Author note: 1 Case Study of PETER MITCHELL CASE STUDY OF PETER MITCHELL Name of the student: A university: Author note: One case study: Clinical reasoning cycle
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Running head: CASE STUDY OF PETER MITCHELL CASE STUDY OF PETER MITCHELL Name of the student: Name of the university: Author note:
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1 CASE STUDY OF PETER MITCHELL Clinical reasoning cycle is the process where healthcare professionals collect cues from the patient’ssituationsandthenprocesstheinformationinordertounderstandtheneedsand requirements of the patients(Kusminski et al., 2016). This is followed by effective planning and implementing different types of interventions followed by successful evaluation of the interventions (Bhupathiraju et al., 2016). This assignment would be mainly based on a using the clinical reasoning cycle by nurses in order to identify the nursing care priorities and then developing care interventions that would help in development of the health of the patient named Peter Mitchell in the case study. One of the most important care priority areas for the patient is hypertension.The case study has stated that blood pressure level of Peter was high as per reported in medical history section . This blood pressure is found to be much higher than that of the normal blood pressure which tends to be around 120/80 mmHg. This increases the risks for different types of cardiovascular disorders as studies have found positive correlation between high blood pressure and increased chances of heart diseases. Therefore, the high blood pressure needs to be kept in control(Hartman et al., 2018). Peter has been found to have the habit of smoking 20 cigarettes per day which can be considered to be one of the highest risk factor for high blood pressure.Nicotine which is present in cigarettes smoking is one of the most dangerous compounds that has direct impact on the arteries and make the arteries much narrow. They result in building up fatty substances inside the arteries making the arteries much narrower(Patterson et al., 2016). Hence, the blood flowing through the narrow arteries faces difficulty thereby increasing the blood pressure level. The arteries also become much stiff as well because of the effect of nicotine smoking. Researchers are of the opinion that high smoking rates results in thrombus formation resulting in higher number of blood clots among the affected individuals(Bhupathiraju et al., 2016). Such blood clots get attached to the wall of the blood vessels and increase the stresses on heart thereby exposing the individuals for both heart attack and stroke(Lih et al., 2015).Therefore, in order to protect Peter,the nursing professionals need to control his smoking habits and thereby reduce the blood pressure level of Peter to normal. In order to manage the condition of hypertension, the first goal that the nursing professionals should set is to reduce his smoking habit and control hypertension. The first intervention that nurses should be taking is to educate him about the risks that reside with situations of hypertension and taking of proper initiatives for keeping the blood pressure under control. He would be provided with important medications that help in managing the blood pressure level. In addition to this, he should be instructed to lose extra weights, eat a healthy diet, reducing sodium in the food intakes, exercising regularly and
2 CASE STUDY OF PETER MITCHELL others. The nursing professionals should also teach him importance of measuring his blood pressure level(Farsalinos et al., 2016). Quitting smoking is another significant intervention that nurses should advise to Peter to manage his blood pressure levels. The nurse should refer Peter to a substance abuse counselor who would help Peter to become self-determined in leaving smoking for his health through effective counseling therapies like cognitive behavioral therapies and similar such therapies. Cognitive behavioral therapy is found to be highly beneficial in altering the behavior of smoking and helping individuals quit smoking through self-motivation, determination as well as enthusiasm(Little et al., 2016). Another important intervention that can be also suggested is the nicotine replacement therapy. This therapy also helps by exerting some forms of psychological effects on his mood as well as attention states. Different types of nicotine replacement products that can also help the patient to overcome his smoking habit would be Sublingual nicotine tablet, Nicotine lozenge, Nicotine inhaler, Nicotine nasal spray and others(Hartman et al., 2018). He would be requested to visit the healthcare center for follow- ups forevaluation of the health condition of the patient. Here, the healthcare professionals would undertake various evaluation of his health condition like vital signs, his smoking cessation graphs and similar others. This would make them understand whether Peter is responding to the intervention or that he requires changes in his treatmentDaskalopoulou et al., 2015).. Another important care priority would be management of obesity and unmanaged diabetes conditions to ensure better quality life.The patient was seen to suffer from poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. He also suffered from symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping.Studies have found a close relationship between obesity and diabetes type-2. It has been found that the abdominal fat mainly causes the fat cells in releasing a specific form of chemical called the pro-inflammatory chemicals. This chemical has the ability to disrupt the function of the insulin responsive cells in the body thereby making the body cells much less sensitive to the action of the hormone insulin(Lih et al., 2015). This insulin is produced by the cells of the pancreas and helps in maintaining the blood glucose level in blood by making cells accept glucose from blood. Therefore, even when the insulin is present in the system, the body cells become non-responsive to insulin and hence blood glucose levels increase. Therefore, a close connection is believed to exist between obesity and diabetes issues(Booth et al., 2016). Another hypothesis is also put forward by many researchers and more work is being conducted to prove it. It is stated that conditions of obesity or overweight puts stress on the on the endoplasmic reticulum of the cells which are actually membranous networks present in the cytoplasm of the cells
3 CASE STUDY OF PETER MITCHELL (Little et al., 2016). When such networks are found to contain more nutrients that they can handle effectively, they start sending signals to the cells for dampening the insulin receptors of the cells that are present on surface of the cells. Therefore, cells are seen to become resistant to insulin and thereby blood glucose level is seen to increase. In this way, in case of Peter also obesity might have resulted him to suffer from diabetic conditions. Due to lack of health literacy, he might have not been able to understand the importance of having healthy diets and therefore, his conditions of obesity and diabetes hadremainunmanagedoverthenumberofyears.Hehadbeenalsosufferingfromobesity hypoventilation syndrome and sleep apnea which are other complications of obesity as well(Harvey, 2015). This is characterized by individuals suffering from short breathing sessions where individuals stop breathing altogether for short times during sleeping(Daskalopoulou et al., 2015). This might impact the heart and hencePeter may be also vulnerable to develop cardiovascular disorders. Conditions of diabetes as well as obesity should be both maintained as first priority to ensure that Peter lives healthy life(Ozemek et al., 2017). The nurse should focus on the health education session for Peter where he should be taught in details about the negative impacts of obesity and diabetes. Peter had been already told by his previous GP about importance of weight loss but still he has found it quite difficult to comply with the procedures discussed. In the present situation, the healthcare professionals should be mainly focusing on the self- motivation and coping-capability development of the patient about different healthy behaviors and lifestyle interventions taught to him(Hafez et al., 2017). This can be done successfully by motivational interviewingasevidence-basedstudieshavefoundpositivecorrelationbetweenmotivational- interviewing and development of motivation to follow a healthy lifestyle pattern. The nurse should be guiding the patient with weight-loss maintenance program that would comprise of five important aspects(Massetti et al., 2017). These would be learning to self-monitor the weight on a regular basis with the second one being the consuming of low fat diet with more green vegetables and fruits. The thirdwouldbeundertakingregularphysicalexerciseseverydayforapproximatelyonehour (Daskalopoulou et al., 2015). The fourth one would be minimization of the screen time and the fifth one would be more and more consumption of home cooked meals and less intake of alcohol. Peter should be also referred to counselors who would help him to overcome depression and regain back his confidence. Peter should be set with easier goals first so that he can achieve them and his confidence gradually arise unlike the previous time where he felt it was hard for him to maintain the interventions set by his previous GP. A diabetes educator can also be allocated for him who would teach him about
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4 CASE STUDY OF PETER MITCHELL how to control blood glucose levels by effective managing his medications. Moreover, the educator would also teach him about whom to monitor his blood glucose level everyday by the help of glucometer. This would help him realize whether any threatening situations might take place or not and take precautionary measures(He et al., 2017). It would also help professionals to track his blood glucose level everyday and would help them to understand how he is responding to the treatment procedures. The evaluation process would include measuring his weight, measuring his blood glucose level, measuring his satisfaction and several others(Daskalopoulou et al., 2015). This would help the nurse to develop an idea whether the patient is responding to the treaents or intervention needs to be altered. I have realized that clinical reasoning cycle acts as guiding framework that has helped me in first realizing the cues and then understanding the pathophysiology that had made the patient suffer to such an extent. This had in turn helped me setting the goal or the care priorities. I have conducted extensive evidence based researches to find out the interventions that would benefit Peter. The entire procedure had helped me to thin systematically without clouding my mind with different aspects of the patient’s conditions. I had been able to successfully develop the care plan and interventions that benefitted the patient to large extent.
5 CASE STUDY OF PETER MITCHELL References: Bhupathiraju, S. N., & Hu, F. B. (2016). Epidemiology of obesity and diabetes and their cardiovascular complications.Circulationresearch,118(11),1723-1735. https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.115.306825 Booth, H. P., Prevost, A. T., & Gulliford, M. C. (2016). Severity of obesity and management of hypertension, hypercholesterolaemia and smoking in primary care: population-based cohort study.Journal of human hypertension,30(1), 40.https://www.nature.com/articles/jhh201523 Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., ... & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program recommendations for blood pressuremeasurement,diagnosis,assessmentofrisk,prevention,andtreatmentof hypertension.CanadianJournalofCardiology,31(5),549-568. https://doi.org/10.1016/j.cjca.2015.02.016 Farsalinos, K., Cibella, F., Caponnetto, P., Campagna, D., Morjaria, J. B., Battaglia, E., ... & Polosa, R. (2016). Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes.Internal and emergency medicine,11(1), 85-94. https://link.springer.com/article/10.1007/s11739-015-1361-y Hafez, D., Fedewa, A., Moran, M., O’Brien, M., Ackermann, R., & Kullgren, J. T. (2017). Workplace interventionstopreventtype2diabetesmellitus:anarrativereview.Currentdiabetes reports,17(2), 9.https://link.springer.com/article/10.1007/s11892-017-0840-0 Hartmann-Boyce, J., Begh, R., & Aveyard, P. (2018). Electronic cigarettes for smoking cessation.bmj,360, j5543.https://doi.org/10.1136/bmj.j5543 Harvey, J. N. (2015). Psychosocial interventions for the diabetic patient.Diabetes, metabolic syndrome and obesity: targets and therapy,8, 29.doi:10.2147/DMSO.S44352 He, X., Li, J., Wang, B., Yao, Q., Li, L., Song, R., ... & Zhang, J. A. (2017). Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis.https://link.springer.com/article/10.1007/s12020-016-1168-2
6 CASE STUDY OF PETER MITCHELL Kusminski, C. M., Bickel, P. E., & Scherer, P. E. (2016). Targeting adipose tissue in the treatment of obesity-associateddiabetes.NaturereviewsDrugdiscovery,15(9),639. https://www.nature.com/articles/nrd.2016.75 Lih, A., Pereira, L., Bishay, R. H., Zang, J., Omari, A., Atlantis, E., & Kormas, N. (2015). A novel multidisciplinary intervention for long-term weight loss and glycaemic control in obese patients withdiabetes.Journalofdiabetesresearch,2015. https://www.hindawi.com/journals/jdr/2015/729567/abs/ Little, P., Stuart, B., Hobbs, F. R., Kelly, J., Smith, E. R., Bradbury, K. J., ... & Margetts, B. M. (2016). An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial.The Lancet Diabetes & Endocrinology,4(10), 821-828.https://doi.org/10.1016/S2213-8587(16)30099-7 Massetti, G. M., Dietz, W. H., & Richardson, L. C. (2017). Excessive weight gain, obesity, and cancer: opportunitiesforclinicalintervention.Jama,318(20),1975-1976. doi:10.1001/jama.2017.15519 Ozemek, C., Phillips, S. A., Popovic, D., Laddu-Patel, D., Fancher, I. S., Arena, R., & Lavie, C. J. (2017). Nonpharmacologic management of hypertension: a multidisciplinary approach.Current opinion incardiology,32(4),381-388. https://www.ingentaconnect.com/content/wk/hco/2017/00000032/00000004/art00008 Patterson, E., Ryan, P. M., Cryan, J. F., Dinan, T. G., Ross, R. P., Fitzgerald, G. F., & Stanton, C. (2016). Gut microbiota,obesityanddiabetes.PostgraduateMedicalJournal,92(1087),286-300. https://pmj.bmj.com/content/92/1087/286.abstract