Case Study of Peter Mitchell

Running head: CASE STUDY OF PETER MITCHELL
CASE STUDY OF PETER MITCHELL
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CASE STUDY OF PETER MITCHELL
Clinical reasoning cycle helps nurses to participate in complex cognitive process that utilizes
both formal and informal thinking strategies for gathering data as well as analyzing patient information
to find out nursing priorities and develop care plans for them (Hunter et al., 2016). The assignment
would mainly portray how clinical reasoning cycle can be used in the case study of Peter Mitchell in
order to find out his healthcare priorities and to develop care interventions for him.
One of the most important nursing priorities for Peter Mitchell would be to manage his
uncontrolled diabetes and obesity. He has been found to be 145kgs that is quite high for a normal
human being. He is quite depressed as well as embarrassed about his weight and wants to reduce his
weight. Therefore, this should be treated as the first priority. Studies have also identified obesity to be
one of the biggest risk factor that contributes to occurrence of diabetes (Cheng et al., 2017). It has been
found that as an individual gains weight, the sensitivity of the tissues of the body to that of the effects of
insulin is seen to get diminished. This results to the occurrence of a situation, which is called insulin
resistance when the body cells no more responds to insulin and hence cannot take in glucose from
blood. Because of this factor, blood glucose levels seem to rise high resulting in diabetes (Little et al.,
2016). Another paper had ventured deeper into the working mechanism of insulin resistance where it
has been found that abdominal fact produces the greatest risk. Blood from the visceral fat, which are
often laden with fatty acids, are seen to drain directly into the liver but some of the fatty acids can be
spilled over into the general circulation. Here, they can compete with glucose for being uptake into the
peripheral tissues like that of the muscles. As it can be stated that uptake of glucose is an insulin
mediated process, the competition can promote insulin resistance (Wan et al., 2017)). Many others are
of the opinion that visceral fact also contains the hormones called adipokines. Some of these can further
dampen the sensitivity of the insulin receptors for the effects of the insulin (Sherifali et al., 2015). Hence,
to control diabetes, obesity needs to be managed effectively. Peter is also suffering from obesity
hypoventilation syndrome which is actually a breathing disorder witnessed on patients suffering from
obesity. The syndrome causes patients to have too much carbon dioxide and too less oxygen in the
blood. If treatment is not provided, Peter might suffer from serious and life threatening situations.
Peter is also suffering from high blood glucose level because of unmanaged conditions of diabetes and
even from increased hunger, which is a symptom of diabetes (Ritten et al., 2017). In uncontrolled
diabetes, blood glucose levels seem to remain abnormally high and glucose from blood cannot enter the
cells. Therefore, the body cannot get glucose to convert them into energy and this lack of energy results

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CASE STUDY OF PETER MITCHELL
in a feeling of increased hunger (Wallace et al., 2015). Because of these reasons, the nursing goal should
set for Peter would be to manage his obesity and diabetes.
One of the most important things that had been noticed is that Peter was already given advices
about how to maintain his diets and the different important food components that he needed to
include. However, he had complained that somehow he had found them quite hard to maintain.
Researchers are of the opinion that patients should be always set with easier goals in the initial stages so
that they can complete them and gain confidence (Wan et al., 2017). The nursing professionals should
set easy goals regarding his diets so that he feels motivated when he can complete them successfully.
Firstly, the nursing professional needs to develop health literacy of Peter by which he can be taught
about the disorders of diabetes and obesity in details. Developing knowledge about the disorders and
the ways they affect health of patients can make them careful and motivated o overcome the disorders
(Wallace et al., 2015). Health education also teaches patients with different healthy lifestyle choices that
can help them to manage their disorders (Sherifali et al., 2015). Hence, nurses should educate Peter
about self-management interventions for both obesity and diabetes. Nurses should explain the
importance of exercise in the prevention or the delay in the progression of obesity and diabetes. Nurses
should also educate the patient about the importance of weight control and role that diet plays in the
management of the disorders (Little et al., 2016). Peter has been also found to withdraw himself
completely because he feels embarrassed. He seems depressed because of his health conditions and not
being able to get any jobs as well. Studies are of the opinion that depression as well as anxiety is
intricately associated with diabetes and obesity. Hence, nurses can refer Peter to psychotherapists who
can introduce talk therapists to help him overcome any emotional turmoil that he faces. Nurses can also
refer him to a diabetes educator. Diabetes educators educates patients about importance of identifying
high sugar foods, follow nutritional plans, ways to measure waist circumference, height and weight to
get BMI, using of the glucometer and many others (Cheng et al., 2017).. Oral therapies like insulin
novomix, metformin and others should be initiated and Peter should be taught about its importance and
doses that need to be taken properly. In order to evaluate condition of Peter during his follow-ups, his
blood glucose level would be measured to understand how he is managing his diabetes. His BMI should
be measured to find out whether he is losing weight or not. Mental health conditions should also be
analyzed by using depression-measuring tool successfully.
Another important nursing priority would be to manage hypertension of the Peter. The health
issue of hypertension can result in many complications in lives of patients like that of heart failure,