Analysis of Sleep Apnea and Obesity

The given assignment is based on a research paper titled 'Adult obstructive sleep apnoea' published in The Lancet. It involves analyzing various studies related to sleep apnea, obesity, and lifestyle factors such as smoking and physical activity. The papers also discuss the impact of diabetes management and primary prevention of Type 2 diabetes. The assignment aims to understand how these factors contribute to the development of sleep apnea and obesity.

Running head: CASE STUDY 1
Case study 1
Name of the student:
Name of the University:
Author’s note

1CASE STUDY 1
In primary health care setting, nurses are at the forefront of care as they spend the
maximum time with patient. In case of chronically ill patients, multiple factors have an impact
on their health status and treatment outcomes (Sallis, Owen & Fisher, 2015). Hence, for nurse, it
is necessary to have knowledge about different factors that affect health of patient and prioritize
care accordingly for the optimal health of patient. Prioritization of care is dependent on clinical
reasoning skills and good judgment and decision making capacity of nurse. Clinical reasoning
and judgments supports nurses to avoid adverse events and provide safe high-quality care
(Papastavrou, Andreou & Efstathiou, 2014). This essay presents an overview about the process
of prioritizing care by the analysis of a case scenario related to Peter Mitchell, a 52 year old male
with obesity and type 2 diabetes and developing priorities of care for the client. The justification
for the two care priorities is also given by the application of clinical reasoning cycle.
Clinical reasoning cycle is the tool that supports nurses in problem solving, critical
thinking and decision making for the safety of patient. The first step is considering the patient
situation (Hunter & Arthur, 2016). The case is about Peter Mitchell, a 52 year old male who was
admitted to hospital for poorly controlled diabetes, obesity ventilation syndrome and sleep
apnoea. To collect cues about factors contributing to the issue, client history and patient
assessment records were analyzed. His past history revealed that he was a smoker for 30 years.
To control his obesity, he had started eating low, energy protein diet on dietician’s
recommendation and also visited a physiotherapist to start a light exercise at home. Review of
his past history also revealed that he suffered from depression and had gastro oesophageal reflux
disease in the past. His past social history showed that he gained more weight after leaving the
job and weight issues were the main reason for his unemployment. Hence, from this information,
the association between obesity and physical activity is understood. Unemployment issues

2CASE STUDY 1
further reduced his physical activity levels and made him prone to risk of apnoea and other
health issues too. If his weight is not controlled further, then he may be at risk of developing
cardiovascular disease too (Koolhaas et al., 2017).
To identify the main problem or issue in Peter, processing information is necessary to
prioritize care. His presenting symptoms during the hospital admission were sleep ventilation
syndrome, sleep apnoea and uncontrolled diabetes. His weight was 145 kg and height 170 cm.
This meant he had BMI of 50.2. A person is classified as obese when his BMI is 30 or more than
30 (Ogden et al., 2015). Hence, Peter Mitchell’s obesity is at extreme level. Furthermore, his
obesity is the major reason for symptoms like sleeps apnoea and sleep ventilation syndrome.
Sleep apnoea is a disorder associated with disruptions in breathing during sleep. This occurs
because of the collapse of the pharyngeal airway during sleep and obesity and aging are regarded
as the major risk factor of the disease (Franklin & Lindberg, 2015). Obesity increases the
deposition of fat around the pharyngeal airway, which contributes to the collapsibility of
pharyngeal airway. Fat deposition also impairs functional residual capacity of patient (Jordan,
McSharry & Malhotra, 2014). His symptom of sleep ventilation syndrome is also linked to
obesity. Hence, it is clearly understood that obesity is one of the major health issue in patient.
While processing Peter’s last observation in discharge data, it has been found that his BP
and respiratory rate are above normal value. His BP of 180/92 indicates that he is hypertensive.
He also has symptoms of shakiness, diaphoresis, increased hunger and high blood glucose level.
All this are directly linked to uncontrolled diabetes. This clinical judgment has been made
because both hypertension and diabetes have a common pathway. People who are hypertensive
are at high risk of diabetes. There is overlap between etiology and disease mechanism of diabetes
and hypertension too. Uncontrolled diabetes is also a factor that increases risk of hypertension in

3CASE STUDY 1
patient (Cheung & Li, 2012). Hence, it can be said that obesity and uncontrolled diabetes has
contributed to hypertension in Peter.
From the analysis and processing of health information of Peter, uncontrolled diabetes
and obesity is identified as two major problems in patient that has deteriorated his health and led
to abnormal symptoms in patient. The analysis of causes behind Peter’s symptoms and his
abnormal vital signs also showed obesity and uncontrolled diabetes to be a major reason for
adverse symptoms and morbidity in patient. He was also suffering from diaphoresis, a condition
leading to abnormal sweating in patient. People who are obese are most like to have the
symptoms of diaphoresis (Yeh et al., 2011). Hence, based on the identification of major problem
in patient, two important nursing priorities identified for the recovery of Peter is to control blood
sugar level of Peter and reduce obesity in patient. I aim to do this by development of
comprehensive nursing care plan related to treatment as well as patient education. Relevant
treatment options like pharmacological intervention will improve vital sign of patient and patient
education factor will encourage Peter to make healthy changes in his lifestyle and physical
activity levels (Nanditha et al., 2016).
Two fulfill the two care priorities of patient, different course of nursing actions or care
plan has been prepared both for controlling obesity as well as blood sugar level. In relation to the
care priority of controlling all adverse symptoms related to obesity, the first strategy is to
support Peter to quit smoking. This is important because smoking is likely to further worsen the
symptoms of sleep breathing difficulty and apnea for Peter (Mirambeaux Villalona et al., 2016).
Evidence has shown that each o the condition of smoking and sleep obstructive apnea adversely
affects each other. If patient continues smoking, it can increase the severity of apnea through
changes in upper airway neuromuscular function and increase in upper airway inflammation

4CASE STUDY 1
(Krishnan, Dixon-William & Thornton, 2014). Hence, smoking cessation strategies needs to be
implemented. As Peter is a heavy smoker, abrupt quitting of smoking will be difficult for him.
Hence, initially Peter can be encourages to use substitutes for cigarettes by the implementation of
nicotine replacement therapy. Later on, Peter can also be motivated to quit smoking by educating
him about the adverse impact of smoking on his blood glucose level and cardiovascular health.
This will enhance his willingness to quit smoking himself.
To control Peter’s obesity, another plan of action is to implement lifestyle intervention so
that he adapts positive health behavior to minimize weight gain. Lifestyle interventions are
effective not only in preventing weight gain, but also in decreasing hypertension and onset of
type 2 diabetes related complication (Sargent, Forrest & Parker, 2012). To control his weight
gain, it will also be important for nurse to review daily food intake of Peter and take dietician’s
advice to provide low calorie food to patient. Considering that Peter is highly obese and this is
having an impact on his respiratory function, the nurse also needs to educate patient about the
need to control binge eating and staying active. The nurse should also guide patient in engaging
in physical activity every day. Initiation of moderate intensity 60 minutes physical activity or
resistance training on a daily basis can help to prevent abnormal weight gain in patient.
Combination of exercise training and dietary intervention significantly reduces weight of patient
(Strasser, 2013).
In relation to the care priority of uncontrolled diabetes and hypertension, it is planned to
implement pharmacological intervention in patient. The medication like Metformin and
Metoprolol will be continued to control high blood sugar and blood pressure in patient
respectively. Apart from pharmacological intervention, other nursing plan of action for
controlling high blood sugar level in patient includes assessment for signs of hyperglycemia or

5CASE STUDY 1
hypoglycemia in patient and control blood glucose level regularly. Nurse can strengthen Peter’s
capability to engage in self-management of diabetes by means of education and coaching. The
patient education plan can educate Peter about recommended level of BP, BGL level, provide
details about life style changes and using appropriate website or health information tool to
successfully manage their diabetes. Motivational interviewing will be particularly important
because Peter lacked the motivation to change his lifestyle and engage in physical activity or
dietary changes (Levich, 2011).
After the implementation of the course of action, evaluating outcome of the key nursing
action implemented for Peter will be important. This can be done by checking patient’s
compliance with exercise regimen and dietary intervention. Secondly, patient vital parameters
like BP, BGL and symptoms of sleep apnea and breathing difficulty needs to be assessed to
ensure that the care priority helped to improve the condition of patient. Reflecting on the care
process is also necessary to find out any challenges in implementing the care plan and
prioritizing future action to address those challenges in the future.
The essay gave an insight into the methods used to identify patient problem and prioritize
care for patient by means of analysis of health issues in Peter Mitchell. The application of the
steps of clinical reasoning cycles helped to collect cues and process those informations to
identify nursing intervention for patient. Furthermore, identification of two health problem in
patient helped to priorities care and implement targeted nursing intervention for the promotion of
health in patient. This process helped to develop effective care plan to support Peter to control
his obesity and blood glucose level.

6CASE STUDY 1
References:
Cheung, B. M., & Li, C. (2012). Diabetes and hypertension: is there a common metabolic
pathway?. Current atherosclerosis reports, 14(2), 160-166.
Franklin, K. A., & Lindberg, E. (2015). Obstructive sleep apnea is a common disorder in the
population—a review on the epidemiology of sleep apnea. Journal of thoracic
disease, 7(8), 1311.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Jordan, A. S., McSharry, D. G., & Malhotra, A. (2014). Adult obstructive sleep apnoea. The
Lancet, 383(9918), 736-747.
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.
Levich, B. R. (2011). Diabetes management: optimizing roles for nurses in insulin
initiation. Journal of multidisciplinary healthcare, 4, 15.
Mirambeaux Villalona, R., Manas Baena, E., Arrieta Narvaez, P., Jaureguizar Oriol, A., Jimenez,
G., Garcia de Leaniz, J., ... & Pedrera Mazarro, A. (2016, September). Is smoking a risk

7CASE STUDY 1
factor for sleep obstructive apnea?. In JOURNAL OF SLEEP RESEARCH (Vol. 25, pp.
353-354). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL.
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.
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and
adult obesity in the United States, 2011-2012. Jama, 311(8), 806-814.
Papastavrou, E., Andreou, P., & Efstathiou, G. (2014). Rationing of nursing care and nurse–
patient outcomes: a systematic review of quantitative studies. The International journal
of health planning and management, 29(1), 3-25.
Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health
behavior: Theory, research, and practice, 5, 43-64.
Sargent, G. M., Forrest, L. E., & Parker, R. M. (2012). Nurse delivered lifestyle interventions in
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systematic review. obesity reviews, 13(12), 1148-1171.
Stead, L. F., Koilpillai, P., Fanshawe, T. R., & Lancaster, T. (2016). Combined pharmacotherapy
and behavioural interventions for smoking cessation. The Cochrane Library.
Strasser, B. (2013). Physical activity in obesity and metabolic syndrome. Annals of the New York
Academy of Sciences, 1281(1), 141-159.

8CASE STUDY 1
Yeh, K. H., Skowronski, M. E., Coreno, A. J., Seitz, R. E., Villalba, K. D., Dickey-White, H., &
McFadden Jr, E. R. (2011). Impact of obesity on the severity and therapeutic
responsiveness of acute episodes of asthma. Journal of Asthma, 48(6), 546-552.