NR 283 Week 4 DVT Pathophysiology Concept Map Example

Concept Map: A Clot Forming in the Calf of a 71-Year-Old Woman Three Days After Hip Replacement, Drawn in Three Bands From Her Risks to Her Chart

Student Name

College of Nursing, Chamberlain University

NR 283: Pathophysiology

Instructor Name

Month Day, Year

Concept Map: A Clot Forming in the Calf of a 71-Year-Old Woman Three Days After Hip Replacement, Drawn in Three Bands From Her Risks to Her Chart

The Patient and the Layout

Mrs. D. is 71, on the third day after a total right hip replacement. She has a body mass index of 34, takes oral estrogen for menopausal symptoms, and has walked only twice since surgery because of pain and dizziness. She is receiving a prophylactic anticoagulant injection once a day, but the case notes that her first dose was given 30 hours after surgery instead of the planned 12, because of bleeding from the wound. At 1000 on day three she reports that her right calf aches and looks bigger than the left. Details are composite.

The map fits on one page and is read across, in three bands. The left band holds her risk factors, and only hers. The middle band holds the process, with each box naming something that changed. The right band holds the findings a nurse would record. Every strand starts on the left and reaches the right; a strand that stops in the middle describes a process no one could ever notice.

Band One: This Patient's Risks Only

The left band has five boxes, each drawn from her case. Surgery on the hip three days ago, which injures vein walls near the operation and triggers clotting. Walked twice in three days, which slows blood flow in the leg veins because the calf muscle pump is idle. Body mass index 34, which is associated with higher venous pressure in the legs. Oral estrogen, which increases clotting factors. Anticoagulant started 18 hours later than planned, which left the first day and a half after surgery less protected.

Risk factors that belong to venous thrombosis in general, such as cancer, pregnancy or an inherited clotting disorder, are not on the map, because the case gives no evidence that she has them. A map that lists every possible risk says nothing about this patient.

Band Two: Every Box Names Something That Moved

The middle band is organized around the three conditions that together favor clot formation in veins: sluggish flow, a damaged vessel lining, and blood more ready to clot than usual. Wolberg et al. (2015), in their review of venous thrombosis, describe how clots in veins typically begin in areas of slow or disturbed flow, such as the pockets behind the valves of the deep leg veins, where the vessel lining and blood components interact to start clotting.

Each box in this band states a change: blood flow in calf veins slows; vein wall near surgery activated; clotting factors raised; clot forms behind a valve in a deep calf vein; clot grows along the vein; outflow from the calf blocked; and, on a separate strand, fragment breaks loose and travels to the lungs; pulmonary artery branch blocked; part of the lung ventilated but not perfused; right side of the heart strains against raised pressure. A box reading "coagulation" or "embolism" would name a topic; these name what moved.

Band Three: Strands That Reach the Far Side

The right band holds the findings, and every strand from the middle band ends in one.

From blocked calf outflow: right calf circumference 3 centimeters larger than the left, measured 10 centimeters below the kneecap; calf warm and tender to touch; aching she describes as "a cramp that won't go away."

From the vein wall and clotting factors: no direct finding on the chart; the strand reaches the right band through the clot it produces, which the map shows by joining it to the calf findings.

From the pulmonary strand: sudden shortness of breath; breathing rate above 24; heart rate above 110; oxygen saturation falling on the same oxygen; chest pain that is sharp and worse on breathing in; new anxiety or a sense that something is wrong.

At 1000 on day three, only the calf findings are present. The pulmonary strand is drawn in dashed lines, with its findings in a box labeled "watch for," because the reason for mapping it is that those findings would mean the clot had moved and would change her care within minutes.

A Key Rather Than a Guess

The map carries a key so that a reader does not have to guess. Solid lines are changes supported by her findings today. Dashed lines are changes that could follow and would be recognized by the findings at their end. A small triangle marks each finding the nurse should report now: the calf findings, reported this morning to the surgical team, who ordered a leg ultrasound. A circle marks findings that would need an emergency response: any finding on the pulmonary strand, which would mean a rapid response call.

The key also explains one box that looks out of place: anticoagulant started late. It sits in the risk band rather than the process band because it did not cause a change in her body; it removed a protection. That distinction matters for the next patient, because a late first dose is a fixable system problem, not a property of the patient.

Reading the Map Backward

A map read from left to right explains what happened. Read from right to left, it shows where the process could have been interrupted, and that second reading is the one worth carrying to other patients. Starting from the swollen calf and tracing back, each box in the risk band is a place where nursing or the team could act. Walking: she walked twice in three days, and each additional walk, even to the bathroom and back, would have used the calf muscle pump that keeps blood moving. The late anticoagulant: the delay had a reason, wound bleeding, but a delay of 18 hours in a patient with four other risks was a decision that deserved a documented discussion. Estrogen: whether to stop it before an elective operation is a question for the surgeon and her own provider before surgery, not after. Her weight could not be changed in the time available.

The backward reading also shows which risks nursing owns directly. Walking and the timing of doses are in nursing's hands every shift. That is why, in the handover after this morning's report, the plan for the rest of the day includes walking her with physical therapy twice after pain medicine, leg exercises every hour while awake, and confirming the anticoagulant dose is given on time, while the ultrasound result is awaited.

References

Wolberg, A. S., Rosendaal, F. R., Weitz, J. I., Jaffer, I. H., Agnelli, G., Baglin, T., & Mackman, N. (2015). Venous thrombosis. Nature Reviews Disease Primers, 1, Article 15006. https://doi.org/10.1038/nrdp.2015.6