Case Study Of One-Peter Mitchell Samples

Chronic health conditions are multifactorial in nature and the care process by nurse must involve the clinical and patient needs. The treatment outcomes are affected by multiple factors and the nurse must be aware of different factors affecting the patient’s health (Helgeson & Zajdel, 2017). The essay deals with the case study of Peter Mitchell are a 52 year old male with morbid obesity and type 2 diabetes. The aim of the essay is to prioritize the patient needs for care integrating the different aspects of patient needs. Prioritization refers to use of clinical reasoning and decision making skills to design care process that can avoid adverse outcomes (Urden, Stacy & Lough, 2015). In reference to the chronic condition presented in the case study, the essay will identify and discuss two priorities of care while applying the clinical reasoning cycle by Levett-Jones. It is a non-linear process to analyse the series of contributing and predisposing factors. It helps develop goal driven patient care (Dalton, Gee & Levett-Jones, 2015). The clinical reasoning cycle involves eight stages, where the first stage is â€Å"consideration of patient’s situation† (Dalton, Gee & Levett-Jones, 2015). In the given case study Peter, 52 year old male is admitted to the medical ward with morbid obesity and type 2 diabetes. The patient is presented with the poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. The second stage of the clinical reasoning cycle is â€Å"collection of cues and information†. In this stage the patient’s current information is reviewed using case history, previous assessment and new information is collected through further assessment (Dalton, Gee & Levett-Jones, 2015).   The patient history shows obesity and type 2 diabetes, hypertension, sleep apnoea and depression. The patient also has history of gastro oeasophageal disease reflux and smoking (for 30 years).   The patient was previously on high protein diet to reduce weight. Peter had difficulty copi ng with the weight loss. He was instructed for light exercises by his physiotherapist. As per the patient social history, he lost his job due to insulin therapy. His weight gain, obesity and diabetes interfered with his occupations and that added to his fatigue and other health issues. Overweight is also interfering with his activities of daily living, and may have increased risk of apnoea. It added to socially isolation. He lives alone and lacks emotional support, which may also be the cause of stress and poor health. However, the patient is motivated to quit smoking and lose weight with appropriate supervision.   The patient’s assessment results showed BP 180/92mmHg, height 170cms, Weight 145kgs, HR 102 Bpm, Sp02 95% on RA, RR 23 Bpm. The handover informs different medications for abnormal vital signs and diabetes. The untreated condition may increase the risk of cardiovascular problems and other comorbidities (Koolhaas et al., 2017).     Ã‚   An important part of clinical reasoning cycle refers to â€Å"processing of information†. It involves interpreting the information, relating with the clinical knowledge to prioritize care (Dalton, Gee & Levett-Jones, 2015).   It will better help to prioritize the care.   The weight and height of the patient indicates a BMI of 50.2, which much greater than the normal range of 30, indicating obesity (Mark & Somers, 2016). Obesity is associated with ventilation syndrome and sleep apnoea. It may be the cause of upper airway obstruction that is causing the episodes of shallow breathing, when sleeping. Smoking also results in airway obstruction and apnoea (Krishnan et al., 2014). The patent may be immediately provided with oxygen. It may increase the risk of further health deterioration. Hypertension may be due to high blood pressure and increased heart rate. If untreated it may worsen diabetes as the patient is obese, which also influences blood pressure (Heymsfield & Wadden, 2 017). Increase in respiratory rate, blood pressure, high glucose level may increase the risk of heart failure or collapsibility of pharyngeal tract. Excess adipose tissue restricts the movement of diaphragm and that of chest muscles (Mark & Somers, 2016). Altogether it may affect the inhalation, exhalation as well as heart rate. It is essential to reduce weight of the patient as fatty tissue in excess amount may increase vascular resistance. Diabetes also increases blood pressure and hypertension by predisposing arteries to arthrosclerosis. It may increase the risk of kidney failure, stroke and other health issues (Cheung & Li, 2012). Social isolation and smoking may further increase the risk of anxiety and depression (Choi & DiNitto, 2014). The main problem or health issue of the patient can be identified by synthesizing facts and inferences (Dalton, Gee & Levett-Jones, 2015). The main health issue of the patient, from the above analysis, is clearly obesity and diabetes as they are linked with all the other presenting sign and symptoms.   The adverse symptoms such as hypertension, high blood glucose level, diaphoresis, or abnormal seating are common in obesity and uncontrolled diabetes. Obesity increases insulin production for compensating high glucose level. It increases the type 2 diabetes and sequentially appetite, weight gain. Diabetes is also associated with shakiness and diaphoresis. Unusual sweating or diaphoresis is common symptom in overweight and obese individual. Hypertension is also observed in both obesity and diabetes people but the later has greater influence on the hypertension (Heymsfield & Wadden, 2017). Therefore, the signs and symptoms are common in both diseases like a cyclical pathway. Interventi on is immediately required to decrease obesity and control diabetes. It will consequently improve his activities of daily living and social life.   Applying clinical reasoning cycle, establishment of goals that will yield desired health outcomes in the patient is important part of care process (Dalton, Gee & Levett-Jones, 2015).     The two priorities for   nursing care is reduction in weight and control the blood glucose level. I will do this by developing comprehensive   nursing care plan that is patient centered and evidenced based. Taking action based on evidence will ensure positive health outcomes as per clinical reasoning cycle (Dalton, Gee & Levett-Jones, 2015). To fulfill the first priority of reducing the weight of Peter, a realistic weight reduction plan will be formulated, along with appetite reduction and diet plan. It will be initiated on collaboration with dietician. Peter will be given a weekly weight loss protocol. The diet plan will include high protein and low fat consumption.   The patient will be monitored for ignoring the signals of hunger or track any distortion. The rational for this lifestyle intervention is decrease in hypertension and cholesterol with protein intake. A weight loss by ten kg may have positive impact on the cholesterol and blood pressure as per Nanditha et al., (2016). Further physical activity is essential for overweight individual. It will help reduce weight every month and enhance the metabolic rate.   The patient may be recommended for aerobics as it puts lest press ure on joints. Swimming is also considered better than jogging and walking. Involving in physical activity for 30 minutes for five days in a week will help the body mange sugar level by improving sensitivity to insulin (Koolhaas et al., 2017).    The patient will be supported with education to encourage him to lose weight. Peter will be educated about healthy diet and need of high protein consumption in present condition. To patient may be administered with the anti-obesity medication. Orlistat is another affective medicine for BMI greater than 30 kg/m2 in decreasing the absorption of dietary fat by 30%. It will help reduce weight and associated complications. It may include glycosidase inhibitors, metaformin or insulin therapy (Bedhiafi et al., 2018). The pharmacological interventions will be initiated by collaborating with the general physician attending Peter. To control the glucose level, which is the second   nursing priority metaformin may be continued as it was previously administered. Further blood pressure can be controlled by administering metaprolol (Yang et al., 2018). Medication will be administered as per the instructed dosage. Patient education is also important to self monitor glucose and for self-management of complications due to obesity and diabetes. The patient will be educated to cope up with the mental health concerns associated with weight loss program. The patient may be encouraged to stop smoking as it elevates blood sugar in diabetes patients. Referring to cognitive behavioural therapist may be effective to help Peter manage stress due to lifestyle interventions specially Smoking cessation. Further, the effect of smoking on his respiratory efficiency and Heart rate will be explained. It will relive him of fatigue (Lycett et al., 2015). The rationale for educational intervention is to encourage client in adopting h ealthy behaviour. The effectiveness of the outcomes must be evaluated as per the knowledge of clinical reasoning cycle (Dalton, Gee & Levett-Jones, 2015).   The patient’s weight will be monitored daily.   It is important to assess his understanding of the illness and treatment procedure to ensure compliance. The patient’s vital signs will be assessd to rule of any side effects of medications and modified diet. The patient will be monitored for deviations in exercise, nutrition and diet recommendations. The client is expected to demonstrate reducing weight as per plan and healthy eating. The patient is expected to self monitor glucose and show high self esteem in coping with complications. It is also important to assess for hyperglycemia condition (American Diabetes Association, 2015). Reflection on the care process is the last stage of the clinical reasoning cycle that involves contemplating on the caring and learning process (Dalton, Gee & Levett-Jones, 2015). It may be difficult for client to adhere to dietary recommendations in initial phase of treatment as he lacks emotional support.   The patient also has low self esteem due to poor body image. To address the challenges I will engage client in motivational therapy and group discussions to promote social connectedness (Harvey, 2015).   Further, challenges will be identified to prioritize future action.   The essay helped learn ways to identify patient health issue and prioritize care for Peter using clinical reasoning cycle. Identification of health issues assisted in prioritizing care. The tool helped in collecting and analyzing the clinical information. Analysis facilitated the understanding of factors underlying the Peter’s health’s complications. Prioritizing the care guided the development of adequate nursing interventions. The interventions to reduce weight and control glucose level in patient are based on evidence. It will help to address the priority issues and promote the patient health. American Diabetes Association. (2015). 3. Initial evaluation and diabetes management planning.  Diabetes Care,  38(Supplement 1), S17-S19. Cheung, B. M., & Li, C. (2012). Diabetes and hypertension: is there a common metabolic pathway?.  Current atherosclerosis reports,  14(2), 160-166. Choi, N. G., & DiNitto, D. M. (2014). Role of new diagnosis, social isolation, and depression in older adults’ smoking cessation.  The Gerontologist,  55(5), 793-801. Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum.  Australian Journal of Advanced Nursing , The,  33(2), 29. Harvey, J. N. (2015). Psychosocial interventions for the diabetic patient.  Diabetes, metabolic syndrome and obesity: targets and therapy,  8, 29. Helgeson, V. S., & Zajdel, M. (2017). Adjusting to chronic health conditions.  Annual review of psychology,  68, 545-571. Heymsfield, S. B., & Wadden, T. A. (2017). Mechanisms, pathophysiology, and management of obesity.  New England Journal of Medicine,  376(3), 254-266. Koolhaas, C. M., Dhana, K., Schoufour, J. D., Ikram, M. A., Kavousi, M., & Franco, O. H. (2017). Impact of physical activity on the association of overweight and obesity with cardiovascular disease: The Rotterdam Study.  European journal of preventive cardiology,  24(9), 934-941. Krishnan, V., Dixon-Williams, S., & Thornton, J. D. (2014). Where there is smoke†¦ there is sleep apnea: exploring the relationship between smoking and sleep apnea.  Chest,  146(6), 1673-1680. Lycett, D., Nichols, L., Ryan, R., Farley, A., Roalfe, A., Mohammed, M. A., ... & Aveyard, P. (2015). The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study.  The Lancet Diabetes & Endocrinology,  3(6), 423-430. Mark, A. L., & Somers, V. K. (2016). Obesity, hypoxemia, and hypertension: mechanistic insights and therapeutic implications.  Hypertension,  68(1), 24-26. Nanditha, A., Snehalatha, C., Ram, J., Selvam, S., Vijaya, L., Shetty, S. A., ... & Ramachandran, A. (2016). Impact of lifestyle intervention in primary prevention of Type 2 diabetes did not differ by baseline age and BMI among Asian?Indian people with impaired glucose tolerance.  Diabetic Medicine,  33(12), 1700-1704. Urden, L. D., Stacy, K. M., & Lough, M. E. (2015).  Priorities in critical care nursing. Elsevier Health Sciences. Yang, T., Hao, Y., Zhou, S., Jiang, Y., Xu, X., Qu, B., ... & Liu, W. (2018). GW26-e0732 Superior Dynamic Heart Rate Control and Non-Inferior Blood Pressure Control with Bisoprolol vs Metoprolol Sustained Release Tablet in Mild-to-Moderate Hypertension: CREATIVE Study.  Journal of the American College of Cardiology,  66(16 Supplement), C202.

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