Using the attached Concept Map Template can you create a Concept Map based on the information below:
Concept Map: Acid-Base Balance
NURSING PROCESS TEMPLATE
Assessment (Recognizing Cues)
Relevant Patient Information:
Mr. John Doe, 55-year-old male, presents with shortness of breath, confusion, and weakness.
History of chronic obstructive pulmonary disease (COPD), recently treated for a respiratory infection.
Important Data:
Vital signs: BP 130/85 mmHg, HR 105 bpm, RR 28 breaths/min, Temp 99.0°F, SpO2 85% on room air.
Physical examination: Respiratory distress, use of accessory muscles, diffuse wheezing.
ABGs: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, PaO2 60 mmHg.
Immediate Concerns:
Respiratory acidosis due to CO2 retention.
Hypoxemia and risk of respiratory failure.
Analysis (Analyzing Cues)
Consistent Patient Conditions:
COPD exacerbation leading to respiratory acidosis.
Possible underlying infection exacerbating respiratory symptoms.
Cues Supporting Conditions:
Low pH and elevated PaCO2 indicate respiratory acidosis.
Low PaO2 and SpO2 indicate hypoxemia.
Cause for Concern:
Worsening respiratory distress and potential respiratory failure.
Impaired gas exchange leading to acid-base imbalance.
Additional Information Needed:
Results of complete blood count, serum electrolytes, and chest X-ray.
Response to non-invasive positive pressure ventilation (NIPPV).
Analysis (Prioritizing Hypotheses)
Respiratory acidosis due to COPD exacerbation.
Hypoxemia due to impaired gas exchange.
Potential underlying infection worsening respiratory status.
Planning (Generate Solutions)
Goal: Improve oxygenation and ventilation.
Intervention: Initiate NIPPV to assist with breathing and improve gas exchange.
Goal: Correct acid-base imbalance.
Intervention: Monitor ABGs closely and adjust ventilation settings as needed.
Goal: Stabilize vital signs.
Intervention: Monitor vital signs frequently and adjust treatments to maintain stability.
Goal: Manage underlying infection if present.
Intervention: Obtain chest X-ray and start appropriate antibiotic therapy if infection is confirmed.
Goal: Educate patient and family on COPD management.
Intervention: Provide education on the use of inhalers and strategies to prevent exacerbations.
Implementation (Take Actions)
NIPPV: Administer and monitor for effectiveness, adjusting settings as needed.
ABG Monitoring: Perform serial ABGs to assess respiratory status and acid-base balance.
Vital Signs Monitoring: Regularly check and document BP, HR, RR, Temp, and SpO2.
Chest X-ray: Obtain imaging to check for infection or other abnormalities.
Patient Education: Teach proper inhaler use and COPD management strategies.
Evaluation (Evaluating Outcomes)
Oxygenation and Ventilation: Improvement in ABGs (normalization of pH, decrease in PaCO2, and increase in PaO2).
Acid-Base Balance: Stabilization of ABGs within normal range.
Vital Signs Stability: Maintaining BP, HR, and SpO2 within normal limits.
Infection Management: Reduction in symptoms and signs of infection if present.
Patient Knowledge: Increased understanding of COPD management and proper inhaler use.
CONCEPT MAP TEMPLATE
Patient Information (SBAR)
Situation (S): Mr. John Doe, a 55-year-old male, presents to the emergency department with shortness of breath, confusion, and weakness. He has a history of chronic obstructive pulmonary disease (COPD) and has been experiencing increased shortness of breath over the past three days.
Background (B): Mr. Doe has a 20-year history of smoking, which he quit five years ago. He has been diagnosed with COPD for the past ten years and uses albuterol and ipratropium inhalers regularly. He was recently treated for a respiratory infection with antibiotics. He has no known allergies and is compliant with his COPD management plan.
Assessment (A): Upon examination, Mr. Doe is in respiratory distress. His vital signs are: BP 130/85 mmHg, HR 105 bpm, RR 28 breaths/min, Temp 99.0°F, and SpO2 85% on room air. He is using accessory muscles to breathe and has diffuse wheezing on auscultation. Arterial blood gases (ABGs) reveal the following: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, PaO2 60 mmHg.
Recommendation (R): Admit Mr. Doe to the intensive care unit for further management. Initiate non-invasive positive pressure ventilation (NIPPV) to improve oxygenation and ventilation. Obtain a complete blood count, serum electrolytes, and chest X-ray. Monitor ABGs closely and adjust treatment as necessary.
Main Concept
Concept: Acid-Base Balance
Recognizing Cues (S&S)
Shortness of breath
Confusion
Weakness
Respiratory distress with use of accessory muscles
Diffuse wheezing
ABGs: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, PaO2 60 mmHg
SpO2 85% on room air
Disease Process/Pathophysiology/Risk Factors
Disease Process and Pathophysiology:
COPD is characterized by chronic airflow limitation and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It leads to alveolar destruction and loss of lung elasticity, resulting in impaired gas exchange. COPD exacerbations can lead to respiratory acidosis due to CO2 retention.
Risk Factors:
Long-term smoking history
Recent respiratory infection
Non-compliance with COPD management
Analyzing Cues/Conditions
Respiratory acidosis due to increased PaCO2.
Hypoxemia due to impaired gas exchange.
Increased work of breathing and respiratory distress.
Potential underlying infection exacerbating COPD symptoms.
Prioritizing Hypotheses
Respiratory acidosis due to COPD exacerbation.
Hypoxemia due to impaired gas exchange.
Potential underlying infection worsening respiratory status.
SMART Planning: Generate Solutions/Outcomes/Interventions
Improve oxygenation and ventilation:
Within 2 hours of initiating NIPPV, Mr. Doe’s SpO2 will improve to >90%.
Correct acid-base imbalance:
Within 24 hours, ABG results will show a pH between 7.35-7.45.
Stabilize vital signs:
Within 4 hours, Mr. Doe’s HR will be below 100 bpm, and RR below 25 breaths/min.
Manage underlying infection if present:
If infection is confirmed, Mr. Doe will show reduced signs of infection within 48 hours of starting antibiotics.
Educate patient and family on COPD management:
By discharge, Mr. Doe and his family will demonstrate correct inhaler use and understand strategies to prevent exacerbations.
Taking Action – (How To)
NIPPV: Set up and monitor Mr. Doe on NIPPV, adjust settings based on ABG results.
ABG Monitoring: Draw and analyze ABGs every 2-4 hours, adjust treatment accordingly.
Vital Signs Monitoring: Check BP, HR, RR, Temp, and SpO2 every hour initially, then every 4 hours as condition stabilizes.
Chest X-ray and Labs: Perform a chest X-ray and obtain CBC and serum electrolytes to identify any underlying infections.
Patient Education: Provide step-by-step instructions and demonstration on inhaler use, educate on avoiding triggers, and managing COPD at home.
Evaluating Outcomes
Oxygenation and Ventilation: SpO2 levels above 90% and improvement in ABG results.
Acid-Base Balance: ABG results showing a normal pH and reduced PaCO2 levels.
Vital Signs Stability: BP, HR, and RR within normal limits, stable over consecutive checks.
Infection Management: Decrease in signs of infection (e.g., reduced fever, improved WBC count).
Patient Knowledge: Mr. Doe and his family correctly demonstrate inhaler use and verbalize understanding of COPD management strategies.
Notes: The information provided was just a make up patient case. Please include some reference. My school uses Turnitin application. Please no plagiarism, Thank you!
Please utilize these Resource/Book(s):
Giddens, J. F. ([Insert Year of Publication]). Concepts for Nursing Practice (4th ed.). Elsevier – Evolve. https://pageburstls.elsevier.com/books/9780323812085
Huether, S. E., McCance, . L., & Brashers, V. L. ([Insert Year of Publication]). Understanding Pathophysiology (7th ed.). Elsevier – Evolve. https://online.vitalsource.com/books/9780323639088
