Nursing Management

This paper discusses the role of a community nurse in managing the disease condition of a patient through the clinical reasoning cycle. The case study focuses on Peter Mitchell, a 52-year-old male with diabetes type 2, hypertension, and other related problems. The nursing priorities include managing the patient's symptoms and lifestyle risks. The effectiveness of the treatment is evaluated through various assessments.

Running head: NURSING MANAGEMENT
Nursing Management
Name of the Student
Name of the university
Author Note

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In delivering a safe and good quality patient care in a hospital setting, the role of a
community nurse is very crucial and it is associated with the patients’ psychological,
emotional and social needs along with the medical needs. The case study of Peter Mitchell
is discussed in this paper along with the two nursing priorities of managing the disease
condition of the patient by using the clinical reasoning cycle (CRC) proposed by Levett
Jones. The Levett – Jones CRC comprises of a few process such as collection of cues,
processing of information, understanding patient problems, intervention implementation,
outcome evaluation and reflection. At first, the community nurse should consider the
situation of the patient and then evaluate the situation with adequate sympathy and the
nurse should not show any bias towards the patient so that the nurse can understand the
priorities and needs of the patient. In this case study, it is observed that, Peter Mitchell is a
52 year old male who is referred to the hospital with the problems like diabetes type 2,
hypertension, hyperglycemia, shakiness, polyphagia, sleep apnoea, diaphoresis. The
community should also assess the social status of the patient in order to give more proper
and effective treatment to the patient. In various studies it is observed that, the most of the
patients isolate themselves from the society due to negativity of their life and mostly they live
alone. Along with the nurse also should consider the smoking behaviour of the patients as it
is associated with the loneliness. (Oliver, 2017). . From the case study it can be observed
that, the primary health concerns of Peter are the diabetic condition and his obesity and
related metabolic problems. In addition, the nurse should also take care about the poor
social wellbeing, social isolation gastrointestinal complications. Additionally, the nursing
priority goal should also cover the lifestyle factors of patient such as smoking behaviour. On
the other hand the second nursing priority should be management of lifestyle risks by
improving sleeping pattern, smoking cessation, reducing obesity of the patient within next 2
weeks.
In this case study, the first priority of nursing care should be the management of
diabetic symptoms, such as management of blood glucose level, blood pressure within next

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2 weeks. As a part of the first nursing priority action plan, the nurse should collect cues from
the patients’ information as it is essential process in nursing practice. The community nurse
should collect the information regarding the current medication of Peter as he is having a few
medicines for his problems. . Therefore, it is the duty of the nurses, to collect medical history
of the patients. In this case, the nurse should collect Peter Mitchell’s blood pressure data,
blood glucose level, lipid profile of Peter along with his anthropometric data such as height,
weight, waist circumference as the patient is obese is nature (Lavie et al., 2014). Nurse will
process and connect the information with the physiological disease condition. Therefore, if
the nurse can relate the information with the Peter’s symptoms of hypertension,
hyperglycemia, then the nurse can correlate with the situation to the uncontrolled diabetes
as insulin resistance can enhance the blood glucose levels of the body and increased
hypertension due to the accumulation of lipids in the blood vessels (Lorando et al., 2018).
Then the nurse should allow to continue the current medications of diabetes such as
novomix and metformin. Metformin is a well-known medication for the management of
hyperglycemic condition through regulation of blood glucose production by hepatic cells. On
the other hand, novomix is used as external insulin which is used to treat the insulin
resistance condition among the diabetic patients (Dworacki et al. 2015 ). However, if the
nurse detects an esophagal inflammation, then the nurse can continue the current medicine
of Peter that is Nexum. This drug molecule acts as a proton pump inhibitor which can reduce
the gastric acid production in the GI tract. The symptoms of hypertension can be countered
with the medicine named lisinopril that can reduce the hypertensive symptoms through
inactivation of angiotensin-converting enzyme (ACE) activities which is a key player of RAAS
mechanism – a blood pressure regulating activity. In addition to this, the nurse must perform
regular monitoring of Peter’s blood pressure, blood sugar levels as it will help the community
nurse to examine the effectiveness of the Peter’s disease management (Maliha & Townsend
, 2015). Extreme level of blood glucose level will indicate the nurse to identify this condition
as the uncontrolled diabetes with symptoms like hyperlipidemia, hyperglycemia and
hypertension (Meek et al., 2015). Moreover, a high waist circumference will help the nurse

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to identify the condition as obesity as high BMI and increased waist circumference are the
indicative factors for the abdominal obesity and metabolic complications. Therefore, the risk
of cardiovascular disease cannot be mitigated as well. The symptoms of Peter will also allow
the nurses to identify conditions such as bad dietary habits, sleep apnoea, smoking and
these are associated with the more severe risks of diabetes and cardiovascular disease
(Van Nimwegen et al., 2015). Along with this, abnormal cardiovascular may cause
tachycardia and cardiac arrhythmia and these may happen due to the uncontrolled diabetes.
Therefore the nurses can collaboratively work with the multidisciplinary teams in order to
provide better care. As a part of this, a cardiologist may help the nurses in the cardiovascular
assessment process and a diebetologist also can provide support to the community nurse in
assessing long term effect of Peter’s condition. For the management of esophageal
complications the nurse may collaboratively work with a gastroenterologists. A dietary
assessment will also be required as the diet comprises of dietary fibres and moderate
protein can improve the diabetic condition of the patient ( Ley et al., 2014). Moreover, a
GERD assessment will help to identify the Peter’s present status of diabetic management
as it is indicative factor of disease progression of neuropathy.
On the other hand the second nursing priority should be management of lifestyle
risks by improving sleeping pattern, smoking cessation, reducing obesity of the patient within
next 2 weeks. As a part of this, the nurse may take opinion from a nutrition specialist who
can fix the diet plan for Peter and that should be comprised of low carbohydrates ,
antioxidants, dietary fibres, moderate proteins as such diet can improve the insulin sensitivity
and blood sugar levels of the patients. The abnormal anthropometric measurement will
indicate the current condition of the body and along with this, it may indicate the near future
outcome of the patient as obesity and related measurements such as higher BMI, as obesity
is closely associated with risk of diabetes and hypertension (Depp et al., 2014). The result
of the Fagerström Test will allow the community nurse to assess the Peter’s current
attempts of cessation of smoking and it is very important as habits of smoking promotes the

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risks of cardiovascular problems which should be stopped immediately. The STOP-BANG
questionnaire will allow the community nurses to assess the status of Peter’s current obesity
and diabetes management status as obesity can alter the breathing and sleeping behaviour
(Chung, Abdullah & Liao, 2016). Moreover, the nurse also perform a joint venture with an
occupational therapist as the therapist can help Peter in managing his weight through light
exercises. Exercise will help in glucose metabolism and increase glucose reuptake by the
muscles. An increased waist circumference is the indication of the problems like high BMI of
the patient. Along with this the increased waist circumferences of Peter also suggest that, he
had high amount of deposited adipose in his belly and that fact restricted Peter from
performing any kind of activities of daily life. From the case study, it was also observed that,
he had not found any job due to his problem of obesity Hence, the community nurse
selected the obesity management as one of the care priorities in case of Peter. As a result,
the blood glucose level of the patient will also be regulated in a passive way. Nurse should
take follow up from the patients about the anthropometric measurement such as weight,
circumference of the patient as these are the contributors of diabetes and hypertension risk
factor (Ortner Hadžiabdić et al., 2015). The patient is also addicted to smoking and hence
the nurse should perform the the Fagerström Test for Nicotine Dependence for assessing
his dependency on nicotine ( Grant et al., 2014). The condition of sleep apnoea can be
examined by using the STOP-BANG questionnaire. In addition, a dietary and cardiovascular
assessment may be performed by the community nurses as diabetes, nutritional profile and
cardiovascular disease are interconnected. A Gastrointestinal Reflux Disease ( GERD) may
require as GERD in diabetes condition is associated with the symptoms of peripheral
neuropathy ( Ha et al., 2016).
After applying the care priorities , the nurse should evaluate the effectiveness of the
treatment through checking the blood glucose level, blood pressure level, body weight, waist
circumference of the Peter . The Fagerström Test should be performed to check the nicotine

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dependency and for sleep apnoea STOP BANG questionnaire should be evaluated. For
assessing the cardiovascular condition, the should search help from a cardiologist.
From this case study, I have combated successfully with a critical condition as the
patient has complicated situation with obesity, diabetes, hypertension and hyperglycemia.
Although, I managed the condition quite well, still I have lack in knowledge about the
psychological association with the physiological disease condition of the patient. Hence, I
failed to incorporate the knowledge in the management plan of Peter. Therefore, from this
learning I got the experience and I will use this in my future practice.

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