitor Respiratory pattern 6. Respiratory pattern was unlabored
7. Provide comfort measures 7. Distraction and reinforcement received
8. Explain everything clearly 8. Pt understood each part of her treatment plan
Evaluation of outcomes objectives: Pt and parent anxieties were decreased on day of care. Goal was met
Problem #7 Knowledge Deficit r/t lack of knowledge of triggers and medication administration
as evidenced by asking frequent question
General Goal: Pt will have no lack of knowledge
Predicted Behavioral Outcome Objective (s): The patient will have all questions answered and
disease process explained on the day of care.
Nursing Interventions Patient Responses
1. Explain disease process 1. Pt voiced that she understood.
2. Explain purpose of Albuterol 2. Pt voiced that she understood
3. Explain purpose of using spacer 3. Pt voiced that she understood
4. Explain importance of rinsing 4. Pt voiced that she understood
after each use
5. Explain purpose of Flonase 5. Pt voiced that she understood
6. Assess pt’s ability to understand 6. Pt had adequate mental capacity for age
7. Provide Resources 7. Resources received
8. Ask if pt or family has any further 8. Pt states she has no questions at this time
questions
Evaluation of outcomes objectives: All question were answered, and disease process was understood. Goal
met
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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Problem #8 Impaired Family Processes r/t hospitalization as evidence by child and parent away
from the rest of the family.
General Goal: Restored Family Processes
Predicted Behavioral Outcome Objective (s): The patient will be discharged home on the day of
care.
Nursing Interventions Patient Responses
1. Offer emotional support 1. Support received
2. Assess for signs of anxiety 2. No anxiety observed
3. Albuterol administration 3. Pt tolerated administration well
4. Flonase administration 4. Pt tolerated administration well
5. Offer breaks to parent 5. Patient did not want parent to leave
6. Discuss stressors 6. Parent voiced concern about missing several
days of work.
7. Provide comfort measures 7. Distraction and reinforcement received
8. Explain everything clearly 8. Pt understood each part of her treatment plan
Evaluation of outcomes objectives: Patient was not able to be discharged on day of care. Goal not met.
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
