NU142 Unit 3 Concept Map Example

Risk That Moves With the Clock: A Concept Map Following a Composite 49-Year-Old Woman Through Total Thyroidectomy From Preoperative Baseline to the Third Day After, With Each Risk Placed in the Window When It Peaks

[Student Name]

Purdue University Global

NU142: Medical-Surgical Nursing I

Unit 3 Concept Map

[Instructor Name]

[Date]

The patient is composite; the map is given as time windows, nodes and labeled links because the original is a diagram, and values are bracketed where illustrative.

The Patient

[Mrs. J.], a composite 49-year-old bank teller, has a large multinodular goiter that presses on her trachea and makes swallowing uncomfortable. Her thyroid function is normal. She is scheduled for a total thyroidectomy. Preoperative baseline: voice clear, calcium [9.4] mg/dL, no history of neck surgery.

Window One: Before Surgery

Node A, baseline assessment. Links: "establishes comparison for" voice quality, calcium and airway. Node B, teaching. Links: "prepares her for" supporting her head when moving, reporting tingling and expecting a hoarse voice for a short time. Node B also links to Node A with "uses the baseline to explain": she is told her voice and calcium will be compared with today's values, so she understands why staff will keep asking her to speak and about numbness.

Window Two: First 24 Hours

Node C, surgical field near the trachea and blood vessels. Link to Node D, neck hematoma: "bleeding into a closed space can compress." Link from D to Node E, airway obstruction: "pressure on the trachea causes." Nursing actions attached to D and E: "check the dressing and the back of the neck, where blood pools; listen for stridor; keep suture removal equipment at the bedside as the surgeon directs" (Harding et al., 2023).

Node F, recurrent laryngeal nerves running beside the thyroid. Link to Node G, voice change: "stretch or injury causes hoarseness; injury to both nerves can cause airway narrowing." Action: compare her voice with the baseline every few hours.

The most dangerous risks sit in the first window, and the map puts the bedside equipment there too, because a hematoma can close an airway faster than help can arrive.

Window Three: Days One to Three

Node H, parathyroid glands, small structures behind the thyroid that control calcium. Link to Node I, low parathyroid hormone: "bruising or removal of the glands during surgery causes." Link from I to Node J, low calcium: "less hormone leads to." Link from J to Node K, nerve and muscle excitability: "low calcium increases," with signs: numbness around the mouth and fingertips, muscle cramps, Chvostek's and Trousseau's signs. Link from K to Node L, laryngospasm or seizure: "severe low calcium can cause." Actions: calcium levels as ordered, typically every [12] hours at first; calcium supplements as prescribed; ask her about numbness each time vital signs are taken. Low calcium after total thyroidectomy is usually temporary but can become permanent in a small share of patients, so its signs are taught before discharge as well as watched for in hospital (Harding et al., 2023).

Window Four: Before Discharge and Beyond

Node M, no remaining thyroid tissue. Link to Node N, hypothyroidism: "without the gland, hormone production stops." Link from N to Node O, levothyroxine: "lifelong replacement is required." Teaching attached: take it each morning on an empty stomach, separate from calcium by several hours because calcium reduces its absorption (Burchum & Rosenthal, 2022), and have thyroid levels checked in [six] weeks.

Nursing Problems Across the Windows

The map also shows how her priority nursing problems change. In window two, risk for ineffective airway clearance and risk for bleeding lead the list. By window three, risk for injury from low calcium moves to the top, while airway risk falls as the first day passes without swelling. In window four, deficient knowledge about lifelong hormone replacement and calcium supplements becomes the main focus. Placing the problems in time keeps the night nurse on day zero focused on the airway and the day-two nurse focused on calcium, instead of both nurses trying to watch everything equally. Teaching is spread across windows rather than saved for discharge, since a patient who is told on the first evening what tingling means is more likely to report it early (Potter et al., 2023).

Links Between Windows

Calcium supplements in window three interact with levothyroxine in window four, so the map draws a dotted line between Nodes J and O labeled "separate doses." Hoarseness from window two can last into window four, so the voice node carries forward with a follow-up visit if it does not improve.

Reading the Map

Time runs from left to right. Each window has its nodes stacked vertically and its nursing actions written beside them. Solid arrows show cause; dotted arrows show interactions across windows. The map lets a nurse taking report on day two see at a glance that airway risk has fallen and calcium risk is at its height. A version of the map printed for Mrs. J. herself shows only windows three and four, with the symptoms she should report and the morning routine for her new medicine, written in plain words.

References

Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.