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Concept Map (TEMPLATE)
Student Name:
Instructor:
DATE Care Provided and UNIT:
Patient Information
(1)
Patient Initials: S P
Age & Gender: 75 Male
Height/Weight:
Code Status:
Living Will/ DPOA:
History of Present Illness (HPI), Pathophysiology of Admitting
Dx (Cite References) Medical, Surgical, Social History (1).
WHAT BROUGHT THE PT TO THE HOSPITAL? WHAT
EVENTS LEAD UP TO THIS? WHAT HAPPENED WHEN
THEY GOT TO THE HOSPITAL- UNTIL NOW WHEN YOU
ARE PROVIDING CARE? (USE SEPARATE ATTACHED
WORD DOC WHEN NEEDED)
Medical History: (SEE RUBRIC REQUIREMENTS
)
PAST DIAGNOSED MEDICAL PROBLEMS
Surgical History: (SEE RUBRIC REQUIREMENTS
)
PAST DIAGNOSED SURGICAL PROBLEMS
Social History:
SMOKING/ CIGARETTE/ TOBACCO/ E-CIGARETTE
/MARIJUANA USEALCOHOL/ ELICIT DRUG USE
Chief Complaint
Admitting Diagnosis & Admission Date
G I Bleed and Acute Anemis
Erickson’s Developmental Stage Related to pt. & Cite
References (1) *
List and Discuss specific stage (based on objective
assessment)
Cultural considerations, ethnicity, occupation, religion, family
support, insurance. (1) (14) Socioeconomic/Cultural/Spiritual
Orientation & Psychosocial Considerations/Concerns: include
the following Social Determinants of Health (SDOH)
❋Economic Stability
( MAY DELETE THESE ‘TIPS” TO USE SPACE)
❋ Education
❋Social and Community Context
❋ Health and Health Care
❋ Neighborhood and Built Environment
Concept Map (TEMPLATE)
Student Name:
Instructor:
DATE Care Provided and UNIT:
Key Diagnostic Tests/ Procedures and Lab Results with Dates
and Normal Ranges (3)
Lab Tests
Normal Ranges
Admission Lab Values
Current Lab Values
Explain Abnormal Labs
R/T Your Pt
INCLUDE: Appropriate Diagnostic Tests/ Procedures- DATEs
and RESULTS
(Can add See attached Word Doc)
ANTICIPATED TRANSFER/ DISCHARGE PLANNING:
DISCUSS: PRIORITY GOALS TO BE ACHIEVED to
TRANSFER or DISCHARGE
EQUIPMENT
( MAY DELETE THESE ‘TIPS” TO USE SPACE)
MEDS
TREATMENT
REFERRALS NEEDED
Medical Management and Collaborative Plan
(from MD, PT, OT notes….etc.) *Consider past 24 – 48 hours
Patient Education (In Pt.) for Transfer/ Discharge Planning
ASSESS LEARNING STYLE:
LEARNING PREFERENCE: WRITTEN, VIDEO, etc.
LEARNING BARRIER(S): LANGUAGE, EDUCATION LEVEL
ASSISTIVE DEVICES: GLASSES, HEARING AIDES, etc.
Medications & Allergies (2)
Medication Name
Dose
Route
Freq.
Indications (PRN meds must include
MD ordered Indication)
Mechanism of Action
Side Effects/
Adverse Reactions
Nursing Considerations
RN Considerations
Concept Map (TEMPLATE)
Student Name:
Instructor:
DATE Care Provided and UNIT:
Respiratory (7)
Cardiovascular (6)
Vital Signs (4)
Neurological (5)
ASSESSMENT/
REVIEW OF SYTEMS
Musculoskeletal
(8)
GI
Hydration/Nutrition (9)
GU (10)
Rest/ Exercise (11)
Integumentary (12)
Misc.
Psychosocial (14)
Endocrine (13)
Concept Map (TEMPLATE)
Student Name:
Instructor:
DATE of Care Provided and UNIT:
Priority Nursing Diagnosis #1
Priority Nursing Diagnosis #2
PLAN OF CARE
Evaluation #1
Intervention #1
At Risk Dx.-
Outcome/Goal #1
Outcome/Goal #1
At Risk Interventions
At Risk Outcomes/
Goal
Evaluation #2
At Risk Evaluation Plan
Interventions # 2
(VM/GP/KL-V5)
Concept Map (TEMPLATE)                Student NameInstruc.docx

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Concept Map (TEMPLATE) Student NameInstruc.docx

  • 1. Concept Map (TEMPLATE) Student Name: Instructor: DATE Care Provided and UNIT: Patient Information (1) Patient Initials: S P Age & Gender: 75 Male Height/Weight: Code Status: Living Will/ DPOA: History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite References) Medical, Surgical, Social History (1). WHAT BROUGHT THE PT TO THE HOSPITAL? WHAT EVENTS LEAD UP TO THIS? WHAT HAPPENED WHEN THEY GOT TO THE HOSPITAL- UNTIL NOW WHEN YOU ARE PROVIDING CARE? (USE SEPARATE ATTACHED WORD DOC WHEN NEEDED) Medical History: (SEE RUBRIC REQUIREMENTS
  • 2. ) PAST DIAGNOSED MEDICAL PROBLEMS Surgical History: (SEE RUBRIC REQUIREMENTS ) PAST DIAGNOSED SURGICAL PROBLEMS Social History: SMOKING/ CIGARETTE/ TOBACCO/ E-CIGARETTE /MARIJUANA USEALCOHOL/ ELICIT DRUG USE Chief Complaint Admitting Diagnosis & Admission Date G I Bleed and Acute Anemis Erickson’s Developmental Stage Related to pt. & Cite References (1) * List and Discuss specific stage (based on objective assessment) Cultural considerations, ethnicity, occupation, religion, family
  • 3. support, insurance. (1) (14) Socioeconomic/Cultural/Spiritual Orientation & Psychosocial Considerations/Concerns: include the following Social Determinants of Health (SDOH) ❋Economic Stability ( MAY DELETE THESE ‘TIPS” TO USE SPACE) ❋ Education ❋Social and Community Context ❋ Health and Health Care ❋ Neighborhood and Built Environment Concept Map (TEMPLATE) Student Name: Instructor: DATE Care Provided and UNIT: Key Diagnostic Tests/ Procedures and Lab Results with Dates and Normal Ranges (3) Lab Tests Normal Ranges Admission Lab Values Current Lab Values Explain Abnormal Labs R/T Your Pt
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  • 6. INCLUDE: Appropriate Diagnostic Tests/ Procedures- DATEs and RESULTS (Can add See attached Word Doc)
  • 7. ANTICIPATED TRANSFER/ DISCHARGE PLANNING: DISCUSS: PRIORITY GOALS TO BE ACHIEVED to TRANSFER or DISCHARGE EQUIPMENT ( MAY DELETE THESE ‘TIPS” TO USE SPACE) MEDS TREATMENT REFERRALS NEEDED Medical Management and Collaborative Plan (from MD, PT, OT notes….etc.) *Consider past 24 – 48 hours Patient Education (In Pt.) for Transfer/ Discharge Planning ASSESS LEARNING STYLE: LEARNING PREFERENCE: WRITTEN, VIDEO, etc. LEARNING BARRIER(S): LANGUAGE, EDUCATION LEVEL ASSISTIVE DEVICES: GLASSES, HEARING AIDES, etc.
  • 8. Medications & Allergies (2) Medication Name Dose Route Freq. Indications (PRN meds must include MD ordered Indication) Mechanism of Action Side Effects/ Adverse Reactions Nursing Considerations RN Considerations
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  • 13. Concept Map (TEMPLATE) Student Name: Instructor: DATE Care Provided and UNIT: Respiratory (7) Cardiovascular (6) Vital Signs (4) Neurological (5) ASSESSMENT/ REVIEW OF SYTEMS
  • 15. GU (10) Rest/ Exercise (11) Integumentary (12) Misc. Psychosocial (14) Endocrine (13)
  • 16. Concept Map (TEMPLATE) Student Name: Instructor: DATE of Care Provided and UNIT: Priority Nursing Diagnosis #1 Priority Nursing Diagnosis #2 PLAN OF CARE Evaluation #1 Intervention #1 At Risk Dx.-
  • 17. Outcome/Goal #1 Outcome/Goal #1 At Risk Interventions At Risk Outcomes/ Goal Evaluation #2 At Risk Evaluation Plan Interventions # 2 (VM/GP/KL-V5)