concept map - chief medical diagnosis question

Daytonite, BSN, RN · May 28, 2007

as I prepare a concept map (hypothetical client) with an admission diagnosis that includes "possible carcinoma" - do I include this "possible carcinoma" or just the stated diagnosis in the Chief Medical Diagnosis box (with the date of admission)?

What are the directions you were given when you were originally told to use this form? Do you have any class notes to refer to on this? The term "Chief Medical Diagnosis" can have different meanings to different people. I would clarify this with your instructor(s). For instance, in the U.S. that particular term is not used in connection with acute hospital medical records. The term we use is Principal Diagnosis and it is only determined by the physician upon discharge of the patient.

GingerSue · May 28, 2007

The Schuster article (same as the concept mapping link by Shuster that is the same as the article) is all that I have in terms of instructions for making a concept map.

Schuster says "write the patient's major medical diagnosis in the middle of a blank sheet of paper", this is the "primary health problem" - and in the diagram the central box is "Chief Medical Diagnosis"

- in the link, concept mapping, that Chief Medical Diagnosis is the reason that the patient is seeking health care, hospitalization, not always a medical diagnosis, may be high-level wellness

so in this case, the client has a diagnosis, with a possiblity of carcinoma, so the person really does have the thought/worry of carcincoma to deal with (even though it turns out to be benign - but this is not known at the time of admission)

Daytonite, BSN, RN · May 28, 2007

i think i can clear this up for you since i have the author's book and this business of what goes into the center of the concept map itself is clearly defined in her book although i do not see the term chief medical diagnosis used in the book.

in my copy of concept mapping: a critical-thinking approach to care planning by pamela mchugh schuster on page 3 where she is giving an overview on the steps in putting together a basic concept map, she states the following: "the central figure of the map is whatever reason the patient is seeking health care--the reason for the hospitalization, extended care, or visit to the outpatient center. . .the central figure may not always contain a medical diagnosis. . ." and the information following that describes situations pertaining to outpatient, or office visits. a high level of wellness is never going to be a reason for admission to a hospital for care. you will only see these kinds of diagnoses with outpatient or office visits for things like routine physical exams, flu shots, vaccinations and other preventative care. the reason for hospitalization is explained further on page 26 of chapter 2 of the book where the author is advising students on the procedure for getting assessment information from a patient's medical record during the data gathering process.

"6. reason for hospitalization

again, the face sheet has this information. the reason for hospitalization is typed clearly on the face sheet without abbreviations. many students struggle with abbreviations and poor handwriting, both of which can be avoided by obtaining the reason for hospitalization from the face sheet. this is generally a medical diagnosis and, if applicable, includes the surgical procedure. although many things may have happened to a patient during hospitalization, it is important to know what the initial problem was that brought the person into the hospital in the first place." [italics and bold-facing added for emphasis]

i think this gives you the information you need to determine what the chief medical diagnosis should be. since you said that this is a hypothetical patient, then i would go with the diagnosis you were given in the case scenario. if it was stated as "possible carcinoma" then that is what i would go with. the reason is because based upon that medical diagnosis, medical treatments and interventions were performed upon the patient by the doctor. as a result of those treatments and interventions the nurse will be finding patient problems for the patient's care plan that need to be addressed by the nursing staff. if you don't use that diagnosis, then there is no rational reason for the things the doctor has done to the patient. keep in mind that one of the reasons for using the concept map format is to visually show the relationships that exist between the data, problems, and interventions.

loricatus · May 28, 2007

The easiest, and more professional sounding approach to take would be to state the diagnosis as r/o [rule out] carcinoma of ______, instead of "possible carcinoma."

GingerSue · May 29, 2007

thanks

I figured that I would include the carcinoma possibility in the Chief Medical Diagnosis box. Maybe include the "hematuria" & "abd pain", with some of the test results prior to the surgery - or does that seem to be too much?

Then put the operation, with the date.

It is the "benign" finding that I next wondered about including (with the date). It was a post-op diagnosis.

Seems like more than the author intended, but I really don't know what to do with the complete information, and it seems incomplete if I don't include these items.

Daytonite, BSN, RN · May 29, 2007

In your central box I would put:

possible carcinoma

That is the reason for the patient's admission and surgery. Hematuria and abdominal pain are symptoms that followed the treatment, aren't they? I had to find your other thread to see what else you had posted about this scenario. This is your kidney surgery patient, right? Where did you come up with the hematuria and abdominal pain? Were these symptoms that were listed in the scenario when it was given to you? Or, are they complications that you've discovered occur as a result of the surgery?

Keep in mind that the central box of the concept map is what holds everything together. The care map is like a wheel. The patient's admitting diagnosis is at the center. One way or another, all the patient's assessment data, nursing diagnoses, outcomes, and nursing interventions exist because of that "Chief Medical Diagnosis" and can be directly linked to it. Hematuria and abdominal pain sound like symptoms to me. However, if you had a statement in your scenario like this: This xx-year old patient was admitted to the hospital with possible carcinoma and was having hematuria and abdominal pain, then I would include them in the central box as well, but only if the scenario clearly makes it sound like the doctor has included them as part of the admitting diagnosis.

possible carcinoma

hematuria

abdominal pain

I explained in my previous post that Ms. Schuster's intent for the "Chief Medical Diagnosis" is the doctor's diagnosis at the time of admission to the hospital. The fact that the carcinoma was determined not to exist does not change what goes in your central box on the care map. Your only concern with this finding of the mass being benign is how is it affecting the nursing care of the patient. Those are things that will be addressed in the other boxes surrounding the "Chief Medical Diagnosis" box as a result of the patient's response to this news.

GingerSue · May 29, 2007

thanks,

The hematuria was occurring for about a month before hospitalization.

The abd pain was occuring for several months before hospitalization.

So the patient had test that showed a growth and that the kidney was not functioning.

(I figured these must have been the reasons for the testing in the first place, the pain and then the hematuria, so the patient went to the doctor to find out what's wrong).

It's that post-op diagnosis of "benign" that I am not sure whether to include in the central box. It is medical diagnosis, just later in the hospitalization. It would show up in one of the nursing diagnosis boxes, yes. And it is the reality of the client's status. The realities are the hematuria, the pain, and the tumor (benign).

Daytonite, BSN, RN · May 30, 2007

Reason this out. If you use

benign tumor

as the admitting diagnosis, how are you going to justify things like patient teaching related to the tests done to detect any cancer? Part of the nursing diagnoses for this patient, I think, might also include some of the coping ones. A person who has the potential of cancer looming over their head is likely to have a lot of psychological issues to deal with. If you start out with a diagnosis of "benign tumor", how can you justify bringing those psychological issues into the care plan since they would no longer exist? I think your instructors would expect to see those kinds of issues addressed.

GingerSue · May 30, 2007

no, Daytonite,

I'm not using benign tumor as the admitting diagnosis. That was not my intention, as I mentioned in my original post, this is additional information.

thanks

Daytonite, BSN, RN · May 30, 2007

ok, now i'm confused. schuster is very clear in her book about what goes in that chief medical diagnosis box. i don't think that

possible carcinoma (5/10)

benign tumor (5/13)

meets the criteria for the admitting diagnosis which seems to be the intention of what schuster wants put there. the dates are obviously different. you can't have two admission dates on one visit to the hospital. also, it just doesn't sound right to me to put "possible carcinoma" and "benign tumor" together. they sound exclusionary of each other, kind of like now you have cancer, now you don't. that just doesn't sound rational to me either which is often one of the things that instructors are looking for when they are evaluating a care plan.

you know what? i would discuss this with your instructor to get a clear answer on this.

rn/writer, RN · May 30, 2007

I just read through this thread on mapping as there was nothing like this when I went to nursing school.

Thank you, Daytonite, for your patience and the time you put in explaining this and other ideas in such great detail. I have never so much as laid eyes on one of these puppies, but after reading your descriptions, I feel like I have a grasp of at least the basics.

Thanks for being such a terrific resource.