| Course | NR 327 Maternal-Child Nursing |
|---|---|
| Week | 7 |
| Paper type | Concept map with narrative |
| Length | About 1,170 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 327 Week 7
Concept Map: Intrahepatic Cholestasis of Pregnancy at 34 Weeks in a 30-Year-Old Teacher, Every Strand Ending Twice
Student Name
College of Nursing, Chamberlain University
NR 327: Maternal-Child Nursing
Instructor Name
Month Day, Year
Concept Map: Intrahepatic Cholestasis of Pregnancy at 34 Weeks in a 30-Year-Old Teacher, Every Strand Ending Twice
The Center and the Rule
Mrs. O. is 30, a middle school teacher in her first pregnancy, seen at 34 weeks and 1 day; details have been changed. For ten days she has had itching on her palms and the soles of her feet, worst at night, with no rash apart from scratch marks. Her total serum bile acids are 46 micromoles per liter and her liver enzymes are mildly raised. The diagnosis is intrahepatic cholestasis of pregnancy.
The center box reads: "Bile flow from the liver slows under pregnancy hormones; bile acids build up in the mother's blood and cross the placenta." That is all the mechanism the map carries, because the space is needed for findings. Every strand leaving the center ends twice, once on the woman's side and once on the baby's. Where a strand genuinely reaches only one of them, the map says so. Every box that is true only at one point in the pregnancy or after it carries that point.
The Strands
Table 1 sets out the four strands as they appear on the map, with the connecting words written along each line.
Table 1
The Four Strands of the Map, Each With Its Two Endings
| Strand from the center | Ending for the woman | Ending for the baby | Stage on the box |
|---|---|---|---|
| Bile acids rise in her blood, which causes the itch | Itching of palms and soles, worst at night; sleep of four to five hours; scratch marks on her shins | Bile acids cross the placenta; the risk of stillbirth rises steeply once her level reaches 100 micromoles per liter | Antenatal only; the itch usually settles within days of birth |
| Bile acids stimulate the bowel and uterus, which can bring labor or passage of meconium early | Contractions before term; preterm labor | Meconium in the amniotic fluid; birth before 37 weeks | 34 weeks onward |
| Less bile reaches the gut, which reduces fat absorption | Pale, greasy stools in severe cases; vitamin K may fall and clotting may lengthen | No direct ending on the baby's side at her present level | Only if cholestasis is severe; not present now |
| A planned birth is chosen to limit exposure, which ends the strand for the fetus | Induction, with its own risks and a longer stay | An early-term or late-preterm baby, more likely to need help with breathing and feeding | Timed by her bile acid level |
Note. The third strand is drawn with only one ending, and the map says why on the empty side.
The third strand is the one I nearly drew with two endings out of habit. Poor fat absorption and a low vitamin K belong to severe cholestasis, and Mrs. O. has no pale stools and a normal clotting screen, so the baby's side of that strand stays empty with a note saying why. The stage marks do similar work: the itch box says antenatal only, because an itch still present weeks after birth would point to a different diagnosis and a different map.
Why the Baby's Side Carries the Weight
The strand that decides most of the care runs from her bile acids to the baby. Ovadia et al. (2019) pooled data from more than 5,000 women with this condition. In singleton pregnancies, stillbirth occurred in 0.13% of women whose bile acids stayed below 40 micromoles per liter, 0.28% of those between 40 and 99, and 3.44% of those at 100 or above. Mrs. O. is at 46. On the map, that places her box in the middle band, with an arrow to a monitoring box that says the level is repeated, because what matters is not only where she is today but whether her bile acids keep rising before birth. The same authors note that most women with the condition fall below 100, and that for them, stillbirth risk may be close to that of the general pregnant population provided testing is repeated until delivery.
The itching strand is where the woman's side carries the weight. It is the symptom that brought her in, it is taking her sleep, and she is teaching full days on four hours of it. The map does not treat it as minor because the baby's risk is the larger one.
Actions Hanging From Findings
Each action is attached to the finding it answers. From the itch: cool showers, loose cotton clothes, keeping nails short, a moisturizing cream with menthol if her provider agrees, and a sleep plan with her husband for the nights the itch is worst. From the bile acid level: a repeat level weekly, with the result followed up by the nurse if it is not back in 48 hours. From the risk of stillbirth: daily attention to the baby's usual pattern of movements and a same-day call to labor and delivery triage if it changes. From the plan for birth: teaching about induction, because a date will probably be set before 40 weeks and she has not had a labor before.
One action carries a cost across the map. Ursodeoxycholic acid is often prescribed for the itch. In the PITCHES trial, it did not reduce a composite of adverse perinatal outcomes compared with placebo, 23% against 27%, a difference that was not significant (Chappell et al., 2019). The map draws that honestly: a line from the medication to the woman's itch, marked "may ease," and no line to the baby's risk. The decision to prescribe is her provider's; the nurse's part is to explain that the medication is for her comfort and that the baby's safety still rests on repeat testing and a timed birth.
The planned birth is the other action with a cost drawn onto it. It protects the baby from the risk of stillbirth and costs the woman an induction and possibly a longer labor, and it costs the baby some weeks in the uterus, so the map places a small box under the baby's ending: "early-term baby; watch breathing, temperature and feeding in the first day."
What Would Make Anyone Act
The map ends each branch on a change and a person.
Bile acids at 100 micromoles per liter or above: same-day call to her obstetric provider; the timing of birth will likely change.
Fewer or weaker movements than usual: call labor and delivery triage the same day; do not wait for the next appointment.
Contractions every ten minutes or closer, fluid leaking or bleeding before 37 weeks: go to labor and delivery.
Yellowing of the skin or eyes, pale stools or dark urine: tell her provider at the next contact within 24 hours.
Itching that continues more than a few weeks after birth: her primary care provider, because it would no longer fit this diagnosis.
References
Chappell, L. C., Bell, J. L., Smith, A., Linsell, L., Juszczak, E., Dixon, P. H., Chambers, J., Hunter, R., Dorling, J., Williamson, C., Thornton, J. G., Ahmed, I., Arya, R., Beckett, V., Bhide, A., Brown, H., Bugg, G., Cameron, H., Deole, N., . . . Tan, B. (2019). Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): A randomised controlled trial. The Lancet, 394(10201), 849-860. https://doi.org/10.1016/S0140-6736(19)31270-X
Ovadia, C., Seed, P. T., Sklavounos, A., Geenes, V., Di Ilio, C., Chambers, J., Kohari, K., Bacq, Y., Bozkurt, N., Brun-Furrer, R., Bull, L., Estiú, M. C., Grymowicz, M., Gunaydin, B., Hague, W. M., Haslinger, C., Hu, Y., Kawakita, T., Kebapcilar, A. G., . . . Williamson, C. (2019). Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: Results of aggregate and individual patient data meta-analyses. The Lancet, 393(10174), 899-909. https://doi.org/10.1016/S0140-6736(18)31877-4
NR 327 Week 7 instructions, in plain terms
The Week 7 concept map asks you to map a complication of pregnancy for a patient, linking its pathophysiology to findings, nursing actions and outcomes. The assignment sheet tends to list a central concept, assessment data, nursing diagnoses or problems, interventions with rationale, expected outcomes and evidence, with a narrative and APA references. Keep the physiology to the minimum needed to explain the findings. Make every strand end for both patients, and say so when one side has nothing. Attach each action to the finding it answers. Show the cost an action carries for the other patient. Finish each branch with the change that would prompt a call and the person who would receive it.
How the NR 327 Week 7 example is put together
The center section describes Mrs. O.'s ten days of itching on her palms and soles, worse at night, and gives the one-sentence mechanism in the center box. Table 1 sets out four strands with an ending for her and an ending for the baby, plus the stage on each box. The narrative explains why the vitamin K strand has only one ending, given her normal stools and clotting screen. Ovadia and colleagues' pooled stillbirth figures by bile acid level show why the baby's side carries the plan. Comfort measures hang from the itch, and the planned birth is shown with its cost to both patients. Chappell and colleagues' PITCHES trial frames the medication. The last section lists five changes with whom to call for each.
Where the points sit in the NR 327 Week 7 rubric
Concept map rubrics usually score the accuracy of the central concept, assessment data, linkages between concepts, nursing interventions with rationale, outcomes, evidence and the quality of the narrative with APA. Linkages earn the most points when each strand runs from the mechanism to a finding and then to both patients, as Table 1 does. Assessment data is credited for specifics such as where and when she itches. The intervention row scores when actions are attached to findings and their costs are stated. Explaining the empty side of the third strand shows the reasoning graders reward. Outcomes earn credit because every branch ends in a measurable change and a named person. Ovadia and colleagues and Chappell and colleagues support the evidence row.
NR 327 Week 7 help: mistakes that cost points
Students lose the most on this map by drawing it entirely down the woman's side, with the baby as one box near the bottom. Another loss comes from leaving the stage off the map, since many complications mean different things at 30 and 38 weeks. Long physiology sections crowd out findings and actions. Actions floating at the edge of the map with no line to a finding lose linkage points. Maps that end on nouns, such as "monitoring," instead of a decision also fall short. Check that every figure you cite matches the source. If your assigned complication is preeclampsia or gestational diabetes, send the case details and we can show how an NR 327 concept map would give each strand two endings.
Get a NR 327 Week 7 example written to your instructions
Send the Week 7 complication your classroom assigned and the map template if there is one, and a custom map is built inside it and returned inside 24 to 48 hours. The first one is free. If your section grades a written rationale beside the diagram, send that too and the two of them arrive together.
More NR 327 papers and pre-licensure samples
- NR 327 Week 1: Normal Pregnancy Adaptation Post
- NR 327 Week 2: Antenatal Assessment Write-Up
- NR 327 Week 3: Fetal Movement Teaching Plan
- NR 327 Week 4: Unfolding Labor Case Response
- NR 327 Week 5: Postpartum Assessment Write-Up
- NR 327 Week 6: Newborn Transition Write-Up
- NR 327 Week 8: Family Care Plan
- NR 328 Week 7: Family Teaching Handout
- NR 326 Week 7: Therapeutic Milieu Brief
- NR 341 Week 7: Rapid Response Analysis
- NR 325 Week 7: Atrial Fibrillation Handover Report
NR 327 Week 7 questions, answered
How much physiology belongs on the map?
Only the part that makes a link readable. A marker can see whether you understand the mechanism from one well written connector, and everything past that competes with the findings for room. Maps that fail on this are usually accurate and crowded: three rings of biochemistry and one thin branch holding anything a nurse would do. Assessment is what is being marked here.
What if the complication hits only one patient?
Say that on the map and defend it briefly. Some do sit mostly on one side, and a writer marking the other side as unaffected with a short reason has shown exactly the reasoning this course wants to see. What loses ground is saying nothing, because a marker cannot separate a considered judgment from an omission when both look like an empty branch.
Does the map need references?
Usually two or three, and placement counts for more than quantity. A source sits against the link it supports, which normally means the mechanism connector and the monitoring limit. A list under the diagram with nothing pointing at it reads as ornament. Where your classroom asks for a narrative beside the map, that is where citations sit most naturally.
Where can I find a free NR 327 Week 7 sample paper?
This page shows the full Week 7 concept map narrative for Mrs. O.'s cholestasis, the four-strand table, the bile acid evidence, the actions with their costs, the escalation list and the references.
Why does one strand in the NR 327 Week 7 map have only one ending?
Poor fat absorption and low vitamin K belong to severe cholestasis, and Mrs. O. has normal stools and a normal clotting screen, so the map explains why the baby's side of that strand is empty.