NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
Name: Click or tap here to enter text.
Course Click or tap here to enter text.
:
Client Information (SBAR) Concept of the Map
Mr. J.R. Brooks is a 69-year-old male who presented to the Gas Exchange
Emergency Department with worsening shortness of breath over COPD
the past 3 days. He reports increased fatigue and difficulty
Situation “catching his breath even while sitting.” He has a productive
cough with thick yellow sputum. At home, he normally uses
oxygen at 2 L via nasal cannula PRN, but today he requires 4 L to
maintain SpO₂ at 90%.
Past medical history: Chronic Obstructive Pulmonary Disease
(diagnosed 5 years ago), hypertension, hyperlipidemia.
Smoking history: 40 pack-years, quit 5 years ago.
Medications: Albuterol inhaler, Tiotropium, Lisinopril, Simvastatin.
Background
Allergies: No known drug allergies (NKDA).
Social: Lives independently, previously reported good compliance
with home inhalers.
Recent: Upper respiratory infection reported last week.
Vital signs: BP 154/88 mmHg, HR 112 bpm (tachycardia), RR
28/min (labored), Temp 38.3°C (100.9°F), SpO₂ 85% on room air,
90% on 4 L NC.
Respiratory: Audible wheezing, accessory muscle use, pursed-lip
Assessment breathing, productive cough with yellow sputum.
Appearance: Patient appears anxious, fatigued, and has
increased work of breathing.
Findings suggest acute COPD exacerbation with possible infectious trigger.
Recommendation Admit patient to step-down or medical unit for close monitoring
of respiratory status.
Continue and titrate supplemental oxygen to maintain SpO₂
between 88–92% (avoid hyperoxia in COPD).
Initiate nebulized bronchodilator therapy and administer IV
corticosteroids per protocol.
Start empiric antibiotics to address suspected bacterial infection.
Encourage use of pursed-lip breathing techniques to reduce
dyspnea.
Monitor ABGs, electrolytes, and fluid status closely.
Provide patient education on COPD management and reinforce smoking
cessation.
, Recognize Cues Analyze Cues
Subjective Cues (from patient report): Impaired Gas Exchange
Patient states: “I can’t catch my breath, even sitting Evidence: SpO₂ 85% on room air, 90% on 4 L
down.” (Dyspnea at rest) NC; RR 28/min with labored breathing;
accessory muscle use; pursed-lip breathing.
Reports increased fatigue over the past 3 days.
Explanation: In COPD, alveolar damage and
Reports productive cough with thick yellow sputum. chronic inflammation reduce oxygen diffusion.
The patient’s hypoxemia and increased work of
Objective Cues (clinical findings): breathing indicate impaired gas exchange
(Potter et al., 2023).
SpO₂: 85% on room air, 90% on 4 L NC → hypoxemia
despite oxygen therapy. Ineffective Airway Clearance
RR: 28/min, labored, with accessory muscle use and Evidence: Productive cough with thick yellow
pursed-lip breathing → increased work of breathing. sputum, audible wheezing, coarse breath
sounds.
HR: 112 bpm (tachycardia) → compensatory response
to hypoxemia. Explanation: Infection and excess mucus
obstruct the airways, making it difficult for the
Temp: 38.3°C (100.9°F) → febrile, suggesting patient to clear secretions effectively. This
infectious process. contributes to wheezing and further impairs
ventilation (Shah et al., 2023).
Audible wheezing and coarse breath sounds → airway
obstruction. Risk for/Presence of Infection
BP: 154/88 mmHg → hypertensive, possibly stress- Evidence: Temperature 38.3°C, productive
related. cough with purulent sputum, recent upper
respiratory infection.
Patient appears anxious and fatigued.
Explanation: The fever and sputum
characteristics suggest a bacterial respiratory
infection, which may be precipitating the COPD
exacerbation (GOLD, 2023).
Activity Intolerance (secondary to dyspnea and
fatigue)
Evidence: Patient unable to catch breath even
at rest, reports fatigue.
Explanation: Increased energy demands of labored
breathing reduce tolerance for physical activity, even
minimal exertion (Potter et al., 2023).
Prioritize Hypotheses Generate Solutions
1. Impaired Gas Exchange Oxygenation Goal (Impaired Gas Exchange)
Priority #1 (Most urgent) Within 30 minutes of initiating supplemental oxygen
1. and titrating to appropriate levels, Mr. Brooks’ SpO₂
Rationale: Low SpO₂ (85% RA, 90% on 4 L NC) and tachypnea indicate
compromised oxygenation. Without correction, this could progress to acute will increase to and remain within 88–92% (COPD
respiratory failure, which is life-threatening. target range), as measured by continuous pulse
oximetry, without signs of oxygen toxicity.
2. Breathing Pattern Goal (Impaired Gas
Exchange)
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
Name: Click or tap here to enter text.
Course Click or tap here to enter text.
:
Client Information (SBAR) Concept of the Map
Mr. J.R. Brooks is a 69-year-old male who presented to the Gas Exchange
Emergency Department with worsening shortness of breath over COPD
the past 3 days. He reports increased fatigue and difficulty
Situation “catching his breath even while sitting.” He has a productive
cough with thick yellow sputum. At home, he normally uses
oxygen at 2 L via nasal cannula PRN, but today he requires 4 L to
maintain SpO₂ at 90%.
Past medical history: Chronic Obstructive Pulmonary Disease
(diagnosed 5 years ago), hypertension, hyperlipidemia.
Smoking history: 40 pack-years, quit 5 years ago.
Medications: Albuterol inhaler, Tiotropium, Lisinopril, Simvastatin.
Background
Allergies: No known drug allergies (NKDA).
Social: Lives independently, previously reported good compliance
with home inhalers.
Recent: Upper respiratory infection reported last week.
Vital signs: BP 154/88 mmHg, HR 112 bpm (tachycardia), RR
28/min (labored), Temp 38.3°C (100.9°F), SpO₂ 85% on room air,
90% on 4 L NC.
Respiratory: Audible wheezing, accessory muscle use, pursed-lip
Assessment breathing, productive cough with yellow sputum.
Appearance: Patient appears anxious, fatigued, and has
increased work of breathing.
Findings suggest acute COPD exacerbation with possible infectious trigger.
Recommendation Admit patient to step-down or medical unit for close monitoring
of respiratory status.
Continue and titrate supplemental oxygen to maintain SpO₂
between 88–92% (avoid hyperoxia in COPD).
Initiate nebulized bronchodilator therapy and administer IV
corticosteroids per protocol.
Start empiric antibiotics to address suspected bacterial infection.
Encourage use of pursed-lip breathing techniques to reduce
dyspnea.
Monitor ABGs, electrolytes, and fluid status closely.
Provide patient education on COPD management and reinforce smoking
cessation.
, Recognize Cues Analyze Cues
Subjective Cues (from patient report): Impaired Gas Exchange
Patient states: “I can’t catch my breath, even sitting Evidence: SpO₂ 85% on room air, 90% on 4 L
down.” (Dyspnea at rest) NC; RR 28/min with labored breathing;
accessory muscle use; pursed-lip breathing.
Reports increased fatigue over the past 3 days.
Explanation: In COPD, alveolar damage and
Reports productive cough with thick yellow sputum. chronic inflammation reduce oxygen diffusion.
The patient’s hypoxemia and increased work of
Objective Cues (clinical findings): breathing indicate impaired gas exchange
(Potter et al., 2023).
SpO₂: 85% on room air, 90% on 4 L NC → hypoxemia
despite oxygen therapy. Ineffective Airway Clearance
RR: 28/min, labored, with accessory muscle use and Evidence: Productive cough with thick yellow
pursed-lip breathing → increased work of breathing. sputum, audible wheezing, coarse breath
sounds.
HR: 112 bpm (tachycardia) → compensatory response
to hypoxemia. Explanation: Infection and excess mucus
obstruct the airways, making it difficult for the
Temp: 38.3°C (100.9°F) → febrile, suggesting patient to clear secretions effectively. This
infectious process. contributes to wheezing and further impairs
ventilation (Shah et al., 2023).
Audible wheezing and coarse breath sounds → airway
obstruction. Risk for/Presence of Infection
BP: 154/88 mmHg → hypertensive, possibly stress- Evidence: Temperature 38.3°C, productive
related. cough with purulent sputum, recent upper
respiratory infection.
Patient appears anxious and fatigued.
Explanation: The fever and sputum
characteristics suggest a bacterial respiratory
infection, which may be precipitating the COPD
exacerbation (GOLD, 2023).
Activity Intolerance (secondary to dyspnea and
fatigue)
Evidence: Patient unable to catch breath even
at rest, reports fatigue.
Explanation: Increased energy demands of labored
breathing reduce tolerance for physical activity, even
minimal exertion (Potter et al., 2023).
Prioritize Hypotheses Generate Solutions
1. Impaired Gas Exchange Oxygenation Goal (Impaired Gas Exchange)
Priority #1 (Most urgent) Within 30 minutes of initiating supplemental oxygen
1. and titrating to appropriate levels, Mr. Brooks’ SpO₂
Rationale: Low SpO₂ (85% RA, 90% on 4 L NC) and tachypnea indicate
compromised oxygenation. Without correction, this could progress to acute will increase to and remain within 88–92% (COPD
respiratory failure, which is life-threatening. target range), as measured by continuous pulse
oximetry, without signs of oxygen toxicity.
2. Breathing Pattern Goal (Impaired Gas
Exchange)
