What Is a Concept Map? How to Create a Nursing Concept Map, With a Pyelonephritis Example
7 min read Concept map assignment: Pyelonephritis
What is a concept map, and how do you create one? Create a concept map for pyelonephritis. The content must include:
- Pathophysiology and definition
- Etiology, risk factors (genetic predisposition and environmental factors if applicable) and causative factors
- Common signs and symptoms
- Labs and diagnostic tests
- Nursing interventions and medical treatment
- Complications of the disease
- Patient and family education
What is a concept map?
A concept map is a visual diagram that places a central topic, here a disease, in the middle and links it to related ideas in boxes or “nodes.” In nursing education, concept maps help students organize what they know about a condition, see how causes lead to signs and symptoms, and connect assessment findings to nursing interventions and teaching. Unlike an outline, a concept map shows relationships, such as how urinary obstruction (a risk factor) allows bacteria to ascend (pathophysiology), which produces flank pain and fever (symptoms).
How to create a nursing concept map in 6 steps
- Put the disease in the center. Write the condition and a one-line definition.
- Add a node for each required section. Use the headings your rubric lists so your instructor can find every element.
- Start with pathophysiology. Explain what happens in the body; most other boxes follow from it.
- Fill in findings and data. List signs, symptoms, labs and diagnostic tests, and note what abnormal results mean.
- Link problems to care. Match nursing interventions, treatments and education to the specific findings and complications.
- Draw connecting lines and cite sources. Use arrows or labels to show relationships, and add APA references below the map.
Model concept map: Pyelonephritis
Original example for study purposes. Rebuild it in your course’s template and cite your textbook.
Tap the image to open it full size.
Concept map content explained
Original example for study purposes (about 700 words).
Definition. Pyelonephritis is a bacterial infection of the renal pelvis and kidney parenchyma. Most cases are acute and arise when a lower urinary tract infection ascends to the kidney (Johnson & Russo, 2018).
Etiology and causative factors. Escherichia coli causes most community-acquired cases. Other organisms include Klebsiella, Proteus, Enterococcus and Staphylococcus saprophyticus, and hospital-acquired or catheter-associated infections are more likely to involve resistant organisms. Less commonly, bacteria such as Staphylococcus aureus reach the kidney through the bloodstream.
Pathophysiology. Bacteria from the bowel colonize the periurethral area, ascend the urethra into the bladder and travel up the ureter, a process aided by vesicoureteral reflux, obstruction or reduced ureteral peristalsis. Bacterial adhesins (fimbriae) allow E. coli to attach to uroepithelial cells. In the kidney, bacteria trigger an intense neutrophil response, causing inflammation, interstitial edema and tubular injury. Without prompt treatment, infection can form abscesses, cause scarring or spread into the bloodstream, leading to urosepsis.
Risk factors. Environmental and host factors include female anatomy (short urethra), sexual intercourse, spermicide use, urinary catheters, kidney stones, benign prostatic hyperplasia, pregnancy, diabetes, immunosuppression, older age and previous UTIs. Genetic and congenital factors include vesicoureteral reflux, which often runs in families, structural anomalies of the urinary tract and a family history of recurrent UTIs, especially in a woman’s mother.
Signs and symptoms. Typical findings include fever, chills, flank pain, costovertebral angle tenderness, nausea and vomiting, often with dysuria, frequency and urgency. Older adults may present only with confusion, falls or reduced function, and some patients show signs of sepsis such as tachycardia and hypotension (Johnson & Russo, 2018).
Labs and diagnostic tests. A urinalysis typically shows pyuria and bacteriuria and may show nitrites; white blood cell casts suggest kidney involvement. A urine culture with susceptibility testing should be obtained before antibiotics in every patient with suspected pyelonephritis so that therapy can be adjusted (Gupta et al., 2011). Other tests include a CBC, basic metabolic panel or creatinine, C-reactive protein, blood cultures in severely ill patients and a pregnancy test in women of childbearing age. CT or ultrasound is used for severe illness, suspected obstruction or abscess, or when fever persists after 48 to 72 hours of appropriate therapy.
Nursing interventions.
- Monitor vital signs, temperature trends, pain and mental status for signs of sepsis.
- Obtain urine (and blood) cultures before the first antibiotic dose, then give antibiotics on schedule.
- Encourage fluid intake of about 2 to 3 L per day unless restricted, or give IV fluids if the patient is vomiting; monitor intake and output.
- Give antipyretics, analgesics and antiemetics as ordered, and use comfort measures such as warmth to the flank.
- Monitor creatinine and urine output, remove unnecessary catheters and review culture results with the provider.
Medical treatment. Treatment depends on severity and local resistance patterns. For outpatients, the 2010 IDSA/ESCMID guideline recommends oral ciprofloxacin for 7 days when local fluoroquinolone resistance does not exceed 10%, or trimethoprim-sulfamethoxazole for 14 days if the organism is known to be susceptible; an initial IV dose of a long-acting agent such as ceftriaxone is advised when resistance is higher (Gupta et al., 2011). Hospitalized patients receive IV antibiotics, such as ceftriaxone or broader agents when resistant organisms are suspected, followed by oral step-down therapy guided by culture results. Obstruction is relieved with a ureteral stent or nephrostomy tube.
Complications. Complications include urosepsis and septic shock, renal or perinephric abscess, emphysematous pyelonephritis (mostly in people with diabetes), acute kidney injury, chronic scarring with hypertension or reduced kidney function and, in pregnancy, preterm labor.
Patient and family education.
- Take every antibiotic dose even after feeling better, and report side effects.
- Drink adequate fluids unless restricted, void every 3 to 4 hours and urinate after intercourse.
- Wipe from front to back and avoid spermicides if UTIs recur.
- Seek care immediately for persistent fever, vomiting that prevents taking medicine, worsening flank pain or confusion.
- Keep follow-up appointments, and families of older adults should watch for new confusion as an early sign of infection.
References
Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Moran, G. J., Nicolle, L. E., Raz, R., Schaeffer, A. J., & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103–e120. https://doi.org/10.1093/cid/ciq257
Johnson, J. R., & Russo, T. A. (2018). Acute pyelonephritis in adults. New England Journal of Medicine, 378(1), 48–59. https://doi.org/10.1056/NEJMcp1702758
[Your medical-surgical nursing textbook, in APA format.]
Before you submit: check your current institution’s antibiogram and your textbook for preferred antibiotics, since resistance patterns change. Add arrows in your own map to show how each risk factor and complication connects to the pathophysiology.
Frequently asked questions
What is the difference between cystitis and pyelonephritis?
Cystitis is a bladder (lower urinary tract) infection with dysuria and frequency. Pyelonephritis involves the kidney and usually causes fever, flank pain and systemic symptoms.
Why are WBC casts important?
White blood cell casts form in the kidney tubules, so they suggest the infection involves the kidney rather than only the bladder.
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