Case Study on Primary Health Care Setting


Added on  2021-04-21

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Running head: CASE STUDY 1Case study 1Name of the student:Name of the University:Author’s note
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1CASE STUDY 1In primary health care setting, nurses are at the forefront of care as they spend themaximum time with patient. In case of chronically ill patients, multiple factors have an impacton their health status and treatment outcomes (Sallis, Owen & Fisher, 2015). Hence, for nurse, itis necessary to have knowledge about different factors that affect health of patient and prioritizecare accordingly for the optimal health of patient. Prioritization of care is dependent on clinicalreasoning skills and good judgment and decision making capacity of nurse. Clinical reasoningand judgments supports nurses to avoid adverse events and provide safe high-quality care(Papastavrou, Andreou & Efstathiou, 2014). This essay presents an overview about the processof prioritizing care by the analysis of a case scenario related to Peter Mitchell, a 52 year old malewith obesity and type 2 diabetes and developing priorities of care for the client. The justificationfor 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, criticalthinking and decision making for the safety of patient. The first step is considering the patientsituation (Hunter & Arthur, 2016). The case is about Peter Mitchell, a 52 year old male who wasadmitted to hospital for poorly controlled diabetes, obesity ventilation syndrome and sleepapnoea. To collect cues about factors contributing to the issue, client history and patientassessment 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’srecommendation and also visited a physiotherapist to start a light exercise at home. Review ofhis past history also revealed that he suffered from depression and had gastro oesophageal refluxdisease in the past. His past social history showed that he gained more weight after leaving thejob 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
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2CASE STUDY 1further reduced his physical activity levels and made him prone to risk of apnoea and otherhealth issues too. If his weight is not controlled further, then he may be at risk of developingcardiovascular disease too (Koolhaas et al., 2017). To identify the main problem or issue in Peter, processing information is necessary toprioritize care. His presenting symptoms during the hospital admission were sleep ventilationsyndrome, 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 than30 (Ogden et al., 2015). Hence, Peter Mitchell’s obesity is at extreme level. Furthermore, hisobesity 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 occursbecause of the collapse of the pharyngeal airway during sleep and obesity and aging are regardedas the major risk factor of the disease (Franklin & Lindberg, 2015). Obesity increases thedeposition of fat around the pharyngeal airway, which contributes to the collapsibility ofpharyngeal airway. Fat deposition also impairs functional residual capacity of patient (Jordan,McSharry & Malhotra, 2014). His symptom of sleep ventilation syndrome is also linked toobesity. 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 BPand 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 madebecause both hypertension and diabetes have a common pathway. People who are hypertensiveare at high risk of diabetes. There is overlap between etiology and disease mechanism of diabetesand hypertension too. Uncontrolled diabetes is also a factor that increases risk of hypertension in
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