Concept Map

Running Head: CONCEPT MAP 1

Concept Map # 1 Adidley Garcia

West Coast University

Cultural considerations, ethnicity, occupation, religion, family support, insurance. (1) (14) Socioeconomic/Cultural/Spiritual Orientation & Psychosocial Considerations/Concerns, to include the following Social Determinants of Health

 Patient states he is currently unemployed. Patient lives with family and his daughter.

 Patient states he is catholic.  Patient is American  Patients preferred language is English.

History of Present Illness (HPI), Pathophysiology of Admitting Dx

(Cite References) Medical, Surgical, Social History (1).

Mr. Kokoris is a 72-year-old mala who presented to North Shore

Medical Center with complains of worsening chest pain 3 days prior to arrival. The pain was reported as 10 in a scale of 0-10 and radiate on left

arm, neck, right arm, back, and upper abdomen. Patient also report mild

nauseas and diaphoresis. Patient stated he was sent to his PCP due to his symptoms. Further work up progress. Cardiology following

Medical History

Patient has a history of Hypertension, obesity and hyperlipidemia.

“Heart failure often develops after other conditions have damaged or weakened your heart, conditions like obesity and high lipids. However,

the heart doesn't need to be weakened to cause heart failure. It can also

occur if the heart becomes too stiff. In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill

properly between beats. In some cases of heart failure, your heart muscle

may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your

body. Over time, the heart can no longer keep up with the normal

demands placed on it to pump blood to the rest of your body.” (Mayo clinic, 2018)

The pathophysiology of hypertension is an area which seek to explain

how work and the causes of hypertension, which is a chronic disease characterized by elevation of blood pressure. Hypertension can be

classified by cause as either essential (also known as primary or idiopathic) or secondary. About 90–95% of hypertension is essential

hypertension. (ncbi.com, 2001)

Obesity it is a condition that increases the risk of other diseases and

health problems, like heart disease, diabetes, high blood pressure and

some cancer according Mayo Clinic. (Mayo Clinic, 2019)

“Hyperlipidemia or high cholesterol level can run in families. People who inherit the condition can get very high cholesterol, along with

triglycerides and other fats, those can build up inside your arteries. This

makes the blood vessels narrower and makes it more difficult for blood to get through. Your blood pressure could go up”. And also cause

arteriosclerosis

The buildup can also cause a blood clot to form. If a blood clot breaks off and travels to your heart, it causes a heart attack. If it goes to your

brain, it can cause a stroke. (Mayo Clinic, 2019)

Surgical History

Patient denies any surgical history.

Social History

Patient denies any use of alcohol, tobacco or illicit drugs.

Chief Complaint

Patient complains of chest pain and some

shortness of breath.

Admitting Diagnosis Chest Pain with possible

Myocardial Infarction

Patient Information (1)

Name: P.K

Age: 72

Gender: Male Code Status: Full codes

DPOA: NA

Living Will: Yes

Patient Education (In Pt.) & Discharge Planning (home needs)

 Recommend Dietary Approaches and stabilize Hypertension (DASH) diet. (Health promotion)

 The patient has to continue the follow up with primary care physician.

 Patient demonstrated understanding of the discharged planning explaining back the appropriate diet to follow and the lifestyle change he has to make.

 Patient is to be on 2L of O2.

 Medications (lifelong)

 Home BP monitoring

 Signs of hypokalemia and hyperkalemia since he is taking diuretics that deplete or spare potassium

 Drink lots of fluids to prevent electrolyte imbalance.

 Instruct patient in energy-conserving and energy-efficient behaviors.

 Encourage exercise 30 min 3 times a day.

 Managing stress.

 Getting adequate rest.(American Heart Association, 2019)

Concept Map #1

Student Name: Adidley Garcia

Instructor: Luis Diaz-Paez

Diagnostic Test/ Lab Results with dates

and Normal Ranges (3)

Test Norms Date

Current

Value

Sodium

level

136-

145mEq/

L

9/10/19 137

Potassium

level

3.5-5 9/10/19 4.1

BUN 10-20 9/10/19 12

Creatinine

level

0.6-1.2 9/10/19 0.64 (L)

HCT 45%-

52%

9/10/19 43.6

WBC 5,000-

10,000

9/10/19 5.3

RBC 4-6

million

9/10/19 4.98

Platelet

count

150,000-

450,000

9/10/19 140(L)

Troponin-

t

<0.35

ng/ml

9/10/19 0.87

Hgb 13.5-17.5

(Men)

9/10/19 14.8

Chest X-

ray

Clear

bilaterall

y lungs,

Normal

heart

size.

9/9/19 Cardio

megaly

Erickson’s Developmental Stage Related to pt. & Cite

References (1)

Erikson’s developmental stage: Ego-Integrity V.S.

Despair

 Late adulthood

 Virtues: Wisdom

 Important event: During this stage of development the patient contemplates their accomplishments and are able to develop integrity if they see they are

leading a successful life. If they do not see

themselves leading a successful life they become dissatisfied with life and develop despair, which

leads them to depression and hopeless. (McLeod,

2018).

Outcome/Goal #2

Patient will decreased

episodes of dyspnea and angina by end of

the shift. Along with

sweating

PC Interventions

 Encourage frequent position changes every 2 hours.

 Provide frequent skin care

 Use pulse oximetry to monitor oxygen saturation and

pulse rate.

 Promote active/passive ROM exercises.

Priority nursing diagnosis #1

 Decreased Cardiac Output related to cardiac muscle

disease, rhythm, and

electrical conduction as evidence by

increased heart rate.

Vital Signs (4)

Temp 97.2

HR 75

BP 168/93

SpO2 92

Neurological (5)

The patient was awake,

alert, and oriented to person, place and time.

There were no obvious

neurologic abnormalities. Gait

normal.

Respiratory (7)

Lung sounds were

diminished at bases bilaterally. No ralles,

rhonchi or wheezes

were noted.

Priority nursing diagnosis #2

 Inadequate tissue perfusion related to

alterations in rate,

rhythm, electrical conduction as

evidenced by chest

pain, cool and

diaphoresis skin.

Outcome/Goal #1

Patient will have normal

cardia cardiac output as

evidenced by blood pressure and pulse rate and rhythm by

the end of the shift.

Interventions # 2

 Elevate head of bed and encourage frequent position

changes.

 Administer oxygen therapy as ordered.

 Monitor and record vital signs

 Promote adequate rest periods

 Administer medications as indicated( Lisinopril)

Assessment/ Evaluation #1

 Patient heart rate within normal limits, monitored electrocardiogram (ECG) for rate and rhythm.

 Patient blood pressure is within the normal limits at the end of the shit

Goal was met.

Assessment/ Evaluation #2

 Chest pain and dyspnea was resolved with normal troponin levels and oxygen 2 L in place

 Head of the bed was in Fowlers’ position and reparation rate within the normal values at the end

of the shit Goal was met

PC Evaluation Plan

Patient skin integrity was kept intact the whole shift.

Goal met.

PC Outcomes/Goal

Maintain skin integrity by the end

of the shift.

Nutrition/Hydration

(8)

Well-nourished and

well developed.

Rest/ Exercise (11)

Patient is able to

ambulate on his own.

GI (9)

Negative for Abdominal pain, Constipation, Diarrhea, Jaundice, Nausea and Vomiting.

Abdominal pain, Constipation, Diarrhea,

Jaundice, Nausea and

Vomiting. Soft no

tender or distention

GU (10)

Negative for Dysuria,

Hematuria and Polyuria (Genitourinary). No

suprapubic or CVA

tenderness.

Misc. (Ht/Wt)

192 Wt

190 cm Ht

Endocrine (13)

Negative for Cold

intolerance, Heat intolerance, Polydipsia

and Polyphagia.

Cardiovascular (6)

Revealed: normal S1

and S2. The rhythm

was regular, and no

murmurs, rubs, clicks,

or gallops.

Psychosocial (14)

Negative for Anxiety

and Depression. Appropriate mood and

affected, normal

through process

Integumentary (12)

Skin is dry, warm and

intact. No rash and no

cellulitis lesion

Interventions #1

 Administer Beta blockers as ordered.

 Assess oxygen saturation and blood pressure with pulse oximetry and blood

pressure machine.

Potential

Complications/ at

risk for

Patient at risk for

impaired integrity

related to decreased

tissue perfusion.

Medical Management/ Orders/ Medications & Allergies (2)

Name Dose RT Freq. MOA RN

Considerati

ons

Side effects and Adverse effects

Furosemide 2om

g

Oral One tab

Daily

Blocks the

absorption of

sodium, chloride, and water from

the filtered fluid

in the kidney tubules.

Monitor

Potassium

levels.

Side Effects: increased urination and thirst, muscle

cramps and weakness, dizziness, diarrhea with

stomach pain, and Constipation.

Adverse Effect: dehydration, dark urine, jaundice and Electrolyte imbalance, loss of appetite, and weight

loss.

Carvedilol

(Coreg)

6.25

mg

Oral One tab

Q12Hr

It works by

blocking the action of

epinephrine, on

the heart and blood

Monitor

blood pressure and

heart rate.

Side Effects: Dizziness, Fatigue Low blood pressure (hypotension) Weight gain, High blood sugar (hyperglycemia)

Diarrhea, Slow heart rate.

Adverse effect: Liver damage (hepatotoxicity),Impotence, Bronchospasm

Abnormal lung sounds (rales)

Depression

Lisinopril 5mg Oral 1 tab

Daily

Inhibits

angiotensin-

converting enzyme (ACE)

Monitor

Blood

Pressure

Side Effects: dizziness, cough, headache, Diarrhea,

low blood pressure, fatigue, nausea and/or vomiting Adverse Effects: chest pain, high potassium levels and psoriasis

Atorvastatin (Lipitor)

10m g

Oral One tab daily,

bedtim

e

Calcium channel blocker.

Monitor pulse, blood

pressure,

edema and lung sounds.

Side Effects: Gastrointestinal symptoms Like diarrhea. Cold symptoms such as a runny or

stuffy nose, Joint pain, Insomnia

Urinary tract infection, Nausea Loss of appetite

Adverse Effects: Chest pain (angina) Lightheadedness and fainting Shortness of breath, Muscle weakness

Severe allergic reaction (anaphylaxis)

Oxygen 2ml Nasal

cannu la

PRN Improve end-

expiratory lung volumes

Monitor

heart rate, Blood

pressure,

Assess lung sounds.

Side Effects: Skin and nose irritated. Nose dryness

You may get nosebleeds once in a while. Headache Adverse Effect: Oxygen toxicity and short of breath,

nauseas, visual change and disorientation.

References: Beevers, G., Lip, G. Y., & O'Brien, E. (2001, April 14). ABC of hypertension: The pathophysiology of hypertension. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120075/

Common Side Effects of Lasix (Furosemide) Drug Center. (n.d.). Retrieved from https://www.rxlist.com/lasix-side-effects-drug-

center.htm

Decreased Cardiac Output – Nursing Diagnosis & Care Plan. (2019, January 29). Retrieved from https://nurseslabs.com/decreased-

cardiac-output/

Heart failure. (2017, December 23). Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-

20373142#targetText=Heart failure often develops after,weakened to cause heart failure.&targetText=But heart failure can occur,such

as high blood pressure.

Hyperlipidemia: Causes, Symptoms, Diagnosis, Treatment. (n.d.). Retrieved from https://www.webmd.com/cholesterol-

management/hyperlipidemia-overview#1

Lifestyle Changes for Heart Failure. (n.d.). Retrieved from https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-

heart-failure/lifestyle-changes-for-heart-failure

McLeod, S. A. (2018, May 03). Erik Erikson's stages of psychosocial development. Retrieved from

https://www.simplypsychology.org/Erik-Erikson.html

Obesity. (2019, August 22). Retrieved from https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742