NRSG366 Individual Case Study

Running head: ESSAY
NRSG366 Individual Case Study
Name of the Student
Name of the University
Author note

ESSAY1
Community health nurses have the duty of using their nursing skills, with the aim of
providing care services to patients, while directing the latter to necessary healthcare
amenities that is beyond the basic scope of practice (Stanhope & Lancaster, 2015).
According to Levett-Jones (2010) nurses having adequate skills of clinical reasoning are
able to bring about a positive impact on the health outcome of the patients, who manifest the
presence of complex health problems. This assignment will discuss the case scenario for a
patient Peter Mitchell, following the clinical reasoning cycle.
The first step is consideration of the patient Peter Mitchell is a 52 year old male who
has been admitted to the medical ward, following poor glycemic control, and upon reporting
signs and symptoms of increased hunger, shakiness, and sleep apnoea. During previous
episodes of admission, he had been advised to follow a LEHP diet for reducing weight,
owing to the fact that he is obese. In addition, he is an active smoker and has been smoking
for the past 30 years. The current scenario involves referral post-discharge, with the aim of
managing his clinical manifestation and weight problems.
The second phase of the cycle involves collection of information and cues from the
patient. An analysis of the results from his investigation suggests that his weight is 145 kg,
thus confirming obesity. In addition, he also suffer from a range of comorbid conditions
namely, hypertension, sleep apnoea, type 2 diabetes, and GERD (gastro-oesophageal reflux
disease). He is also under several medications namely, lisinopril, metformin, insulin novomix,
pregabalin, metoprolol, and nexium. The prevalence of a high body weight can be accredited
to the production of ghrelin and leptin that control the appetite of a person by exerting their
actions on the central nervous system, which in turn affects the amount of energy
expenditure and food intake (Khodabakhshi et al., 2015). His smoking habits can be allied
with the presence of type 2 diabetes and sleep apnoea. The chemicals present in tobacco
damage the arterial wall linings, thus leading to narrowing of the arteries and subsequently
increasing the blood pressure (Leone, 2015). Furthermore, nicotine present in tobacco also
works by relaxing the muscle rings located in lower oesophagus, According to Kohata et al.
(2016) relaxation of the ring often results in trickle of the stomach acids, and leads to a
burning sensation. In addition, it was also found that losing a secure employment as a fork
lift driver, and separation from spouse and kids, created a substantial impact on Peter’s
health, which in turn made him socially isolated. Furthermore, his current condition also
makes it difficult for him to conduct activities of daily living, thus worsening the scenario.
While processing information in the third phase, it must be taken into consideration
that smoking results in inflammation in the body that causes swelling and interferes with the
cell function of the body, thus increasing the risks of diabetes (Pan, Wang, Talaei, Hu & Wu,

ESSAY2
2015). Presence of type 2 diabetes indicates a blood glucose levels higher than 125 mg/dL.
Sleep apnoea also indicates that Peter manifests episodes of shallow breathing and pauses
in breathing, while he is sleeping. This can be accredited to the build-up of carbon dioxide in
the bloodstream that are detected by chemoreceptors located in the blood (Krishnan, Dixon-
Williams & Thornton, 2014). Furthermore, his smoking habit can also be associated with
sleep apnoea due to the fact that inflammation of the upper airways due to the stimulant
impacts of nicotine on the airway muscles. Furthermore, being obese or overweight has
been identified as a major risk factor that contributes to abnormal levels of sugar in the
bloodstream. Peter’s social isolation can also be associated with the fact that being
overweight increases the likelihood of a person to suffer from depressive symptoms.
In the fourth phase that involves synthesis of inferences and facts, it can be
suggested that the major problems manifested by Peter that need immediate attention are
high blood glucose levels, and obese. Taking into consideration the fact that people suffering
from diabetes report presence of one or more comorbidities such as, hyperlipidaemia,
cardiovascular complications, non-alcoholic fatty liver disease, obesity, renal disease, and
obstructive sleep apnoea, there is a need to take immediate actions for restoring the amount
of glucose in bloodstream to normal levels (Schram et al., 2014). Another issue that must be
immediately addressed is the increased body weight due to its association with stroke,
osteoarthritis, gallbladder disease, hyperuricemia, hypertension, and other comorbid medical
problems (Castro, Kolka, Kim & Bergman, 2014).
The following phase involves establishment of goals for the patient. The two care
priorities that are in accordance to the care priorities identified above are namely, (i) lowering
the blood glucose levels of Peter within 100-125 mg/dL, and (ii) reducing the body weight of
Peter to an extent that the BMI is within 22-24.9.
The course of action for the pre-defined goals will form the next phase of the clinical
reasoning cycle. Owing to the fact that sustained hyperglycaemia creates a negative impact
on almost all cells and tissues located in the body, and is also related with complications of
the kidneys, blood vessels, nerves, and eyes, the nursing care action plan for Peter would
encompass effective pharmacological and non-pharmacological strategies for normalising
the levels of blood glucose, while reducing the likelihood of associated complications. In
addition to his current medication regimen, Peter will be administered sulfonylureas such as,
glimepiride and glyburide in order to stimulate secretion of insulin from the pancreas
(Weissman et al., 2014). These will also enhance the sensitivity of the cell receptors to the
insulin hormone, thereby decreasing the synthesis of glucose from stored glycogen and
amino acids. Peter will also be instructed to take rapid-acting insulin such as, Humalog,