Concept Map Analysis: Type 2 Diabetes Mellitus
with Non-Healing Diabetic Foot Ulcer
Patient Model: Sequoia — 54-Year-Old Native American Female
NUR 302: Integrated Nursing Practice
Southern New Hampshire University
Department of Nursing
June 10, 2026
Abstract
This paper presents a comprehensive concept map analysis for Sequoia, a 54-year-old
Native American female presenting with Type 2 Diabetes Mellitus (T2DM), a non-healing
right plantar foot ulcer, major depressive disorder secondary to recent widowhood, and
hypertension. The concept map integrates seven interrelated branches: pathophysiology,
clinical cues and signs/symptoms, diagnostics, evidence-based medical management,
nursing diagnoses and interventions, Social Determinants of Health (SDOH) with cultural
humility, and patient education with discharge planning. Each branch is aligned with the
National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement
Model (NCJMM) phases and incorporates current 2026 American Diabetes Association
(ADA) Standards of Care. The analysis emphasizes the intersection of physiological,
psychosocial, and socioeconomic factors driving Sequoia's clinical presentation and
proposes holistic, culturally congruent nursing interventions.
Keywords: concept map, Type 2 Diabetes, diabetic foot ulcer, NCJMM, SDOH, cultural humility, Native
American health, wound care
, NUR 302 Concept Map — Sequoia T2DM
1. Primary Diagnosis and Patient Profile
CENTER NODE: Primary Medical Diagnosis
Type 2 Diabetes Mellitus (T2DM) with Non-Healing Diabetic Foot Ulcer (Right Plantar Surface)
Secondary Diagnoses: Major Depressive Disorder (recent onset, secondary to widowhood); Hypertension
The concept map is anchored by Sequoia's primary medical diagnosis of T2DM complicated
by a non-healing diabetic foot ulcer on the right plantar surface. This diagnosis represents a
convergence of chronic hyperglycemia-induced microvascular and macrovascular complications,
further compounded by psychosocial stressors and SDOH barriers. Sequoia's profile—a
middle-aged Native American woman in a rural setting, recently widowed, facing transportation
and food security challenges—exemplifies the complex interplay of biological, psychological, and
social determinants that drive health disparities in Indigenous populations. The concept map's seven
branches radiate from this central node to provide a comprehensive, systems-based view of her
clinical presentation and nursing care priorities.
2. Branch 1: Pathophysiology
The pathophysiological cascade begins with chronic hyperglycemia, which drives the
formation of Advanced Glycation End-products (AGEs). AGEs cause progressive microvascular
damage, resulting in peripheral neuropathy characterized by loss of protective sensation in the
lower extremities. This sensory deficit leads to unrecognized minor trauma—such as pressure
injuries or foreign bodies—that go undetected until significant tissue damage has occurred.
Simultaneously, AGEs cause macrovascular damage, producing Peripheral Arterial Disease (PAD)
that reduces oxygen and nutrient delivery to the wound bed. The combined effects of tissue
hypoxia, impaired immune response (due to hyperglycemia-mediated leukocyte dysfunction), and
sustained mechanical stress culminate in non-healing ulceration (ADA, 2024).
A critical psychosocial dimension compounds this physiological cascade. Sequoia's recent
widowhood has triggered a grief response associated with elevated cortisol and chronic stress,
which directly worsens glycemic control through increased hepatic gluconeogenesis and insulin
resistance. This bidirectional relationship between psychological distress and metabolic
dysregulation creates a vicious cycle that undermines both wound healing and self-care motivation,
illustrating the importance of addressing behavioral health in diabetic wound management.
3. Branch 2: Clinical Cues and Signs/Symptoms (Recognize Cues)
The NCJMM's first phase—Recognize Cues—requires the nurse to identify both subjective
and objective data that signal Sequoia's clinical status. Subjective cues include her reports of
fatigue, expressions of hopelessness (stating she is "not seeing the point" in managing her health),
and a variable pain assessment that is itself a significant finding: the fluctuating nature of her pain
reflects the sensory loss characteristic of diabetic peripheral neuropathy, where patients may feel no
pain despite serious tissue damage, or may experience neuropathic pain disproportionate to
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with Non-Healing Diabetic Foot Ulcer
Patient Model: Sequoia — 54-Year-Old Native American Female
NUR 302: Integrated Nursing Practice
Southern New Hampshire University
Department of Nursing
June 10, 2026
Abstract
This paper presents a comprehensive concept map analysis for Sequoia, a 54-year-old
Native American female presenting with Type 2 Diabetes Mellitus (T2DM), a non-healing
right plantar foot ulcer, major depressive disorder secondary to recent widowhood, and
hypertension. The concept map integrates seven interrelated branches: pathophysiology,
clinical cues and signs/symptoms, diagnostics, evidence-based medical management,
nursing diagnoses and interventions, Social Determinants of Health (SDOH) with cultural
humility, and patient education with discharge planning. Each branch is aligned with the
National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement
Model (NCJMM) phases and incorporates current 2026 American Diabetes Association
(ADA) Standards of Care. The analysis emphasizes the intersection of physiological,
psychosocial, and socioeconomic factors driving Sequoia's clinical presentation and
proposes holistic, culturally congruent nursing interventions.
Keywords: concept map, Type 2 Diabetes, diabetic foot ulcer, NCJMM, SDOH, cultural humility, Native
American health, wound care
, NUR 302 Concept Map — Sequoia T2DM
1. Primary Diagnosis and Patient Profile
CENTER NODE: Primary Medical Diagnosis
Type 2 Diabetes Mellitus (T2DM) with Non-Healing Diabetic Foot Ulcer (Right Plantar Surface)
Secondary Diagnoses: Major Depressive Disorder (recent onset, secondary to widowhood); Hypertension
The concept map is anchored by Sequoia's primary medical diagnosis of T2DM complicated
by a non-healing diabetic foot ulcer on the right plantar surface. This diagnosis represents a
convergence of chronic hyperglycemia-induced microvascular and macrovascular complications,
further compounded by psychosocial stressors and SDOH barriers. Sequoia's profile—a
middle-aged Native American woman in a rural setting, recently widowed, facing transportation
and food security challenges—exemplifies the complex interplay of biological, psychological, and
social determinants that drive health disparities in Indigenous populations. The concept map's seven
branches radiate from this central node to provide a comprehensive, systems-based view of her
clinical presentation and nursing care priorities.
2. Branch 1: Pathophysiology
The pathophysiological cascade begins with chronic hyperglycemia, which drives the
formation of Advanced Glycation End-products (AGEs). AGEs cause progressive microvascular
damage, resulting in peripheral neuropathy characterized by loss of protective sensation in the
lower extremities. This sensory deficit leads to unrecognized minor trauma—such as pressure
injuries or foreign bodies—that go undetected until significant tissue damage has occurred.
Simultaneously, AGEs cause macrovascular damage, producing Peripheral Arterial Disease (PAD)
that reduces oxygen and nutrient delivery to the wound bed. The combined effects of tissue
hypoxia, impaired immune response (due to hyperglycemia-mediated leukocyte dysfunction), and
sustained mechanical stress culminate in non-healing ulceration (ADA, 2024).
A critical psychosocial dimension compounds this physiological cascade. Sequoia's recent
widowhood has triggered a grief response associated with elevated cortisol and chronic stress,
which directly worsens glycemic control through increased hepatic gluconeogenesis and insulin
resistance. This bidirectional relationship between psychological distress and metabolic
dysregulation creates a vicious cycle that undermines both wound healing and self-care motivation,
illustrating the importance of addressing behavioral health in diabetic wound management.
3. Branch 2: Clinical Cues and Signs/Symptoms (Recognize Cues)
The NCJMM's first phase—Recognize Cues—requires the nurse to identify both subjective
and objective data that signal Sequoia's clinical status. Subjective cues include her reports of
fatigue, expressions of hopelessness (stating she is "not seeing the point" in managing her health),
and a variable pain assessment that is itself a significant finding: the fluctuating nature of her pain
reflects the sensory loss characteristic of diabetic peripheral neuropathy, where patients may feel no
pain despite serious tissue damage, or may experience neuropathic pain disproportionate to
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