Case Study: Applying Clinical Reasoning Cycle to Peter Mitchell's Care

This case study focuses on Peter Mitchell, a 52-year-old divorced man with diabetes, obesity, and a smoking habit, and explores how healthcare professionals can utilize the Clinical Reasoning Cycle (CRC) to improve his quality of life. The assignment highlights the interconnectedness of Peter's health issues, particularly the relationship between obesity and poorly controlled diabetes, and the risks associated with his smoking. The study emphasizes the importance of health literacy, diet, exercise, and medication management in addressing these conditions. The case study proposes a range of nursing interventions, including lifestyle modifications, smoking cessation support, and blood pressure management strategies. It underscores the need for patient counseling, diabetes education, and monitoring to ensure Peter's engagement and adherence to the care plan. The assignment aims to provide a detailed overview of Peter's health challenges and the application of the CRC to achieve positive patient outcomes. This approach involves a multi-faceted approach, including nutritional therapy, drug therapy, physical activity, home monitoring, and lifestyle modifications, to address the patient's health concerns and promote a better quality of life.

Running head: CASE STUDY OF PETER MITCHELL
CASE STUDY OF PETER MITCHELL
Name of the student:
Name of the university:
Author note:

1
CASE STUDY OF PETER MITCHELL
Clinical reasoning cycle can be defined as the procedure through which the healthcare
professionals use their inductive as well as deductive cognitive skills to make clinical decisions
for providing safe care to patients. Researchers are of the opinion that clinical reasoning can be
considered as the approach that involves scientific knowledge that may be sometimes in the form
of scientific reasoning (Wills & Kelly, 2018). In clinical reasoning cycle, critical thinking is
considered inherent in clinical reasoning which thereby helps professionals to take decisions that
result in best outcomes for the patients (Tate et al., 2016). The professionals then need to
evaluate the outcomes of the initiatives taken and reflect on and learn from the procedures. This
assignment will exhibit how a professional can use the CRC cycle to sequentially proceed
through the case of Peter and help him with interventions so that he can develop a better quality
life.
Peter Mitchell is seen to be a 52 years old man who is currently divorced and has two
sons. Sons do not have very close relationships with their father and rarely visits him as they live
in other towns. He is seen to suffer from diabetes and even does not know how to properly
control the disorder for better life. He is also suffering from obesity and smokes about 20
cigarettes in a particular day. He is also seen to be in the preliminary stage of depression and has
isolated himself socially. H e is quite embarrassed by his huge weight that may be another reason
for his depression.
His disorder of obesity is the first priority of nursing professionals. Two important
connections are found between the chronic situations of obesity as well as diabetes. His ill
controlled obesity symptoms have been the main reason for which his diabetes could not come
under control. Researchers have stated that when individuals exhibit overweight conditions, it
creates a stress on the endoplasmic reticulum which are membranous networks found inside the

2
CASE STUDY OF PETER MITCHELL
cells (Brown et al., 2017). When these organelles have more the amount of nutrients that they
can carry successfully, the networks begin sending alarming signals. These signals tell the cells
of the body to slow down or dampen the receptors of insulin in the cells that are present on the
surface. Therefore, the cells of the body become resistant to insulin for which sugar level in the
blood increases. Researchers have also stated another important theory that links obesity with
diabetes. Abdominal fat mainly causes the fat cells to release a particular type of chemicals that
are called the pro-inflammatory chemicals. These chemicals become successful in making the
body less sensitive to action of the insulin. Therefore, the cells of the body become less
responsive when the pro-inflammatory chemicals are present in the body (Cook eta l., 2018).
Obesity hyperventilation syndrome has mainly taken place because of ill-managed obesity. Here,
the patients feel to breathe rapidly as well as deeply. As a result, it leads to high blood carbon
dioxide as well as low oxygen concentration sin the blood. This may expose him to lung
disorders in future.
Nursing professionals can conclude that as Peter has poorly managed diet system and no
proper health literacy to maintain obesity as well as diabetes. He has developed serious
syndromes of sleep apnoea, obesity hyperventilation syndrome, increased hunger and high basal
glucose level. If both the disorders are treated properly, he will develop better quality lives. From
the case study, it becomes quite clear that Peter suffers from lack of determination and
confidence to adapt to different interventions to lose weight although he understand the necessity
of the interventions in his life. Proper health literacy would be ensured for Peter where he should
be first taught about how his obese situation had been the reason of his poorly controlled diabetes
and how they are threatening his life. The first initiative of the nurse would be to counsel him in
ways by which they can assure peter’s self-inclination and determination to follow the strategies

3
CASE STUDY OF PETER MITCHELL
proposed by them (Lewis et al., 2016). Once they are confirmed that Peter is determined to
follow their advice, they should develop a diet plan for Peter. Peter should be advised to
undertake light physical exercises that would help him burn down her extra calories should
follow this. He should begin with easier exercise for less than 10 minutes that would be followed
by longer periods of exercises in the later days. He should be also advised to be sure that he has
less sedentary time and should involve himself in different light activities (Teixeira et al., 2015).
Diabetes educator can be assigned to him so that he can learn how to measure blood glucose
levels, check them regularly, administer medications effectively and keep his BGL level in
check..
Another priority area that the nursing professionals should provide importance to is
the controlling of blood pressure of the patient and thereby maintaining the symptoms of
hypertension. The normal blood pressure of patient is usually 120/80mmHG. However, in case
of the patient, it is seen that he has very high pressure that is about 180/92 mmHg. This makes
the patient vulnerable to stroke, heart attacks and many others. Therefore, the professionals
should take initiatives by which his blood pressure should be kept in check so that he remains
safe from stroke, heart attack and many others (Hunter, 2012). Peter’s habit that makes it most
vulnerable to high level of blood pressure is his smoking behavior where he smokes for about 20
cigarettes per day.
Smoking of nicotine is one of the most important reason for which this disorder may take
place as nicotine results in increasing of heart rate and blood pressure (Butcher et al., 2018).
Researchers are of the opinion that nicotine is responsible for narrowing the arteries called
vasoconstrictions as well as hardening of the walls of the arteries. This often exposes the blood
to undergo clotting which thereby puts stress on the heart (Brown et al., 2017). For this reason,

4
CASE STUDY OF PETER MITCHELL
individuals are exposed to stroke and heart attacks. Fatty substances called plaques may also
build up in the arteries affecting the smooth flow of blood and therefore blood pressure increases
(Boddenheimer & Baul, 2016). Therefore, nursing professionals should help Peter to control his
smoking behavior so that his blood pressure remains under control. In order to help him to leave
his smoking habit, substance abuse counselor can be arranged for him who would help him to be
self-determined, motivated and enthusiastic to live his smoking habit and start afresh. Nicotine
replacement therapy can be proposed for him as it helps individuals to overcome their habits and
urges to smoke nicotine (Martinez et al., 2014). Moreover, nicotine replacement products should
also be proposed to him like Nicotine nasal spray, Nicotine inhaler, Sublingual nicotine tablet,
Nicotine lozenge and others (Con et al., 2015). He should be also taught to measure his blood
pressure level so that he can understand whether his blood pressure levels are stable or requires
consulting health professionals. Besides, the smoking cessation therapy, the nursing professional
should also inculcate a teaching session where she should be describing Peter about the
importance of nutritional therapy, drug therapy, physical activity, home monitoring of BP as well
as tobacco cessation. The professional would also encourage Peter about lifestyle modification
were the first initiate would be weight reduction of the patient. Dietary approach would mainly
involve eating several servings of fishes each week. He should also eat plenty of vegetables and
fruits. Moreover, he should also take lot of fibers in is diet and drink lot of water. He may also
follow the DASH diet that is highly beneficial in lowering of blood pressure. He should be also
instructed to lessen dietary intake of sodium and not adding salt in his food. Moreover, regular
physical activities as swimming, jogging, brisk walking and others help in maintaining the
weight and keeps lowered blood pressure. Stress also has huge contribution in the increase of
blood pressure and therefore it is important for the nursing professional to make him introduce to

5
CASE STUDY OF PETER MITCHELL
relaxation therapy. This relaxation therapy along with guided imagery and biofeedback also help
in decreasing blood pressure. Moreover, the nursing professionals should assess effectiveness of
the coping strategies by closely observing the behaviors of Peter. She should see how well, peter
is able to verbalize concerns, feelings, and his willingness to participate in the treatment plan.
This will help the nurses to understand how well he would be self-motivated to follow the care
plans. If peter is not showing self-determination, he should be counseled before beginning care
interventions.
From the entire discussion, it is seen that clinical reasoning cycle has helped the
professionals to reflect each of the aspects of Peter’s health and also helped them to sequentially
develop a plan where two health priorities of Peter was established. Proper interventions had be
proposed for Peter so that he can overcome his ill health, develop health literacy about his
conditions, feels empowered and thereby can lead a proper quality life free from any life threats.

6
CASE STUDY OF PETER MITCHELL
References:
Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role
for nurses. New England Journal of Medicine, 375(11), 1015-1017.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing:
Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing:
Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2018). Nursing
Interventions classification (NIC)-E-Book. Elsevier Health Sciences.
Conn, V. S., Ruppar, T. M., Chase, J. A. D., Enriquez, M., & Cooper, P. S. (2015). Interventions
to improve medication adherence in hypertensive patients: systematic review and meta-
analysis. Current hypertension reports, 17(12), 94.
Cook, D. (2018). Adult obesity 2: treatment and management options for weight loss and
maintenance. Nursing, 9, 57.
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters
Kluwer/Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest,
NSW: Pearson

7
CASE STUDY OF PETER MITCHELL
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D.
(2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D.
(2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences.
Martínez-González, N. A., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing,
M., & Rosemann, T. (2014). Substitution of physicians by nurses in primary care: a
systematic review and meta-analysis. BMC health services research, 14(1), 214.
Tate, D. F., Lytle, L. A., Sherwood, N. E., Haire-Joshu, D., Matheson, D., Moore, S. M., ... &
Michie, S. (2016). Deconstructing interventions: approaches to studying behavior change
techniques across obesity interventions. Translational behavioral medicine, 6(2), 236-
243.
Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij,
I., ... & Brug, J. (2015). Successful behavior change in obesity interventions in adults: a
systematic review of self-regulation mediators. BMC medicine, 13(1), 84.
Wills, J. D., & Kelly, M. (2018). Systematic review: What works to address obesity in
nurses. Occupational Medicine.