Clinical Reasoning Cycle Case Study Analysis

This paper discusses the application of the clinical reasoning cycle in the case of Peter Mitchell, a patient with poorly controlled type 2 diabetes and other secondary healthcare conditions. The focus is on identifying two nursing care priorities and interventions for Peter. The priorities chosen are the management of excessive weight and increasing health literacy. The paper explores the link between chronic healthcare conditions, depression, and social isolation, and emphasizes the importance of patient education in improving healthcare outcomes.

Running head: NURSING ASSIGNMENT
CLINICAL REASONING CYCLE CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

1NURSING ASSIGNMENT
While suffering from chronic healthcare conditions, several physical, mental and
environment factors becomes the crucial factors depending on which the care plan for the
patient is developed (Wilkes et al., 2014). In this situation prioritizing care becomes the most
important factor as depending on this, the effectiveness of the care process is determined and
the healthcare professionals are assume preferable outcomes for the care process (Kogan,
Wilber&Mosqueda, 2016). Therefore, while conducting care process, the priority of the care
should dependent of the patient’s health and wellbeing needs and then integrating those needs
to the healthcare intervention so that favourable outcome could be achieved (Wilkes et al.,
2014). Clinical reasoning cycle is one such tool which could be used by the healthcare
professionals to align the patients need with the well- being priority of the patient and then
highlight the priority of care (Dalton, Gee& Levett-Jones, 2014).
In this paper, discussion about Peter Mitchell (52), who is suffering from poorly
controlled type 2 diabetes and other secondary healthcare conditions and hence, through the
use of Levett- Jones Clinical reasoning cycle, the application of frame work would be used so
that identification of two nursing care priorities and intervention could be obtained. The two
priority of care chosen for Peter would be
The first step of clinical reasoning cycle is considering patient’s healthcare
condition, as per which, the healthcare condition and concerns of Peter Mitchell would be
included in the study. The primary concerns which should be considered in his health condition
is his poorly managed type 2 diabetes mellitus, sleep apnoea and his obesity condition, due to
secondary or associated health conditions such as increased hunger, diaphoresis, shakiness of
hand and high blood glucose level was observed. While considering patients health condition,
his excessive overweight should be reviewed as he weighed around 145 kg. As perInzucchi et
al. (2015), type 2 diabetes in combination with overweight could affect the health condition of
patient chronically as in such situation, the organs and heart muscles becomes weaker due to
excess pressure weight of the body. Further, Franceschi and Campisi(2014), also mentioned
that overweight elderly adults are more likely to acquire chronic and acute healthcare conditions
that younger generation. Therefore, this was the crucial information which was recorded in Peter
Mitchell’s condition. Further, as per American Diabetes Association(2015), overweight body with
high Blood Glucose level and uncontrolled type 2 diabetes could lead to myocardial infarction or
congestive heart failure associated cardiac disorders. Therefore, these two conditions along
with his 30 years long smoking habits which could affect his lungs and make him prone to suffer
from breathing disorders.

2NURSING ASSIGNMENT
Further, as per the second step of the clinical reasoning cycle, important cues were
collected from the provided case study of Peter. The first cue which should be addressed in
this situation is his uncontrolled diabetes condition, due to which peter lose his job. While
undergoing his insulin therapy he gained tremendous weight and shifted from 105 kg to 145 kg
at present. Peter is conscious about his weight and considers himself as a biggish guy due to
which he starts isolating himself from the society. The patient is suffering from type 2 diabetes
from 9 years and due to which he has become affected with depression. His family does not
visit him frequently and due to his embarrassed body weight, he does not mix with people
socially (Tisminetzky et al., 2017). Further, it was also seen that he is suffering from
hypertension and increased blood pressure. As per Falvo and Holland (2017) physical
appearance plays an important role in the social isolation of patients affected with chronic
disease conditions and if they feel unconfident about their personality, they starts isolating
themselves from the society. Further, it was also seen that patients, with increased blood
pressure, hypertension and type 2 diabetes, consume more food than others as they believe
through this they would be able to overcome their stress (Streiner, Norman & Cairney, 2015).
Further, it is evident from the research of Correll et al. (2015) that, patients with prolonged
period of disease, develops hypertension or depression condition as they lose hope of their
health improvement. This is evident from the patient’s poor diabetic condition as he was unable
to maintain his diet and nutritional content to improve his diet and habits as no one was present
in his home to take care of his diet and smoking habits.
Processing these above- mentioned information determined that all the healthcare
concern of Peter Mitchell is linked with one another as occurrence of one has increased the
chance of others. Due to his diabetic condition, his overweight and depression situation raised
and now these situation increased risk of different cardiovascular diseases. Therefore, it was
seen that at 52 years age, he was suffering from 145 kg overweight, that lead to depression and
hypertension, which elevated his blood pressure, as it was excessively high if compared to
normal condition which is 52 years, 7o kg weight and normal blood pressure. Hence, the gaps,
which were identified in the care process of Peter Mitchell was associated to his improper
management of diabetes in which diet and nutrition plays an important role.
Therefore, the problems which were identified for the discussion in the care
process of Peter Mitchell are his improper diabetes management, due to which he has
gained excessive amount of weight (through this, the sleep apnoea, overeating habit and
shakiness related secondary concerns would be solved) and the excessive depression

3NURSING ASSIGNMENT
condition due to lack of proper companionship, and social isolation. Therefore, the two
priorities which would be targeted in this clinical reasoning cycle would be management
of his excessive weight (to control obesity and increasing weight gain by including
physical exercise) and to increase the health literacy of the patient, educational and
training sessions would be provided.
While establishing goal for the identified concerns, the first goal for the peter Mitchell
would be losing some excess body fat and weight so that he could focus on other aspects of
care. As per the case study, the patient agrees to take part in light body weight exercises and
hence, his plan of care would include exercise in the presence of physiotherapists. Further, it
was also noted that the patient is not completely known of his diabetes condition and dies not
know the process through which prognosis of diabetes could be achieved. Hence, the patient
would be provided with educational and training sessions so that through these the literacy of
patient regarding diabetes could be increased and peter could be provided with skills so that he
could take care of his elevated blood glucose level.
The action plan is the next step of Levett Jones clinical reasoning cycle as per which,
Peter Mitchell would be provided with healthcare literacy and for this a community healthcare
nursing professionals would be employed. As per Goffman (2014), application of community
healthcare nursing for patient education would help the patient to understand his illness and
disabilities in a different way and would provide him with hope so that he could overcome his
depression and hypertension due to persistent diabetes and obesity. Further, in patient
education, peter would be taught about the benefits of proper diet and nutrition so that he could
overcome the obesity condition with proper nutrition for his diabetes and increased blood
pressure related condition (Liu et al., 2014). Furthermore, through patient education, the patient
would be provided with self-monitoring and self-awareness so that the patient could understand
the insulin therapy process and implement it on his own care process (Fumagalli et al., 2015).
Therefore, the patient would be provided with counselling for his mental state hypertension, so
that he could be encouraged to take part in social events and through this, he could overcome
the depression condition, and could freely take part in his social life despite of his physical
inability (Goffman, 2014). Further as per Whited et al. (2018), weight management could
improve the patient’s sleep apnoea related condition as through weight management the
adipose tissue surrounding the facial area and throat, due to which the obstruction related to
sleep apnoea is resolved. Therefore, this would be included in the action plan to overcome the
primary and secondary concern of Peter Mitchell.

4NURSING ASSIGNMENT
Another priority for Peter and his health condition would be identifying the reason for his
social isolation and loneliness. In this aspect, family centered care would be implemented for
peter. As per Nefs et al. (2015), social isolation, loneliness and similar conditions could affect
patients affected with obesity and type 2 diabetes mellitus severely. Hence, the primary
intervention would target to reduce the social isolation condition is Peter Mitchell so that through
this, the patient and his associated awareness could be improved. Further as per Reed and
Pipe (2016), exercise is an effective tool, using which depression among patients with
overweight could be reduced as it provided them with hope and determination that their health
condition would be improved. Hence, the patient would be asked to perform light body weight
exercise every day for 15 to 20 minutes so that through this, his excessive body weight could be
controlled and he could control his excessive hunger. Further, to increase the social awareness,
the patient would be provided with psychological sessions so that while undergoing the process,
he could regain his confidence and motivation to overcome his illness and lead a normal life like
before. Hence, as perFingeret, Teo and Epner (2014), the patient would be provided with
exercise, diet and social counselling so that his stress and social isolation due to his physical
inabilities could be overcome.
Further, evaluation of the process and its effectiveness would be determined by
assessing the blood pressure and BMI rate of the patient. Further his blood glucose level would
be assessed so that the effect of new diet and nutrition regime could be understood (Househ,
Borycki&Kushniruk, 2014). The stress and depression of the patient would be conducted by the
mental healthcare professionals whom, with the help of conversation and communication with
the patient, would assess his mental state. Increased social participation would make the
healthcare professionals aware about his improved social interaction skills (Shaya et al., 2014).
Through the analysis of this case study, I was able to understand that there is a clear
link between depression, stress, low self-esteem and increased diabetes complications, and
occurrence of several complication in patients. Further, I was able to understand the fact that
providing patient education is the best way to make the patient a part of the healthcare process
as it enable them to take care of their own healthcare process.

5NURSING ASSIGNMENT
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