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(Doc) Evidence-Based Practice and Research Methodologies

   

Added on  2021-04-17

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Evidence Based Nursing Research1

Nurses can provide prioritised care the patients by using clinical reasoning cycle. LevettJones clinical reasoning cycle is a step wise approach for providing nursing intervention. Itincorporates multiple sequential steps like collection of patient information, processing ofinformation, planning and implementing interventions, evaluating outcomes and reflecting onand learning from the process. Levett Jones clinical reasoning cycle gives opportunity for thenurse to think critically and helps nurse to understand patient’s condition and planintervention accordingly. In this essay, clinical reasoning cycle is being followed to prioritisecare for Peter. First prioritised care identified for Peter is reduction in body weight andsecond prioritised care is reduction in blood glucose level. In this case scenario, case of 52 yr old Peter Mitchell is being discussed. Peter is having pastmedical history of obesity, type 2 diabetes, hypertension, depression, sleep apnoea and gastrooesophageal disease reflux disease. Data indicates that his pat body weight was 145 kgs andBMI was 50.2 m2. Moreover, due to administration of insulin, he was gaining significantamount of body weight. Hence, first prioritised to be provided to Peter is weight reductionand keeping body weight in control. Along with medical intervention, dietician andphysiotherapist intervention also required for his body weight control. Dieticianrecommended him to consume low energy and high protein diet. Low energy and highprotein content diet can be helpful to reduce energy reserve and reducing body weight.Physiotherapist asked him to perform light exercise which can result in more energyexpenditure as compared to the energy consumption. Increase in body weight is associatedwith other several co-morbid conditions diabetes, hypertension and depression. Theseconditions can be effectively controlled by control in the body weight. It is evident that obesepeople can have breathing problem also. All these conditions are evident in Peter. His bloodpressure is 180/92 mmHg which is higher as compared to the normal blood pressure which is120/80 mmHg. His respiratory rate is 23 Bpm which is higher as compared to the normalrespiratory rate which should be between 12 – 20 Bpm. Higher respiratory rate is indicationof the breathing insuffiecncy. His heart rate is 102 Bpm which is slightly higher as comparedto the normal heart rate. There can be multiple risk factors for the occurrence of obesity likephysical, physiological, psychological and genetic, environmental responsible for theoccurrence of obesity (Ahima, & Lazar, 2013). Diet and medication related factors are also responsible for the occurrence of obesity in thepeople. In case of Peter physical, psychological and medication related factors are responsiblefor increase in body weight in Peter. Peter is unemployed hence he is not doing much2

physical work, he is having psychological feeling of fatigue and insulin administration are thephysical, psychological and medication related factors respectively are responsible forobesity in Peter. As compared to obesity, BMI is the important indicator for obesity (Zeng etal., 2014). BMI more than 40 m2 can be considered as the severe obesity condition. In case ofPeter, BMI is 50.2 m2, which indicates he is severe case of obesity. It is evident that life-expectancy can be drastically reduced in obesity and it co-morbidconditions. Due to all these co-morbid conditions, Peter need to take different medicationslike insulin and metformin for reducing blood glucose level, lisinopril and metoprolol forhypertension and pregabalin for pain. Since, all these medications need to takesimultaneously. Hence, these medications can affect efficacy of another medication. Hence,obesity need to be controlled to control other co-morbid conditions and to prevent medicationinteractions. Obesity is also responsible for the narrow opening of the respiratory tract; hencePeter is experiencing breathing problem and sleep apnea (Hamilton, &Naughton, 2013).Social support is necessary for the control of body weight. However, Peter is experiencingsocial isolation due to sustained increase in body weight and failure to secure job. Socialinvolvement can be helpful in augmenting his physical activity and also to reduce stress anddepression. Stress and depression are responsible for exaggerating obesity. In obese patients,valve at the top can be overloaded which lead to secretion of acid in the stomach. Thissecretion of acid results in the gastro-intestinal reflux in obese patient like Peter. Differentinterventions like nutritional, medial, social, psychological and behavioural need to beimplemented in case of Peter. Since, obesity is a multifactorial disease, it cannot becontrolled by single intervention. Implementation of multiple interventions at the same timecan be helpful in reducing body weight in severe body obese patients like Peter. Bycontrolling weight of Peter, other co-morbid conditions can be effectively controlled (Haire-Joshu and Tabak, 2016). Second identified priority for Peter is to control blood glucose level. Nurse need to controlblood glucose level to control other conditions like obesity ventilation syndrome and sleepapnoea. Control in the blood can be useful in controlling symptoms like shakiness,diaphoresis and increased hunger. Since, 9 years he is having diabetes and it resulted in otherconditions like obesity and hypertension. It is evident that diabetes can sustain after age of50. In diabetes, in response to increase in the blood sugar level body can produce moreamount of insulin. However, due to destruction of beta cells insulin lose its sensitivity tocontrol blood sugar level. Hence, diabetes patient become resistant to insulin. This insulin3

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