Concept Map help!

[queenbey]

Hi so I need to create a concept map with 3 primary concerns relating to my patient. I've got 2 done completely and I think they are good, but i'm just really struggling to come up with a third nursing diagnosis. Could anyone give me some ideas? Let me tell you guys a little bit about my patient for starters:

32 year old male in the hospital on a cardiac floor for currently 7 days for a diagnosis of bacteremia after his LVAD reinsertion - had positive blood cultures. Contact precautions.

Has a history of non ischemic cardiomyopathy following a heartmate II implant in 2010. In addition he has had an LVAD pump infection previously as well.

All vital signs were stable and normal.

No edema and his sternal incision sights looked clean.

Platelets are slightly low

Hgb & hematocrit slightly low but not significant

urinates and bowls fine

up ad lib

cardiac diet.

So, what I have so far is:

POSITIVE BLOOD CULTURES (admit diagnosis)

Nanda #1: infection

AEB: microorganism invasion in blood, fevers of 101 or higher upon diagnosis.

NIC: Maintain a clean environment, monitor vvitals, inspect wound sites for infection, monitor blood labs such as WBCs for worsening in infectious state.

NOC: Negative blood cultures & WBC count returns to normal, no fevers.

Nanda #2: Risk for hyperthermia

AEB: temps of 101 upon admission, having coolness and chills.

NIC: monitor vitals q6. Administer fever reducers in order- ie tylenol or motrin, provide ice pack upon request.

NOC: keep fevers down, have vital signs continue to be stable at time of discharge

so are those good? what else can I do? I don't consider hypthermia a primary concern but I absolutely couldn't think of anything else...help!!

[ArtClassRN, ADN, RN]

You're a nursing student for pete's sake! Skin integrity, activity or other related dx is fine. You can also pick any of the bs psychosocial ones. Or, be my hero and pick "Energy Field, disturbed."

[tokebi]

We have to keep looking at the bigger picture, the patient as a whole. You are not limited by his admitting diagnosis.

He has a history of cardiomyopathy and LVAD. Do you think we need to watch his cardiac function? Make sure he maintains adequate cardiac output?

Do you think he needs education on infection, treatment, prevention, etc? Knowledge deficit is a handy nursing dx, since it applies to anyone.

[queenbey]

Ahh thanks! You gave me some good ideas, I think I know where i'm going to go with this now!! :)

[HouTx, BSN, MSN, EdD]

You're a nursing student for pete's sake! Skin integrity, activity or other related dx is fine. You can also pick any of the bs psychosocial ones. Or, be my hero and pick "Energy Field, disturbed."

HA HA HA HA HA Thanks, I needed that!

[Esme12, ASN, BSN, RN]

remember that the care map is about the patient assessment...what do they need? What would a patient with heart failure need? what affects them? How do they know they are doing alright? Are they SOB? Do they have edema? what is their weight? What meds do they take? What would a low platelet count be indicative of? What is a VAD patient at risk for?