Nursing Case Study: Applying Clinical Reasoning Cycle for Patient Care

This nursing case study examines a 52-year-old man, Peter Mitchell, with morbid obesity and type 2 diabetes, who has experienced multiple medical emergencies. The assignment utilizes the clinical reasoning cycle to analyze the patient's condition, including symptoms like shakiness, high BGL levels, and difficulty breathing. It delves into his medical history of tobacco use, depression, and sleep apnea, and his psychosocial background, including unemployment and social isolation. The analysis identifies key care needs such as managing diabetes and obesity, along with other conditions like hypertension and depression. Two complex care priorities are highlighted: obesity management and diabetes self-management. The assignment outlines goals for diet, exercise, and glucose management, and discusses evaluation methods and reflection to improve patient-centered care. The study concludes that the clinical reasoning cycle is an effective tool for evidence-based practice in nursing.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction: 2
Case scenario analysis: 3
Care needs: 4
Two complex care priorities with justification: 5
Conclusion: 7
References: 8

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Introduction:
One of the greatest responsibilities in case of the nursing individuals can be considered the
clinical judgments. In most cases the nursing individuals are expected to take prompt clinical
decisions in both the care planning and execution. Now it has to be mentioned that the impact of
the care decision making can have a very severe impact on the well being of the patients.
Furthermore, in certain cases any wrong decision taken in the care planning procedure can even
cost the patients if his or her life. Therefore, the values if the nursing decisions are extreme and
that is the reason why there have been many initiatives take in the attempt to streamline the
process of clinical judgment or decision making as possible (Stellefson, Dipnarine & Stopka,
2013).
Clinical reasoning cycle can be considered to be one of the most impactful and effective
strategic intervention that has proved to improve the clinical judgments and eradicate the issues
that are prevalent in the scenario of clinical decision making. The clinical reasoning cycle can be
defined as the scientific step by step process of collecting different cues of patient situational
analysis, processing the collected information, identification of the care needs, planning and
implementation of interventions based on care priorities, evaluating outcomes and reflecting on
the entire procedure (Levett-Jones et al., 2010). This assignment will attempt to use the clinical
reasoning cycle to analyse the patient situation and formulate care interventions based on the
care needs and the care priorities f the patient by the means of employing clinical reasoning cycle
with the help of a case study.

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Case scenario analysis:
The very first step of the clinical reasoning cycle is the collection of the informative cues
regarding the condition of the patient. On a more elaborative note, this step of the cycle is
associated with the patient situation analysis, and investigation of the facts linked issues of the
patient. In this case, the patient Peter Mitchell is a 52 year old man with a morbid obesity and
type 2 diabetes. There have been three particular medical emergencies due to which the patient
had been admitted to the health care facility, poorly controlled diabetes, and obesity ventilation
syndrome and sleep apnoea. The subjective data of the patient also indicate at a few key
symptoms that the patient had been exhibiting such as shakiness, diaphoresis, increased hunger,
high BGL levels and difficulty breathing whilst sleeping. Along with that patient history also
reveals his past history of tobacco usage for 30 years, the patient smoked 20 cigarettes a day.
According to the information mentioned above the patient had been neglecting his high blood
glucose levels and the added impact of morbid obesity. From the symptoms that the patients had
been exhibiting signs of severe hyperglycemia, and he had also been at a risk for diabetic coma
(Garber et al., 2013).
Further investigations indicate at the fact that the patient had been previously suggested to
follow a weight loss regime involving a strict low fat diet and daily exercise, which the patient
refused to acknowledge because of it being “too hard” for him. His past medical history
investigations unravelled presence of depression, Hypertension, Sleep apnea, and Gastro
oesophageal disease reflux disease along with obesity and type 2 diabetes. Therefore, it can be
mentioned that as Peter had been suffering with quite a few health disorders and each one of
them had an impact on his present condition, his negligence to follow a proper diet and an

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exercise regimen further worsened the condition for him enhancing his risk of hyperglycemia
and even diabetic coma (Garber et al., 2016).
The psychosocial information about the patient indicate that he had been a government
employee 3 years ago had weighed 105kgs, after losing his job his diabetes and obesity worsened
further and after the start of the insulin the patient gained far more weight. Along with that, due
his abnormally obese physique and fatigue he has difficulty finding employment lives alone after
his divorce. The impact of his severe hyperglycemia and extremely high body weight restricted
his chances of carrying out normal activities of daily living, and as he lived alone in his house, he
had no one to care for him either. However, after his recent episode of hyperglycemia and
increased chances of diabetic coma helped him realize the need for making efforts to lose weight
and better management of his conditions. With the absence of any advisor or family member to
rely on, the patients is unsure of where and how to start working for better health outcomes
which indicates that the patients is anxious, clueless and depressed.
Care needs:
According to the clinical reasoning cycle, the second and third stage of the cycle is associated
with the process of collecting cues from the patients regarding the subjective and objective
patient data and processing all the information that has been collected by the nursing
professional. This process gives rise to the identification of the care needs of the patients and by
interpreting, discriminating, relating, inferring, and predicting performed by the nursing
professional (Dalton, Gee & Levett-Jones, 2015).
Hence, focusing on the care needs of the patients, many care priorities are apparent from the
case study. First and foremost it has to be mentioned that the patient had a very poorly controlled

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diabetes type to the patient it has to be mentioned that obesity often leads deterioration of bith
physical and mental health and wellbeing by the virtue of altered body image, related co-morbid
disorders, social isolation, fatigue, mobility restriction and depression. Hence the very first care
need for the patient has to be reduction and better management of his exceeding body weight.
The next care need that can be highlighted in here is better management of the diabetes that the
patient had been having (Vashist, 2012). It has to be understood that extreme morbid obesity
when coupled with faulty management of diabetes can lead to severe exacerbations like coronary
heart diseases and renal diseases, hence better management of his diabetes will be one of the
greatest care need. Other care needs for the patient includes hypertension, sleep apnoea,
depression, and social isolation.
Two complex care priorities with justification:
The clinical reasoning cycle provides the health care professional with the opportunity to
sort through the overlapping care needs. In this case as well, the next step of action will be for
the nursing professional to focus on the most crucial care priorities of the patient and decide on
two particular care priorities that the patient will need immediate care intervention for. The
fourth stage of the clinical reasoning cycle, the nursing professional will need to identify the key
issues that the patient has been suffering from and formulate a care plan including the patients
and his preferences in the process (Levett-Jones et al., 2010). Based on the subjective and
objective data, the care priorities for the patient include obesity management and better self
management of the diabetes. It has to be mentioned that global epidemic of obesity is indicative
of the increasing prevalence and incidence rate of type two diabetes. Similarly without effective
management of obesity the patients can lead to many health disorders like congestive heart
failure, coronary arterial diseases, renal diseases and many more which can easily lead to

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fatalities if not managed properly. Along with that the patient had type 2 diabetes for more than 9
years and with the lack of self management of the disease coupled with excessive body weight at
145 kg, the above mentioned risks were even higher. Hence, based on synthesis of the patient
data discovered from the past medical history and the investigation by the nursing professional,
the choice of both of the care priorities are relevant and justified (Feinman et al., 2015).
The 5th stage of the CRC focuses on synthesis of achievable goals involving the care
priorities decided in the previous steps, and taking relevant actions to address the chosen care
priorities. The collection and synthesis of the patient data indicates the fact that that patient did
not have a strict diet plan at all; hence the very first goal for the patient will be to focus on a diet
plan that matches his needs and preferences. The next goal for the patents can be a low to high
exercise regimen. The patents will need to start with a low grade exercise program that will help
him get used to the habit of exercise and slowly the exercise regimen will evolve to higher
difficulty level to match up with need of the patient (Rueda-Clausen, Padwal & Sharma, 2013).
For diabetes management, the patient had not been regular with his checkups and blood
glucose management; hence the first goal for this patient must focus on the regular glucose level
management. It has to be mentioned in this context that the patient will need to be instructed to
acquire any self operated glucose level monitoring device and should be educated to check it
regularly. Along with that that patients will be needed to be educated and motivated to regularly
take the medications that has been prescribed to him (Chen et al., 2012).
The last two steps of the clinical reasoning cycle in to evaluate the outcome of the
management goals and then reflect on the whole process. For the evaluation process, the nursing
professional can monitor the weight, blood glucose level and BMI of the patient. A changed
attitude towards his obesity and diabetes and efforts to change his condition will also be a

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evaluation outcome measurement strategy for the patient. The primary motive behind the
reflection phase is to enhance the patient centered aspect of the care and whether the care
approach can be refined any further to match the needs of the patient any further
(Chandrasekaran et al., 2012).
Conclusion:
On a concluding note, clinical reasoning cycle is an excellent tool for the nursing individuals
to employ evidence based practice and critical analytical thinking while caring for the patients
and addressing different issues by the means of a series or spiral of linked clinical encounters. it
helps effectively in sorting out the relevant patient care cues, identifying care priorities and
designing care plan that will address each of the care priorities. In this case study as well, the
CRC helped in identification and determination of the particular care priorities of Peter Mitchell
and helped in designing care goals that are focussed and recovery oriented for him.

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References:
Chandrasekaran, C. V., Vijayalakshmi, M. A., Prakash, K., Bansal, V. S., Meenakshi, J., &
Amit, A. (2012). Herbal approach for obesity management. American Journal of Plant
Sciences, 3(07), 1003.
Chen, S. M., Creedy, D., Lin, H. S., & Wollin, J. (2012). Effects of motivational interviewing
intervention on self-management, psychological and glycemic outcomes in type 2
diabetes: a randomized controlled trial. International journal of nursing studies, 49(6),
637-644.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
The, 33(2), 29.
Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., ...
& Nielsen, J. V. (2015). Dietary carbohydrate restriction as the first approach in diabetes
management: critical review and evidence base. Nutrition, 31(1), 1-13.
Fisher, E. B., Boothroyd, R. I., Coufal, M. M., Baumann, L. C., Mbanya, J. C., Rotheram-Borus,
M. J., ... & Tanasugarn, C. (2012). Peer support for self-management of diabetes
improved outcomes in international settings. Health affairs, 31(1), 130-139.
Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., ...
& Garber, J. R. (2016). Consensus statement by the American Association of Clinical
Endocrinologists and American College of Endocrinology on the comprehensive type 2
diabetes management algorithm–2016 executive summary. Endocrine Practice, 22(1),
84-113.

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Garber, A., Abrahamson, M., Barzilay, J., Blonde, L., Bloomgarden, Z., Bush, M., ... &
Grunberger, G. (2013). American Association of Clinical Endocrinologists'
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Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... &
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Rueda-Clausen, C. F., Padwal, R. S., & Sharma, A. M. (2013). New pharmacological approaches
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Stellefson, M., Dipnarine, K., & Stopka, C. (2013). Peer reviewed: The chronic care model and
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Vashist, S. K. (2012). Non-invasive glucose monitoring technology in diabetes management: A
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