Schuster • 1n AC linical Judgment Approach to Patient Care FIFTH EDITION • • • • • • • • • • & .. • • • • • • • -· • • • • • • • • • • • • • • • • • • • • • F.A.DAVIS 9473_FM_i-xiv 14/11/19 10:54 am Page i Ace your courses with Davis’s SUCCESS SERIES Q&A | Course Review | NCLEX®-Prep “My test scores definitely went up after I found these books.” —Sakin Mahama, Student, Georgia Baptist College of Nursing “My #1 go-to the week before ANY exam!” —Andrea A., Amazon.com “The rationales are the reason I love the books in the Davis Success series.” —Lynn Coburn, Amazon.com SAVE 20% ORDER TODAY! + FREE SHIPPING FADavis.com Use Promo Code: DAVIS20 Promotion subject to change without notice. Offer valid for individual purchases from FADavis.com in the US only. 9473_FM_i-xiv 14/11/19 10:54 am Page ii 9473_FM_i-xiv 14/11/19 10:54 am Page iii Concept Mapping A Clinical Judgment Approach to Patient Care FIFTH EDITION Pamela McHugh Schuster, PhD, FNP-BC Professor of Nursing Youngstown State University Youngstown, Ohio 9473_FM_i-xiv 14/11/19 10:54 am Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2020 by F. A. Davis Company All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor, Nursing:Jacalyn Sharp Senior Content Project Manager: Amy Romano Illustration and Design Manager:Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Schuster, Pamela McHugh, 1953- author. Title: Concept mapping : a clinical judgment approach to patient care / Pamela McHugh Schuster. Description: Fifth edition. | Philadelphia, PA : F.A. Davis Company, [2020] | Includes bibliographical references and index. | Summary: “The purpose of this book is to teach nursing students how to use concept mapping theory to develop a concept care map, which is to be used in the direct care of patients and to communicate with members of the health-care team. Concept mapping is a diagrammatic teaching and learning strategy that allows students and faculty to visualize interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments. Concept care maps result in a clear mental model of the patient health state and situation. Students must learn to share relevant information with the specific aim of creating a shared mental model with members of the health-care team to prevent errors that result in patient injuries and death”—Provided by publisher. Identifiers: LCCN 2019044000 (print) | LCCN 2019044001 (ebook) | ISBN 9780803694736 (paperback) | ISBN 9780803694743 (ebook) Subjects: MESH: Patient Care Planning | Nursing Process—organization & administration | Concept Formation | Audiovisual Aids Classification: LCC RT42 (print) | LCC RT42 (ebook) | NLM WY 100.1 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2019044000 LC ebook record available at https://lccn.loc.gov/2019044001 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-9473-6/19 0+$.25. 9473_FM_i-xiv 14/11/19 10:55 am Page v This book is dedicated to nursing students and clinical faculty intent on development of clinical judgment in patient situations and delivery of excellent patient care. This book is also dedicated to my husband, Fred, and to my children, Luke, Leeanna, Patty, Isaac, Brent, and Maggie, and grandchildren Adam, Lucas, Julianna, Cameron, and Benjamin. 9473_FM_i-xiv 14/11/19 10:55 am Page vi 9473_FM_i-xiv 14/11/19 10:55 am Page vii PREFACE The purpose of this book is to teach nursing students how to use concept mapping theory to develop sound clinical judgments by using a concept map when providing direct care to patients and to communicate with members of the interprofessional team. Concept mapping is a diagrammatic, nonlinear, and iterative teaching and learning strategy that allows students and faculty to visualize interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments. Through diagramming elements of management of clinical situations, students learn to critically think and analyze patient care delivery. Concept care maps result in a clear mental model of the patient health state and situation. Students must also learn to share relevant information with the specific aim of creating a shared mental model with members of the interprofessional team to prevent errors that result in patient injuries and death. The fifth edition of Concept Mapping: A Clinical Judgment Approach to Patient Care is updated and revised on the basis of the continued use of concept care maps in varied clinical settings and the recommendations of the faculty and students who have been working with concept care maps since the first publication. The title has changed slightly from A Critical Thinking Approach to A Clinical Judgment Approachbecause concept mapping improves critical thinking and results in excellent clinical judgment and improved clinical performance. This edition includes funda- mental, medical-surgical, pediatric, psychiatric, women’s health, and critical care studies and integrates American Nurses Association (ANA) Standards of Nursing Prac- tice and North American Nursing Diagnosis Association (NANDA) Nursing Diagnoses. The online resources include 22 additional case studies so that students can practice creating maps for various clinical settings as they advance through a nursing program. The creation of a concept care map is the result of a five-step process. Before devel- oping a care map, the student must collect information about the patient, including his- tory, physical examination, medications, laboratory, test results, and treatments. From that information, the student develops a skeleton diagram of the patient's health problems (step 1). The student then uses critical thinking and analyzes and categorizes patient in- formation (step 2) and indicates the relationships between the nursing and medical diag- noses (step 3). In step 4, the student forms clinical judgments and develops patient goals, outcomes, and nursing strategies for each nursing diagnosis. Step 5 is to evaluate the patient response to each nursing strategy and to summarize clinical judgments with regard to out- comes. Care mapping enables the student to recognize the relationships between medical and nursing care problems, including integration of pathology, medications, treatments, and laboratory and diagnostic testing. Using this care map process, the student: ◗ Identifies the primary patient care problems using specific data/cues ◗ Analyzes patient information and categorizes the data to describe problems and provides data/cues to support each problem within a box on the care map ◗ Draws lines between boxes to indicate relationships ◗ Assigns numbers to the problems to indicate their priority ◗ Develops a goal, outcomes, and strategies for each problem ◗ Uses the case mapping process to form sound clinical judgments and to select appropriate strategies to provide safe and effective care ◗ Uses care maps as the basis for documentation in patient medical records vii 9473_FM_i-xiv 14/11/19 10:55 am Page viii viii Preface ◗ Uses care maps to participate in developing a shared mental model of the patient’s health status and situation with members of the interprofessional team to prevent patient harmful events After the theoretical discussion of each step to develop the care map, the book presents case studies and end-of-chapter exercises that the student can use to gradually develop the ability to clinically reason and formulate accurate and complete nursing diagnoses and then develop the individualized plan of care. Concept care maps promote clinical reasoning and development of sound clinical judgments, leading to an accurate mental model of the patient situation and clear, succinct communication with the interprofessional team. My best wishes for much success in nurs- ing, and I hope you find this book and the online resources helpful in designing excellent care plans and providing safe and effective patient care. A Note about Usage To avoid both sexism and the constant repetition of “he or she,” “his or her,” and so forth, masculine and feminine pronouns are used alternately throughout the text. 9473_FM_i-xiv 14/11/19 10:55 am Page ix CONTRIBUTOR LIST Louise A. Aurilio,PhD, RN-BC, Mary Beth Lukach,MSN, RN, CNS NE-BC, CNE Senior Lecturer of Nursing Professor Emeritus of Nursing Kent State University Trumbull Youngstown State University Warren, Ohio Youngstown, Ohio Depression With Polysubstance C-section With Gestational Diabetes Abuse (P) (OB) Newborn With Jaundice (OB) Valerie O’Dell,DNP, RN, CNE Professor of Nursing and MSN Program Kimberly A. Ballone,DNP, FNP-BC Director Professor of Nursing Youngstown State University Youngstown State University Youngstown, Ohio Youngstown, Ohio Newborn With Jaundice (OB) Cystic Fibrosis in Hospital (Peds) Newborn of Mother With Gestational Respiratory Syncytial Virus (Peds) Diabetes (OB) Vaginal Delivery With Laceration and Sheila Blank,DNP, RN Repair (OB) Assistant Professor of Nursing Vaginal Delivery for Gravida 9(OB) Youngstown State University Youngstown, Ohio Nicole Olshanski,DNP, CNM Child With Food Allergy and Assistant Professor of Nursing Anaphylactic Symptoms(Peds) Youngstown State University Youngstown, Ohio Laura Calcagni,MSN, RN, CNE Pregnancy With Sexually Transmitted Assistant Professor of Nursing Infection(OB) Youngstown State University Youngstown, Ohio Teresa Peck,MSN, RN Status Post Cardiac Arrest/Myocardial Lecturer Infarction (CC) Youngstown State University Youngstown, Ohio Kelly Clark,MSN, RN Adult With Attention-Deficit/ Instructor of Nursing Hyperactivity Disorder(P) Hiram College Hiram, Ohio Jill E. Rankin,DNP, RN Bipolar With Psychosis (P) Assistant Professor of Nursing and Nursing Program Director Susan Lisko,DNP, RN, CNE Hiram University Professor of Nursing Hiram, Ohio Youngstown State University Osteosarcoma With Chemotherapy Youngstown, Ohio (Peds) Appendectomy (MS) Sickle Cell Crisis (Peds) ix