Case Study Analysis: Nursing Priorities for Peter Mitchell

This case study analysis focuses on the nursing priorities for Peter Mitchell, a patient with poorly managed diabetes and associated health complications. The analysis utilizes the Levett-Jones clinical reasoning cycle to develop a plan of care for the patient. The two nursing priorities identified are the management of his breathing pattern and weight. The action plan includes patient education, bronchodilator administration, and weight management strategies. The effectiveness of the intervention will be evaluated to assess the improvement in the patient's health condition.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS (PETER MITCHELL)
Name of the student
Name of the university
Author note

2CASE STUDY ANALYSIS
Nursing priority is a crucial healthcare strategy followed by community nursing
professionals. This helps the nursing professionals to apply interventions for critically or
terminally ill patients depending upon their needs and using it they could develop a plan of care
for each of the patient and their associated ailments (Wielenga et al., 2015). Therefore, to
develop a plan of care depending upon the healthcare needs of the patients, nursing
professionals should utilize the Levett- Jones clinical reasoning cycle (Dalton, Gee & Levett-
Jones, 2015). Through the help of the multiple steps of Clinical Reasoning Cycle, nursing
professionals are able to develop intervention goals as per patients’ ailments and care needs
and then assists them to develop an action plan so that health improvement could be observed
(McSharry & Lathlean, 2017).
The primary aim of this assignment is to analyze the case study of Peter Mitchell (52),
who is suffering from poorly managed diabetes since 9 years and due to this, he is suffering
from severe health complications, such as overweight, stress, hypertension and sleep apnoea.
Therefore, this assessment would help to identify the two nursing priorities such as his
prolonged diabetes and specifically his overweight and his sleep apnoea as it could lead to
severe cardiac disorder in the patient.
While analyzing Peter’s condition, it was seen that his prolonged diabetes is his primary
healthcare complication (Dalton, Gee & Levett-Jones, 2015). Further, his healthcare
complication includes hypertension; sleep apnoea, shakiness in hands, increased hunger,
diaphoresis and high blood sugar level and shortness of breath. Peter has quit his job so that he
could resume his insulin treatment however it has affected him negatively by increasing his
weight and he gained more than 40 kg in this period (105 to 145 kg). As per Montesi et al.
(2016), prolonged diabetes could be one of the reasons for his increased weight as a majority of
the people associated with prolonged diabetes were associated with overweight in the research
of Mitanchez et al. (2015). Further, it was also seen that he lacks motivation and could not
comply with the protein-rich diet and physical; an exercise which was given to him to reduce his
weight. His low motivation, self- confidence could also be observed through the aspect that he
become socially isolated and suffered from depression and hypertension throughout his ailment
(McMullen & Sigurdson, 2014). Mentally and emotionally, he was weak as his two sons were
not regular at visiting their ill father and hence, he lost all the hope and motivation.
Further, Peter’s elevated diabetes condition was the first cue which was noticed and it
was identified that all the secondary conditions occured due to this condition (Dalton, Gee &

3CASE STUDY ANALYSIS
Levett-Jones, 2015). This elevated diabetes affected his employment, increased his social
stigma and contributed to increasing in his weight. Further, it was seen that the patient is
suffering from depression and as per de Morais et al. (2014), prolonged health concerns could
increase stress and depression among patients as the patients are generally unaware of the
preventive measures to overcome it rapidly. This made him suffer from depression and stress
and resulted in his elevated blood pressure which ultimately increased his hypertension. As per
Holwerda et al. (2014) social isolation and hypertension are two primary feelings that the patient
suffering from chronic healthcare condition suffer from because they are not confident about
their health and loses their determination power. Hence all these cues were collected from
Peter’s health condition and his elevated blood glucose level due to his prolonged diabetes was
identified as the primary healthcare condition that was the reason of his resultant secondary but
severe healthcare complications (Schroedl et al., 2014).
Processing the information of Peter and his history indicated that the health complication
of Peter was interlinked with each other. His 9 year prolonged diabetes condition lead to his
obesity and depression condition. This further increased the risk factor of sleep apnoea of the
patient as American Diabetes Association (2016) mentioned that prolonged diabetes with
excessive weight increases the risk factor for the cardiovascular condition. Further, it is evident
that due to his elevated weight, he was unable to communicate in society because it increased
his social stigma and affected his mental health condition (American Diabetes Association,
2015). Hence, identification of healthcare gaps indicated that his improper management of
diabetes was the sole reason, due to which all the secondary healthcare complication arises.
Therefore, the two healthcare complications which would be targeted for the healthcare
intervention would be his improper breathing pattern, that lead to his elevated blood pressure
and risk of COPD and sleep apnoea. Further, the second problem which would be targeted in
this scenario would be his overweight condition, so that correlated sleep apnoea, the risk of
cardiac disorders and obesity could be eliminated and his quality of life could be improved
(Messner & Bernhard, 2014).
As per the Levett-Jones and as per these two nursing priorities for the healthcare for the
patient would be chosen so that he could overcome the health complication easily (Dalton, Gee
& Levett-Jones, 2015). The first goal for patient management would be his uncontrolled
breathing pattern and the patient would be involved in the cares process as
Nursingmidwiferyboard.gov.au. (2019) mentioned that the inclusion of patient health literacy

4CASE STUDY ANALYSIS
with other effective care intervention helps to improve patient condition rapidly. Besides
education, he would be provided with activities and strategies using which he could maintain his
uncontrolled breathing pattern associated with sleep apnoea. The second goal would be the
application of light to moderate exercise as overweight is one of the primary reason due to
which the majority of the obese patient suffer from sleep apnoea condition (Holwerda et al.,
2014). Both of these goals would be implemented for 4 weeks of a short period so that the
effectiveness of intervention could be assessed and further extension if required, could be
provided (American Diabetes Association, 2016).
The action plan for achievement of the first goal would be the application bronchodilators
for faster and rapid relief of the patients breathing pattern. In this strategy, the nursing
professionals would provide the patient with healthcare literacy so as community nursing
professionals; it is their duty to strategies and techniques to overcome their health complication.
To achieve the SMART goal developed, nursing professionals would provide the patient with
healthcare education of 4 breathing techniques that Peter should follow for their breathing
improvement (Dolák & Tóthová, 2014). He would be informed about the strategies of
prevention of ineffective breathing pattern verbally in his ward so that with other interventions,
patient could be provided with education regarding preventive measures of COPD, and
breathing disorder (Van Der Gucht et al., 2014). Further, as per the NMBA standards he would
be included on the healthcare intervention sessions so that he could develop his own goals and
prepare himself with self-determination to achieve them. Through administration of
bronchodilators, for rapid and fast relief, and mitigating the risk of COPD by providing education
about breathing pattern, his sleep apnoea and risk of COPD would also be reduced (Ovechkin
et al., 2016). Achievement of these goals would help to reinforce proper breathing pattern for the
patient and he would be able to resume his medication for diabetes so that healthcare
complications related to diabetes could also be managed.
As the second priority of care, the nurse can concentrate on the management of his
sleep apnoea so that e could not get affected by cardiovascular disease risks. The nursing
professionals may work collaboratively with the physiotherapists and cardiologists so that his
obesity and weight increase could be managed and his risk factors of sleep apnoea could be
mitigated. As per Deacon et al. (2016), to treat sleep apnoea, nursing professionals should
implement weight management as due to heavyweight around neck and chest, he could
develop severe sleep apnoea and could develop cardiovascular diseases (Calik, 2016). Further,

5CASE STUDY ANALYSIS
he would also provide with smoking and alcohol reduction literacy and hence it would help to
overcome her breathing-related complications. These action plans would be implemented for 5
weeks so that at the end of the timeline the growth of the intervention and its effects could be
evaluated and if required, reimplementation could be observed.
Finally, evaluation of the nursing intervention and determining the effectiveness of the
care plan was performed. In this case study, application of patient education and literacy would
help in making him aware of his illness so that he could manage his own breathing condition
and with medical assistance and evaluation of this would be assessed by observing his health
improvement. Further, the evaluation of the second goal for weight management would be
achieved by assessing his weight before and after the intervention so that effectiveness of
weight management and patient education for sleep apnoea condition could be achieved.
Hence, in reflection I would state that application of Levett- Jones helped me to understand the
strategy using which every cue of healthcare condition of the patient could be connected so that
they could help them to determine patient priority. Further, development of action plan and
nursing priority helped me to assess my abilities as a community nursing professionals.

6CASE STUDY ANALYSIS
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