NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
Client Information (SBAR) Concept of the Map
Situation
Hi, this is Jane Doe, calling from the ER. I’m the nurse caring for
a 5-year-old boy with an apparent acute illness with severe
exacerbation of asthma presented to the ER.
Inflammation
Background
The client was alert and speaking in short sentences due to
shortness of breath. Inspiratory and expiratory wheezes audible
without the use of a stethoscope with intercostal retractions
noted. Productive cough, stuffy nose, and fever for 3 days per
mother. Current fever of 101.4 F axillary, HR of 130 bpm, RR 40
bpm, O2 sat of 88% on RA, BP 105/65. Patient has NKDA and no
significant past medical history other than diagnosis of asthma
Assessment I think the patient is experiencing asthma exacerbation possibly
due to respiratory illness.
Recommendation I recommend starting nebulizer treatments and would like you
to come place orders as soon as possible, please.
Recognize Cues Analyze Cues
• Tachypneic (high respiratory rate) – 40 bpm
• Hypoxic (low oxygen saturation) - 88% on RA
• Pyrexia (fever) - 101.4 F x 3 days
• Productive cough and stuffy nose for 3 days per mother
•Audible inspiratory and expiratory wheezes
•Tachycardic (rapid heart rate) – 130 bpm
• Wheezing indicates bronchiole
inflammation causing airway constriction
(Potter et al., 2023).
• Dyspnea (shortness of breath) causes
tachypnea and tachycardia (World Health
Organization, 2023).
• Hypoxia (low oxygen saturation) is related to
the impaired gas exchange due to the airway
constriction (Potter et al., 2023).
• Fever is related to suspected respiratory
infection (Ni et al., 2023).
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Situation: This includes an introduction of who YOU are, who the patient is, and the MOST important detail / the major reason you are calling.
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Background: All details mentioned in the background are relevant to the issue mentioned in Situation. Current vitals are here. Results of any current assessments/labs are here. Relevant history included here. Not all sentences here need to be complete.
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Assessment: This is what you, as the nurse, think is happening with your patient. This is one sentence that begins "I think..." It includes a possible reason.
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Recommendation: This is a recommendation for the next action needed. It begins "I recommend..." and tells the person you are calling something you recomment they do.
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Concept: the word or term listed here is NOT a disease - it is exactly the word/term used for the concept in HESI dashboard or the Concepts textbook for your course.
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Recognize: Cues are listed as bulleted items. Exact numbers and values are included. Some are subjective, some are objective.
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Analyze: Notice that all of these are mentioning cues listed in Recognize Cues. Each is ONE sentence with verbs that show the relationship between a cue and a possible issue / concern.
NOTICE that these have (author, year) in-text citations to support them.
Prioritize Hypotheses Generate Solutions
1.
Wheezing/dyspnea
1.
Within 30 minutes of breathing
treatment, wheezing diminished as
evidenced by clear lung sounds in all
lung fields. (World Health Organization,
2023).
2.
Within 10 minutes of application of
supplemental oxygen via nasal cannula,
the client will obtain oxygen saturation
levels >95% (Potter et al., 2023).
2.
Hypoxia of 88% on RA
3.
Client will demonstrate improved airway
clearance through effective coughing and
absence of audible wheezing by the end
of shift.
4.
The client’s temperature will decrease
from 101.4 F down to< 99F within 2 hours
following antipyretic medication
administration.
3.
Fever
5.
By the end of shift, the client will
correctly demonstrate the use of inhaler
spacer 3 times, as a result of proper
client and caregiver education provided
by the nurse (Potter et al., 2023).
Take Action
1. Administer medications/breathing treatments as directed to decrease wheezing.
2. Administer supplemental oxygen via nasal cannula and titrate oxygen to maintain oxygen saturation
>95% (World Health Organization, 2023).
3. Nurse will educate client and caregiver on how to perform coughing exercises to maintain airway
clearance.
4. Administer antipyretic medication as needed to decrease fever (Potter et al., 2023).
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Hypotheses: Each of these boxes has one of the issues that was mentioned in Analyzing cues. Each of these is one term / phrase.
Each of these is an issue that the patient is facing.
These are listed in order of "Which one will I address first" from a Nursing perspective.
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Solutions: Each box has ONE SMART goal. Each SMART goal includes specific elements (see highlighting). SMART goals may include in-text citations.
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Time limit
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nursing intervention
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measurable outcome
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Some possible sentence structures to follow for SMART goals:
Within X time of Y intervention, the client will show Z measurable outcome (with #).
The patient will (measurable outcome) by (reasonable time) after (nursing intervention).
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Actions: Each of these boxes identifies and describes the action (intervention) the nurse will take to meet each SMART goal. What will YOU will do as the nurse to help your patient meet the goals you made in Generating Solutions.
Notice how #1 action goes with #1 SMART goal... #4 action goes with #4 SMART goal
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notice that nursing intervention is sometimes not required
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Notice that these are all ACTIONS. verbs like "watch", "observe", "monitor", "assess"... are NOT used because they are assessments instead of actions.
5. Nurse to educate the client and caregiver regarding inhaler and spacer use.
Evaluate Outcomes
1. Within 30 minutes of breathing treatment, wheezing had resolved, as evidenced by clear lung sound
in all lung fields. (World Health Organization, 2023).
2. The client’s oxygen saturation was 98% within 10 minutes on 2L via nasal cannula.
3. By end of shift, client was able to properly perform coughing exercises and maintain airway
clearance based on the education provided by the nurse.
4. Client’s temperature decreased from 101.4 F to 98.9 F, 1 hour after administering the antipyretic
medication.
5. By end of shift, caregiver and client demonstrated the appropriate use of inhaler with spacer 3
times.
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Outcomes: Each of these states whether the # goal mentioned in "solutions" was met, using the "action" taken.
Each gives evidence for how it was met. Each says when it was met.
Notice how #1 outcome goes with #1 SMART goal and #1 action. #4 outcome goes with #4 SMART goal and #4 action.
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Time limit
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intervention
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evidence
References
Ni, J., Chowdhury, N., & Giles, B. L. (2023). The latest national asthma education and
prevention program guidelines: A review for the busy pediatrician. Pediatric
Annals, 52(4), e153–e158. https://doi.org/10.3928/19382359-20230209-01
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2023). Fundamentals of nursing (11th
ed.). Elsevier.
World Health Organization. (2023). World health statistics 2023: Monitoring health for the
SDGs, sustainable development
goals. https://www.who.int/publications/i/item/9789240074323
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References: all sources cited in the text are included as references here.
The page is DOUBLE SPACED and the references use HANGING INDENTS.