Case Study on Diabetes Management and Lifestyle Improvements

This case study focuses on the management of diabetes and lifestyle improvements for a patient named Peter Mitchell. It discusses the role of community nurses in providing holistic care and implementing lifestyle changes. The study explores the use of the Clinical Reasoning Cycle (CRC) to address nursing priorities such as diabetes management and weight loss. It also highlights the importance of considering social and psychological factors in patient care. The case study provides insights into cue collection, information processing, problem identification, goal establishment, and action planning. It emphasizes the need for collaboration with multidisciplinary teams and regular monitoring and evaluation of treatment outcomes.

Running head: INDIVIDUAL CASE STUDY
INDIVIDUAL CASE STUDY
Name of the Student:
Name of the University:
Author note:

1INDIVIDUAL CASE STUDY
Introduction: The role of the community nurse lie beyond merely the alleviation of
symptomatic conditions of disease and are hence required to consider a variety of multifaceted
patient needs at the social, emotional and psychological level necessitating the dissemination of
holistic care (Philips et al., 2015). The following paper demonstrates the case management of
two nursing priorities of: management of diabetes and associated metabolic complications
and implementation of lifestyle improvements of weight loss and smoking cessation, for
the patient, Peter Mitchell using the Clinical Reasoning Cycle (CRC). The CRC, as postulated
by Levett-Jones (2017), implies an essential nursing process underlying the collection of cues,
processing of information, understanding patient problems, intervention implementation,
outcome evaluation and reflection.
Consider the Patient Situation: The community nurse must assess and evaluate the
situation of Peter Mitchell with empathy and without bias, in order to obtain key insights
concerning patient needs and priorities (Levett-Jones, 2017). Peter Mitchell has been referred to
after detection of uncontrolled diabetes coupled with associated conditions of polyphagia,
hyperglycemia, sleep apnea, diaphoresis and shakiness. The community nurse must also
consider the Peter Mitchell’s social and psychological situations (Levett-Jones, Courtney-Pratt &
Govind, 2019). It can be observed that the patient prefers social isolation due to a negative body
image and lives alone due to marital separation. Additional patient characteristics which the
nurse must consider is the patient’s habitual smoking.
Collect Cues: Cue collection implies the essential nursing process of obtaining
information relevant to the patient’s unique condition. The concerned community nurse must
then collect information considering Peter’s existing medications as well as medical history
(Levett-Jones, 2017). Considering the anthropometric, carbohydrate and lipid metabolic
complications associated with diabetes, the community nurse must also collect information on
Peter Mitchell’s blood pressure, blood glucose levels and lipid profiles, along with weight, height,
hip and waist measurements (Gregg, Sattar & Ali, 2016). Further considering the patient’s
smoking habits, the community nurse can assess his dependency rates using the Fagerström
Test for Nicotine Dependence (The Cancer Council Victoria, 2019). His condition of sleep
Apnea can be assessed by the community nurse using the STOP-BANG Questionnaire (Chung,
Abdullah & Liao, 2016). Further, a cardiovascular and dietary assessment may be required
considering the association between diabetes, heart and nutritional profiles (Wright, 2017).
Lastly screening for Gastrointestinal Reflux Disease (GERD) using X-rays or diagnostic referrals

2INDIVIDUAL CASE STUDY
of manometry or endoscopy may be required since GERD in diabetes has been linked to
detrimental symptoms of peripheral neuropathy (Sirchak, Stan & Brych, 2018).
Process Information: The community nurse will seek to process and relate the results
with relevant physiological disease conditions (Levett-Jones, 2017). If the collected information
indicates Peter’s symptoms of dyslipidemia, hyperglycemia and hypertension then the nurse
may process the same by relating the results to a state of uncontrolled diabetes, since diabetes-
induced insulin resistance results in the aggravation of blood glucose levels followed high lipid
mobilization, endothelial fat accumulation and increased hypertension (Reddy, Zhang &
Natarajan, 2015). Anthropometric measurements will indicate current disease status and future
health outcomes, since abdominal obesity in the form of high waist circumference and body
mass index (BMI) is indicative of diabetes aggravation and risk of cardiovascular symptoms
(Noureddin & Rinella, 2015). The Fagerström Test for Nicotine Dependence will notify about
Peter’s present attempts at smoking cessation since high smoking can increase risk of
hypertension and cardiovascular function and hence, must be immediately corrected (Glasheen
et al., 2018). Assessment of sleep using the STOP-BANG questionnaire will allow community
nurse to assess the Peter’s present diabetes and obesity management status, since obesity can
lead to disrupted breathing and sleeping habits further resulting in insulin resistance and
diabetic symptom aggravation (Koo et al., 2018). A cardiovascular assessment in the form of
heart rate and rhythm monitoring will identify Peter’s present diabetic status since uncontrolled
diabetes results in hindered lipid metabolism, endothelial adiposity and atherosclerotic risk
(Shah et al., 2015). A dietary assessment will indicate Peter’s compliance to treatment and
diabetic status since a diet comprising of moderate proteins and complex carbohydrates is
beneficial for diabetes mitigation (Karami et al., 2018). A GERD assessment will indicate Peter’s
present status of diabetic management since prevalence of the same is indicative of disease
progression of neuropathy (Ha et al., 2016).
Identify the Problem: The community nurse will then proceed to identify Peter’s present
problems and identify salient nursing diagnostic points (Levett-Jones, 2017). Excessive levels of
blood sugar, lipid or pressure will hence, compel the nurse to identify and diagnose Peter with
uncontrolled diabetes, evidenced by metabolic symptoms of hyperglycemia, hyperlipidemia and
hypertension (Hameed et al., 2015). A high BMI and waist circumference will encourage the
nurse to identify and confer a primary diagnosis of obesity and secondary diagnosis of
metabolic risk since high body weight and waist circumference are indicative of abdominal
obesity and further risk of metabolic complications such as diabetes and cardiovascular disease

3INDIVIDUAL CASE STUDY
(Mailard et al., 2016). The assessment will also require the nurse to identify nursing risk factors
which may aggravate his condition. This will include, sleep apnea, dietary and smoking
evaluation, since sleeplessness, faulty diet and smoking poses high risk of future diabetes
aggravation and cardiovascular disease acquisition (Cespedes et al., 2016). Abnormal
cardiovascular assessment results in the form of arrhythmia and tachychardia will indicate
nursing diagnosis of cardiovascular disease risk with uncontrolled diabetes as a risk factor
(Hanlon et al., 2017). Esophageal inflammation through GERD assessments will indicate
diabetes aggravation and disease progression due to its links with disrupted nerve impulse
transmission and neuropathy (Rouf et al., 2017).
Establish Goals: The nurse must identify goals for Peter’s disease management, based
on nursing priorities of care (Levett-Jones, 2017). Peter’s primary health concerns are his
diabetic condition and obese status since these have resulted in increased risk of metabolic and
gastrointestinal complications, social isolation and poor social wellbeing. Additional lifestyle
factors of smoking and carelessness have also been implicated to be key nursing goals, since
these contribute to disease aggravation and negative health outcomes (Brown et al., 2017).
Hence, community nursing SMART goals include:
 Management of diabetic symptoms and associated metabolic complications by achieving
optimum blood glucose, blood pressure and blood lipid profiles along with prevention of
cardiovascular, gastrointestinal and neuropathic risks, within the next 2 weeks.
 Management of lifestyle risks and detrimental behaviors through sleep and dietary
improvement, along with smoking cessation within the next 2 weeks.
Take Action: The nurse must may be required to continue with his ongoing medications
of metformin and novomix. Metformin aids in the management of hyperglycemia via regulating
hepatic glucose production (Forslund et al., 2015). Novomix is an external insulin used to
combat intrinsic insulin resistance and ineffectiveness characteristic in diabetes patients
(Xiaolang et al., 2018). Hypertensive symptoms can be managed through nursing administration
of lisinopril – a medication recommended to treat hypertension and associated cardiovascular
complications through the restriction of angiotensin-converting enzyme (ACE) activities - a key
component in the blood pressure regulating activities of RAAS mechanism (Şenkardeş et al.,
2017). Upon detection of esophageal inflammation characteristic of GERD – the nurse may
continue with the Peter’s current medication of nexum - a proton pump inhibitor known to
combat the same through regulation of gastric acid production (Imhann et al., 2016).

4INDIVIDUAL CASE STUDY
The nurse must engage in regular monitoring and assessment. Regular monitoring of
Peter’s blood pressure and blood sugar levels by the nurse to identify signs of disease
progression or management and efficacy of the treatment being followed (Haugstvedt et al.,
2016). Further, the nurse may work collaboratively with a multidisciplinary care team to assess
those symptoms of Peter which are beyond her scope. This may require a cardiologist and a
diabetologist who will conduct additional cardiovascular assessments and lipid profile evaluation
to assess Peter’s risk of future acquisition of cardiovascular diseases and dyslipidemia – a long
term complication of uncontrolled diabetes (Waldrop et al., 2016). Further, the nurse,
diabetologist and gastroenterologist may work collaboratively to conduct esophageal
assessments and quality of life (QOL) evaluation on Peter to identify his current status of GERD
and potential future risk of peripheral neuropathy acquisition (Takeshita et al., 2018) .
The nurse may need to work collaboratively with a nutritionist who will recommend a diet
low in sugars and moderate in proteins, fiber, complex carbohydrates and dietary antioxidants
since such a diet alleviates diabetic symptoms through increased satiety, high glycemic index,
stabilized blood sugar levels and improved insulin sensitivity (Weickert & Pfeiffer, 2018).
Additionally, the nutritionist may be required to plan a diet which is devoid of chemically,
physically and texturally irritating foods to aid in easy swallowing and prevention of GERD
aggravation (Sethi & Richter, 2017). The nurse may also need to work collaboratively with an
occupational therapist and fitness expert who can recommend stretching and a mild exercise
plan as per the Department of Health’s 150 to 300 minutes physical activity per week since the
same has been implicated to aid in joint flexibility and diabetes management through improved
glucose uptake and metabolism by the muscles (Diouf et al., 2016). The nurse must also
engage in weekly anthropometric assessments since a high BMI and waist circumference are
risk factors underlying diabetes (Kusminski, Bickel & Scherer, 2016). The nurse may refer Peter
to a counselor who manage his smoking dependence via cognitive behavioral therapy,
motivational interviewing or mindfulness approaches (Kahler et al., 2015).
Evaluate: The nurse can evaluate the efficacy of the above treatments by regularly
monitoring Peter’s blood levels of glucose and pressure coupled with anthropometric
assessments since a hyperglycemia, hypertension and obesity are key diabetic risk factors
(Qui, 2019). Further the nurse can evaluate Peter’s smoking using the Fagerström Test for
Nicotine Dependence followed by the STOP BANG questionnaire for sleep apnea, since the
smoking along with obesity are key risk factors for sleep apnea which in turn may aggravate
diabetes. The nurse may work collaboratively to encourage cardiovascular and esophageal

5INDIVIDUAL CASE STUDY
assessments by cardiologist and gastroenterologist to evaluate risk for cardiovascular diseases
and neuropathy (Wiley et al., 2015).
Reflect: I have successfully learned to manage complicated metabolic cases consisting
of host of disease complications. My nursing scenario was about Peter Mitchell, a 52 year old
man who presented with diabetes, hypertension, hyperglycemia, GERD and apnea. As a
community nurse, I worked successfully in a multidisciplinary treat to manage the patient’s
multiple morbidities. I lack knowledge on associations between psychological wellbeing and
patient disease condition, which was required considering Peter’s engagement in social
isolation and smoking. For future practice, I must incorporate my newly acquired knowledge on
psychological wellbeing and disease associations. I must also improve my current knowledge
on the relationship between lifestyle, gastrointestinal health and metabolic disorders in
individuals.

6INDIVIDUAL CASE STUDY
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