Evidence-Based Health Care Priorities for Peter Mitchell

The systematic discussion of two significant evidence-based health care priorities for the
selected ‘Peter Mitchell’ scenario is performed using clinical reasoning cycle (EHA, 2018).
The presented case study reveals the poor health status of a 52-year male Peter Mitchell
affected with obesity, type 2 diabetes, hypertension, sleep apnea, and gastroesophageal
reflux disease (GERD).
Peter experiences clinical signs/symptoms of difficulty breathing (during sleep), poorly
controlled blood glucose level, elevated hunger, diaphoresis, fatigue, shakiness, smoking
addiction. He is also affected by unemployment and social isolation. He also experiences
substantial difficulty in independently undertaking his personal care and ADLs (activities of
daily living). He presently receives insulin, metformin, metoprolol, and dietary interventions to
effectively manage his clinical symptoms.
Peter’s obesity and poorly elevated blood glucose level substantially deteriorate his health-
related quality of life and wellness outcomes (Yousefzadeh, Shokoohi, & Najafipour, 2015).
Peter’s diabetes mellitus substantially increases his risk of cardiovascular disease and
related complications. Peter’s sleeping disturbance and related breathing difficulty is a direct
outcome of his obesity hypoventilation syndrome that substantially elevates the risk of
respiratory and metabolic complications (Katyal & Bollu, 2019). Patient’s GERD status
elevates his risk for pulmonary disease, esophageal adenocarcinoma, Barret’s esophagus,
peptic stricture, and erosive esophagitis (Badillo & Francis, 2014). Peter also experiences a
high risk for the chronic renal disease under the impact of diabetes and hypertension
(Lastra, Syed, Kurukulasuriya, Manrique, & Sowers, 2014).
The probable causes of Peter’s presently reported disease conditions are based on the poor
health-related quality of life, adverse glycemic control, poor mental health, limited physical
activity, smoking addiction, inappropriate diet, limited disease awareness and coping skills,
ineffective self-care capacity, and reduced self-sufficiency.
Peter’s two care priorities will determine the health care goals requiring timely
accomplishment in the context of improving his wellness outcomes in the shortest timeframe.
These care priorities will be based on the enhancement of health-related QoL (Quality of
Life) and psychosocial/mental health outcomes.
The preliminary objective of improving Peter’s health-related QoL is based on the
normalization of his blood glucose level. This step will substantially reduce Peter’s risk of
hyperglycemia-related tissue deterioration and assist in controlling the clinical manifestations
of hunger and fatigue. Peter’s health-related QoL should be improved in a manner to
maintain his premeal and post-meal blood glucose levels within 70-130mg/dl and 180mg/dl
(or less) respectively (DTC_UCSF, 2019). Similarly, the health-related QoL should effectively

normalize Peter’s systolic and diastolic blood pressures to 120mmHg-140mmHg and
70mmHg-90 mmHg respectively (Lin et al., 2016).
The community health nurse will need to actively coordinate with Peter in the context of
enhancing his autonomy, positive emotions, resiliency, social ties, healthful diet, and
physical activity pattern (CDC, 2018). The substantial improvement of these attributes will
actively enhance Peter’s overall well-being and treatment outcomes. Health-related QoL
enhancement measures will also focus on improving peter’s mood and energy level (i.e.
mental and physical health perceptions), social support system, and functional status. The
community health nurse will enhance Peter’s knowledge of various physical activities in
accordance with his interest level and weight management requirement. Daily brisk walking
activity with a speed of 5.6km/hr for a duration of 40 minutes will effectively enhance Peter’s
catabolic activity and assist his weight-reduction process to a considerable extent
(Hamasaki, 2016). The nurse will motivate Peter in the context of undertaking an aerobic
exercise to effectively improve his diabetes control while increasing the scope of weight loss
through insulin sensitivity improvement. The aerobic exercises including walking, treadmill,
and cycling will elevate Peter’s glucose uptake level across the skeletal muscle while
effectively improving the process of glucose transporter translocation (Thent, Das, & Henry,
2013). Furthermore, the nurse will also guide peter to undertake resistance training in the
context of improving his quality of life, daily energy expenditure, and insulin sensitivity.
The informed food choices in Peter’s case will assist in controlling his body weight, lipid
level, blood pressure, and glycemic control. The nurse will enhance Peter’s knowledge and
awareness related to the recommended dietary pattern in the context of reducing his risk of
cardiometabolic manifestations. The dietary administration of olive and fish oils will
substantially assist in enhancing Peter’s overall glucose metabolism (Sami, Ansari, Butt, &
Hamid, 2017). Similarly, the utilization of the Mediterranean diet will minimize Peter’s risk of
diabetic retinopathy and related clinical complications. The community health nurse will
guide Peter in the context of consuming a high fiber diet not only to improve his glycemic
control but also to overcome the clinical symptoms of gastrointestinal reflux disease. The
high-fiber diet in Peter’s case will include whole grains, legumes, nuts, fruits, and green leafy
vegetables (MFMER, 2019). The biweekly consumption of fish, including tuna, mackerel,
and salmon will improve Peter’s omega-3 fatty acid level and reduce the risk of
cardiovascular disease. Furthermore, the administration of peanut, olive, canola oils and
avocados will assist in improving Peter’s HDL (high-density lipoprotein) level to a
considerable extent. The community health nurse will guide Peter in the context of avoiding
the consumption of saturated fats, trans fats, cholesterol, and sodium to reduce the risk of
arterial clogging and related cerebrovascular accident (Duman, 2013). The nurse will also

enhance Peter’s awareness related to the need for a salt-restricted diet to effectively control
his systolic and diastolic blood pressures. The reduced consumption of saturated fats, meat,
sweet, and snacks will also help in stabilizing Peter’s blood pressure. The nurse will
effectively monitor Peter’s diet and accordingly facilitate the consumption of vegetable-
based/milk-based proteins along with dietary fibers, fish oil, calcium, and potassium for
minimizing the hypertension manifestations (Duman, 2013).
The community health nurse will require initiating cognitive counseling sessions for Peter in
the context of enhancing his awareness regarding the adverse effects of tobacco addiction
(Chen et al., 2014). The utilization of self-help materials and face-to-face individual
consultation will motivate Peter in the context of quitting the smoking habit and reducing the
extra pounds. The cognitive behavior therapy in Peter’s care will effectively challenge his
smoking behavior while minimizing negative apprehensions related to the relapse of tobacco
addiction. The community health nurse will perform a therapeutic alliance with Peter through
the systematic utilization of motivational communication to foster his desire of quitting the
smoking habit. The community health nurse will compassionately enhance Peter’s autonomy
while providing him several psychosocial strategies for overcoming tobacco addiction.
Nurses’ empathetic attitude and active listening will substantially improve Peter’s trust and
confidence in the recommended cognitive behavioral approach regarding smoking cessation
(Efraimsson, et al., 2015). The cognitive behavioral intervention will enhance Peter’s
problem-solving and coping skills against the reported clinical manifestations and passive
environmental circumstances. The community health nurse will motivate Peter in the context
of modifying his thinking pattern related to tobacco abuse. The enhancement of Peter’s
knowledge regarding smoking withdrawal symptoms will also help him to minimize the
tobacco addiction pattern to an unprecedented level. The utilization of motivational cues and
aversion therapy will also enhance Peter’s unpleasant feeling towards tobacco utilization
(VMC, 2018). The utilization of cognitive behavioral therapy for weight reduction through the
enhancement of focussed exercise and eating habits will not only minimize Peter’s smoking
addiction but reduce is the risk of anxiety, depression, and other adverse mental health
outcomes.
The community health nurse will need to utilize therapeutic communication in the context of
evaluating Peter’s level of compliance with the recommended pharmacotherapy (Popa-Velea
& Purcărea, 2014). Therapeutic relationship establishment in Peter’s case will effectively
facilitate the genuine exchange of emotions and enhance his psychological support system
to a considerable extent. The assertive communication strategy will motivate Peter to share
his personal attitudes, emotions, opinions, and health-related expectations with the
community health nurse. This attempt will facilitate the customization of psychosocial