1. Chapter 3 Concept Mapping: Grouping Clinical Data in a Meaningful Manner 劉芹芳 楊玉娥 周汎澔 林麗娟

2. Objectives 1. Identify the ANA nursing standard of care related to organizing patient data. 2. Identify primary medical diagnoses. 3. Review patient profile data to determine general health problems. 4. Categorize patient profile data under health problems resulting from the patient’s response to the health problem. 5. List primary assessments associated with the medical diagnosis. 6. Label nursing diagnoses. 7. Specify relationship between nursing diagnoses.

3. Concept Map Assessment data (use critical-thinking skills to organize data) Nursing diagnoses

4. 3 Steps to Develop a Concept Map 1. Develop a basic skeleton diagram (to formulate initial impressions of the clinical patient profile data) 2. Analyze and categorize data (to arrange data in hierarchical order) 3. Label diagnoses—Analyze relationships between problems (to make meaningful associations between segments of the map)

5. Scenario  Age ： 80 y/o  Sex ： M  Admission date ： 3/21  住院原因： Diabetes  醫學診斷： New onset diabetes （ defined above ） History of hypertention

6.  Laboratory data ： blood glucose ： 450 glycohemoglobin ： 12 ％ cholesterol ： 240 urine analysis ： 3+ sugar, no ketones, no protein, no WBCs, clear yellow Scenario— 續

7.  Medications Humulin N 35U q.A.M., 7 ： 30 A.M. Valsartan 80mg q.A.M., 9 A.M. Acetaminophen 650mg, q4h, p.r.n.  Treatments Accu-check q.i.d., ac & hs Support Service ： Dietary Consultations ： Diabetes educator Scenario— 續

8.  Type of diet ： 1800 ADA  Intake ： 2200 Problems ： swallowing, chewing, dentures （ nurse’s notes ） Needs assistance with feeding （ nurse’s notes ） Nausea or vomiting （ nurse’s notes ） Overhydrated or dehydrated （ evaluate total I/O ） Belching Other ： history of polyphagia  Urine Output ： 1800 Scenario— 續

9.  Activity ： Weakness  Physical assessment BP ： 138/92 TPR ： 98.4 – 77 – 19 Height ： 175 ㎝ Weight ： 79 ㎏ Scenario— 續

10.  Neurological/Mental Status alert and oriented to person, place, time  Religious preference ： Catholic  Marital Status ： Widower  Occupation ： Retired  Emotional state ： Anxious about giving insulin and following diet Scenario— 續

11. Step 1-1 Develop a Basic Skeleton Diagram

12. Database for Patient with Diabetes Step 1-1: Develop a basic skeleton diagram Map the framework of propositions a. find patient’s key problems concepts b. start by centering the medical diagnosis

13. Newly Diagnosed Diabetes Nutrition LearningAnxiety BP problems Elimination

14. Step 1-2 Looking Up Information

15.  Drugs  Laboratory and Diagnostic Tests  Diet  Medical Diagnoses

16. Step 1-3 Preventing Falls and Skin Breakdown

17. Assessment Directions Place an “x” in front of elements that apply to your patient. Based on the assessment, check whatever applies to the patient. A patient for whom you place four or more “x” marks is at risk for falling

18. General Data X Age over 60 __History of falls before admission __Postoperative/ admitted for operation __Smoker

19. Physical Condition __Dizziness/ imbalance __Unsteady gait __Diseases/ other problems effecting weight-bearing joints X Weakness __Paresis __Seizure disorder

20. __Impairment of vision __Impairment of hearing __Diarrhea X Urinary frequency

21. Medications __Diuretics or diuretic effects X Hypertensive or CNS suppressants drugs __Postoperative/ admitted for operation (e.g., narcotic, sedative, psychotropic, hypnotic, tranquilizer, antihypertensive, antidepressant) __Medication that increase GI motility

22. Ambulatory Devices Used __Cane __Crutches __Walker __wheelchair __Geriatric (geri) chair __Braces

23. Mental Status __Confusion/ disorientation __Impaired memory r judgment __Inability to understand or follow directions

24. Step 2: Analyze and Categorize Data 圖 3-1

25. Not Sure ： Skin breakdown ？ Newly Diagnosed Diabetes Anxiety BP Problems 138/92 Nutrition Polydipsia I =2200 O =1800 Weakness 79 ㎏ Elimination I =2200 O =1800 Polyuria Learning Figure 3-1

26.  Step 3 ： Label Diagnoses—Analyze Relationships between Problems Many students have a tendency to select nursing diagnoses too quickly, without first looking at and organizing all data. 1.NANDA system 2.Gordon’s Functional Health Patterns 3.NANDA’s Human Response Patterns

27.  Figure 3-4-1 Figure 3-4-1  Figure 3-4-2 Figure 3-4-2

28. Summary  Psychosocial-cultural assessment -- 請看 Chapter 6  The purpose of this chapter was to take you slowly through the first three step of the concept map care planning process.  自行練習：請參考附件