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Concept Map Essay

  • Submitted by: femochy001
  • on March 17, 2015
  • Category: Miscellaneous
  • Length: 623 words

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Below is an essay on "Concept Map" from Anti Essays, your source for research papers, essays, and term paper examples.

Patient Bio-data:

Name: A. H.       Age: 59,       Sex: Male,     Race: Caucasian     Marital Status: Widower

Reason for admission:   Infected ankle wound from bed rest.
Medical History: Depression, DM Type 2, Infected sacral wound.

(A). Psychosocial Assessment Data:
  * Patient oriented to time, place and person (X3).
  * Patient is emotionally unstable and exacerbated by the death of wife 6 month ago.
  * Patient is bed bound, and has not been eating well.

NANDA Problem:
  * Risk for loneliness related to loss of spouse as evidence by patient exacerbation and not eating well
Nursing Interventions:
  *   Assist patient with ADL’s including (bathing, dressing and oral hygiene).
  * Encourage patient to verbalize his feeling and try to engage him in discussion if he wants to and time permit.
  * Provide patient with nutritional meal, and identify patient favorite diet with patient,
  * Ensure that patient's chosen diet is rich in protein and other nutrients that will aid wound healing.
(B). Physiologic Integrity Assessment Data:
  * Patient has Diabetic type 2.
  * Infected wound which developed while on bed rest following an ankle sprain.
  * Patient need support to ambulate.
  * Patient has unstable gait and his on fall precaution.

NANDA Problem:
  * Impaired mobility related to unstable gait evidence by patient history of fall and ambulatory support.
  * Risk for Impaired skin integrity related to decrease mobility.
Nursing Interventions:
  * Make sure infected wound site is clean using aseptic wound care procedure.
  * Ensure that open wounds are well covered after cleaning.
  * Ensure patient personal hygiene and oral care is done daily.
  * Change patient linen and underwear when moist to prevent skin breakdown.
  * Ensure that patient is constantly repositioned to prevent skin breakage.
(C) Self Care Assessment Data:
  * Patient has a risk for fall related to prior fall

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