Can someone help me with concept mapping please?

Nursing Students Student Assist

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Hi, I'm trying to work on my concept map & I'm just not sure if I'm doing it correctly or not...Our program gave us like a 5 minute lecture on these maps & everyone seems to be lost on it....Anyways here goes....

My diagnosis was: Hyponatremia

Reason for needing healthcare: Falls

Here's some key problems NANDA Diagnoses & supporting data I have so far:

- Altered thought processes r/t neurological dysfunction

1.) Progressive dementia

2.) 65+

3.) Progressive dementia

4.) Reminding patient to watch fluid intake

5.) CT Head results

- Risk for falls r/t diminished mental status

1.) 65+

2.) Patient requires use of assistive devices

3.) History of falls

4.) CT head results

5.) PT results; staggering right leg possibly r/t CT results.

- Fluid volume excess r/t increase in ADH & H2O retention

1.) Low serum Na

2.) SIADH

3.) Water intoxication, no signs of edema, pt on

4.) Patient complaining of headache & nausea.

- Excess fluid volume r/t excessive intake of hypotonic fluids

1.) Patients poor appetite but drinks a lot of fluids.

2.) I wanna say intake > output; however, my patient's output was higher than their intake but they did have a high PVR earlier in the day like of 300 mL.

I'm connecting a lot of these boxes together with one another & just see 3 more key problems. But just curious, does that look like I'm doing this right?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
K I do, & will do! Thank you a bunch, this is helping out a ton. As for my etiologic factors, they'll always be my related to something. So, like if I pick Impaired physical mobility it be: Impaired physical mobility related to neurological impairment.

For supporting evidence do you think I could put something such as....Possibly not r/t low sodium serum because as levels increase symptoms don't improve?

You must follow the NANDA I definitions as dictated by NANDA I and supported by the evidence/symptoms you collected from your patient.

Impaired physical Mobility A limitation in independent, purposeful physical movement of the body or of one or more extremities

Defining Characteristics what does your patient have.

Decreased reaction time; difficulty turning; engages in substitutions for movement (e.g., increased attention to other’s activity, controlling behavior, focus on pre-illness disability/activity); exertional dyspnea; gait changes; jerky movements; limited ability to perform gross motor skills; limited ability to perform fine motor skills; limited range of motion; movement-induced tremor; postural instability; slowed movement; uncoordinated movements

Related Factors (r/t) ...becaue

Activity intolerance; altered cellular metabolism; anxiety; body mass index above 75th age-appropriate percentile; cognitive impairment; contractures; cultural beliefs regarding age-appropriate activity; deconditioning; decreased endurance; depressive mood state; decreased muscle control; decreased muscle mass; decreased muscle strength; deficient knowledge regarding value of physical activity; developmental delay; discomfort; disuse; joint stiffness; lack of environmental supports (e.g., physical or social); limited cardiovascular endurance; loss of integrity of bone structures; malnutrition; medications; musculoskeletal impairment; neuromuscular impairment; pain; prescribed movement restrictions; reluctance to initiate movement; sedentary lifestyle; sensoriperceptual impairments

So you patient has impaired physical mobility due the patient apparent impairment/muscle/neuromusclar impairment As evidenced by the patients unsteady gait, the patient drags her leg, uses an assertive device, and a history of frequent falls.

Use what the book gives you and what you can prove by the assessment of your patient that they have this symptom.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
K I do, & will do! Thank you a bunch, this is helping out a ton. As for my etiologic factors, they'll always be my related to something. So, like if I pick Impaired physical mobility it be: Impaired physical mobility related to neurological impairment.

For supporting evidence do you think I could put something such as....Possibly not r/t low sodium serum because as levels increase symptoms don't improve?

What evidence you you actually have that this is neurological? YOu know she has a physical impairment and she drags her leg the etiology is to be determined.

I am signing off tonight...leave any questions I'll be back....LOL I hope it helped.

Okay, thank you.

Just get back to me whenever you can, our instructor gave us over Spring Break to work on this, so take your time :).

I just don't get how is the etiology to be determined? I've already met the patient & our instructor has told us the etiologic factor is basically after the related to, so hence; Impaired physical mobility R/T NEUROMUSCULAR IMPAIRMENT. Which I know she has a neuromuscular impairment, so what is it that I'm missing or is our instructor teaching us incorrectly lol?

Some evidence I thought I had was that we knew she had dementia or the CT Head results of chronic small vessel ischemia secondary to cerebral atrophy.

EDIT: But I guess that's isn't actual evidence, instead of just a theory on my end. Which I shouldn't be doing :(

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I figured you have data...LOL If you have positive data, then yes, if your CT result is positive showing chronic small vessel ischemia secondary to cerebral atrophy. You can say neuromuscular involvement (although her dragging her leg still can be hip related...have they x-rayed the hip to be sure she doesn't have a subtle fracture?) ....but saying dementia is the medical diagnosis. You can say she has confusion due to the positive CT result but you shouldn't make the jump of the medical diagnosis of dementia.

The presence of small vessel disease make me think even more she is a undiagnosed diabetic with a neurogenic bladder.

You can still use hyponatremia as a contributing factor because she is still in a clinically significant low level it can cause confusion, seizures, stupor come and death.

Do you see the subtle difference? Do you see how we developed the care plan based on the data provided as you told me more and more about the patient? Use that data....look at what your patient needs, what may be causing her symptoms...then go and look at what diagnosis applies.

I don't know why schools do not tell you about having the ultimate resource...Nursing Diagnoses: Definitions and Classification 2012-14 (Nanda International) they can be bought or rented for around $26.00 and free shipping to students. A light will shine if you get this book and make you life a whole lot easier.

K thank you again!

I'm starting to also think she has an undiagnosed diabetes, especially after looking at my notes I noticed her labs drawn from earlier in the morning had a blood glucose level of 128, & I knew she hadn't had anything to eat at least since around Thursday evening but it didn't state if it was fasting or not so I wasn't sure, but would it be fasting since she hadn't eaten since yesterday evening & labs were drawn really early that Friday morning?

Also I knew the doctor hadn't seen her that day either,& I think those were the only glucose lab drawn since she had been there or at least what I noticed in the chart. So maybe there now trying to keep a pattern of her glucose levels possibly to rule out diabetes?

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