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NURS FPX 6021 Assessment 1 Concept Map

Student Name

Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

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Date

 

Concept Map:

 Patient Info
Name: Walter B. Harris | Gender: Female | Age: 72

Vitals: Temp: 37 °C (98.6 °F), BP: 162/94, Pulse: 92, Respiratory rate: 26 and shallow

Chief complaint: Shortness of breath (SOB) and difficulty breathing

Medical history: Hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD)

 

Nursing Diagnosis
Subjective Data
Objective Data
Impaired gas exchange related to destruction of the alveoli, narrowing of bronchioles, and trapping of air resulting in the loss of lung elasticityDifficulty breathing and SOBCrackles and wheezing heard upon auscultation, dyspnea, tachypnea, nasal flaring, use of accessory muscles, late signs of cyanosis (Linton, 2015), and oxygen saturation is 90% on room air
Ineffective airway clearance related to bronchoconstriction, increased mucus productionThe patient states she has been sleeping in a recliner chair for the past three nights because of difficulty breathingWheezing heard upon auscultation, dyspnea, tachypnea, and use of accessory muscles (Linton, 2015)
Activity intolerance related to hypoxia (imbalance between oxygen supply and demand)“I find it difficult to breathe. I can’t catch my breath when I walk a few feet.” — Jane DoeLate signs of cyanosis, crackles and wheezing heard upon auscultation, and use of accessory muscles (Linton, 2015)
Nursing Interventions
Rationale
Independent Interventions (II): Monitor the patient’s arterial blood gases, oxygen saturation, vital signs, and color and assess for manifestations such as restlessness, anxiety, lethargy, and confusionThis process will help detect potential hypoxemia or hypercapnia (LeMone et al., 2015)
Collaborative Interventions (CI): Supervise oxygen (O2) at 2 L/min through nasal cannula as ordered. Instruct the patient and kin not to increase the O2 levelOxygen therapy is used to treat hypoxia and is prescribed for chronic and acute breathing problems (Rees, 2017). However, a sudden increase in the O2 level can lead to respiratory failure (Linton, 2015)
II: Position the patient in an upright or high Fowler’s position (Linton, 2015)This posture promotes lung ventilation (LeMone et al., 2015)
II: Instruct and teach the patient to perform the pursed-lip breathing techniqueThis technique slows the respiratory rate and reduces air trapping and fatigue (LeMone et al., 2015)
II: Demonstrate pursed-lip and diaphragmatic breathing and encourage the patient to practice them periodicallyThese techniques reduce air trapping and fatigue and help maintain open airways (LeMone et al., 2015)
II: Position the patient in an upright or high Fowler’s positionThis posture promotes lung ventilation (LeMone et al., 2015)
CI: Encourage deep breathing and the use of an incentive spirometerUsing an incentive spirometer prevents complications such as pneumonia and atelectasis (LeMone et al., 2015)
CI: Collaborate with a respiratory therapist to teach the patient how to cough effectivelyThis technique helps open distal alveoli and remove secretions (LeMone et al., 2015)
II: Provide emotional support to the patientThis intervention will be therapeutic, make the patient feel comfortable, and help her cope with the diagnosis (Kazanowski, 2017; LeMone et al., 2015)
Expected Outcomes
Arterial blood gases and vital signs will be consistent with patient norms, indicating improvement in gas exchange (Linton, 2015)
The pursed-lip breathing technique will reduce dyspnea (Linton, 2015)
The patient will have open airways. Signs of clear and open airways are normal depth and rate of respiration, normal breathing sounds, and effective coughing of secretions (Linton, 2015)

Value and Relevance of Evidence 

This analysis covers the evidence-based concept maps developed for a patient, Mrs. Smith, in two different healthcare settings – acute care and home health settings. The evidence used to create these concept maps is valuable and relevant to the case study. All of these articles are credible. The article by Chahal et al. (2020) is relevant to the case study due to its explanation of the connection between heart failure (decreased cardiac output) and acute renal failure (ARF).

This study presents that decreased cardiac output is common in ARF patients, evidenced by fluid overload within the body. One of the presenting complaints in our case study is shortness of breath (SOB), an indicator of fluid overload. Furthermore, this study provides insights into the effectiveness of diuretics in lessening chest congestion and improving breathing abilities. Moreover, the study by Ramachandran et al. (2022) debates the effectiveness of supplemental oxygen, which is necessary for improving tissue perfusion and minimizing cardiac burden, ultimately influencing Mrs. Smith’s SOB. 

Similarly, the article by Patil and Salunke (2020) is valuable as it discusses another nursing diagnosis of fluid volume excess and its connection with peripheral edema and loss of urine output in ARF patients, comparable to Mrs. Smith’s. This information is further supported by another article by Vaara et al. (2021), presenting the effectiveness of fluid volume restriction in ARF patients. These articles are valuable and relevant in our case study to provide evidence-based best practices for alleviating Mrs. Smith’s symptoms and planning her healthcare.

NURS FPX 6021 Assessment 1 Concept Map

The nursing diagnosis of risk for electrolyte imbalance is supported by Chen et al. (2021), which is one of the patient’s safety risks due to renal dysfunction in Mrs. Smith’s case. To intervene and prevent such risk, Hunter and Bailey (2019) encourage limiting potassium ingredients in the diet and emphasize the need for patient education about hyperkalemia symptoms. This educational intervention is further supported by Castro and Sharma (2023), who present the symptoms of hypokalemia and explain that the patient needs to recognize the signs and intervene promptly. 

In another concept map, the evidence from Nixon et al. (2019) is used as a valuable resource that emphasizes the importance of supporting pressure areas to prevent pressure injuries in chronic renal patients like Mrs. Smith, who are at high risk of developing these injuries in community care settings. Additionally, Mrs. Smith suffers from imbalanced nutritional status due to her inability to cook nutritious and adequate meals. This nursing diagnosis requires nursing intervention to collaborate with a dietitian and develop an effective dietary plan for the patient, preventing complications (van Westing et al., 2020).

Lastly, Mrs. Smith is at high risk of social isolation due to her daughter’s inability to meet her. For this purpose, the evidence motivates nurses to develop therapeutic interaction with the patient (Drageset & Haugan, 2021) and encourage family engagement in the patient’s healthcare (Heydari et al., 2020). The insights presented in these resources are relevant to Mrs. Smith’s present situation, enabling healthcare providers to plan effective nursing care.

Interprofessional Strategies 

Interprofessional collaboration is imperative in achieving the desired outcomes as most of the nursing actions depend on physician’s orders and effective coordination with other healthcare professionals, such as dietitians, in our case study. For instance, physicians must prescribe medications and instruct the amount of fluid restriction, which nurses follow during their medication and fluid administration. Correspondingly, a dietitian plays a role in establishing a dietary plan for the patient to maintain nutritional status. Additionally, the nurses collaborate with the patient and her family members to encourage their participation in Mrs. Smith’s healthcare process, ensuring the achievement of desired outcomes. 

However, several knowledge gaps persist in these interprofessional strategies, which could further improve the analysis. These are related to dietary preferences and Mrs. Smith’s daily living routine. Furthermore, her readiness to adapt and availability of adequate resources to successfully implement these strategies are other vital gaps in knowledge loom.  Filling in these knowledge gaps is advised and necessary to guarantee Mrs. Smith receives individualized and evidence-based care using best practices. 

Additional Evidence

The first concept map is about Mrs. Smith, a 52-year-old female patient who is admitted to the ICU with complaints of high blood glucose levels, fatigue, nausea, lower limb edema, blurred vision, low urinary output, and shortness of breath. She is diagnosed with acute renal failure and has diabetes type II as a comorbidity. Using NANDA International, we developed three distinct nursing diagnoses – decreased cardiac output, fluid volume excess, and risk for electrolyte imbalance. These diagnoses are further supported by relevant evidence, developing a nursing care plan for the patient using best practices as nursing interventions. 

Similarly, the second concept map is for the same patient in her community care setting, where the patient is under home healthcare follow-up for six weeks. The patient’s blood sugar levels are controlled, and she is voiding adequate urine output. She observed a reduction in the swelling in her lower limb. However, she is concerned about her daughter not getting enough time to meet her, which is also causing hindrances to her proper meal intake as she cannot cook for herself. Based on this situation, we integrated three nursing diagnoses: risk for impaired skin integrity, imbalanced nutrition: less than body requirement, and risk for social isolation. The nursing interventions added are based on evidence-based, valuable, and relevant literature explained previously. 

Practical communication approaches utilized are clear and accessible lines of communication with shared decision-making, therapeutic communication among nurse-patient interaction, plain language, and active listening. These communication approaches assist in building practical rapport with the patient to encourage participation. Moreover, interprofessional collaboration requires effective technological communication mediums to prevent gaps and address the barriers. These approaches lead to the successful implementation of the nursing care plans, resulting in desired outcomes. 

References 

Castro, D., & Sharma, S. (2023). Hypokalemia. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482465/ 

Chahal, R. S., Chukwu, C. A., Kalra, P. R., & Kalra, P. A. (2020). Heart failure and acute renal dysfunction in the cardiorenal syndrome. Clinical Medicine20(2), 146–150. https://doi.org/10.7861/clinmed.2019-0422 

Chen, X., Xu, J., Li, Y., Xu, X., Shen, B., Zou, Z., Ding, X., Teng, J., & Jiang, W. (2021). Risk scoring systems including electrolyte disorders for predicting the incidence of acute kidney injury in hospitalized patients. Clinical Epidemiology13, 383–396. https://doi.org/10.2147/CLEP.S311364 

NURS FPX 6021 Assessment 1 Concept Map

Drageset, J., & Haugan, G. (2021). Associations between nurse–patient interaction and loneliness among cognitively intact nursing home residents – a questionnaire survey. Geriatric Nursing42(4), 828–832. https://doi.org/10.1016/j.gerinurse.2021.04.001 

Heydari, A., Sharifi, M., & Moghaddam, A. B. (2020). Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review. Geriatric Nursing41(4), 474–484. https://doi.org/10.1016/j.gerinurse.2020.01.020 

Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: Pathophysiology, risk factors and consequences. Nephrology Dialysis Transplantation34(Suppl 3), iii2–iii11. https://doi.org/10.1093/ndt/gfz206 

Nixon, J., Smith, I. L., Brown, S., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., Coleman, S., Collier, H., Fernandez, C., Gilberts, R., Henderson, V., Muir, D., Stubbs, N., Walker, K., Wilson, L., & Hulme, C. (2019). Pressure relieving support surfaces for pressure ulcer prevention (PRESSURE 2): Clinical and health economic results of a randomised controlled trial. EClinicalMedicine14, 42–52. https://doi.org/10.1016/j.eclinm.2019.07.018 

Patil, V. P., Salunke, B. G. (2020). Fluid overload and acute kidney injury. Indian Journal of Critical Care Medicine24(S3), 94–97. https://doi.org/10.5005/jp-journals-10071-23401 

Ramachandran, G., Prasad, C. H., Garre, S., & Sundar, A. S. (2022). Oxygen Management in heart failure patients. Indian Journal of Clinical Cardiology3(3), 150–156. https://doi.org/10.1177/26324636221081585 

NURS FPX 6021 Assessment 1 Concept Map

Vaara, S. T., Ostermann, M., Bitker, L., Schneider, A., Poli, E., Hoste, E., Fierens, J., Joannidis, M., Zarbock, A., van Haren, F., Prowle, J., Selander, T., Bäcklund, M., Pettilä, V., Bellomo, R., Bellomo, R., Vaara, S., Bitker, L., Eastwood, G., … Uddin, R. (2021). Restrictive fluid management versus usual care in acute kidney injury (reverse-aki): A pilot randomized controlled feasibility trial. Intensive Care Medicine47(6), 665–673. https://doi.org/10.1007/s00134-021-06401-6 

van Westing, A. C., Küpers, L. K., & Geleijnse, J. M. (2020). Diet and kidney function: A literature review. Current Hypertension Reports22(2), 14. https://doi.org/10.1007/s11906-020-1020-1 

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