Concept Map Narrative

Marissa Hooper Tonelero

Capella University

MSN-FP6021

June 2018
 MSN-FP6021 Concept Map

Most Urgent Nursing Diagnosis: Nursing Diagnosis 2:

Risk for overweight related to weight gain as evidence by Disturbed sleep pattern related to inadequate quality of
patient statements about gaining 12 pounds and pants fitting Patient Info: sleep as evidence by patient stating she has vivid dreams
tightly. (NANDA, 2015). and is unable to fall asleep easily. (NANDA, 2015).
 Carrie Alves
 31-year-old
 Female
 Irregular menstrual cycle

Nursing Diagnosis 3: Education:

Treatment:
Treatment: Education: -Sleep
Risk for ineffective childbearing process related to irregular -Healthy diet
-Nutrition and menstrual cycles as evidence by three periods within six hygiene
-Nutrition plan
weight loss education months and negative pregnancy tests. (NANDA, 2015). -Avoid
coaching -Sleep hygiene caffeine
-Health risks
-Physical related to
activity plan overweight

Outcomes:
Pt will establish a healthy
diet and maintain glucose
Outcomes: levels <150.
Treatment:
Pt will adhere to Education:
-Menstrual and
nutrition and physical -How to track
ovulation
activity plans. Pt will menstruation and
tracking
be able to state risks ovulation
of being overweight. -Birth control
-Proper birth control
usage

Outcomes:
Pt will learn how to
properly take birth control
and track ovulation and
menstruation each month.
Running head: CONCEPT MAP 3

Concept Map Narrative

Carrie Alves is a 31-year-old female who presents to St. Anthony’s Medical Center with

complaints of irregular menstrual cycles over the last six months. Carrie notes having only three

periods in the past six months with a negative pregnancy test. She also notes weight gain of 12

pounds, difficulty falling asleep and staying asleep, and an increase in facial hair growth. Carrie

is seeking medical advice because she is “freaked out”. Carrie also states these occurrences

began after quitting birth control. Carrie’s symptoms align closely with Polycystic Ovarian

Syndrome (PCOS) – the most common endocrine disorder in women of reproductive age (Kim,

et al., 2016).

Patient Needs with Regards to Patient-Centered Concept Map

During her interview, Carrie exhibited risk for overweight as evidence by gaining 12

pounds and feeling that her pants are getting tighter. Carrie stated she was scared to weigh

herself at first, but noted her weight gain when she finally did. Carrie is at risk for overweight

and obesity, but her scenario does not offer her current height and weight so it is difficult to

determine her risk. It would be ideal to offer Carrie nutritional and weight loss coaching to

mitigate her weight gain issues. It would also help to provide physical activity recommendations

so that she may lose the weight she has gained. It is also appropriate to initiate a discussion on

health risks related to being overweight or obese. Weight gain is a common symptom of PCOS,

so a well-planned nutrition and exercise plan may help Carrie to lose and maintain her weight

(Office on Women's Health, 2016).

In addition to weight gain, Carrie also noted difficulty sleeping. Carrie stated she

sometimes jolts awake during her sleep and then finds it difficult to fall back to sleep. She also

notes having vivid dreams. These symptoms align with a disturbed sleep pattern. It would be
CONCEPT MAP 4

helpful to teach Carrie about adequate nutrition, exercise, and sleep hygiene. “The sleep-wake

cycle plays a critical role in balancing the body’s immune function” (Wilson & Brooks, 2018, p.

7). Sleep hygiene helps promote healthy sleep habits that affect the body’s function. Sleep

hygiene habits to teach are: (a) avoid naps more than 30 minutes; (b) keep the same wake

schedule; (c) avoid nicotine and caffeine a few hours before sleep; (d) practice meditation,

reading, or aromatherapy prior to sleep; and (e) do not use computers, TVs, or cell phones 90

minutes prior to sleep (Wilson & Brooks, 2018).

Lastly, Carrie is at risk for ineffective childbearing related to irregular menstrual cycles

and negative pregnancy tests. These could be related to a PCOS diagnosis. Women with PCOS

may have irregular menstrual cycles (less than eight per year). Women with PCOS may also

experience an increase in facial hair growth, which Carrie noted. While PCOS is a type of

infertility, women with PCOS can still get pregnant. However, successful pregnancies typically

require assistance, such as weight loss, medication, in vitro fertilization (IVF), or surgery (Office

on Women's Health, 2016). It is important to educate Carrie on proper tracking of menstruation

and ovulation, and appropriate usage of birth controls. Carrie will experience less menstrual

cycle irregularity with improvements to her nutrition and exercise routine (Marzouk, Nabil, &

Senna, 2015).

Interprofessional Strategies and Achievement of Desired Outcomes

Carrie’s main concern is her risk for overweight and obesity. To implement nutrition and

exercise education, nurses, doctors, and dieticians will need to work together. These

interprofessional collaborations will ensure that all of Carrie’s needs are being met and covers

“the big picture” for her plan of care (DeBate, Daley, Vamos, Kline, Marsh, & Smith 2014).

Since Carrie potentially has PCOS, she is at an increased risk for diabetes, increased blood
CONCEPT MAP 5

pressure, unhealthy cholesterol levels, sleep apnea, depression, and anxiety (Office on Women's

Health, 2016).

With all of these potential comorbidities, interprofessional collaboration is a must to

achieve the desired outcomes. Nutritional experts, such as registered dieticians, should be

utilized in the teaching of proper nutritional intake. In addition, physical therapists or personal

trainers should be involved in the education pertaining to proper exercise techniques for weight

loss. Weight gain or difficulty losing weight is very common in women who have PCOS (Office

on Women's Health, 2016). Furthermore, the primary care physician and a gynecologist should

collaborate to educate Carrie on how to properly track menstruation and ovulation to help

determine the frequency and length of menstrual cycles, and proper birth control usage to help

with managing her menstrual cycle regularity.

Each of these collaborations will aid in achieving the desired outcomes for Carrie. Carrie

will learn to manage her diet and exercise routine, discover methods of weight loss, and gain

knowledge of menstruation and ovulation tracking. By working together, each discipline will be

able to holistically treat Carrie’s symptoms and disease process.

CONCEPT MAP 6

References

DeBate, R., Daley, E. M., Vamos, C. A., Kline, N., Marsh, L., & Smith, S. (2014).

Transdisciplinary Women's Health: A Call to Action. Health Care For Women

International, 35(10), 1113-1132. doi:10.1080/07399332.2013.840636

Kim, J., Mersereau, J., Khankari, N., Bradshaw, P., McCullough, L., Cleveland, R., & ...

Gammon, M. D. (2016). Polycystic ovarian syndrome (PCOS), related

symptoms/sequelae, and breast cancer risk in a population-based case-control study.

Cancer Causes & Control, 27(3), 403-414. doi:10.1007/s10552-016-0716-7

Marzouk, T., Nabil, H., & Senna, M. (2015). Impact of a Lifestyle Modification Program on

Menstrual Irregularity among Overweight or Obese Women with Polycystic Ovarian

Syndrome. Korean Journal Of Women Health Nursing, 21(3), 161-170.

doi:10.4069/kjwhn.2015.21.3.161

NANDA nursing diagnosis list 2015-2017. (2015). NANDA International,1-13.

Office on Women's Health. (2016). Polycystic ovary syndrome. Retrieved from

https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-

ovary-syndrome.html

Wilson, D. R., & Brooks, E. J. (2018). Sleep & Immune Function: Nurse Self-Care & Teaching

Sleep Hygiene. Beginnings, 38(1), 6-23.