Case Study Involving Use of Clinical Reasoning Cycle

CASE STUDY 1
CASE STUDY INVOLVING USE OF CLINICAL REASONING CYCLE
Name:
Institutional affiliation:

CASE STUDY 2
DIABETES; FIRST PRIORITY OF CARE
Clinical reasoning cycle has been defined as the ability to have critical skills as a
community health nurse to identify a patient who is deteriorating and evaluating the outcomes of
the goal set for the patient (Hunter & Arthur,2016). Nurses with good clinical reasoning skills
have better judgement skills and are able to assess and plan for an emergency patient
promptly. Diabetes is an endocrine condition which refers to high blood sugar levels as a result
of low insulin levels or tissue resistance to insulin. Diabetes type two is whereby the islets of
Langerhans in the pancreas produce insulin but the tissues are resistant. The first step in
clinical reasoning cycle is considering the client’s situation. Peter is 52 was diagnosed with
diabetes type two which is poorly controlled nine years ago. He was admitted with high blood
glucose levels and increased hunger. He is on insulin novomix and metformin an oral
antidiabetic.
The second step is to collect patient data regarding the clinical condition. Peter is obese
and currently weighs 145kgs an increase from 105 kgs. According to Czech (2017) obesity has
been linked to insulin resistance causing diabetes type two. This calls for weight management
and reduction to reduce chances of complications. Peter commenced on a diet to help him
reduce weight and also light exercises. He is meant to continue with exercises after discharge.
Peter also feels isolated as he is unable to manage his weight therefore, he needs counselling
and motivation by the community health nurse. He also thinks weight loss is too difficult to be
implemented.
Diabetes type two is mainly has late onset although it is also affects adolescents. The
pathophysiology manifests by insulin resistance in the tissues which results in high blood
glucose levels. This causes infections, glycosuria and constant fatigue. Complications of
diabetes include nephropathy, visual impairment, delayed wound healing which may lead to
gangrene, neuropathy and hyperosmolar hyperglycemic state. Also, the patient may be
hypoglycemic if he administers excess insulin. Sleep apnea has been associated with the
development of diabetes type two (Doumit & Prasad, 2016). Peter is on insulin novomix which
converts blood glucose to glycogen while metformin is a biguanide which enhances the action of
insulin on tissue. Pregabalin is used to manage the neuropathic pain caused by diabetes.
The third step is to interpret the information and predict an outcome that is expected
after community health nurse’s intervention. Peter requires constant follow up which ensures
that he is involved in his on care and the diabetes is under management. The nurse will work

CASE STUDY 3
with Peter to form exercise plan and adhere to it. It is necessary for him to administer insulin
and note any signs of hypoglycemia that may occur. The desired outcome is a reduction in
Peter’s weight and decrease in blood glucose levels in random blood glucose tests and glycated
hemoglobin test which is done after three months.
The fourth step is identifying the major problem and deduce a nursing diagnosis. Since
Peter has high blood glucose levels which is the main clinical morbidity the nursing diagnosis
will be unstable blood glucose related to insulin resistance. Peter presents with multiple
comorbidities such as hypertension and gastroesophageal reflux disease hence requires
multidimensional care. It is also important to advise Peter to seize smoking as this complicates
his management due to vascular compromise and increased hypertension.
The fifth step is to establish the goal and outcome criteria which will determine the level
of success attained by Peter. The major goal is to maintain Peter’s blood glucose within the
normal range which will be assessed by random blood sugar tests, fasting blood glucose and
glycated hemoglobin tests. The second goal is to ensure weight reduction from 145kgs.
The sixth step is to take action. The community health nurse helps to Peter to formulate
an eating plan in accordance to the dietician low energy high protein diet low salt diet. This is
tailored to meet Peters budget considering that he is unemployed and he relies on government
benefits. He agrees to what works best for him as it will determine the success. The nurse also
assists Peter in formulating an exercise plan as reviewed by the physiotherapist and
emphasizes on the need to lose weight to Peter. The nurse should follow up if he is adhering to
the plan which may involve various activities such as walking. The nurse encourages Peter on
the need to meet the set goal everyday such as 1000 steps a day. Most importantly the nurse
educates Peter on how to administer insulin on the subcutaneous tissue; the right amount to
prevent hypoglycemia and what to do in case of hypoglycemia such as taking juice. The nurse
also teaches Peter on conducting random blood sugar tests using a kit and how to interpret the
results. Peter should also be aware of signs of diabetic complications.
The seventh and last step involves evaluation and reflection. This involves check listing
whether Peter’s blood glucose is within the normal range using the record of random blood
glucose levels and if he can administer the insulin appropriately. Peter should have a daily
record of his exercise activities and the number of steps he has attained. This will go a notch
higher to running and gym activities depending on his commitment levels.