TEMPLATE FOR CONCEPT MAP Please draw lines & arrows to indicate relationships between nursing diagnoses Key Problem #1 Supporting Data/Assessments 1. 2. 3. 4. 5. Reason for Seeking Health Care: Medical Diagnosis Key Problem #2 Key data and assessments: Key Problem #3 Supporting Data/Assessments 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. Supporting Data/Assessments 1. 2. 3. 4. 5. PMH, Medications Key Problem #4 Supporting Data/Assessments 1. 2. 3. 4. 5. 1/4 STEPS 4 and 5: IDENTIFY GOALS/OUTCOMES, FORMULATE NURSING INTERVENTIONS, DESCRIBE PATIENT RESPONSES/ EVALUATE CLIENT’S RESPONSES AND DETERMINE IF GOAL WAS MET (Example #4) Nursing Diagnosis # 1 Goal/Outcome: Nursing Interventions 1. Rationale 1. Patient Responses to Interventions 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5. Patient/Family Teaching: Evaluation: References: 2/4 Nursing Diagnosis # 2 Goal/Outcome: Nursing Interventions 1. Rationale 1. Patient Responses to Interventions 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5. Patient/Family Teaching: Evaluation: References: 3/4 Nursing Diagnosis # 3 Goal/Outcome: Nursing Interventions 1. Rationale 1. Patient Responses to Interventions 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5. Patient/Family Teaching: Evaluation: References: 4/4

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