Factors Influencing Nursing Care Plans for Patients with Chronic Healthcare Conditions

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Notes

1
NURSING
Numerous factors influence the development of the nursing care plans for the
patients who are suffering from chronic healthcare conditions. For a primary healthcare
nurse, the clinical priority must be designed based on the exact needs of the patients (Cruz,
Carvalho & Sousa, 2014) stated that prioritization can be defined as a n integral part of the
nursing profession and prioritization of care helps to increase the effectiveness of the overall
outcome of care. Prioritization is mainly achieved through collaboration and integration of the
diverse aspects of the patient’s requirement. The following essay aims to analyse the two
different priorities care on the basis of the critical evaluation of the case study of Peter
Mitchell, a 52-year old male suffering from type 2 diabetes. The generation of the two care
priority will be based on the framework of the Levett Jones Clinical reasoning cycle.
Clinical reasoning cycle is a framework through which the nursing professionals
make use of their critical thinking and cognitive skills in order to frame the care plan for the
patients by highlighting the main priority of care(Alfaro-LeFevre, 2015). Levett Jones clinical
reasoning cycle helps the nursing professionals to deduced the care priority based on the
structured framework that is starting from collection of cues, processing of the relevant
information, establishment of goals, taking appropriate actions and simultaneous evaluation
of the outcomes of care (Levett-Jones, 2017).
In “considering of the patient’s information”, the main factors that must be taken
under consideration is Peter Mitchell is suffering from obesity ventilation syndrome, poorly
managed type 2 diabetes mellitus (T2DM) and sleep apnoea. Other associated symptoms
include increased rate of hunger, visible symptoms of shakiness while admitted to medical
ward, difficulty breathing whilst sleeping and high level of blood glucose. According to
Abdelaal, le Roux & Docherty, 2017), morbid obesity has fatal health consequences in
comparison to moderate obesity. Severely over-weight individuals, weighing around 100 to
200 pounds and are over 50-year of age have more complex health issues in comparison to
individuals who weigh moderately. The conditions become even more serious when the
person is predisposed with T2DM. Peter Mitchell is 145 kgs and thus his escalating body
mass index (BMI) is an important point of consideration while framing the priority of care.
This high blood glucose level (BGL) and increases rate of hunger indicates his poorly
controlled state of the T2DM. Lavie, McAuley, Church, Milani and Blair (2014) stated that
people who are overweight and is suffering from T2DM, are vulnerable towards developing
cardiovascular complication, hepatic malfunction and renal failure. Peter’s smoking habits
(20 cigarettes per day) is another point that must be taken into urgent consideration. Pan,
Wang, Talaei, Hu & Wu(2015) stated that smoking of cigarettes increases the vulnerability
and severity of T2DM.

2
NURSING
“Collection cues or information” is the second step of the clinical reasoning cycle.
Peter Mitchell was initially 105 kgs in weight however after he left his job ( 3 years ago) and
went to insulin medication for management of diabetes and this is followed by the drastic
increase in weight (145 kgs at present). Peter Mitchell was diagnosed with T2DM 9 years
ago and is also suffering depression (since past 3 months) along with hypertension.
American Diabetes Association (2014) stated that uncontrolled diabetes is associated with
increase rate of hunger. Individuals who are unable to control their hunger or follow the
proper diet plan, develops high BGL. The depression of Peter Mitchell might be due to his
sudden loss of job and also because of his poor social image as embarrassed about his
size. Matthewset al. (2016) stated that social isolation due to poor body image or lack of self-
esteem leads to the development of depression. However, Tabák, Akbaraly, Batty and
Kivimäki (2014)stated that development of T2DM for a prolong period of time lead to the
development of persistent depression. The study conducted by De Boer et al. (2017)
revealed that diabetes and hypertension and inter-related. There is a substantial overlap
between the T2DM and development of high blood pressure in the disease mechanisms and
etiology. The increase in the blood pressure level leads to increase in the severity of T2DM.
Lifestyle of Peter Mitchell is also unhealthy as he is unable to follow an anti-diabetic diet plan
and at the same time smokes 20 cigarettes per day. His lack of observance of low-energy
high protein diet is associated with lack of proper support at home (Peter Mitchell stays
alone) leading to further gain in weight.
Process of the information, revealed that there is a connection between weight
gain, diabetes mellitus, hypertension, depression and poor life style habits along with lack of
proper financial and mental support at home.
Name of the condition Patient parameter Normal parameter
Weight 145 kg in respect to 170 cms
of height
60 to 72 Kg
Blood pressure 180/92 120/80
The main gaps in the processing of the information is Peter Mitchell is exact diet plan
the Peter Mitchell follows at home or whether he skips meal out of sheer depression or lack
of proper mental support at home. Bi et al. (2015) stated that skipping meals among
individuals with T2DM leads to increase in the severity of T2DM. The medical history of
Peter Mitchell reveals gastro-intestinal reflux (GERD) disease which is irrelevant in
connection to this current scenario as there is no direct relation with T2DM.