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 outcomes? What should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-restricted- Goal
setting)
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
interventions were effective? Are there other interventions that
could be more effective? Did the patient’s care outlook or status
improve?
Patient Information (SBAR, H&P)
66-year-old female, 40 years of smoking history,
presents with:
 Productive cough with yellow sputum
 Chest discomfort
 Trouble breathing
 Poor vitality
 Respiratory
Wheezing and respiratory Distress and
discomfort Hypoxemia
 Blood pressure: 154/91 mmHg
 Heart rate: 93 beats per minute
 Respiration rate: 22 breaths per minute
 Body temperature: 98.4 degrees Fahrenheit
 Environmental O2 saturation: 88%
A 66-year-old female has smoked for 40 years. Her symptoms
include a productive cough that yellows her clear sputum, chest
discomfort, trouble breathing, and poor vitality. Wheezing and
respiratory discomfort are present. The person's blood pressure
is 154/91 mmHg, heart rate is 93 beats per minute, respiration
rate is 22 breaths per minute, body temperature is 98.4 degrees
Fahrenheit, and environmental O2 saturation is 88%. The main
concerns are respiratory distress and low O 2 saturation.
The patient has emphysema history. Symptoms of respiratory
distress include dyspnea, wheezing, low O2 saturation,
respiratory insufficiency, and chest tightness. The respiratory
discomfort increases with certain factors. Sputum visual
differences may indicate a respiratory illness.
Emphysema contributes to COPD. COPD is a respiratory disorder
that restricts bronchial airflow. COPD increases the risk of heart
and respiratory infections. The patient's main goals are to treat
her respiratory distress and check her secretions for infection.
A constant 2LPM O2 infusion will not cause respiratory discomfort
and maintain O2 saturation above 95%. Lung sounds and
respiratory status are assessed to attain these goals. There will
be no unconsciousness. The patient will clear her airway by
removing secretions and maintaining lung function.
O2 must be provided immediately*. Diagnostically, arterial blood
gases (ABGs) should be assessed*. To treat respiratory
infections, antibiotics are necessary*. The nurse will teach the
patient proper breathing methods for airway clearance. The
nurse will stress quitting smoking to the patient. The nurse will
teach the patient how to use an incentive spirometer to identify
breathing restriction.
Healthy indicators include 95% O2 saturation, a consistent
respiratory rhythm and pace, easy breathing, and lung sounds.
Patients can keep their airways clear by sneezing and
expectorating mucus. Increased head of bed (HOB) maintenance
improved respiratory comfort.
Main Concept
(Should be focus of below map)
CONCEPT MAP TEMPLATE:

Recognizing Cues (S&S) Disease Process/Pathophysiology/Risk Factors

COPD is a respiratory illness

1. SOB that blocks bronchial airflow.
2. 02 Sat 88% Bronchitis, emphysema, and
3. Wheezing other diseases are risk factors.
4. Chest tightness Cigarette use is another risk
factor.

Analyzing Cues/Concerns Prioritizing Hypotheses

Supporting 1. The patient will wheeze and expectorate

Respiratory discomfort, decreased oxygen mucus to clear the airway.
saturation, audible wheezing, thoracic tightness,
dyspnea, and sputum changes are common 2. Supplemental O2 saturation will
symptoms of COPD.
always exceed 95%.
Concerning
02 saturation 88%, tachypnea, wheezing, chest 3. Normal breathing is expected from
tightness, and fatigue. the patient.

Generate Solutions/Outcomes/Interventions Taking Action – (How To)

SMART Planning
1. Starting oxygen delivery immediately is critical*.
1. When the patient maintains O2 saturation above
95% at 2 liters per minute, respiratory distress 2. Diagnostic tests require arterial blood gas (ABG)
symptoms are absent. studies*.
2. Consider respiratory and lung sounds.
3. The treatment of respiratory infections requires
3. Maintain an open respiratory route with antibiotics*.
effective coughing. The nurse will teach the patient how to breathe properly
4.
to clear their airway.
5. The nurse will educate the patient on smoking cessation.

Evaluating Outcomes

1. Improved O2 saturation levels, reaching a target of 95% or higher.

2. Maintaining breathing rhythm and pace is advised.

3. Easy breathing and pulmonary auscultation.

4. Capable of coughing and releasing mucus to clear the respiratory system.

5. Reduced chest discomfort and improved overall comfort level in the patient.
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