Mrs. Smith (black female), a 52-year-old with a history of Type II Diabetes Mellitus

Engage with a Vila Health scenario and then create a concept map that illustrates a plan for achieving high-quality outcomes for a patient.

Introduction
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you should complete the assessments in this course in the order in which they are presented.

The biopsychosocial (BPS) approach to care is a way to view all aspects of a patient’s life. It encourages medical practitioners to take into account not only the physical and biological health of a patient, but all considerations like mood, personality, and socioeconomic characteristics. This course will also explore aspects of pathophysiology, pharmacology, and physical assessment (the three Ps) as they relate to specific conditions, diseases, or disorders.

The first assessment is one in which you will create a concept map to analyze and organize the treatment of a specific patient with a specific condition, disease, or disorder.

The purpose of a concept map is to visualize connections between ideas, connect new ideas to previous ideas, and to organize ideas logically. Concept maps can be an extremely useful tool to help organize and plan care decisions. This is especially true in the biopsychosocial model of health, which takes into account factors beyond just the biochemical aspects of health. By utilizing a concept map, a nurse can simplify the connection between disease pathways, drug interactions, and symptoms, as well as between emotional, personality, cultural, and socioeconomic considerations that impact health.

Professional Context
The purpose of a concept map is to visualize connections between ideas, connect new ideas to previous ideas, and to organize ideas logically. Concept maps can be an extremely useful tool to help organize and plan care decisions. This is especially true in the context of the biopsychosocial model, which takes into account factors beyond just the biochemical aspects of health. By utilizing a concept map, a nurse can simplify the connection between disease pathways, drug interactions, and symptoms, as well as between the emotional, personality, cultural, and socioeconomic considerations that impact health.

Scenario
You have already learned about evidence-based practice and quality improvement initiatives in previous courses. You will use this information to guide your assessments, while also implementing new concepts introduced in this course. For this assessment, you will engage in the Vila Health: Using Concept Maps for Diagnosis scenario, develop a concept map, and provide supporting evidence and explanations.

Instructions
For this assessment, you will develop a concept map and a short narrative that supports and further explains how the concept map is constructed. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your evidence-based plan addresses all of the bullet points. You may also want to read the Concept Map scoring guide and Guiding Questions: Concept Map [DOCX] to better understand how each grading criterion will be assessed.

Part 1: Concept Map
Develop an evidence-based concept map that illustrates a plan for achieving high-quality outcomes for acute and chronic stages for a patient with renal failure related to diabetes in both an acute care facility and in the community.
You can achieve this by following the Vila Health scenario.
You will have a total of two concept maps. One will show the acute care facility with three diagnoses, and the other will show a home health community setting with three diagnoses.
Part 2: Additional Evidence (Narrative)
Justify the value and relevance of the evidence you used as the basis for your concept maps.
Analyze how interprofessional strategies applied to the concept map can lead to the achievement of desired outcomes.
Construct the concept maps and linkage to additional evidence in a way that facilitates a reader’s understanding of key information and links. This will be done by adding links in each section of the concept map that will show your value, relevance, and evidence.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
Submission Requirements
Length of submission: Each concept map should be on a single page, if at all possible. You will add links to each section of your concept map for additional evidence and narratives that support your concept maps.
Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your concept map, decisions made regarding care, and interprofessional strategies. Resources should be no more than five years old.
APA formatting:
For the concept map portion of this assessment, format resources and citations according to current APA style. Please include references both in-text and in the reference page that follows your narrative.
For the narrative portion of this assessment: An APA Template Tutorial [DOCX] is provided to help you in writing and formatting your analysis. You do not need to include an abstract for this assessment.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
Develop an evidence-based concept map that illustrates a plan for achieving high-quality outcomes at the acute and chronic stage for a patient with renal failure related to diabetes in both an acute care facility and in the community.
Justify the value and relevance of the evidence used as the basis for a concept map.
Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.
Analyze how interprofessional strategies applied to the concept map can lead to achievement of desired outcomes.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
Create links within each section of the concept map for any additional evidence in a way that facilitates understanding of key information.
Integrate relevant sources to support assertions, correctly formatting citations within the concept map and references using current APA style.

You are an ICU nurse (black male) at St. Anthony Medical Center. You have been assigned Mrs. Smith (black female), a 52-year-old with a history of Type II Diabetes Mellitus, who was admitted this morning with high glucose levels and Acute Renal Failure.

Ask her some questions in order to create a concept map.

_____________
Concept Map

Part 1: Concept Map of a Diabetic Patient with Renal Failure
Information of the Patient
Mrs. Johns is an African American woman in her sixties who has had Type II Diabetes Mellitus and acute kidney failure in the past. Over the past two weeks, Mrs. Johns has monitored her sugar level frequently. According to her, the fasting glucose levels have fluctuated ranging from 200 to 350+ after each meal. She states that she was not feeling well since her legs are swollen more than normal. I am quite exhausted and also have some blurry vision. Mrs. Jones reports feeling weak and a bit sick, not emptying as frequently as she typically does, and having trouble breathing while moving to the mailbox.
Acute Care Setting Concept Map
Description Assessment Treatment Outcomes
Utmost Urgent Nursing Diagnosis 1 A 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus Mrs. Johns maintains track of her fasting levels of blood sugar, which have been averaging below 200 and rising to 350 after eating. The hemoglobin A1C level is close to 8.5. 1. Do remind the patient to turn on her phone light before standing up.
2. Sustain the lowest feasible position for the patient’s bed.
3. Install an alarm clock on the patient’s bed. 4. Keep an eye on the individual for any mutational abnormalities in the brain. The patient exhibits a hemoglobin A1C score of 7%, a reading of blood sugar of less than 180 mg/dL, and a fasting blood sugar level of less than 140 mg/dL. The patient will reach and keep the levels of blood sugar within appropriate limits.
Nursing Diagnosis 2: Possibility for Extra Fluid Volume A 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus Mrs. Johns has been diagnosed with renal insufficiency and acute kidney failure. 1. Examine the patient for edema sensations and indications.
2. Carefully document the patient’s consumption and output.
3. Check the urine concentration of the patient.
4. Measure the patient each day at the same time. The patient’s consumption and output are appropriate. The individual’s urine still has a normal particular gravity. The weight of the patient fails to change. There is no edema seen in this individual.
Nursing Diagnosis 3: Risk for Falls A 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus She continually monitors her blood sugar, but she is concerned that it has trouble remaining within acceptable limits. The patient reports feeling tired and having trouble inhaling. Mrs. Johns’ home assessment revealed that she receives very little or no support within the residence. Every evening, she puts an effort to have her granddaughter visit, but she is too busy parenting her own two children and working. 1. Do remind the patient to turn on the phone light before standing up.
2. Adopt the lowest feasible posture for the patient’s bed.
3. Set an alarm clock on the patient’s bed.
4. Keep an eye on the patient to look for mentational disorders. There will not be any falls for the patient. Before standing up, the patient will turn on her call lighting. The patient will express in words that she understands the advised safety precautions necessary to assist keep her from experiencing a fall.

Community Setting Concept Map
Description Assessment Treatment Outcomes
Utmost Urgent Nursing Diagnosis 1 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus Monitoring her blood sugar regularly but is concerned that it fails to remain within a reasonable range. 1. Evaluate the patient’s understanding of insulin delivery, food, and exercise concerning Type II Diabetes Mellitus. 2. Assess the patient’s capacity for learning. 3. Consider any obstacles to comprehending the treatment plan, such as financial constraints, religion, and level of education. The client expresses verbally her comprehension of the actions undertaken to manage her diabetes type 2 Mellitus, including the testing, blood tests, or activities. The patient will follow a nutritious diet and activity plan.
Nursing Diagnosis 2: Possibility for Extra Fluid Volume 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus Monitoring her blood sugar regularly but is concerned that it fails to remain within a reasonable range .Consider all obstacles to comprehending the treatment plan, such as financial constraints, religion, and level of education. Consider all obstacles to comprehending the treatment plan, such as financial constraints, religion, and level of education.
Nursing Diagnosis 3: Risk for Falls 62-year-old woman with Acute Renal Failure and Type II Diabetes Mellitus She is a single woman who, if her type 2 diabetes is not adequately handled, might develop neuropathy in her legs. Her risk of burns, skin weeping, and getting sick is increased by it. Examine what the patient knows about wearing shoes outside and the relative humidity of the tub that she bathes in. The patient expresses verbally their comprehension of correct foot hygiene, and their skin remains fresh, dry, and undamaged.

Part 2: Narrative Report

Patient Analysis
Mrs. Johns is an African American woman in her sixties who has had Type II Diabetes Mellitus and acute kidney failure in the past. Over the past two weeks, Mrs. Johns has monitored her sugar level frequently. According to her, the fasting glucose levels have fluctuated ranging from 200 to 350+ after each meal. She states that she was not feeling well since her legs are swollen more than normal. I am quite exhausted and also have some blurry vision. Mrs. Jones reports feeling weak and a bit sick, not emptying as frequently as she typically does, and having trouble breathing while moving to the mailbox.
Evaluation
Mrs. Johns is experiencing acute renal failure and insufficient glucose management, as per the patient’s subjective knowledge. A review of data from the National Diabetes Fact Sheet, Type 2 diabetes is the seventh-leading cause of mortality in America (Yu et al., 2018). Diabetes patients accounted for over 20 percent of healthcare spending in 2013 (Vaidya & Aeddula, 2022). Hyperglycemia can cause both macrovascular and capillary illnesses as long-term consequences. Among the primary microvascular effects of diabetes is diabetic kidney failure.
Worth and Significance of Evidence
Mrs. Johns has started regularly checking her fasting glucose levels with her glucometer and has concluded that they remain consistently high. Mrs. Johns having difficulty with her many health care concerns. I carefully evaluated my options and came up with a strategy to handle her medical issues. Mrs. Johns is in dire need of instruction on correct glucose administration, nutrition, physical activity, and insulin administration (Fort, 2005). I have created a plan of treatment for Mrs. Johns in the evaluation that follows in an attempt to satisfy her demands and to quickly solve each.
Mrs. John’s first-hand story offers proof that she has struggled to maintain her blood sugar levels within the normal range. This data is valuable because it provides us with a foundation for her care strategy. The initial nursing evaluation I have made for Mrs. Johns for the intensive care environment is the risk for fluctuating glucose levels based on data gathered from the patient. Her failure to maintain her blood glucose levels within the typical range demonstrates this. According to what I have found out, Mrs. Johns is at risk of having too much fluid because of acute renal failure. Due to Mrs. Johns’ grievances of fatigue and feeling short of breath, I have concluded that she is at risk of falling (Chen et al., 2020).
Outcome Evaluation
For Nursing Diagnosis III: Risk Falls, I decided that Mrs. Johns will explain her comprehension of how to prevent falls while in the ICU. Mrs. Johns has to be cognizant of her input and output to avert CKD and finally ESRD. Mrs. Smith’s most critical nursing diagnosis for a neighborhood setting is Deficient (Kistler et al., 2021). It is known that Mrs. John will communicate her awareness of the techniques, tests for blood, and actions intended to manage her Type II Diabetes Mellitus verbally. Mrs. John will follow a diet and fitness plan.
Conclusion
Mrs. Johns will have a greater chance of managing her type 2 diabetes and acute kidney damage if the crucial things are done. Mrs. Johns has a greater likelihood of extending her life and improving her experience of her life as long as she engages in treatment and the team of professionals successfully communicates with her.

References
Chen, J., Zeng, H., Ouyang, X. et al. (2020). The incidence, risk factors, and long-term outcomes
of acute kidney injury in hospitalized diabetic ketoacidosis patients. BMC Nephrol 21, 48.
Fort, J. (2005). Chronic renal failure: a cardiovascular risk factor. Kidney International, 68, S25-
S29.
Kistler, B. M., Moore, L. W., Benner, D., Biruete, A., Boaz, M., Brunori, G., … & Kalantar-
Zadeh, K. (2021). The International Society of Renal Nutrition and Metabolism Commentary on the National Kidney Foundation and Academy of Nutrition and Dietetics KDOQI clinical practice guideline for nutrition in chronic kidney disease. Journal of Renal Nutrition, 31(2), 116-120.
Vaidya, S. R., & Aeddula, N. R. (2022). Chronic renal failure. In StatPearls [Internet].
StatPearls Publishing.
Yu, S. M., & Bonventre, J. V. (2018). Acute Kidney Injury and Progression of Diabetic Kidney
Disease. Advances in chronic kidney disease, 25(2), 166–180.

Editing and Rewriting Sample
The nursing diagnoses presented in the concept map for a diabetic patient with renal failure are not entirely correct.

In the acute care setting, the nursing diagnosis for utmost urgent care is unclear and not specific enough. The treatment plan suggested does not seem to directly address the patient’s condition, which includes acute renal failure, Type II Diabetes Mellitus, and symptoms such as leg swelling, exhaustion, and blurry vision. The treatment plan should focus on managing the patient’s blood sugar levels, monitoring kidney function, and addressing symptoms such as leg swelling and blurry vision. The nursing diagnosis for possibility of extra fluid volume is appropriate, but the outcomes listed are not specific enough to evaluate the effectiveness of the treatment plan. The nursing diagnosis for risk for falls is appropriate, but the treatment plan should focus on preventing falls related to the patient’s symptoms and condition.

In the community setting, the nursing diagnosis for utmost urgent care is again unclear and not specific enough. The nursing diagnosis for possibility of extra fluid volume is appropriate, but the treatment plan is repetitive and not specific enough. The nursing diagnosis for risk for falls is appropriate, but the treatment plan should focus on preventing falls related to the patient’s symptoms and condition.

Overall, the nursing diagnoses need to be more specific to the patient’s condition, and the treatment plans should be more targeted to address the patient’s symptoms and conditions. The outcomes listed in the concept map should be more measurable to evaluate the effectiveness of the treatment plan.

Sample Revision Guide

from the above, write what you think may be the correct eg by suggest the correct clear and specific nursing diagnosis for the acute care setting, community setting, specific treatment plans, that are targeted to address the patient’s symptoms and conditions

Based on the information provided, here are some possible nursing diagnoses, treatment plans, and interventions that may be appropriate for this patient:

Nursing Diagnosis:

Acute pain related to surgical incision and inflammation as evidenced by patient’s verbal report of pain and facial grimacing.

Treatment Plan:

Administer analgesics as ordered by the physician to manage pain.
Assess pain regularly using a pain rating scale to determine effectiveness of pain management.
Use non-pharmacologic pain management techniques such as distraction, relaxation techniques, or guided imagery to enhance pain relief.
Evaluate the effectiveness of pain management interventions and modify the plan as necessary.

Nursing Diagnosis:

Risk for infection related to surgical incision as evidenced by the presence of an open wound and patient’s recent surgery.

Treatment Plan:

Monitor the surgical incision site for signs and symptoms of infection such as redness, swelling, warmth, pain, and drainage.
Provide wound care and dressing changes as ordered by the physician to promote healing and prevent infection.
Educate the patient and family members about signs and symptoms of infection, wound care, and proper hand hygiene techniques to reduce the risk of infection.

Nursing Diagnosis:

Impaired mobility related to postoperative weakness and discomfort as evidenced by patient’s limited range of motion and difficulty ambulating.

Treatment Plan:

Encourage the patient to perform range of motion exercises and ambulation as tolerated to promote circulation and prevent complications such as deep vein thrombosis (DVT).
Use assistive devices such as a walker or cane to assist the patient with ambulation if necessary.
Provide education to the patient and family members about the importance of mobility and the risks associated with prolonged immobility.

These nursing diagnoses, treatment plans, and interventions are just examples and should be individualized based on the patient’s unique needs and condition. It’s important for nurses to work collaboratively with the patient, family members, and interdisciplinary healthcare team to develop an effective plan of care.

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