Evaluation of Case Study: Clinical Reasoning Cycle

Running head: Evaluation of Case Study: Clinical Reasoning Cycle
Evaluation of Case Study: Clinical Reasoning Cycle
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Evaluation of Case Study: Clinical Reasoning Cycle
1
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

Evaluation of Case Study: Clinical Reasoning Cycle
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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