Effective Prioritization of Patient Needs

The assignment analyzes the effectiveness of prioritizing patient needs using the clinical reasoning cycle. It examines how multiple factors influence care for individuals with chronic conditions and highlights the importance of collaboration and integration in delivering appropriate nursing interventions.

Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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Nursing practice entails demonstration of appropriate skills and competencies for
enabling high quality care delivery across settings. Clinical reasoning has been repeatedly linked
with desirable patient outcomes as nurses have the focus on complex yet logical thinking process
for solving problems. The Levett-Jones clinical reasoning cycle acts as a valuable clinical tool
with the help of which nurses are placed in a position to resolve critical patient problems and
ensure an informed decision. The cycle has eight distinct steps each with its own importance in
nursing practice (Abuzour et al., 2018). The present paper focuses on the application of the
Levett-Jones clinical reasoning cycle to resolve the case study of Peter Mitchell. The aim is to
prioritize the care needs of the patient and understand the comprehensive range of interventions
that would be suitable for the patient.
Identification of care priorities for the patient in the present case is the main aim of this
paper. The two care priorities for Peter are obesity and depression. An accurate analysis of the
patient’s condition would draw the conclusion that the symptoms suffered by him are a result of
his obese condition. Further, depression is a prime factor for poor controlled diabetes and
unhealthy lifestyle. While the reduction in body weight would help in better control of glycemia,
recovery from depression would enable the person to have a better quality of life. The
identification of the care priorities has been guided by the Levett-Jones clinical reasoning cycle.
The first step in the clinical reasoning cycle is to consider the patient situation when
presented in the healthcare setting. The patient, in this case, is a 52-year old male named Peter
Mitchell known to suffer from morbid obesity along with type 2 diabetes. His weight is 145 kg
while his height is 170 cm. his earlier admission to the care unit was a result of sleep apnea,
obesity ventilation syndrome, and most importantly poorly controlled hyperglycemia. The
physician referred his admission as Peter was suffering from increased hunger, high BGL levels,

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shakiness, diaphoresis and difficulty breathing whilst sleeping. A referral was made to the local
community care unit as part of his discharge plan so that he could get constant support for
managing his obese condition and clinical comorbidities.
The second step in the clinical reasoning cycle would be a collection of cues and
information about the patient. The medical history of Peter Mitchell includes type 2 diabetes,
obesity, hypertension, sleep apnoea, depression and oesophageal reflex disease. It is known that
the patient has a habit of smoking about 20 cigarettes a day. He had been previously
recommended by a dietician to consider weight reduction while he was admitted to the care unit
previously. In addition, he had received health education from the GP on weight loss benefits,
together with advice on light exercise for weight loss from the physiotherapist. Peter had shown
non-compliance with such weight loss guidelines. The patient became jobless three years back
and since then has gained considerable weight. He suffers fatigue, and his disturbed body image
compels him to be socially isolated. In addition, performing daily activities of living is
challenging for him. For promoting his willingness to lose weight and quit smoking, there is a
need for support and guidance. He is presently under the medication regimen of insulin 30 BD,
Nexium 20 mg, lisinopril 100mg, metformin 500 mg, metoprolol 50 mg, and pregabalin 50 mg.
At the time of his discharge, his vital signs were RR 23 Bpm, BP 180/92mmHg, HR 102 Bpm
and Sp02 95% on RA.
Processing of patient information is the next crucial step in the clinical reasoning cycle
and forms the basis for prioritizing patient care needs. In the present case, the main health issue
of Peter is type 2 diabetes that is a noted chronic metabolic disorder. Type 2 diabetes is the
condition where there is increased blood glucose level of the patient for a prolonged period as a
result of the body’s inability to facilitate production of adequate insulin (Geiss et al., 2017).

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Research indicates that sedentary lifestyle and obesity are the two most well-known risk factors
for developing diabetes. In this regard, it is to be mentioned that obesity has a fine association
with diabetes. According to Kalyani et al., (2014) body mass index is linked strongly with insulin
resistance and diabetes. In individuals who are obese, there is an inappropriate increase in the
amount of glycerol, hormones, cytokines and proinflammatory markers that cause insulin
resistance. The development of diabetes becomes inevitable if insulin resistance accompanies the
failure of β-islet cells of the pancreas to produce it. Body mass and weight gain are central to the
formation of type 2 diabetes. Obese condition of Peter has been the cause of symptoms he suffers
from, sleeps apnoea and sleep ventilation syndrome. Sleep apnoea is the disorder marked by
disruptions in the breathing pattern at the time of sleep. The condition is linked with a collapsed
condition of the pharyngeal airway at the time of sleep for which obesity is a major risk factor.
Sleep ventilation syndrome has also been linked with obese condition (Jordan et al., 2014).
There exists an association between increased body mass and hypertension (Hall et al.,
2014). Peter is known to suffer hypertension as indicated by his BP180/92 mmHg. 120/80
mmHg is the reference range for normal BP of a healthy adult (Pontremoli, 2018). Smoking has
been linked with higher chances of development of hypertension as well as type 2 diabetes. It has
also been proved that smoking regularly increases difficulties in controlling hyperglycemia
(Ferreira et al., 2018).
The medications that have been recommended to Peter are noteworthy for controlling
poorly managed hyperglycemia and other related conditions. Metformin is used for treatment of
type 2 diabetes while Metoprol and Lisinopril are administered for the treatment of high blood
pressure. Nexium is administered to patients suffering from stomach and oesophagus problems
(Lehne & Rosenthal 2014). When analyzing the social life of Peter it has been found that the

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individual is suffering from low self-esteem and in not confident of his body image. Peter is a
divorcee, and since he is living alone, he suffers from social isolation. He is reluctant to socialize
and is embarrassed about himself. According to Black (2016), social isolation leads to depression
in most individuals, leading to low esteem.
Based on the prioritization of patient needs, nursing goals are to be set. The first goal
would be to help Peter in reducing his obesity as indicated by reduced body mass. Since obesity
is the cause of the symptoms suffered by Peter, this would be the first priority. The second goal
would be to help Peter recover from depression and have a better self-image. A realistic self-
image and reduction of depression would aid in the better quality of life (Black, 2016).
Based on the prioritization of needs nursing actions are to be taken for implementing the
required interventions addressing the patient condition. The primary intervention would be to
outline a diet for Peter that can promote weight loss. The objective would be to lower the calorie
intake of the patient and help him to adhere to the diet outlined (Cook, 2018). Research indicates
that a reduction of 1000 calories per day leads to a weight loss of around 2 lbs in a week. Calorie
restriction would be accomplished by avoiding foods that have a high content of carbohydrates,
sugar and fat while increasing the amount of fruits, vegetables and fibre (Butcher et al., 2018).
Since Peter has a sedentary lifestyle, there is a need to increase his physical activity level.
Lifestyle modification would be recommended to him. Motivational interviewing would act as
the best counselling style that is known to explore ambivalence and affect weight loss (Ellis,
2016). Motivational interviewing would rely on non-judgmental questioning together with
reflective listening to understand the patient’s readiness to change. The patient is to be educated
about the importance of physical activity in weight loss process.

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Helping Peter come out of his depression would be noteworthy to improve his quality of
life. The nurse is to acknowledge the feelings of anger, frustration, hostility and grief. This
would enable resolution of emotional conflicts. A sympathetic attitude while providing care to
peter would help him deal with his condition. Constant motivation and support are to be provided
to him so that he is able to adhere to the guidelines outlined (McEwen & Wills, 2017). Social
isolation can be reduced by involving in role-playing in ways of interacting with people in the
society. As a result, Peter would be better placed to interact in the social context. Discussion of
negative feelings is crucial for eliminating the same and instilling a positive outlook towards life
(Riley, 2015). The patient is also to be encouraged to apply imaginary ability for visualizing self
at the desired weight. The rationale behind this action is that mental rehearsals are noteworthy in
helping patients to for deal with anticipated body image changes (Butcher et al., 2018).
The evaluation of the implemented interventions would be done by assessing the quality
of life of Peter and his body mass. This can be done by conducting a thorough assessment of the
patient’s viewpoint and experience regarding his self-esteem and confidence. An accurate health
assessment would confirm whether Peter has been successful in reducing his weight (Black,
2016).
Reflecting on the case study analysis it can be stated that application of the clinical
reasoning cycle to prioritize patient needs has been a valuable learning experience. Through the
application of the cycle, problem solving and clinical judgment were enabled. Key insights
gained from the discussion would help in future nursing practice.
In conclusion, the prioritization of patient needs for care was effective when the clinical
reasoning cycle was applied. Multiple factors are known to influence patient care when the

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individual is suffering from a chronic condition. A primary healthcare nurse is required to
prioritize care needs on the basis of clinical information collected. Collaboration and integration
of different aspects of patient condition based on clinical reasoning ensure maximum care
activities, and the nursing interventions delivered are appropriate.

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