Factors Influencing Nursing Care Plans: A Case Study Analysis

This essay analyzes the clinical priority of a patient with uncontrolled type 2 diabetes mellitus and explores the factors influencing nursing care plans. The analysis is based on the Levett Jones Clinical Reasoning Cycle and includes the development of nursing goals to address the clinical priorities.

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

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Several factors influence the development of the nursing care plans however; the
prime focus relies on designing of the clinical priority based on the exact needs of the
patient. Designing clinical priority based on the patient’s care needs helps to increase the
overall effectiveness of the care plan and thereby helping to improve the outcome of care
(Urden, Stacy & Lough, 2019). The following essay aims to analyse the clinical priority of
Peter Mitchell, a 52-year old man with uncontrolled type 2 diabetes mellitus (T2DM).
Identification of the clinical priority will be based on the Levett Jones Clinical Reasoning
Cycle and this will be followed by development of the nursing gaols to address those clinical
priorities.
In case of Peter Mitchell, the primary information of focus includes obesity ventilation
syndrome, poorly managed T2DM and sleep apnoea. Other addition information includes
increased hunger, high blood glucose level (BGL), difficulty in breathing while sleeping and
visible shakiness. Abdelaal, le Roux and Docherty (2017) stated that morbid obesity is fatal
in comparison to morbid obesity irrespective of age. The conditions become more severe in
the presence of T2DM. Peter Mitchell weights around 145 Kilograms and thus high body
mass index is the first issue that must be taken under urgent consideration. His poorly
controlled diabetes even under the medication of insulin Novomix, is another issue of
consideration which is interrelated with his high BMI and this is reflected in symptoms like
visible shakiness, high BGL and increased hunger. Tangvarasittichai (2015) stated that high
BGL can lead to renal failure and development of cardiovascular problem. Smoking 20
cigarettes per day along with hypertension further make the scenario worse.
“Collection cues or information” it deals with review of the current health information
of the patient and then relate it with necessary pathophysiology and pharmacology. Peter
Mitchell was 105 Kgs when he used to work as fork lift driver. However, after he left his job,
3 years ago, he started taking insulin and gaining weight. Thyfault et al. (2015) stated that
sedentary life like increased sitting time leads to lack of human movements. This result in
decreased rate of the catabolism and when it is associated with unmanaged diet plan, it
adds body mass deposition in the adipose tissues. Peter fails to follow low-energy high
protein diet as recommended by healthcare physicians leading to further gain in weight.
Lecube et al (2017) highlighted that in T2DM is associated with the generation of insulin
resistance followed by low grade of inflammation, micro vascular damage, leptin resistance
and autonomic neuropathy. This is the reason why unmanaged diabetes is the obesity
ventilation syndrome and difficulty in breathing while sleeping is another consideration in
Peter Mitchell. He is uncomfortable about his body image leading to decrease social
participation and development of depression. Ishizawa et al. (2016) stated that diabetic

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complications in elderly with long-term diabetes lead to the development of poor mental
health status.
Processing of information deals with the discovery of the new information and
generating relationships between facts. The analysis of the case study revealed that weight
gain, diabetes mellitus, hypertension and depression is associated with the poor lifestyle of
Peter Mitchell along with lack of proper support at home. Lubkin and Larsen (2018) stated
that poor lifestyle conditions are the main reason behind the development of the non-
communicable disease like T2DM. Moreover, lack of proper support at home leads to
decrease in the tendency of self-management of diabetes for the elderly and thereby
increasing the severity of the disease. The case study reveals that Peter is motivated to lose
weight and quit smoking but is not sure where to start.
The main gap in the processing of the information is lack of proper information about
the diet plan of Peter Mitchell. According to Diabetes Australia (2019), skipping of meal of
consumption of high fat or carbohydrate diet increases the BGL.
The main identified problems include unmanaged diabetes due to unmanaged body
weight and diet, lack of proper guidance of home leading to gaps in the self-management
skills and depression for poor body image leading to social isolation.
Establishment of goal will deal with effective management of the T2DM of Peter
Mitchell.
The first action plan for the management of diabetes will include management body
weight. Nursing intervention will include giving encouraging Mitchell to practice the light
exercise taught by his physiotherapist. After the initiation of the daily practice of the physical
exercise, the intensity of exercise will be increased gradually depending of Mitchell’s
convenience. This can be done by educating Mitchell about importance of the regular
practice of the physical activity and its relation with the body weight and diabetes
management. McKenna and Mirkov (2014) stated educating the patient about the process of
disease progression helps to increase the patient engagement and thereby helping to
increase the therapy adherence and change in the lifestyle. The regular practice of the
physical activity can be done under the community health settings. Guzys and Petrie (2017)
stated community level practice of the physical activity leads to increase participation.
McCance, Heuther, Brashers and Rote (2018) stated that practice of the physical activity
helps to reduce the body mass and along with blood glucose level and thus help in effective
management of T2DM. The second action plan includes improvement in the life style activity
like proper adherence of diet and quitting smoke. The nursing intervention will include

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assisting Peter to quit smoking via giving assistance via Nicotine Replacement Therapy
(NRT). Hartmann‐Boyce, Chepkin, Ye, Bullen and Lancaster (2018) stated that NRT helps to
fight against the withdrawal symptoms and thereby helping to quit smoking. In the domain of
diet plan, the role of the nurse will be arrange a home help for Peter who will help in serving
homemade high protein diet (LEHP). Australian Government funded Commonwealth Home
Support Programme helps elderly to avail home help. Since Peter is unemployed at present
it government funded program will be helpful for him. The third action plan will be periodic
monitoring of the vital parameters like BGL, blood pressure and weight by availing help from
the community healthcare settings. Regular monitoring of the BGL helps in effective
management of T2DM (McCance, Heuther, Brashers & Rote, 2018).
The second establishment of goal will deal with improvement of the mental state.
This can be done by encouraging Peter to take active part under community activities
involving people who are also fighting with diabetes (first action plan). Freeman, Hanlon,
Denslow & Hooper (2018) stated that staying with the people of the same age group or the
groups who are fighting with similar health problems help to improve the self-esteem and
thereby helping to recover from body image shame and depression. Second plan of action to
recover his stated of depression will include effective management of weight. Reduction in
weight will help to overcome the body image issue and gain self-confidence and thereby
helping to fight against depression. When Peter will be confident about his body, he will take
initiative in taking part in social activities. The third action plan deals with counseling with
mental health professionals in order to design patient centered action plan for Peter to
improve his mental well-being (McKenna & Mirkov, 2014). Reduction in his weight will help
to fight against his breathing problem along with hypertension. This will help to ensure
comfortable sleep at night and thereby helping to ensure improve overall quality of life along
with mental state.
Evaluation of the outcome can be done through periodic monitoring of the body
weight and blood glucose level in order to track the prognosis of T2DM and BMI. According
to Diabetes Australia (2019), BGL and body weight is an important indicator for T2DM
management. The mental health status of Peter can be evaluated based on his increased
rate of social participation under community settings.
Thus from the above discussion, it can be concluded that healthy life style habits is
an important parameter to maintain a comprehensive mental and physical well-being.
Engaging patient in the therapy plan and educating patient about the disease progression
helps to increase patient participation and therapy adherence. The education patient about
the process of disease progression also helps to increase the self-management skills among

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the patients. The above clinical analysis also highlighted that for older adults, increase in the
level of social participation is an important constituent in order to maintaining healthy mental-
health and well-being. Increase level of social participation helps to overcome depression
and thereby helping to improve the quality of life. The case study analysis also revealed that
it is also the duty of the nurse to arrange informal help for the older adult who are living alone
in the at home in order to aid them to accomplish daily living activities.

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