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NURA 303 Concept Care Map Template
- Course
- NURA303
- Institution
- Mercer University
This is a comprehensive Concept Care Map Template for Nura 303. *Essential Study Material!!
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NUR313: Concept Care Map TemplateStudent Name: Tamaria Woods Date: 12/01/21 Clinical Adjunct Faculty: Prof. Candy Wellstar AMC
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Key Problem: Pain/Discomfort Key Problem:__Safety__ #__3_
#__1_ “Parking Lot”
NANDA: Acute pain I don’t know how this NANDA: Risk for fall
Supporting Data: fits with the problems.
Nasal fracture Hypokalemia Supporting Data:
Maxillary fracture Diabetic diet Ambulate with assistance
C5 & C6 dislocation Creatine of 2.0 Right sided weakness
Left hip fracture C5 & C6 spin dislocation
Standing balance
impairment
Key Problem:________ #___ Reason for needing health
care: Subarachnoid Key Problem: Safety_______
hemorrhage #_2__
NANDA: NANDA: Risk for impaired
Medical Diagnoses/Surgical skin
Supporting Data: Supporting Data:
Procedure: Diabetes,
Stiches on upper left lip
Hypertension, CVA Stiches on upper left eye
84 years old
Key Assessments: Braden Diabetic
scale, MFS, Vital signs, Right side weakness
Mini-cog, Pain assessment, Immobility
Key Problem:_________ #___
Key Problem:_________ #___
NANDA:
NANDA:
Supporting Data:
Supporting Data:
, NUR313: Concept Care Map Template
Student Name: Tamaria Woods Date: 12/01/21 Clinical Adjunct Faculty: Prof. Candy Wellstar AMC
|2
Priority #__1__
Full Nursing Diagnostic Statement (2-part or 3-part format: Acute pain r/t physical trauma, secondary to a fall as
evidenced by left hip fracture, C5 & C6 dislocation and nasal fracture.
Predicted Behavioral Outcome Objectives: Set up as… “The patient will…” and use SMART format.
Outcome#1The client will report a pain level reduction of a 4 out of 10 after 30 minutes of administered pain
medication.
Outcome#2Following education the client will be able to identify nonpharmacological interventions to use to alleviate
pain.
Outcome#3The client will be able to report when there is a need for pain medication before pain becomes severe
Nursing Interventions Rationale with Citation and Page #
1. Assess pain intensity 1. Provides baseline for interventions and teaching, th
2. Administer NSAIDs as ordered includes prevention of/ or adequate relief from pain; Fa
3. Educate client when to take medications to meet standard of assessing for pain can be legally
4. Encourage to monitor pan interpreted as nursing negligence (Doenges et al., 2019
5. Educate on NSAID side effects p.636)
2. NSAIDs or an opioid analgesic may be required to
6. Determine clints acceptable level of pain
achieve pain relief. (Taylor et al.,2015, p.828)
7. Heat and cold therapy
3. Clients may have beliefs restricting use of medicati
may have a high tolerance for drugs because of recent
current use, or may not be able to take medications at a
participating in substance abuse recover program. (Dav
2019, p.635)
4. Understanding reason for severity of pain associated
with client’s condition and point toward needed
interventions for pain management. (Davis, 20219, p.6
5. NSAIDs labels contain information about the poten
for GI bleeding. (Taylor et al.,2015, p.828)
6. One client pain may not ve 100% pain free but may
as a 3 while another may require medication for pain at
same level because the experience is subjective (Doeng
al, 2019, p.637)
7. The application of local heat dilates peripheral bloo
vessels, increases tissue metabolism, reduces blood
viscosity, and increases capillary permeability, reduces
muscle tension, and helps relieve pain. The local applic
of cold constricts peripheral blood vessels, reduces mu
spasms, and promotes comfort. (Taylor et al., 2015, p.1
1086)
Evaluation: Summarize patient progress toward outcome objectives. Evaluate each outcome above
using a 2-part Evaluative Statement (not met/partially met/met) + client assessment data to support your
decision.
Outcome#1Goal met; client reported a pain level of 2.
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