NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
NURSING PROCESS TEMPLATE:
Assessment (Recognizing Cues)
Which patient information is relevant? What patient data is most
important? Which patient information is of immediate concern?
Consider signs and symptoms, lab work, patient statements, H & P,
and others. Consider subjective and objective data.
Analysis (Analyzing Cues)
Which patient conditions are consistent with the cues? Do the cues
support a particular patient condition? What cues are a cause for
concern? What other information would help to establish the
significance of a cue?
Analysis (Prioritizing Hypotheses)
What explanations are most likely? What is the most serious
explanation? What is the priority order for safe and effective care?
Planning (Generate Solutions)
What are the desirable outcomes? What interventions can achieve these The most severe cause is a dangerous asthma attack or
outcomes? What should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-restricted- Goal setting)
Rahil, a 25-year-old man, who now suffers signs of
respiratory disorders. A severe cough, shortness of breath,
and chest pain are identified by him, and those symptoms
have started worsening in the last week. Rahil has had a past
history of asthma and at the moment they noted that the
child complains of increased wheezing and shortness of
breath, especially at night. From his comprehensive clinical
examination and diagnosis, he presents the following vital
signs: temperature of 100. 5°F usual for a mild fever, 28
breaths per minute which exceeding the normal range of 12-
20 breaths per minute, and their oxygen saturation was 88%.
Indeed, wheezing can be appreciated upon auscultation in
both lungs, and he can bring up thick, yellow, mucoid
sputum when coughing. CBC results point to an elevated
WBC, which indicates that the body is still fighting an
infection or the presence of inflammation. The presented
signs and symptoms are suggestive of a respiratory infection
or an acute asthmatic attack; both of which necessitate
professional medical intervention to avert any further
progression.
The cues indicate that Rahil might be having an asthma
flare-up in addition to respiratory illness like pneumonia or
bronchitis. Persistent cough, thick yellow colored sputum
production, wheezing, and dyspnea are the most common
and typical examples of such diseases. The normalisation of
the remaining parameters excludes a renal-associated
pathology and the mild fever and slightly increased WBC
count indicates an infection. The emergent issue involves the
lack of adequate oxygen and escalated respiratory rate
showing that the patient suffers from undoubted respiratory
problems. Further tests like a chest X-ray and sputum culture
would go along way in confirming Tony’s diagnosis as well
as the recommended treatment plan.
The causes for this particular manifestation might be
worsening of the asthmatic condition or a respiratory
infection in Rahil. The most severe reason is a severe asthma
attack or pneumonia, and both of which are grave conditions
that require urgent treatment in order not to claim lives.
When prioritizing client’s safety and stability: Acute cell l
mask his respiratory distress and guarantee oxygenation His
infection/exacerbation top be treated Consider any resulting
complication such as oxygen level.
It can be concluded that asthma worsening or respiratory
infection can ensure the expression of Rahil’s symptoms.
pneumonia can occur which is a life endangering condition
if not treated within the shortest duration. The nursing
priorities for interventions for safe and effective care are
managing his respiratory distress and status of oxygenation,
confirming the cause of the change in his respiratory status
or infection, and monitoring of the response to
interventions and possible complications including oxygen
saturation levels.

Implementation (Take actions)
How should the intervention or combination of interventions be
performed, requested, communicated, taught, etc.? What are the
priority interventions? (Mark with asterisk)
Evaluation (Evaluating Outcomes)
What signs point to improving/declining/unchanged status? What End tidal carbon dioxide should reduce to <45 mm Hg
interventions were effective? Are there other interventions that and oxygen saturation levels should raise to >95 %
could be more effective? Did the patient’s care outlook or status marking efficiency of oxygen therapy. After
improve?
Hoskins & Clark identified the following desirable
outcomes for Rahil, these are: First- A normal oxygen
saturation levels Second- Decrease in symptoms of cough
and shortness of breath and Third- Elimination of the
infection. To promote these outcomes, one should use
Potentially effective interventions should therefore be made
SMART: Specific, Measurable, Achievable, Realistic, and
a Time Bound. While assessing 5 complaints, specific
client outcomes for Rahil include: *‘The client should
maintain oxygen saturation of more than 95% within the
next 24 hours while on supplemental oxygen’. His fever
should come down to <99 °F with the help of antipyretic
agents. He should recover over the next 48 hours with
bronchodilators and corticosteroids for his wheezing and
shortness of breath.
Safety promotion interventions demonstrated herein shall
be regularly monitored and assessed for effectiveness.
administration of antipyretic medication, the pediatric
patient should come down with the shivering symptoms
and the body temperature should be normalized and
should be less than 99°F. Symptomatically, his symptoms
regarding the breathing problems, like wheezing and
shortness of breath are expected to improve as a result of
bronchodilator and corticosteroid use. High WBC level
will require further testing while positive CRP and
negative bread can only suggest the effectiveness of the
antibiotic therapy if symptoms will disappear and WBC
count will normalize. Last but not least, prescription of
appropriate inhaler technique as well as compliance with
the medications taken will show the successful education
of patient named Rahil.
 Patient Information
(SBAR) Main Concept
S :Rahil, a 25-year-old male with asthma, presents with (Should be focus of below
worsening cough, shortness of breath, and chest pain, along map)
with vital signs indicating respiratory distress
B :Rahil's symptoms have worsened over a week, with
increased wheezing and difficulty breathing, and
Stress and coping
examination reveals wheezing, elevated temperature, and
low oxygen saturation
A :Suspected exacerbation of asthma or respiratory
infection, with signs of respiratory distress and potential
infection
R (Recommendation): Administer bronchodilators and Disease Process/Pathophysiology/Risk Factors
corticosteroids, provide oxygen therapy, consider antibiotic
therapy, closely monitor for deterioration, and educate Rahil
on proper medication use.
In Rahil's case, he is experiencing stress due to his
symptoms of respiratory distress, which exacerbate his
underlying asthma. Chronic stress can activate the
body's "fight or flight" response, leading to increased
heart rate, blood pressure, and respiratory rate, as well
as the release of stress hormones like cortisol and
adrenaline.
Recognizing Cues,
(S&S) Pathophysiology:
Chest pain Stress effects on the immune, hea t, and respiratory
Elevated temperature (100.5°F) systems may be disrupted if stress response is
Increased respiratory rate (28 breaths per minute) chronic.
Decreased oxygen saturation levels (88%) Inflammation and bronchoconstriction are also
Anxiety increased when Rahil experience stress, and this
worsens her asthma symptoms.
Risk Factors:
Responding to the question, self-characteristics are
the principal factors impacting the level of
vulnerability to stress in an individual because
Analyzing
Cues/Concerns personality characteristics, coping strategies, and
social support systems play a significant role in
helping or hindering an individual’s ability to cope
with stress.

Elevated temperature (100.5°F), indicating a mild fever.

Respiratory rate of 28 breaths per minute.
Oxygen saturation levels at 88%.
Low oxygen saturation levels. Prioritizing Hypotheses
Increased respiratory rate.
 Standard asthma control, specifically being able
History of asthma with worsening symptom
to perceive stress or other events potentially
leading to a bronchoconstriction.
 Mental health issues such as stress or fear
associated with respiratory symptoms.
 Coping with stress: lack of and/or ineffective
coping strategies and lack of social support as
factors that contributed to stress and particularly
worsening asthma.
 Generate Solutions/Outcomes/Interventions
SMART Planning Taking Action – (How To)

Administer bronchodilators and corticosteroids to alleviate airway inflammation and bronchospasm, improving respiratory functio
1. Check on the status of the patient’s oxygen level frequently; an in
2. Provide supplemental oxygen therapy to maintain oxygen saturation levels above 95%, ensuring adequate tissue oxygenation.
2. Check Rahil’s temperature; the lowering to below 99°F signified e
3. Initiate antibiotic therapy to treat underlying respiratory infection and reduce inflammatory response.
3. Assess Rahil’s respiratory signs: improved breathing and decrease
4. Educate Rahil on stress management techniques such as deep breathing exercises and progressive muscle relaxation to alleviate
4. I also recommend that in the next visit, Rahil’s WBC count is to be

5. Facilitate access to support groups or counseling services to address5.emotional distress

Evaluating Rahil’s and enhance
prescribed coping
medication strategies.
and coping strategy adh

Evaluating Outcomes

Administer bronchodilators and corticosteroids that the doctor has prescribed, and check that the patient is using the right techniq

Administer additional oxygen through nasal cannula or through a mask depending on the need and should titrate accordingly to th

Start antibiotics prescribed by the HCP through observing reactions and effectiveness for any patients who receive the prescription

Offer sessions on stress awareness and management procedures as well as physically engage the patient in deep breathing exercis

Ensure that Rahil is put through the right forums or counseling to ensure that she has continuous support as she grows in terms of
 References

Coping with Stress. (n.d.). https://www.cdc.gov/mentalhealth/cope-with-stress/index.html

Professional, C. C. M. (n.d.-b). Stress: Coping With Life's Stressors. Cleveland Clinic.

https://my.clevelandclinic.org/health/articles/6392-stress-coping-with-lifes-stressors