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Running Head CONCEPT MAP PART B
Student Number:
Concept Map Part B
Student Name: Tanya Bowman
Student Number: 821-427-853
NURS 252 (466)
Professor: Kelly Ross
Submitted: March 31/15
821-427-853
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853
Concept Map Part B
Determining a priority pathway is important when a nurse is presented with a patient.
Patients can present with multiple issues or they can be less complex. Some patients present
with a vast amount of information whereas some present with very little. This is when the nurses
critical thinking skills are required. Critical thinking is defined as a way of thinking about
anything resulting in the thinker improving their thinking skills. (Kelly & Crawford, 2013) These
skills will continue to develop as the nurse has more experiences. The scenario that I was
presented with was as follows:
Scenario
81 yr. old male, Type 1 Diabetes indicated on medic alert bracelet, found in dumpster, numerous
points of skin break down on arms and legs draining serous fluid, refuses eye contact, will not
answer questions or speak and vitals are: T 38.0, R-16, BP 95/65, O2 sat 97% RA.
The objective for this exercise is to identify the most critical pathway. I chose to focus on
a pathophysiological priority based on my critical thinking skills. The pathophysiological
priority I chose was the patients risk for infection. Within this paper I will be discussing my
rationale for the pathway I chose. We will also discuss my rationale for the clinical
manifestations and nursing interventions indicated in the concept map pathway.
Pathway
Reviewing the scenario I was presented with I chose to focus most on the physiological
pathway. The physiological aspects my patient presented with I felt that he was most at risk for
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853
infection. The information in the scenario that focused my attention to risk for infection was the
fact that the patient had a temperature of 38.0, he had skin breakdown on his arms and legs
draining serous fluid and the patient is a Type 1 Diabetic. All of these clinical manifestations are
are signs an infection could be present. The patient has open wounds and is
immunocompromised as a result of Type 1 diabetes. Studies have shown that diabetes has
contributed to an increase in overall infection rates. (Muller, Gorter, Hak, Goudzwaard,
Schellevis, Hoepelman & Rutten, 2005). As indicated, many health concerns are caused from
infection slowing the wound healing process. (Wound Care Centers).
Clinical Manifestation
The pathophysiology of Type 1 diabetes indicates that it is the B cells being destroyed.
(Lewis, Dirksen, Heitkemper, Bucher & Camera, 2014). With this type of diabetes the body no
longer produces insulin. Insulin is used to help bring glucose into the cells. When there is an
obstruction such as fat the insulin is not able to help the glucose enter the cells. Therefore, the
glucose remains in the blood stream. When glucose remains in the blood stream increasing the
patients’ blood glucose levels as well, restricting the elasticity of the arteries.
When the blood
sugar level is high the red blood cells cannot function properly. They are not able to carry the
nutrients to the tissue that is required for healing. This also decreases the function of the white
blood cells. If the white blood cells are compromised this leaves the patient exposed to a risk for
infection. (Wound Care Centers). Concluding that because a diabetics immune system does not
optimally function they are at a higher risk for infection.
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853
Nursing Interventions
The nursing interventions I chose to implement were to test the patients’ blood sugar,
assess the blood and urine for ketone levels; assess the patient’s knowledge about his diabetes
and provide education. I will now discuss each nursing intervention and provide rationale for my
choices. The first intervention is to test patient’s blood sugar levels. The patient presented
with an indication on the bracelet that he was Type 1 Diabetic. Taking a blood glucose test will
indicate to the nurse whether the patient is in a hypoglycemic or hyperglycemic state. Optimal
blood glucose levels are 4 to 6 mmol/L before meals. ( Lewis, Dirksen, Heitkemper, Buchner &
Camera, 2014). As mentioned in discussion of the clinical manifestation if the blood glucose
level is high his wounds are not getting the proper nutrients to heal properly.
The second intervention is to assess the blood and urine for ketone levels. Newly
diagnosed Type 1 diabetics and diabetics who discontinue their insulin will lead to DKA
( Diabetic Ketone Acidosis). The most well-known causes of DKA are inadequate insulin and
infection (Kitabchi, Umpierrez, Murphy & Kreisberg, 2006). This would be a further
complication and also can indicate that an infection is on board.
The third intervention is assessing the patient’s knowledge about diabetes and wounds. If
the patient has limited knowledge of his chronic condition he is at risk for infections. It
is important the patient to know how to assess their skin. The patient should know what to look
for and how to care for their skin to avoid skin break down. Things to look for would be to not
wear bare feet, inspect your feet daily, and look for reddened hot areas, areas of skin breakdown,
discoloration etc. (RNAO, 2010) Showing the patient the relationship between injury, vascular
disease and neuropathy and the risks for lower extremity injuries are important. Protecting your
skin and understanding the risks is essential to abstaining from further health problems.
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853
The last intervention is to provide education to the patient in proper management of Type
1 diabetes. Nutrition is one of the most important components of diabetes management. Proper
nutrition helps to regulate blood sugar levels. There are three things to ensure proper nutrition
management. They are consistency, quantity and quality. Consistency means eating three meals a
day spaced out between four and six hours, quantity means being cognizant of your portions and
quality is watching those food choices. (RNAO, 2010). Teach proper insulin administration,
also when and how insulin it should be administered. It is important that the patient understand
their diabetic medications. These medications if not taken properly can lead to hypoglycemia
which can be life threatening. Knowing when to seek medical attention, physical activity,
personal hygiene and complications associated with diabetes are other health teaching topics for
a diabetic.
In conclusion I have rationalized my thought process for the pathway that I have chosen.
This particular patient is at risk for infection having a diagnosis of Type 1 diabetes. Type 1
diabetes was the main clinical manifestation identified. Correcting the instability of the blood
sugar levels will promote the healing of his wounds. Assessing for ketones will help to identify
DKA and provide indication an infection is present. Learning the patients knowledge around
their chronic condition is important. If the patient has limited knowledge then they are at risk for
skin breakdown and slow wound healing promoting infection. Lastly, the health teaching being
the most important tool to remaining healthy. Arming the patient with the proper knowledge is
the most important form of prevention.
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853
References
Kelly, P., Crawford, H., (2013) Chapter 17: Decision Making. In Nursing Leadership and
Management 2nd Edition (p.349). Nelson Education Ltd. Toronto, Ont.
Kitabchi, A.E., Umpierrez, E.G., Murphy, M.B. & Kreisberg, R.A., (2006)
Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, Volume 29 no. 12
2739-2748
Lewis S.L., Dirksen S.R., Heitkemper M.M., Buchner L, Camera I.M. (2014) Chapter 52:
Nursing Management: Diabetes Mellitus. In M.A Barry, S. Goldsworthy, D. Goodridge
3rd Ed Medical Surgical Nursing in Canada Pathophysiological Mechanism of Disease
(p.1431,1435, ). Toronto, Elsevier
RNAO (2010) Getting to know your Diabetes: Reference Guide for people with
diabetes.(p.14 & 26) Retrieved March 22, 2015 from http://rnao.ca/sites/rnaoca/files/storage/related/7795_Ref.Guide_for_People_with_Diabetes_PDF_FINAL.pdf
Wound Care Centers: How Diabetes Affects Wound Healing.
Retrieved on March 22, 2015 from: http://www.woundcarecenters.org/article/living-withwounds/how-diabetes-affects-wound-healing
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Running Head CONCEPT MAP PART B
Student Number:
821-427-853