Nursing Assignment: Marcel's Case Study

This nursing assignment discusses the clinical situation of Marcel Lever, a patient with severe risk factors for diabetes. It focuses on two nursing priorities for effective interventions: medication management and self-management skills.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT MARCEL’S CASE STUDY
Name of the student
Name of the university
Author note

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Introduction
Clinical reasoning cycle by Levett-Jones is an important and critical strategy, application
of which enables the care professional with identification of patients primary concerns and the
allow them to decide the priority of care, so that effective care could be provided (Levett-Jones,
Courtney-Pratt & Govind, 2019). In this aspect, the clinical situation of Marcel Lever (70) would
be discussed who has been identified with severe risk factor for diabetes due to his uncontrolled
obesity and his improper management of hypoglycemic condition. Therefore, this paper would
discuss two important nursing priorities for the patient so that effective interventions could be
applied.
Nursing priorities
Patient consideration and collection of cues
Marcel Lever (70) is a retired farmer who has a family history of type 1 and type 2
diabetes conditions. He has been suffering from hypertension and recently has been found with
hyperglycemia. He is 180.5 cm tall and as per his height, his weight is uncontrolled and he
weighs 116 kg. Hence he is obese and reported weakness and fatigue. These patient
considerations could be processes and the cues from the latest research articles should be
collected as per the Levett-Jones clinical reasoning cycle (Levett-Jones, Courtney-Pratt &
Govind, 2019). Researchers Nap-van der Vlist et al. (2018) identified that increased weight,
fatigue and weaknesses are clear indication of diabetes and the patient should know about the
management skills so that he could manage his diabetic condition at an early stage.
Identification of priorities and goals

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The abovementioned discussion indicated to the fact that patient requires proper
knowledge of his increasing risk factor associated with diabetes and the way he could manage
and control the increasing blood glucose level. Further, it was also seen that the patient has
developed retinopathy and neuropathy. Therefore, in this aspect hence, the first priority for
the patient would be managing his medication and maintaining accurate and timely
medication so that her risk of diabetic condition consumption so that patient improvement
could be obsereved. As per Gautam, Bhatta and Aryal (2015), accurate medication is an
intervention that could help the patients to overcome their critical healthcare condition
within a specific time period by increasing their affinity for effective health condition,
control and management of critical healthcare condition (White et al., 2016). Further
researchers also found that with improper management of medication among the patients
suffering from critical healthcare conditions increases their risk factor of developing
complications. This is because they become unable to follow the medication routine
developed for their medication management and their healthcare improvement hindered
(Nap-van der Vlist et al., 2018). Therefore, as per Heijmans et al. (2015), application of
medication administration schedule with management skills training for diabetic condition
would help the nursing professionals to increase the patient’s affinity with the
interventions.
The second intervention that would be selected for Marcel Lever would be
increasing his knowledge acquisition on skills of self-management with diet and nutritional
chart so that by following it, he could manage his increasing obesity condition and could
take his medication effectively. As per the International Diabetes Federation (2019), self-
management is an effective means using which the blood glucose level among individuals

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could be controlled. It was seen that the patient is unable to manage his healthcare
conditions and providing him with a scope and strategy for growth and development would
increase his ability to overcome his diabetes and increased weight management included in
the self- management skills (Gautam, Bhatta & Aryal, 2015). Further, it was seen in the
case study it was mentioned that Marcel has retired from his job and hence his increased
sedentary lifestyle and his physical inactivity could be few of the reasons due to which the
patient could increase his risk factor of severe healthcare complications. Hence this self-
management intervention would help her to overcome her critical risk of diabetes and
associated disorders (Heijmans et al., 2015).
Goals, intervention and evaluation
As per the clinical reasoning cycle by Levett-Jones, this is one of the crucial sections as
patient undergoes interventions for a specific time period so that the effectiveness of the
interventions could be assessed and required modification could be made in the interventions
applied (Levett-Jones, Courtney-Pratt & Govind, 2019). The goal for first priority would be
making a drug or medication management routine so that increased affinity towards
medication for the patient and his knowledge of medication management skills could be
increased hence, this intervention would be applied for 4 weeks. The intervention would be
applied by a nurse educator, who will provide detailed education about the medication
management and the sequence of medication consumption so that increase and improved
outcome could be observed (Xu, Leung & Chau, 2018). Further, with the help of a dietician,
patient would be providing with strategies so that his weight could be reduced. He would be
provided with low carbohydrate food for 4 weeks so that effective changes in the health
condition of the patients could be identified.

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The second goal or intervention would be provided to the patient by applying
patient education regarding self-management skills such as physical activity and in this
course patients would be provided with light to moderate body exercises which he could
perform and could help the patients to reduce his increasing blood glucose level and
increasing obesity (International Diabetes Federation, 2019). Therefore, application of these
interventions for four weeks would help to assess the patient condition and provide the patient
with everything so that he could overcome his critical health conditions. The evaluation of the
processes would be done after 4 weeks of application so that patient’s improvement could be
compared to his previous health conditions (Gautam, Bhatta & Aryal, 2015).
Conclusion
While concluding the paper, it could be said that application of Levett-Jones clinical
reasoning cycle in the case study of Marcel helped to understand the critical situations and
identify the complications that could increase patient’s health issues. Hence, through the
detailed medication management, scheduling and administration strategies and self-
management strategies associated with blood glucose level and weight management were
chosen as the nursing priorities and these aspects were targeted for the application of
interventions. Finally, interventions were evaluated and the effective interventions were applied
for longer time so that Mr. Marcel and his associated risk of diabetes could be eliminated.

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References
Gautam, A., Bhatta, D. N., & Aryal, U. R. (2015). Diabetes related health knowledge, attitude
and practice among diabetic patients in Nepal. BMC endocrine disorders, 15(1), 25.DOI:
https://doi.org/10.1186/s12902-015-0021-6
Heijmans, M., Waverijn, G., Rademakers, J., van der Vaart, R., & Rijken, M. (2015). Functional,
communicative and critical health literacy of chronic disease patients and their
importance for self-management. Patient Education and Counseling, 98(1), 41-48.DOI:
https://doi.org/10.1016/j.pec.2014.10.006
International Diabetes Federation. (2019). International Diabetes Federation - Type 2 diabetes.
Retrieved from https://www.idf.org/aboutdiabetes/what-is-diabetes/type-2-diabetes.html
Levett-Jones, T., Courtney-Pratt, H., & Govind, N. (2019). Implementation and Evaluation of the
Post-Practicum Oral Clinical Reasoning Exam. In Augmenting Health and Social Care
Students’ Clinical Learning Experiences (pp. 57-72). Springer, Cham.DOI:
https://doi.org/10.1007/978-3-030-05560-8_3
Nap-van der Vlist, M. M., Burghard, M., Hulzebos, H. J., Doeleman, W. R., Heijerman, H. G.,
van der Ent, C. K., & Nijhof, S. L. (2018). Prevalence of severe fatigue among adults
with cystic fibrosis: a single center study. Journal of Cystic Fibrosis, 17(3), 368-374.
DOI: https://doi.org/10.1016/j.jcf.2018.03.003
White, R. O., Chakkalakal, R. J., Presley, C. A., Bian, A., Schildcrout, J. S., Wallston, K. A., ...
& Rothman, R. (2016). Perceptions of provider communication among vulnerable
patients with diabetes: influences of medical mistrust and health literacy. Journal of

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health communication, 21(sup2), 127-134. DOI:
https://doi.org/10.1080/10810730.2016.1207116
Xu, X. Y., Leung, A. Y. M., & Chau, P. H. (2018). Health Literacy, Self-Efficacy, and
Associated Factors Among Patients with Diabetes. HLRP: Health Literacy Research and
Practice, 2(2), e67-e77. DOI: https://doi.org/10.3928/24748307-20180313-01