NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
NURSING PROCESS TEMPLATE: Concept- Nutrition
Lillian Carter who is an 82-year-old female who presented to
Assessment (Recognizing Cues)
the ED due to progressive weakness, weight loss, and poor oral
Which client information is relevant? What client data is most intake. Her daughter became concerned when she noticed that
important? Which client information is of immediate concern? her mom was unusually weak, had no energy to get out of bed,
Consider signs and symptoms, lab work, client statements, H & and was coughing more than usual. She also reported that her
P, and others. Consider subjective and objective data. mother had not been eating or drinking much recently and
seemed confused during a recent phone call.
Medical Hx: Type 2 Diabetes, Hypertension (HTN), Mild
Cognitive Impairment, Osteoarthritis
Medications: Metformin, Lisinopril, Acetaminophen
Living Situation: Lives alone, receives Meals on Wheels
occasionally
Subjective Data:
Client Statement: “I haven’t had much of an appetite
lately. It’s just too much trouble to cook for one.”
Daughter reported: Client seems increasingly confused
and has been eating and drinking very little.
Objective Data:
Height 5’3”, Weight: 92lbs, BMI 16.3 (low)
VS: Temp 98.6F, 88HR, RR20, 110/68, pain 0/10, O2
Sat 93%RA
Labs: Albumin: 2.8 g/dL (low), Prealbumin: 12 mg/dL
(low), Hemoglobin: 10.5 g/dL (low), Glucose: 145
mg/dL (fasting)
Appears thin and frail, dry mucous membranes,
decreased skin turgor, unsteady gait
Meal intake < 25% over the last three days
Immediate Concern:
Severe malnutrition and dehydration put the patient
at risk for complications such as infection, impaired
wound healing, falls, decline in cognition and
functional ability
Risk for falls with injury- Frailty, unsteady gait, and
increased weakness from malnutrition put the client
at high risk for falling, which can lead to fractures or
hospitalization
Cognitive decline related to inadequate nutrition and
hydration.
Concern for functional decline and loss of
independence increasing dependency and risk for
alternate living placement
Client conditions that are consistent with the cues:
Analysis (Analyzing Cues)
The cues all strongly suggest the patient is experiencing protein-
Which client conditions are consistent with the cues? Do the cues calorie malnutrition
support a particular client condition? What cues are a cause for
concern? What other information would help to establish the Client conditions that are consistent with the cues:
significance of a cue? BMI of 16.3 (underweight)
Weight of 92 lbs at 5'3"
Poor oral intake (<25%) over the last 3 days
Albumin 2.8 g/dL, prealbumin 12 mg/dL (both low)
Frail appearance, dry mucous membranes, decreased
Page 1 of 12
, skin turgor
Unsteady gait, fatigue, and functional decline
Subjective report: “I haven’t had much of an appetite
lately.”
Social factors: Lives alone, cognitive impairment, lacks
regular meal support
What cues are a cause for concern:
Labs indicating malnutrition (low albumin/prealbumin)
Low BMI indicating chronic undernutrition
Ongoing poor intake — risk of further decline if not
addressed
Physical weakness and unsteadiness, increasing fall
risk
What other information would help to establish the significance
of a cue?
Recent weight trends for 3 months ago
Detailed dietary intake for the last 24 hours
Functional assessment for ability to feed self, shop,
cook
Cognitive screening to evaluate how it may affect
eating behaviors
Labs: BUN and creatinine to help review hydration
status
What explanations are most likely?
Analysis (Prioritizing Hypotheses)
The most likely explanation for Mrs. Carter’s clinical
What explanations are most likely? What is the most serious presentation is protein-calorie malnutrition due to poor oral
explanation? What is the priority order for safe and effective care? intake and mild cognitive impairment. This is supported by
In order of priority, identify the top 4 client conditions. abnormal nutritional lab values (Albumin, Prealbumin,
Hemoglobin). Her diagnosis of Mild Cognitive Impairment and
her dependance on delivery of food from Meals on Wheels also
increases her risk for poor nutrition.
What is the most serious explanation?
The most serious concern is protein-calorie malnutrition. This
increases the risk for infection, delayed healing, and
hospitalization. This condition also leads to physical weakness,
frailty, risk of falls, decline in functional ability, and cognition. If
left untreated, it can result in long-term loss of independence
and even death.
What is the priority order for safe and effective care?
1. Severe nutritional deficiency
2. Dehydration related to poor intake
3. Functional impairment and weakness
4. Cognitive decline caused by malnutrition
What are desirable outcomes?
Planning (Generate Solutions)
1. Improve nutritional intake
What are the desirable outcomes? What interventions can achieve 2. Stabilize weight or gain weight
these outcomes? What should be avoided? (SMART Planning- 3. Improve Lab values
specific, measurable, attainable, realistic/relevant, time-restricted- 4. Increase strength and energy
Goal setting)
What interventions can achieve these outcomes in SMART
format?
Goal 1:
Page 2 of 12
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
NURSING PROCESS TEMPLATE: Concept- Nutrition
Lillian Carter who is an 82-year-old female who presented to
Assessment (Recognizing Cues)
the ED due to progressive weakness, weight loss, and poor oral
Which client information is relevant? What client data is most intake. Her daughter became concerned when she noticed that
important? Which client information is of immediate concern? her mom was unusually weak, had no energy to get out of bed,
Consider signs and symptoms, lab work, client statements, H & and was coughing more than usual. She also reported that her
P, and others. Consider subjective and objective data. mother had not been eating or drinking much recently and
seemed confused during a recent phone call.
Medical Hx: Type 2 Diabetes, Hypertension (HTN), Mild
Cognitive Impairment, Osteoarthritis
Medications: Metformin, Lisinopril, Acetaminophen
Living Situation: Lives alone, receives Meals on Wheels
occasionally
Subjective Data:
Client Statement: “I haven’t had much of an appetite
lately. It’s just too much trouble to cook for one.”
Daughter reported: Client seems increasingly confused
and has been eating and drinking very little.
Objective Data:
Height 5’3”, Weight: 92lbs, BMI 16.3 (low)
VS: Temp 98.6F, 88HR, RR20, 110/68, pain 0/10, O2
Sat 93%RA
Labs: Albumin: 2.8 g/dL (low), Prealbumin: 12 mg/dL
(low), Hemoglobin: 10.5 g/dL (low), Glucose: 145
mg/dL (fasting)
Appears thin and frail, dry mucous membranes,
decreased skin turgor, unsteady gait
Meal intake < 25% over the last three days
Immediate Concern:
Severe malnutrition and dehydration put the patient
at risk for complications such as infection, impaired
wound healing, falls, decline in cognition and
functional ability
Risk for falls with injury- Frailty, unsteady gait, and
increased weakness from malnutrition put the client
at high risk for falling, which can lead to fractures or
hospitalization
Cognitive decline related to inadequate nutrition and
hydration.
Concern for functional decline and loss of
independence increasing dependency and risk for
alternate living placement
Client conditions that are consistent with the cues:
Analysis (Analyzing Cues)
The cues all strongly suggest the patient is experiencing protein-
Which client conditions are consistent with the cues? Do the cues calorie malnutrition
support a particular client condition? What cues are a cause for
concern? What other information would help to establish the Client conditions that are consistent with the cues:
significance of a cue? BMI of 16.3 (underweight)
Weight of 92 lbs at 5'3"
Poor oral intake (<25%) over the last 3 days
Albumin 2.8 g/dL, prealbumin 12 mg/dL (both low)
Frail appearance, dry mucous membranes, decreased
Page 1 of 12
, skin turgor
Unsteady gait, fatigue, and functional decline
Subjective report: “I haven’t had much of an appetite
lately.”
Social factors: Lives alone, cognitive impairment, lacks
regular meal support
What cues are a cause for concern:
Labs indicating malnutrition (low albumin/prealbumin)
Low BMI indicating chronic undernutrition
Ongoing poor intake — risk of further decline if not
addressed
Physical weakness and unsteadiness, increasing fall
risk
What other information would help to establish the significance
of a cue?
Recent weight trends for 3 months ago
Detailed dietary intake for the last 24 hours
Functional assessment for ability to feed self, shop,
cook
Cognitive screening to evaluate how it may affect
eating behaviors
Labs: BUN and creatinine to help review hydration
status
What explanations are most likely?
Analysis (Prioritizing Hypotheses)
The most likely explanation for Mrs. Carter’s clinical
What explanations are most likely? What is the most serious presentation is protein-calorie malnutrition due to poor oral
explanation? What is the priority order for safe and effective care? intake and mild cognitive impairment. This is supported by
In order of priority, identify the top 4 client conditions. abnormal nutritional lab values (Albumin, Prealbumin,
Hemoglobin). Her diagnosis of Mild Cognitive Impairment and
her dependance on delivery of food from Meals on Wheels also
increases her risk for poor nutrition.
What is the most serious explanation?
The most serious concern is protein-calorie malnutrition. This
increases the risk for infection, delayed healing, and
hospitalization. This condition also leads to physical weakness,
frailty, risk of falls, decline in functional ability, and cognition. If
left untreated, it can result in long-term loss of independence
and even death.
What is the priority order for safe and effective care?
1. Severe nutritional deficiency
2. Dehydration related to poor intake
3. Functional impairment and weakness
4. Cognitive decline caused by malnutrition
What are desirable outcomes?
Planning (Generate Solutions)
1. Improve nutritional intake
What are the desirable outcomes? What interventions can achieve 2. Stabilize weight or gain weight
these outcomes? What should be avoided? (SMART Planning- 3. Improve Lab values
specific, measurable, attainable, realistic/relevant, time-restricted- 4. Increase strength and energy
Goal setting)
What interventions can achieve these outcomes in SMART
format?
Goal 1:
Page 2 of 12
