Clinical Reasoning Cycle for Peter Mitchell: Case Scenario

Running head: CASE SCENARIO
Peter Mitchell case study
Name of the Student
Name of the University
Author note

1CASE SCENARIO
Community health nursing focuses on the fact that nurses must be able to completely utilise
their knowledge, skills, and capabilities, in order to deliver healthcare services to the patients, with
the aim of enhancing their health and wellbeing. Clinical reasoning is defined as the procedure by
which nursing professionals collect cues, process information, understand the patient problem,
implement a care plan, evaluate the outcomes and reflect on their learning from the procedure. This
essay will elaborate on the case scenario for Peter Mitchell, by following the stages of the clinical
reasoning cycle.
The first step involves consideration of the patient. Peter Mitchell is aged 52 years old and
had been admitted to the medical ward due to high blood glucose levels. His presenting complaints
also included signs of shakiness, increased hunger, and sleep apnoea. During his previous admission,
he was recommended to show adherence to LEHP diet, with the aim of reducing his body weight
since he has been diagnosed as obese. Furthermore, he has been actively smoking an estimated 20
cigarettes each day for the last 30 years. He is currently unemployed and separated from his wife
and sons. The case scenario encompasses his referral after discharge, and focuses on management
of the priority issues that have been identified.
Collecting information cues is the second step of the reasoning cycle. Upon analysing the
results from the patient assessment, it can be suggested that the high body weight of Peter (145 kg)
is responsible for the manifestation of signs and symptoms of obesity ventilation syndrome (OHS).
Furthermore, his excess body weight is also responsible for obstructive sleep apnoea that is one
primary reason for admission of the patient in the medical ward. Some other health abnormalities
that Peter is currently suffering from includes high glucose levels in the bloodstream, hypertension,
and GERD (gastro-oesophageal reflux disease). The current medications that have been prescribed
to the patient include metformin, lisinopril, insulin novomix, metoprolol, pregabalin, and nexium.
Peter had also been separated from his wife and sons and lived in isolation.
Processing patient information in the third stage will take into account the pathophysiology
of the presenting complaints. There is mounting evidence for the fact that obese patients
demonstrate signs of sleep disorder breathing, which in turn is associated with a reduction in the
sensitivity to increasing amount of PaCO2 (Castro-Añón et al., 2015). Furthermore, obesity has also
been allied with leptin resistance. In addition, obesity and overweight results in several pulmonary
and extrapulmonary ailments that bring about respiratory failure. Elevated levels of levels of
inflammatory and pro-inflammatory markers such as, tumor necrosis factor alpha (TNF alpha),
interleukin-6 (IL-6), interleukin-1 (IL-1), prostaglandin E2 (PGE2), and interleukin-18 (IL-18) trigger
chronic inflammation of the peripheral tissue pathway, thereby causing insulin resistance, and

2CASE SCENARIO
hypofunctioning of the hypothalamic C releasing hormone, subsequently leading to OHS (Shetty &
Parthasarathy, 2015). Hence, the complications observed in Peter were all interrelated. In addition,
hypertension can be associated with his smoking habits since extracts of tobacco are responsible for
damaging the linings of the arterial blood vessels, thus causing artery constriction and elevating the
pressure of blood flow. According to Chang and Friedenberg (2014) there is an increased risk for
GERD with extra abdominal fat that exerts pressure on the stomach and causes backflow of the
gastric acid. Diagnosis of type 2 diabetes suggests that Peter has blood glucose levels greater than
6.9 mmol/L, which in turn can be accredited to his body mass. An increase in weight adds pressure
on the insulin hormone to keep a check on the amount of glucose present in bloodstream (Gallagher
& LeRoith, 2015). This in turn increases resistance of the tissues and muscles to insulin hormone,
thus causing diabetes. Furthermore, the release of non-esterified fatty acids (NEFAs) from adipose
cells and tissues in obese people also supports the association between β-cell dysfunction and
insulin resistance (Pickens et al., 2015). In addition, it has also been found that smoking weakens the
muscles of the airways, thereby causing sleep apnea and increasing the likelihood of suffering from
cardiovascular complications, heart attack, and stroke.
The following stage involves synthesising information from the facts presented in the case
scenario. It can be deduced from the case that two major issues that are faced by Peter are the
presence of obesity ventilation syndrome and type 2 diabetes. Owing to the fact that severely obese
people suffering from OHS report a failure to breath deep enough or rapidly enough that
subsequently leads to a reduction in the oxygen levels in blood, concomitant with the amount of
carbon dioxide, immediate care must be given to address this concern (Hollier et al., 2014). Low
levels of oxygen due to OHS will also result in physiologic narrowing of the pulmonary arteries for
rectifying the ventilation-perfusion matching, thereby putting excessive strain on the right portion of
the heart, referred to as cor pulmonale. Lowering the high blood glucose levels is also crucial for
managing Peter’s health condition since poor glycaemic control might result in possible renal
impairment, neuropathy, cardiovascular damage, limb amputation, and retinopathy (Danziger et al.,
2016).
Establishment of goals for the identified priority problems form the succeeding phase. The
goals developed for Peter’s health management are namely, (i) decreasing the blood sugar levels
within 5.6 to 6.9 mmol/L and (ii) improving symptoms of OHS.
The next stage of the reasoning cycle involves formulating the course of nursing action that
will be adopted for effective management of the health ailments. Peter will be assessed for signs and
symptoms of hyperglycaemia that generally occurs when an insufficient amount of insulin hormone