Evaluation of Case Study: Clinical Reasoning Cycle

The paper outlines the significant role of community nurses in taking care of Peter Mitchell who is 52 years of age with uncontrolled type 2 diabetes, obesity ventilation syndrome, sleep apnoea, depression and hypertension.

Running head: Evaluation of Case Study: Clinical Reasoning Cycle
Evaluation of Case Study: Clinical Reasoning Cycle
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1Evaluation of Case Study: Clinical Reasoning Cycle
The paper outlines the significant role of community nurses in taking care of
Peter Mitchell who is 52 years of age with uncontrolled type 2 diabetes, obesity
ventilation syndrome, sleep apnoea, depression and hypertension. The essay is
analysing the priority of care that is to be given to the patient by the application of
Levett-Jones clinical reasoning cycle. The cycle emphasis on critical thinking ability of
nurse based on his medical history and current signs and symptoms (Hunter & Arthur,
2016). The most important priority of care given to Mr Peter is to manage his
uncontrolled type 2 diabetes and manage obesity so that he can find way to solve his
depression. The essay highlights the patient situation, information from his medical
history and symptoms, analyses and investigate the issue and set priority of care
accordingly, it the essay further, evaluates on its outcome (Levett-Jones, Courtney-Pratt
& Govind).
Looking into the situation of Mr Peter, he is 52 years of age who is unemployed
and divorced. He lives alone and suffers from depression. He was hospitalized in
medical ward because of uncontrolled type 2 diabetes, obesity ventilation syndrome,
and sleep apnoea. He was presented with symptoms of shakiness, diaphoresis,
hyperplasia and high blood glucose level. He was potent smoker for 30 years. He has
gained 40kg of weight since starting insulin. Now, he has developed with morbid
obesity, and not able to perform his daily life activities. On previous consultation with
dietician, they asked him to go for physiotherapy to lose weight; however, he was
motivated to do so, but not sure how to get started with it. Therefore, his self-esteem is
low, which discourages him to do exercise. It is important for community nurse to build
therapeutic relationship with him as this can encourage him to reflect his thoughts
(Mace, et al., 2017).
The important information collected from his medical record is his increasing
weight and dependency on insulin to control his diabetes. He is having problem of sleep
apnoea, which can be linked with hypertension and limitation of his mobility. His poorly
controlled diabetes with high level of blood glucose reveals his ignorance in glycaemic
control and management of his medicine. Further information is assessed from his
dietician and physiotherapist to set priority of care plan. Dietician recommended him to

2Evaluation of Case Study: Clinical Reasoning Cycle
opt protein rich diet because of his low energy and increasing weight, additionally
suggested him for light exercise. However, he finds it difficult to manage his increasing
weight which resulted in morbid obesity which has contributed to other health issue like
obesity hypoventilation syndrome, sleep apnoea and GERD. The other reason that
stopped him from executing weight management, is his depression which arise because
of failure of marriage, unemployment social isolation, health situation and disparity from
family members. These reason has left him with low self-esteem which has wedged on
his emotional and physical wellness (Nigatu, Reijneveld, De-Jonge, Van-Rossum &
Bultmann, 2016)
In order to set best plan of care, community nurse need to identify his major
issue and investigate for synthesis of care strategy (Koivisto et al., 2016). All complex
health condition of Mr Peter is coinciding which is highlighting the need of inherent
motivation to maintain changes in his lifestyle and follow the care plan (Messina et al.,
2017). Mr Peter dependency on external source of insulin and his increasing weight are
often connected with his mental status. Management of his weight is of no doubt first
priority of care through confronting his depression. The nurse also found that his
dependency on insulin is making his life ignorant to healthy diet resulting in high blood
glucose level, which need to be managed efficiently. Therefore, second most important
care should be to accomplish a condition of controlled diabetes. Nurse also identified
that his low self-esteem and depression is the major cause for his health condition
which indirectly weaken his motivation to lose weight and increases his intake of insulin
(Penman et al., 2018). All this has made him to lose interest in his daily activities and
incapable to perform ADLs.
According to the problem of Mr Peter, nurse need to establish goals in
collaboration with him, that majorly focus on providing holistic care (Zamanzadeh, et al.,
2015). Nurse included the patient and care provider like physiotherapist, dietician,
diabetic educator and pharmacist to make a well planned goal for its practical
processing. Peter’s choice should be reflected in goal plan as because this can
enhance his power of independency and respecting him can make him build self-
esteem. As Peter find hard to start his weight lost journey, nurse need to find the reason

3Evaluation of Case Study: Clinical Reasoning Cycle
for it. Nurse investigated his medication which included antidepressant drugs and it is
known to cause increase in weight (Vazzana et al., 2015). Metoprolol and Pregabalin
are the medication given to him that is known to cause depression, obesity
hypoventilation syndrome and sleep apnoea (Lai et al., 2018). It is understood that
feeling week and fatigue is the outcome of depression. Thus, the drugs Mr Peter takes
shows sign and symptoms of daytime sleepiness, low energy, breathlessness and
depression. Therefore, without contracting the issue of his increasing weight, sleep
apnoea and diabetes, he would feel to be low motivated or energy to give attempt to
lose weight.
The nursing intervention given to him will for 3 months of duration. The first
priority of care includes to manage his problem of increasing weight which has left him
with problem of Obesity ventilation syndrome and sleep apnoea. Nurse need to first
consult with his doctor and explain all his condition so that he can prescribe alternative
medicine for his issue which will not lead to depression. As it was identified that Mr
Peter was not able to initiate a step to lose weight, to being with it, nurse can prepare a
well diet planned which will include protein rich food and excludes all those which are
rich in sugar, carbohydrate. This will help him to manage his blood glucose level and
cholesterol level as well. Additionally, this will also help him to reduce weight. To
proceed with the plan, nurse can provide him important teaching and education about
the serious consequence of obesity, so that he can be self-motivated to low weight and
do physical activities (Li et al., 2014). Nurse gave him quality counselling through
demonstrating the importance of self-esteem and self-resilient. This will help him to
come out of his problem of low confidence and could find way to lose weight. Nurse also
created atmosphere of exercise and yoga that can maintain his basal metabolic rate
(Walsh & Oilver 2016). Thus, by following the intervention he can lose weight in more
efficient way. Nurse also suggested him to get enrol in program that focus on weight
management of patient, this will help him to be in regular curriculum of diet and exercise
(Lean et al., 2018).
Second priority of care given to Mr Peter is to deal with his uncontrolled diabetes
connected with depression. Nurse provided education and effective teaching to patient

4Evaluation of Case Study: Clinical Reasoning Cycle
about the ways to accomplish his uncontrolled diabetes. Nurse also gives him
knowledge about negative effect of the diabetes. The diet plan made by the nurse help
him to control his blood glucose level thereby, his dependency on insulin can be
stopped. Nurse can also provide medication in consultation with doctor that will manage
his blood glucose level. He will be introduced to self-monitoring of daily intake of food.
In order to manage his depression level, nurse provided him information about the self-
help, weight loss and support groups for smoking. This will help to develop personal
control and keep him lively in his social life. Long term goal to help him tackle his
depression can be encouraging him to improve his connection with his family members
because social inclusion can assist him with his depression.
In order to evaluate the interventions, nurse have to revisit to the patient every
month and communicate with him about the daily life activity and what problem is he
facing now. Every month his weight and blood glucose level is recorded and compared.
If the weight and blood glucose level is not decreasing, then nurse have to make
changes in his diet plan and increase frequency of physical activity. Mr Peter will be
incorporated in evaluation as he will be asked some basis question related to his life
and if he want some changes, it will be made according to that.
Nurse can further give him time to time counselling in order to improve his mental
instability. Nurse can also promote self-awareness to Mr Peter to recognize his own
weakness so that he can work on it.
Lastly from the discussion it can be concluded that role of nurse in health care of
patient suffering from obesity, diabetes and depression has reflected two priority of care
to manage his obesity and diabetes, given to patient using clinical reasoning cycle. The
priority of care is set by identifying the major issue in the patient by collecting all the
information about the patient. Therefore, a person can perform all his life activity if he
his physiologically fit and able to manage his own illness, further connection with family
member is also important to live a healthy life.

5Evaluation of Case Study: Clinical Reasoning Cycle
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