Clinical Priority and Nursing Care Plan for a Patient with Type 2 Diabetes Mellitus

This essay analyzes the clinical priority and nursing care plan for a 52-year old man with uncontrolled Type 2 Diabetes Mellitus. The essay discusses the factors influencing the development of the care plan and the identification of the clinical priority based on the patient's needs. The nursing goals are also developed based on the identified clinical priority.

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

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The development of the nursing care plan is influenced by several factors however;
the main focus of the care plan relies on the identification of the clinical priority depending of
the exact needs of the patients. Identification of the clinical priority based on the needs of the
patients help in the generation of the patient centred care plan and thereby helping to
improve the overall outcome of care (Urden, Stacy & Lough, 2019). The following essay
aims to analyse the two clinical priority of Peter Mitchell, a 52-year old man suffering from
uncontrolled Type 2 Diabetes Mellitus (T2DM). The identification of the clinical priority will be
done based on the Levette Jones Clinical Reasoning Cycle and subsequent development of
the nursing goals based on the identified clinical priority.
Peter Mitchell main focus in the domain of his physiological health is poorly managed
T2DM, obesity ventilation syndrome or and sleep apnoea. Their information in relation to his
physiological health include increased level of hunger, unmanaged body weight, high blood
glucose level (BGL), difficulty in breathing while sleeping and visible shakiness. The obesity
ventilation syndrome is associated with increase body weight of Peter Mitchell who weighs
145 kilograms. According to DeFronzo et al. (2015) people who are suffering from T2DM can
have detrimental effect on overall health and well-being if they are over-weight. This poorly
controlled diabetes mellitus, lack of employment and sedentary life along with long-term use
of insulin Novomix is another issue behind the gain in the body mass leading to obesity. This
high body weight and poorly managed diabetes mellitus is reflected in visible shakiness,
increased level of hunger and high BGL. DeFronzo et al. (2015) stated that having high BGL
for a prolong period of time leads to the development of hypertension leading to
cardiovascular problems and renal failure. Peter Mitchell smokes 20 cigarettes per day,
making the effective management of diabetes worse.
While collecting of clues, it was highlighted that Peter Mitchell was initially 105
Kilograms in weight when we was employed. Though this body weight was much higher the
permissible limit and the reason could be his sedentary mode of work, he was a fork lift
driver. However, after he left his job, three years before, he gained 40 kilograms extra,
making him 145 Kgs. According to McCance et al. (2018), sedentary lifestyle like decrease
in the physical activity or limited physical activity reduced the overall BMR of the body
leading to gain in weight. In case of Peter, he was not on anti-diabetic diet moreover; his lack
of physical movements along with long term intake of insulin hampered his overall catabolic
function, leading to gain in the overall body mass by fat deposition in the adipose tissue.
McCance et al. (2018) further highlighted that unmanaged diabetes leads to the generation
of insulin resistance. The generation of insulin resistance leads to hamper in the functioning
in the overall activity of liver leading to increase in the blood cholesterol level
(hypercholesterolemia) and deposition of the extra cholesterol in the tissues and arteries

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(Arthrosclerosis). The deposition of cholesterol or fat also occurs in upper airway or the
pulmonary artery leading to generation of obesity mediated sleep apnea and difficulty in
breathing (McCance et al., 2018). Suffering from T2DM for a prolong period of time along
with the intake of metformin leads to the generation or peripheral neuropathy and this might
be a reason behind his shakiness in hands (McKenna & Mirkov, 2014).
The processing of the information highlighted that his weight issues, lack of job
opportunity and lack of support at home is the main cause behind his poor mental health
condition. This poor mental health condition among the older adults leads to depression and
subsequent social isolation (Cacioppo & Cacioppo 2014). The processing of the information
also highlighted that his poor lifestyle condition like unmanaged diet, sedentary life style and
cigarette smoking is making the overall diabetes management poor leading to escalating
BGL. Moreover prolong use of the pharmacological interventions like metformin, insulin
along with poorly managed T2DM is leading to the development of macro and microvascular
complications of T2DM. This micro and macro-vascular complications of diabetes is reflected
in the form of difficulty in breathing, sleep apnoea and shakiness in hand (DeFronzo et al.,
2015).
The main gap in the processing of the information include lack of proper information
of the diet plan followed Peter Mitchell. It is highlighted in the case study that Peter Mitchell
filed to follow the low energy high protein diet however, the exact diet plan followed by him
(whether takeaway or homemade) is not mentioned. Moreover, it is also not mentioned
whether Peter Mitchell skips meal. As per the reports skipping meal or consumption of high
fat diet increases the tendency of high BGL (Diabetes Australia, 2019).
The two identified problems for Peter Mitchell is his unmanaged diabetes and social
isolation.
First action plan for the effective management of Diabetes is regulation of the diet
plan as recommended by the healthcare professionals that is low calories high protein diet
under the assistance of home help who will help Peter to prepare food and abide by the
same (Ley et al., 2014). Australian Government funded Commonwealth Home Support
Programme assists the older adults in accomplishing personal needs (Australian
Government Department of Health, 2019). According to Diabetes Australia (2019) low
calorie diet helps to regulate BGL. The second action plan will be regular practice of physical
activity as per the training module developed by the physiotherapist of Peter. Professionals
of Commonwealth Home Support Programme will give necessary encouragement to Peter to
practice physical activity regularly. Physical activity ensures burning of calories leading to
reduction in body weight and blood glucose level. Reduction in the body weight in turn will

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help to reduce sleep apnea (Colberg et al., 2016). Using assistance from the government
funded project will be financially more stable for Peter because he is unemployed at present.
Cessation of tobacco smoking will be third action plan in order to resolve the problem of
unmanaged diabetes. The smoking reduction can be undertaken by the use of the Nicotine
replacement therapy (NRT). NRT helps to fight against the withdrawal symptoms of
smoking. Reduction in the smoking tendency will help to reduce the severity of diabetes
mellitus (Hartmann‐Boyce et al., 2018). Fourth action plan will be periodic monitoring of the
BGL, hypertension and body weight. This monitoring of the vital parameters can be done
under the community based clinic. A professional from Commonwealth Home Support
Programme will be appointed for Peter who will assist him to the community health clinic
once a week for monitoring of the vital signs. Regular monitoring of the vital signs will help in
early detection of disease severity along with making modifications in the medication dosage
(McKenna & Mirkov, 2014). Fifth action plan involves patient education in order to increase
the level of disease awareness, therapy adherence and development of diabetes self-
management skills. McKenna and Mirkov (2014) stated that patient education is an effective
means of increasing therapy adherence and development of self-management skills. The
case study highlights that tough Peter knows that physical exercise and diet plan is
important for him, he is unsure regarding where to start from. Having a proper knowledge
and guidance will help Peter to take active initiative to indulge in physical activity and anti-
diabetic diet plan. The patient education will be done under the community based health
setup under the presence of the community health nurses (Guzys & Petrie, 2017). The non-
pharmacological interventions will be used in order to manage the T2DM in Peter Mitchell as
long-term use of medicines of diabetes control like Metformin and insulin leads to the
generation of several complication like weight gain and neurological complications.
Reduction in the BGL will help Peter to feel less fatigue and thereby helping him to conduct
the daily living activities.
The second priority is Peter’s social isolation. Social isolation leads o depression
hampering the process of healthy ageing. Moreover Lubkin and Larsen (2018) stated that
prolong T2DM leads to the generation of severe depression hampering mental health and
wellbeing. The action plan for fighting against depression include increasing Peter’s social
participation and this can be done through development of community level activities along
with other participants who are also suffering from weight issues. Staying with people of
same body image will help to improve the self-confidence and thereby helping to increase
self-esteem. Reduction in body weight through physical activity will also give Peter a body
positive image and thereby helping to overcome social isolation. Regular counselling with
the mental professionals will help Peter to further recover from lack of confidence.

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Evaluation of the outcome will be done based on monitoring of the BGL and body
weight in order to ascertain the prognosis of diabetes. The outcomes can also be measure
based on Peter’s pro-active initiatives to abide by the diet plan and perform physical activity.
Peter’s participation in social gatherings will help to ascertain his mental state of mind. A
face-to-face interview might also be helpful in ascertaining the present mental state of Peter
based on his personal perspective (McKenna & Mirkov, 2014).
Thus from the above analysis of the case study based on the priorities of the
patient’s need, the main learning outcome was, the clinical priority differs from person to
person and at the same time depends in the physiological and psychological conditions of
the body. The clinical reasoning of the case study also highlighted how a constant
assistance for an elder adult might help to bring change in his daily living activities. The case
study also helps to highlight the importance of the patient education in order to increase the
patient management in the therapy plan and generation of disease self-management skills.
The study also helped to understand how patient participation helps in evaluation of the
outcome and at the same time helps to increase self-awareness.

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References
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