THINK LIKE A NURSE!

Think Out Loud

Cognitive Maps

• Graphic or pictorial arrangements of related key concepts

• Helps organize knowledge in a format that is compatible with the way we create meaning

• Personal expression of meaning for the subject matter

• Tool to teach students how to think

Concept Maps

• Aids in clarifying a small number of key ideas – not all inclusive

• Encourages reflective thinking • Anchoring of new ideas or concepts with

previously acquired knowledge creates meaningful learning and leads to sound decision-making

Concept Maps

• Presents a clear picture of what the student is thinking

• Provides a general road map for reading; brings it to life

• Missing linkages indicate need for more information

• Pre-mapping for clinical helps provide direction

Concept Maps

• Assists in organizing data• Can improve use of language• Improves communication of ideas

Concept Maps

• Specific structure is context – dependent

• No right or wrong - Individual• Instructor needs to encourage

creativity• Good for small groups ex. post-

conference

Concept Maps

• Concepts are organized with the most general or most important concepts at the top or center of the map. Progressively more specific or less important concepts are placed under the more inclusive concepts.

• ID relevant concepts and develop a hierarchical structure choose links in ways to show valid relationships.

• Structure can vary

Case Study

• P.J. is an 81 year old widowed male.

• c/o sore right foot, trouble walking for “few years”, worse in the last month.

• Hx: Type 2 DM, HTN, diabetic neuropathy, former smoker

• 3 children, all live out of state.

• c/o recent poor appetite.

• 2 dime sized ulcers on right foot, yellow, black toes. + sensation to bilateral feet.

Assessment

• Denies severe pain, 2/10 at toes.• BP 180/92, HR 88 and regular, RR

20 and unlabored, T 36.7• S1, S2. • DP/PT pulse 1+ left, not able to

doppler or palpate on right.

• Bilateral feet cool, R>L• Cap refill R > 3 sec., L = 3 sec.• Scattered expiratory wheezes RUL,

RA, SpO2 = 95%.• AAOX3, pleasant, conversant.• c/o hunger, “haven’t eaten yet

today” (time is now 6:10pm)• Denies bowel/bladder problems.

Group Concept Map Design Risk Factors

81 y.o. Type 2 DM HTN X-Smoker Stress

Pathophysiology

81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid VasoconstrictionElasticity/ productionFragile vessels

Decreased perfusion

Diagnosis/Presenting Problem

81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid VasoconstrictionElasticity/ productionFragile vessels

Decreased perfusion

PVD

Assessment Findings

81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid Vasoconstriction WidowedElasticity/ production 3 children, don’t Fragile vessels live close

Decreased perfusion AAOX3, pleasant, conversant

180/92, 88 PVD 2 dime sized, yellow ulcers R footS1, S2; reg. Feet cool, R>L; temp 36.7 R toes X5 black, hard, uneven + sensation bilat. feet 2/10 pain R toes with palp.RA SpO2 = 95% 1+ DP/PT left, No pulses R foot Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec.RR 20 Hungry, has not eaten today BTs X4 quads

Denies bowel/bladder prob.; has not voided Poor appetite Lives alone

Diagnostics

81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168Decreased Increased lipid Vasoconstriction WidowedElasticity/ production 3 children, don’t Fragile vessels HDL = 38, LDL = 242 live close

Decreased perfusion AAOX3, pleasant, conversant

180/92, 88 PVD 2 dime sized, yellow ulcers R foot ABI R = .15S1, S2; reg. Feet cool, R>L; temp 36.7 ABI L = .40Na/K = 142/3.9 R toes X5 black, hard, uneven + sensation bilat. Feet H/H = 38/12.2 2/10 pain R toes with palp.RA SpO2 = 95% 1+ DP/PT left, No pulses R foot Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec.RR 20 Hungry, has not eaten today BTs X4 quadsBUN/CR= Denies bowel/bladder prob.; has not voided18/1.0 Poor appetite Lives alone

Medications

81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168 Glucotrol 5 mg qdDecreased Increased lipid Vasoconstriction WidowedElasticity/ production 3 children, don’t Fragile vessels HDL = 38, LDL = 242 Lipitor 20 mg qd live close

Decreased perfusion AAOX3, pleasant, conversant

180/92, 88 Metoprolol PVD 2 dime sized, yellow ulcers R foot ABI R = .15S1, S2; reg. 25 mg bid Feet cool, R>L; temp 36.7 ABI L = .40Na/K = 142/3.9 R toes X5 black, hard, uneven + sensation bilat. Feet H/H = 38/12.2 2/10 pain R toes with palp.RA SpO2 = 95% 1+ DP/PT left, No pulses R foot Trental 400mg tid

Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec.RR 20 Hungry, has not eaten today BTs X4 quadsBUN/CR= Denies bowel/bladder prob.; has not voided18/1.0 Poor appetite Lives alone

Care Plan

81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168 Glucotrol 5 mg qdDecreased Increased lipid Vasoconstriction WidowedElasticity/ production 3 children, don’t Fragile vessels HDL = 38, LDL = 242 Lipitor 20 mg qd live close

Decreased perfusion AAOX3, pleasant, conversant 180/92, 88 Metoprolol PVD 2 dime sized, yellow ulcers R foot ABI R = .15S1, S2; reg. 25 mg bid Feet cool, R>L; temp 36.7 ABI L = .40Na/K = 142/3.9 R toes X5 black, hard, uneven + sensation bilat. Feet H/H = 38/12.2 2/10 pain R toes with palp.RA SpO2 = 95% 1+ DP/PT left, No pulses R foot Trental 400mg tid Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec.RR 20 Hungry, has not eaten today BTs X4 quadsBUN/CR= Denies bowel/bladder prob. 18/1.0 Has not voided

Poor appetite Lives aloneInadequate tissue perfusion r/t PVD aeb black toes, cool feet, ABI results.- Granulation tissue will be evident at foot ulcers by __________.

- Elevate R foot; injury precautions; monitor CSM, pulse, pain.