THINK LIKE A NURSE!

1. THINK LIKE A NURSE! Think Out Loud

2. 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

3. 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

4. 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

5. Concept Maps • Assists in organizing data • Can improve use of language • Improves communication of ideas

6. Concept Maps • Specific structure is context – dependent • No right or wrong - Individual • Instructor needs to encourage creativity • Good for small groups ex. post-conference

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. Group Concept Map Design Risk Factors 81 y.o. Type 2 DM HTN X-Smoker Stress

13. Pathophysiology 81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid Vasoconstriction Elasticity/ production Fragile vessels Decreased perfusion

14. Diagnosis/Presenting Problem 81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid Vasoconstriction Elasticity/ production Fragile vessels Decreased perfusion PVD

15. Assessment Findings 81 y.o. Type 2 DM HTN X-Smoker Stress Decreased Increased lipid VasoconstrictionWidowed Elasticity/ production3 children, don’t Fragile vesselslive close Decreased perfusionAAOX3, pleasant, conversant 180/92, 88PVD 2 dime sized, yellow ulcers R foot S1, 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

16. Diagnostics 81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168 Decreased Increasedlipid VasoconstrictionWidowed Elasticity/production 3 children, don’t Fragile vesselsHDL = 38, LDL = 242live close Decreased perfusionAAOX3, pleasant, conversant 180/92, 88PVD  2 dime sized, yellow ulcers R foot  ABI R = .15 S1, S2; reg. Feet cool, R>L; temp 36.7ABI L = .40 Na/K = 142/3.9R toes X5 black, hard, uneven + sensation bilat. FeetH/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 quads BUN/CR=Denies bowel/bladder prob.; has not voided 18/1.0Poor appetite Lives alone

17. Medications 81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168Glucotrol 5 mg qd Decreased Increased lipidVasoconstriction Widowed Elasticity/ production3 children, don’t Fragile vesselsHDL = 38, LDL = 242Lipitor 20 mg qdlive close Decreased perfusionAAOX3, pleasant, conversant 180/92, 88MetoprololPVD  2 dime sized, yellow ulcers R foot  ABI R = .15 S1, S2; reg.25 mg bidFeet cool, R>L; temp 36.7ABI L = .40 Na/K = 142/3.9R toes X5 black, hard, uneven + sensation bilat. FeetH/H = 38/12.2 2/10 pain R toes with palp. RA SpO2 = 95% 1+ DP/PT left, No pulses R footTrental 400mg tid Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec. RR 20 Hungry, has not eaten today BTs X4 quads BUN/CR=Denies bowel/bladder prob.; has not voided 18/1.0Poor appetite Lives alone

18. Care Plan 81 y.o. Type 2 DM HTN X-Smoker Stress BS = 168Glucotrol 5 mg qd Decreased Increased lipidVasoconstrictionWidowed Elasticity/ production3 children, don’t Fragile vesselsHDL = 38, LDL = 242Lipitor 20 mg qdlive close Decreased perfusionAAOX3, pleasant, conversant 180/92, 88MetoprololPVD  2 dime sized, yellow ulcers R foot  ABI R = .15 S1, S2; reg.25 mg bidFeet cool, R>L; temp 36.7ABI L = .40 Na/K = 142/3.9R toes X5 black, hard, uneven + sensation bilat. FeetH/H = 38/12.2 2/10 pain R toes with palp. RA SpO2 = 95% 1+ DP/PT left, No pulses R footTrental 400mg tid Exp. wheezes RUL Cap refill R foot >3 sec., L = 3 sec. RR 20 Hungry, has not eaten today BTs X4 quads BUN/CR=Denies bowel/bladder prob. 18/1.0Has not voided Poor appetite Lives alone Inadequate 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.