Student Name
Capella University
NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1
Prof. Name
Date
Introduction to Narrative
This assessment presents concept maps developed from the Vila Health scenario involving a patient with acute renal failure and type 2 diabetes mellitus. The narrative illustrates concept maps created for two distinct care settings: the acute care environment at St. Anthony Medical Center Home Health Agency and the home health community setting following the patient’s discharge. These concept maps aim to outline nursing diagnoses, interventions, and evidence-based strategies to enhance patient-centered care in both acute and chronic contexts.
Value and Relevance of the Evidence
The concept maps for Mrs. Smith, reflecting acute and chronic care settings, were informed by recent and pertinent evidence-based literature published within the last five years. These resources are drawn from authoritative medical, nursing, and health journals.
For example, Terauchi et al. (2020) explore pharmacological management of type 2 diabetes using insulin and other anti-diabetic medications, indicating that Mrs. Smith can achieve glycemic control through these prescribed treatments.
Similarly, Sardu et al. (2020) recommend interventions for dyspnea, including oxygen therapy and head elevation, to optimize lung expansion and breathing effort. For peripheral edema related to acute kidney injury, evidence supports the use of diuretics, limb elevation, and fluid restriction (Chhablani et al., 2020; Patschan et al., 2019; Singh & Revand, 2022). These strategies are highly relevant to Mrs. Smith’s acute care needs.
NURS FPX 6021 Assessment 1 Concept Map
In the chronic care setting, additional evidence-based interventions were applied to support Mrs. Smith’s ongoing management of diabetes and social well-being. Powers et al. (2020) emphasize diabetes self-management education and support (DSMES) as a non-pharmacological approach to controlling diabetes. DSMES programs provide patients with knowledge on nutrition, exercise, lifestyle modification, and coping strategies.
Mrs. Smith, who requires guidance on healthy eating habits, can benefit from these interventions. Addressing social isolation—a common challenge among patients with chronic diabetes—is essential. Sujan et al. (2021) highlight the importance of family involvement in chronic disease management, particularly for patients with type 2 diabetes, to improve adherence and motivation.
Lambrinou et al. (2019) emphasize the pivotal role of dietitians in developing individualized nutrition plans, ensuring that dietary interventions are manageable and diabetes-friendly. Briggs et al. (2020) further underscore that community and social support networks help patients maintain motivation and consistency in self-care routines.
Interprofessional Strategies
Effective management of chronic illnesses such as diabetes and renal failure requires interprofessional collaboration. For Mrs. Smith, a multidisciplinary team—comprising physicians, nurses, dietitians, and social workers—must coordinate care to ensure optimal outcomes.
- Physician-Nurse Collaboration: Physicians prescribe medications, while nurses administer these treatments and monitor patient responses to prevent errors.
- Dietitian-Nurse Collaboration: Dietitians develop meal plans tailored to Mrs. Smith’s nutritional requirements, while nurses reinforce dietary adherence.
- Social Worker-Nurse Collaboration: Social workers provide support for social isolation, connecting Mrs. Smith to community resources.
Effective interprofessional collaboration also involves family participation, especially when caregivers may have limited availability. Understanding Mrs. Smith’s preferences, family dynamics, and cultural factors is essential for creating individualized care plans.
Additional Evidence
Mrs. Smith, a 52-year-old Black woman, was admitted to the ICU at St. Anthony Medical Center Home Health Agency presenting with weakness, blurred vision, dyspnea, hyperglycemia, and peripheral edema. Her primary diagnoses included acute renal failure and type 2 diabetes mellitus. Using NANDA-I standardized terminology, three nursing diagnoses were identified:
| Nursing Diagnosis | Interventions | Evidence-Based Rationale |
|---|---|---|
| Type 2 diabetes causing hyperglycemia | Administer insulin, monitor glucose levels, provide DSMES | Terauchi et al., 2020; Powers et al., 2020 |
| Impaired gas exchange | Oxygen therapy, elevate head of bed, respiratory exercises | Sardu et al., 2020 |
| Peripheral edema / Poor renal function | Diuretics, fluid management, limb elevation | Chhablani et al., 2020; Patschan et al., 2019; Singh & Revand, 2022 |
Upon discharge after six weeks in acute care, Mrs. Smith transitioned to home health services. Her blood glucose stabilized, urinary output normalized, and peripheral edema decreased. Despite improvements, she required ongoing education about nutrition and faced challenges due to her inability to cook healthy meals and limited support from her daughter.
NURS FPX 6021 Assessment 1 Concept Map (Home Health Setting)
Post-discharge interventions focused on patient-centered communication and adherence to self-management plans:
| Intervention | Implementation | Evidence-Based Support |
|---|---|---|
| Patient-centered communication | Use layman’s terms, active listening, clarify concerns | Subrata, 2021 |
| Diabetes self-management | Education on diet, exercise, glucose monitoring | Powers et al., 2020; Lambrinou et al., 2019 |
| Social support facilitation | Connect to community resources and family networks | Sujan et al., 2021; Briggs et al., 2020 |
These strategies ensured that Mrs. Smith could articulate her concerns and receive tailored guidance for managing her chronic conditions effectively.
Conclusion
Acute renal failure is a common comorbidity in patients with diabetes mellitus, as illustrated by Mrs. Smith’s case. The concept maps demonstrate the integration of evidence-based interventions, interprofessional collaboration, and patient-centered communication strategies. These approaches not only support acute management in the hospital setting but also provide structured guidance for ongoing home-based care, emphasizing education, social support, and lifestyle management to promote optimal health outcomes.
References
Briggs, F. H., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2020). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053
Chhablani, J., Wong, K., Tan, G. S., Sudhalkar, A., Laude, A., Cheung, C. M. G., Zhao, P., Uy, H., Lim, J., Valero, S., Ngah, N. F., & Koh, A. (2020). Diabetic macular edema management in Asian population: Expert panel consensus guidelines. Asia-Pacific Journal of Ophthalmology, 9(5), 426–434. https://doi.org/10.1097/apo.0000000000000312
Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European Journal of Preventive Cardiology, 26(2), 55–63. https://doi.org/10.1177/2047487319885455
NURS FPX 6021 Assessment 1 Concept Map
Patschan, D., Patschan, S., Buschmann, I., & Ritter, O. (2019). Loop diuretics in acute kidney injury prevention, therapy, and risk stratification. Kidney and Blood Pressure Research, 44(4), 457–464. https://doi.org/10.1159/000501315
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report. Journal of the American Pharmacists Association, 60(6). https://doi.org/10.1016/j.japh.2020.04.018
Sardu, C., Gambardella, J., Morelli, M. B., Wang, X., Marfella, R., & Santulli, G. (2020). Hypertension, thrombosis, kidney failure, and diabetes: Is COVID-19 an endothelial disease? Journal of Clinical Medicine, 9(5), 1417. https://doi.org/10.3390/jcm9051417
Singh, S. K., & Revand, R. (2022). Physiological basis of lower limb edema. Approach to Lower Limb Oedema, 25–43. https://doi.org/10.1007/978-981-16-6206-5_3
NURS FPX 6021 Assessment 1 Concept Map
Sujan, Md. S. H., Tasnim, R., Islam, Md. S., Ferdous, Most. Z., Apu, Md. A. R., Musfique, Md. M., & Pardhan, S. (2021). COVID-19-specific diabetes worries amongst diabetic patients: The role of social support. Primary Care Diabetes. https://doi.org/10.1016/j.pcd.2021.06.009
Terauchi, Y., Nakama, T., Spranger, R., Amano, A., Inoue, T., & Niemoeller, E. (2020). Efficacy and safety of insulin glargine/lixisenatide fixed‐ratio combination in Japanese patients with type 2 diabetes. Diabetes, Obesity and Metabolism, 22(S4), 14–23. https://doi.org/10.1111/dom.14036