Concept Map (TEMPLATE) Student Name: Instructor: DATE Care Provided and UNIT:       Patient Information (1) Patient Initials:   Age & Gender:   Height/Weight:   Code Status:   Living Will/ DPOA: History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite References) Medical, Surgical, Social History (1). WHAT BROUGHT THE PT TO THE HOSPITAL? WHAT EVENTS LEAD UP TO THIS? WHAT HAPPENED WHEN THEY GOT TO THE HOSPITAL- UNTIL NOW WHEN YOU ARE PROVIDING CARE? (USE SEPARATE ATTACHED WORD DOC WHEN NEEDED)             Medical History: (SEE RUBRIC REQUIREMENTS) PAST DIAGNOSED MEDICAL PROBLEMS               Surgical History: (SEE RUBRIC REQUIREMENTS) PAST DIAGNOSED SURGICAL PROBLEMS           Social History: SMOKING/ CIGARETTE/ TOBACCO/ E-CIGARETTE /MARIJUANA USE ALCOHOL/ ELICIT DRUG USE   Chief Complaint         Admitting Diagnosis & Admission Date       Erickson’s Developmental Stage Related to pt. & Cite References (1) *List and Discuss specific stage (based on objective assessment) Cultural considerations, ethnicity, occupation, religion, family support, insurance. (1) (14) Socioeconomic/Cultural/Spiritual Orientation & Psychosocial Considerations/Concerns: include the following Social Determinants of Health (SDOH) ?Economic Stability ( MAY DELETE THESE ‘TIPS” TO USE SPACE) ? Education ?Social and Community Context ? Health and Health Care ? Neighborhood and Built Environment             Concept Map (TEMPLATE) Student Name: Instructor: DATE Care Provided and UNIT:       Key Diagnostic Tests/ Procedures and Lab Results with Dates and Normal Ranges (3)     Lab Tests   Normal Ranges Admission Lab Values   Current Lab Values Explain Abnormal Labs R/T Your Pt                                                                                                                                                                 INCLUDE: Appropriate Diagnostic Tests/ Procedures- DATEs and RESULTS   (Can add See attached Word Doc)                                                   ANTICIPATED TRANSFER/ DISCHARGE PLANNING: DISCUSS: PRIORITY GOALS TO BE ACHIEVED to TRANSFER or DISCHARGE   EQUIPMENT ( MAY DELETE THESE ‘TIPS” TO USE SPACE)   MEDS   TREATMENT   REFERRALS NEEDED   Medical Management and Collaborative Plan (from MD, PT, OT notes….etc.) *Consider past 24 – 48 hours   Patient Education (In Pt.) for Transfer/ Discharge Planning   ASSESS LEARNING STYLE: LEARNING PREFERENCE: WRITTEN, VIDEO, etc.       LEARNING BARRIER(S): LANGUAGE, EDUCATION LEVEL ASSISTIVE DEVICES: GLASSES, HEARING AIDES, etc.                 Medications & Allergies (2)   Medication Name Dose Route Freq. Indications (PRN meds must include MD ordered Indication) Mechanism of Action Side Effects/ Adverse Reactions Nursing Considerations RN Considerations                                                                                                                                                                                                                                                                                                                                             Concept Map (TEMPLATE)   Student Name: Instructor: DATE Care Provided and UNIT:       Respiratory (7)         Cardiovascular (6)         Vital Signs (4)         Neurological (5)             ASSESSMENT/ REVIEW OF SYTEMS                                             Musculoskeletal (8)                       GI Hydration/Nutrition (9)       GU (10)         Rest/ Exercise (11)                     Integumentary (12)         Misc.   Psychosocial (14)       Endocrine (13)                 Concept Map (TEMPLATE)   Student Name: Instructor: DATE of Care Provided and UNIT:       Priority Nursing Diagnosis #1     Priority Nursing Diagnosis #2     PLAN OF CARE           Evaluation #1     Intervention #1             At Risk Dx.-           Outcome/Goal #1   Outcome/Goal #1   At Risk Interventions   At Risk Outcomes/ Goal   Evaluation #2           At Risk Evaluation Plan           Interventions # 2                     (VM/GP/KL-V5)