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

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

1NURSING
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

2NURSING
(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