NR 305 Week 4 Functional Health Concept Map Example

Concept Map: A 73-Year-Old Widower Living Alone After a COPD Exacerbation, Organized by Functional Health Patterns

Student Name

College of Nursing, Chamberlain University

NR 305: Health Assessment for the Practicing RN

Instructor Name

Month Day, Year

Concept Map: A 73-Year-Old Widower Living Alone After a COPD Exacerbation, Organized by Functional Health Patterns

The Center of the Map

The central element is Mr. H., a 73-year-old retired machinist whose apartment, up one flight of stairs, he now shares with no one, and who went home five days ago after three hospital days for a flare of his chronic obstructive pulmonary disease, and seen at home by a home health nurse for this assessment. He is at the center rather than his diagnosis because several of the most important findings, his isolation, his stairs and his grief, are not features of the disease but determine how it will go. The first-level branches follow Gordon's functional health patterns, the organizing scheme taught in this course, which groups assessment data by how a person functions rather than by organ system (Gordon, 1994). Findings sit on each branch, and the lines between branches are labeled with the relationship that joins them. Because a concept map is visual, it is presented here as the text of each branch and each labeled line, in the order the map is read.

Branches and Findings

Health perception and management: Describes his health as not good since his wife died; uses two inhalers but says he does not always remember the controller; quit smoking 8 years ago after 45 years of smoking; follow-up appointment with his primary care clinician scheduled in 9 days.

Nutrition and metabolism: Weight 138 pounds, down from 147 three months ago by his report; eats one meal a day, mostly canned soup and toast; says cooking was his wife's job; oral mucosa dry.

Elimination: Reports constipation since discharge, one small bowel movement in four days; urinates without difficulty.

Activity and exercise: Short of breath after 20 steps on level ground and at the top of his 14 stairs; oxygen saturation 90 percent at rest on room air, 85 percent after climbing stairs; stays in his apartment most days; uses no walking aid. Lung sounds were diminished throughout with scattered expiratory wheezes, consistent with the physical findings health assessment texts describe for a person with chronic obstructive lung disease after an exacerbation (Jarvis & Eckhardt, 2024).

Sleep and rest: Sleeps in a recliner because lying flat makes him breathless; wakes several times a night coughing.

Cognition and perception: Alert and oriented; demonstrated his rescue inhaler with poor technique, exhaling into the device and not holding his breath; reading glasses needed for medication labels.

Self-perception and self-concept: Says he feels useless and a burden to his daughter.

Role and relationships: Widowed 10 months; one daughter who lives 40 miles away and visits on Sundays; a neighbor checks on him occasionally.

Sexuality and reproduction: Not assessed in depth at his request; no concerns raised.

Coping and stress tolerance: Reports sadness since his wife's death and that he stopped going to his church group; denies thoughts of self-harm when asked directly.

Values and beliefs: Wants to stay in his own home; says he would rather manage alone than move in with his daughter.

Labeled Lines Between Branches

Activity and exercise leads to nutrition and metabolism: Breathlessness on exertion makes standing to cook tiring, which contributes to eating one meal a day and weight loss.

Nutrition and metabolism worsens activity and exercise: Weight and muscle loss reduce respiratory muscle strength and exercise tolerance, completing a cycle.

Role and relationships and coping feed health perception and management: Grief and the loss of his wife, who managed meals and reminded him about medications, contribute to missed controller doses and poor nutrition.

Cognition and perception limits health management: Poor inhaler technique means that even the doses he takes deliver less medication, which may contribute to breathlessness.

Sleep and rest connects to activity: Sleeping upright in a recliner and waking to cough leave him tired during the day, reducing activity further.

Values and beliefs shapes every intervention: His wish to stay home means any plan must work in his apartment, with his stairs, largely on his own.

What the Map Shows

Read as a whole, the map shows that the disease is not the only driver of Mr. H.'s risk of another admission. Two cycles stand out. The first is physical: breathlessness limits eating, weight loss weakens breathing, and weaker breathing limits activity further. The second is social and emotional: the loss of his wife removed the person who organized meals and medications, and his grief has reduced his contact with others and his motivation to manage his illness. The two cycles meet at nutrition and at medication use. International guidance on chronic obstructive pulmonary disease identifies correct inhaler technique, adherence, pulmonary rehabilitation, nutrition and attention to anxiety and depression as parts of management after an exacerbation, not only medication (Global Initiative for Chronic Obstructive Lung Disease, 2024). The map makes clear which of those Mr. H. is missing.

Why the Map Was Built This Way

An earlier draft of this map placed chronic obstructive pulmonary disease at the center and branched into airway inflammation, air trapping, hypoxemia and medications. It was accurate and nearly useless for planning his care at home, because it could not hold the facts that turned out to matter most: that he eats one meal a day since his wife died, that he sleeps in a recliner and that he climbs 14 stairs to reach his door. Moving the person to the center and using functional patterns as the first branches made room for those findings and, more importantly, for the lines between them. The redraw also showed how many branches were connected to a single change in his life, his wife's death ten months ago, which the disease-centered draft had no place to record at all. For a home health nurse deciding what to do on the next visit, that connection is more useful than any single physical finding.

Priorities the Map Suggests

Three priorities follow from where the branches connect most. First, inhaler technique and a simple routine for the controller inhaler, because this is correctable in one visit and affects breathing directly. Second, nutrition support that does not depend on his cooking, such as a meal delivery program and nutritional supplements, with a referral to a dietitian. Third, attention to grief and isolation, including screening for depression with a validated tool at the next visit, and asking whether he would accept a visit from his church group or a senior center program. His oxygen saturation with exertion should also be reported to his clinician, because it may meet criteria for an exercise oxygen evaluation. Each priority respects his wish to stay at home and depends on his agreement.

References

Global Initiative for Chronic Obstructive Lung Disease. (2024). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. https://goldcopd.org/2024-gold-report/

Gordon, M. (1994). Nursing diagnosis: Process and application (3rd ed.). Mosby.

Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.