how do I concept map and diagnose a complicated pt?

[chardur]

Please help! I am a first semester nursing student and just began hospital clinicals. My assignment is to concept map and diagnose with care plan for hospital patient. I am actually quite good with care plans and understand the process or at least I did with the nursing home/LTC patients, however, this patient has me confused or it is being unfamiliar with hospital charts to collect data. Here is the problem:

64 year old female, 78 pounds, bilateral BKA with LBK amp has stump with chronic wound, admitted with Stage IV pressure wound, DX of DM, CAD HX of multiple occurrences, CHF, ERD on chronic dialysis, dementia r/t alzheimer's disease, has PEG tube. Bedridden, incontinent. Multiple meds.

That's all I know as I have not assessed. Not sure how to fill in the concept map and a reasonable diagnosis within my scope of knowledge.

Any help or suggestions?

[Daltontna]

I would use Impaired Skin Integrity. She has many issues contributing to the slow healing process, such as DM, ESRD, low protein stores and so forth. You actually have a lot to work off of.

[CharlieT]

impaired gas xchange, impaired coping, body image, the choices are many

like daltontna said, you have a ton of things to work with there, some patients are in great shape and therefore are difficult to write a map on, that's sad for a 64 year old

[CharlieT]

I just read your post again, perhaps you feel overwhelmed because this patient has so much going on. Just pick some of the most important problems to work with, I recommend the greatest threat to life. Just like the real world, you can't treat all of her problems at once, so take on the most important ones. We only work 3physical and 1 psycosocial problems on each patient. Of course you will have to comply with your instructor's requirments. Good luck in school.

[llg, PhD, RN]

I agree with CharlieT. Prioritize ... prioritize ... prioritize. Start with the 1 or 2 most important problems. Which ones would they be? Think about what criteria you would use to determine the number 1 priority. I would think that you would start with the one (or ones) that are life threatening and/or are the ones that are her primary reason for hospitalization.

Make a problem list (diagnosis list) ranked or grouped by priority. Start your concept map (or care plan) with the top couple of problems. Then you can add the problems/diagnoses that are just below that in terms of priority.

At some point in the process, you may come to realize that your plan/map includes all that can reasonably be accomplished at one time. At that point, the rest of the stuff might get added to work ... but in reality, it wouldn't actually get done during your shift.