Case Study on Peter Mitchell

This case study explores the clinical reasoning cycle applied to the case of Peter Mitchell, a 52-year-old patient with diabetes, obesity, hypertension, and sleep apnea. The study identifies care priorities and nursing interventions for managing hypertension and reducing smoking, as well as managing diabetes and obesity. The importance of health education, medication, lifestyle modifications, and motivational interviewing is discussed. The case study highlights the use of the clinical reasoning cycle in providing high-quality care.

Running head: CASE STUDY ON PETER MITCHELL
CASE STUDY ON PETER MITCHELL
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CASE STUDY ON PETER MITCHELL
Clinical reasoning cycle helps healthcare professionals in developing care-plans by indentifying
the cues of the patients, processing the information and setting care priorities (Borch et al., 2016). In the
assignment, clinical reasoning cycle would be applied to the case study of the patient named Peter
Mitchell in order to identify two care priorities and care interventions. Peter Mitchell is a 52-year-old
person who is suffering from diabetes as well as obesity with series of complications. He also smokes
heavily and he is not following proper diets and exercise regimes important for his health. He is also
suffering from hypertension and sleep apnea. Care priorities and nursing interventions would be
developed in this assignment for Peter with the help of clinical reasoning cycle.
One of the most important care priorities for Peter would be to develop his symptoms of
hypertension. It has been found already by the nurse that his blood pressure was high. The normal
blood pressure of the patients needs to be around 120/80 mmHg. Studies have found that high blood
pressure is intricately associated as one of the risk factor for cardiovascular disorders (Edelman et al.,
2015). Hence, Peter can become highly vulnerable to cardiovascular issues besides diabetes. Peter is
found to smoke 20 cigarettes per day, which acts as one of the contributing factors for high blood
pressure level. Cigarette smoking has negative heath impacts on heart and blood vessels where nicotine
participates in increasing the blood pressure, boosting the heart-rate, and causing the arteries in
becoming narrow and constricted (Borch et al., 2016). It has been found that if the restricted blood flow
becomes long-drawn-out of that of the arteries, a heart attack or deadly blood clots might also take
place. Many of the studies are of the opinion that smoking as well as exposure to second hand smoking
increases the risk for the build-up of the plaques or the fatty substances inside the arteries ( Conn, 2015).
This leads to cardiovascular situations called atherosclerosis that is a process, which is in turn
accelerated by high blood pressure. Moreover, cigarette smoking is also seen to worsen many other
health problems related to high blood pressure like that of the cardiopulmonary problems (Rasjö Wrååk
et al., 2015). Hence, Peter can be found to get highly exposed to cardiovascular disorders like heart

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CASE STUDY ON PETER MITCHELL
attack, atherosclerosis as well as cardiopulmonary problems. Hence, the first priority would be managing
his conditions of hypertension and reduction of smoking of cigarettes (Jung et al., 2017).
In order to manage his conditions of hypertension, the nursing professionals would need to
undertake important interventions. The first intervention would be to develop heath literacy of the
patient and educate him about the negative aspects of smoking and its effects on blood pressures
(Harvey, 2015). Studies have found that when patients are educated about the negative impacts of their
lifestyle-choices and they are made aware how such choices are affecting their health, their compliance
with medications and treatments increases and they feel motivated to change (Jung et al., 2017). Hence,
Peter would be provided health education about his unhealthy choices of smoking. The next step would
be prescribing him proper medications that control the blood pressure. Studies have found that lifestyle
modifications like eating healthy diets, losing of extra weights and reducing different sodium intake in
different food components, undertaking physical exercises regularly can help in managing the blood
pressure level (Feinman et al., 2015). Patients can also be taught to learn the ways of measuring blood
pressure at home. This helps them to understand their health condition and thereby take precautionary
measures (Bashur et al., 2015). All these interventions would be suggested to Peter as well. In order to
help Peter in quitting smoking, the nurse would need him to refer to a substance abuse counselor. The
expert can help him to overcome his smoking habits through psychotherapies like cognitive behavioral
therapies (Gonder-Frederick et al., 2016). This therapy is actually a talking therapy that can help people
in managing their problems by changing the ways they think and behave, making them self-motivated
and determined. The nurse attending Peter can also suggest him about nicotine replacement therapy
(Rasjö Wrååk et al., 2015). This therapy mainly functions by exerting specific types of psychological
effects on his mood as well as different attention states. Studies have also found the success of many
nicotine replacements products like Sublingual nicotine tablet, Nicotine lozenge, Nicotine nasal spray,
Nicotine inhaler, and others (Butcher et al., 2018). Hence, use of such products can be suggested to

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CASE STUDY ON PETER MITCHELL
Peter. For effective evaluation, the nurse should ask the patient for follow-up sessions where his health
would be checked once again and changes in lifestyle choices need to be asked. His vital signs should be
checked along with his smoking cessation attributes. This would help them to understand whether Peter
is responding and complying with the intervention or not (Jung et al., 2017).
Another important priority would be effective management of diabetes and obesity so that
Peter can lead better quality lives. Obesity is found to be one of the risk factors that result in
development of diabetes (Budd & Peterson et al., 2015). Peter has been found to of 145 kgs, which is
much higher than that normal body weights. Obesity is found to trigger different changes in the
metabolism of the body, which causes the fat tissue to release fat molecules in the blood stream. This in
turn affects the insulin responsive cells leading to that of the reduced insulin sensitivity (Harvey, 2015).
Many of the studies are of the opinion that abdominal fats also causes the fat cells in releasing pro-
inflammatory chemicals thereby making the body less sensitive to that of hormone insulin ( Suissa et al.,
2017). This is mainly done by affecting the function of the insulin responsive cells as well as the ability of
the cells to respond to that of insulin. Therefore, As Peter had stated that he had always been of the
“biggish guy” implementing that his weight was always quite high, obesity can be considered to be one
the factor that caused diabetes in him. Peter is seen to have unmanaged levels of blood glucose levels,
as he has not been able to manage the interventions advised by previous healthcare professionals. He is
seen to suffer from symptoms like shakiness, increased hunger, difficulty breathing whilst sleeping.
Increased hunger takes place when during diabetes; glucose from blood cannot enter the cells due to
resistance of the cells towards insulin or due to lack of insulin. Therefore, the body cannot convert the
food into energy and lack of energy increases hunger among the patients (Vallerand, 2018). This might
be a reason why Peter is suffering from increased hunger. Peter is also seen to be suffering from obesity
hyperventilation syndrome and even sleep apnea. In such cases, patients suffer from short breathing
sessions where the individuals are seen to stop breathing altogether for short times during sleeping.

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CASE STUDY ON PETER MITCHELL
These are seen to have negative impacts on the conditions of heart and the lungs making him vulnerable
to threatening situations. Therefore, both the conditions of obesity and diabetes need to be handled
with care (Butcher et al., 2018).
One of the main nursing interventions would be to include Peter in motivational interviewing
process. It has been seen that the previous professionals had advised him to undertake various lifestyle
modifications but he has not been motivated enough to undertake such lifestyle changes. Motivational
interviewing can be described as he counseling approach that is based on the directive, client-centered
counseling style for eliciting behavior changes and by helping clients in exploring and resolving
ambivalence (Budd & Peterson et al., 2015). The nurses would be able to develop motivation and
determination among Peter by involving him in this approach so that he feels determined to modify his
lifestyle choices and live better quality lives. Following the development of determinations, nurses
should educate the patient about the different healthy lifestyle choices that he would need to take and
discuss the rationale by which the changes would benefit him (Butcher et al., 2018). It might have
happened that previous professionals had told him about the interventions but did not discuss the
reasons behind adopting them. Therefore, Peter might have been confused. Hence, nursing
professionals should educate Peter in details about the pathophysiology and lifestyle choices important
for diabetes and obesity and discuss the rationale for choosing them (He et al., 2017). The nurse should
also guide Peter about the ways of weight management like consuming of low calorie foods, fresh fruits
and vegetables with high amount of fibers, exercises and physical activities and similar other lifestyle
choices (Creber et al., 2015). He should be more focused on home cooked meals rather than relying on
fast foods as the latter is calorie-dense. Peter should be also referred to the diabetes educator. Diabetes
educators teaches patients about ways of managing blood sugar level, ways to handle the glucometer
equipment, importance of regular screening sessions as well as diet management. Peter should be also
referred to counselors who would help him to get over his symptoms of depression as well as anxiety.

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CASE STUDY ON PETER MITCHELL
Peter has already failed to achieve the previous set of goals and interventions that the previous nurses
had provided him. Therefore, setting of difficult goals can make him feel demotivated and discouraged.
Hence, nurses should first set up easy goals for Peter so that he can achieve them and gain confidence
(Lee et al., 2015). The evaluation process would mainly to track down his weight to find out whether the
interventions are helping him to lose weight or not. His blood sugar level should be also routinely
screened in every follow-up. Moreover, the quality of life of the patient should be also assessed with the
help of depression –assessment-checklist. This would help to ensure that he is happy and satisfied in life
(Butcher et al., 2018).
I have realized that clinical reasoning cycle had guided me in a systematic manner about how to
approach the different signs and symptoms of patients to that of setting priority goals and developing
care plan interventions. It had helped me link the different aspects of patients with the care needs and
requirements of the patient, helping me to provide high quality care. In the future as well, I would be
applying the clinical reasoning cycle so that I can provide high quality care to patients that help them
lead better quality lives.
From the above discussion, it can be seen that one of the care priorities as found for Peter is
management of hypertension. Nurses need to help and guide Peter to reduce his smoking behavior
through various interventions like cognitive behavioral therapy, nicotine replacement therapy, as well as
others. Nurses also need to educate peter about lifestyle interventions like diet and exercises that can
control his blood pressure. Another priority that was evaluated was obesity and diabetes. Educating
patient about blood glucose management, use of glucometer and several other actions need to be
taken. Beside, Peter should be involved in motivational interviewing. This would help him to feel
motivated and undertake self-management abilities like lifestyle modifications, being educated about
blood glucose level control and similar others.

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CASE STUDY ON PETER MITCHELL
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