Peter Mitchell's Care: Clinical Reasoning and Prioritization Analysis

This case study explores the application of clinical reasoning in the care of Peter Mitchell, a 52-year-old patient with Type 2 diabetes, morbid obesity, and other comorbidities. The assignment follows the clinical reasoning cycle, analyzing the patient's situation, collecting and interpreting cues, identifying priorities (diabetic control and obesity), and developing a care plan. The analysis emphasizes the importance of self-management support, community resource linkage, and written documentation for Peter's treatment. The study highlights the critical role of nurses in assessing patient needs, prioritizing care, and implementing interventions, including dietary modifications, exercise, and smoking cessation support. The assignment concludes by emphasizing the evaluation of outcomes to assess the effectiveness of the care plan and the need for adjustments if necessary, demonstrating a comprehensive approach to patient care based on the clinical reasoning framework.

Clinical reasoning is the process by which the clinicians and the nurses collect the cues,
do the processing of the information, evaluate the problem or situation of the patient, plan
interventions and implement them, evaluate the outcomes of the interventions and increase their
knowledge from the process. The process of the Clinical reasoning is a cyclic process of
interlinked clinical meetings rather than a linear process (Croft, et.al, 2017). For the development
of the clinical reasoning model, the thinking strategies involved are description of the situation of
the patient, collection of the information of new patient, reviewed and relate the information,
interpretation of the information, recalled the knowledge, discrimination between the irrelevant
and the relevant information, matching and predication of the information analysis of the
information for diagnosing and identification of the problem, establishment of the goal and
objective, selection of an action course and their evaluation (Croft, et.al, 2017).
It is the prior responsibility of the nurse when he or she entered the patient room immediately
collect the relevant data conclude the information and initiation of the relevant management.
According to the clinical reasoning cycle, the health care professional has to examine and discuss
the stages in the clockwise direction for the facilitation of decision making and empowering the
clear care plan formulation (Lapkin, et.al,2010). The patients suffering from the chronic
condition, the care required by these patients are influenced by the multiple factors and care
prioritization given to these patients depend upon clinical care and patient needs both.
There are number of principle that can be used for the management of the chronic condition
Development of partnership with the patient related to the treatment
Focus on the concern and priorities of the patient
Follow the five A’s principle that are assessment, advise, agreement, assistance and arrangement

Support self-management of the patient
Organization of proactive supplements
Linkage of the patients with support and resources that are community based
Use of the written information such as registers, treatment cards and plans, for the patient
monitoring and reminder, there should also proper documentation
Assure the patient regarding care continuity
In the case of the Peter Mitchell, care priority could be determined by understanding the clinical
and the patient needs both. There should be maintenance of the treatment partnership with the
patient and focus on the priorities and concern of the Mitchell. As in the case of Peter Mitchell,
there is no one to take care of him so, primary health care nurse should support self-management
of the Peter and try to connect him with the community support and resources. In the case of
Peter management of the information in written format is necessary as it will help him to monitor
and also reminds him about the treatment plan and progress. To know about the top two
priorities of the care treatment, in the case of the peter Mitchell, the primary health care nurse
has to follow the clinical reasoning cycle of Levett-Jones(Lapkin, et.al,2010).. As it is a cyclic
process, there are numbers of stages or steps that have to be followed.
The first step is the consideration of the situation of the patient. The situation means the disease
condition of the patient either chronic or acute; the pathetic condition from which the patient is
suffering, which medication and treatment are given to them (Levett-Jones et al., 2010). In the
case of Peter Mitchell, the primary health care nurse should consider the situation of the patient.
As from the case study, it is clear that Peter is 52 years old and suffering from the Type 2

diabetes and morbid obesity. By examining all the above information, the primary health care
nurse can easily have the knowledge about the situation of the Peter Mitchell.
In the second step of the clinical reasoning cycle, there is the collection of the cues and the
information of the patient such as the review on the current medical history and collection of the
information related to the current activity and the treatment given to the patient. In the case
study, from the first stage, it is cleared that Peter is suffering from Type 2 diabetics, obesity and
sleep apnoea (O’Donnell, Jones, & Howard, 2012). The current history of Peter Mitchell is that
he was admitted to the hospital with the syndrome of obesity ventilation, uncontrolled diabetes,
and sleep apnoea. His general physician referred him after he was examined with the diaphoresis,
shakiness, high level of BGL, increased hunger and breathing problem during sleeping. He is a
big smoker for 30 years and approximately smokes about 12 cigarettes’s/day. Examination of the
past medical history revealed that he is suffering from Type 2 diabetes that was diagnosed 9
years ago, Hypertension, Obesity (weight 145kgs having 50.2m2BMI), Sleep apnoea,
Depression that is diagnosed 3 months prior by General Physician), Gastro oesophageal reflux
disease (Bloomgarden, 2006).
The current medication given to the peter is Metformin 500mg BD, Insulin Novomix 30 B D,
Nexium 20mg daily Lisinopril 10mg daily, Pregabalin (Lyrica) 50mg nocte, Metoprolol 50mg
BD and on dischare from the hospital the last observations are height 170 cms, Weight 145 kgs,
HR 102 & RR 23 Bpm, BP 180/92 mmHg, Sp02 95% on RA (Bloomgarden, 2006).
When Peter was previously admitted, he was seen by the dietician that recommended him the
low energy and diet having high protein content for the weight reduction. The general physician
of the Peter had already discussed the weight losing for the betterment of the disease condition

but the Peter had done nothing to reduce weight because it seemed to be very hard for the peter
(Uday, Campbell, & Shepherd, 2014). The physiotherapist reviewed the Peter and recommended
the light exercises. After that, the Peter was discharged from the hospital and referred to the
community care unit for weight management and clinical care.
From all the above information, it is easy for the primary health care nurse to collect the cues
and the whole information of the Peter Mitchell. It is cleared that the chronic condition of the
peter is due to his carelessness, social isolation, diabetes, smoking and obesity.
In the third step, there is recognition of the changes in the patient condition. In the case of Peter
Mitchell, the condition was not much critical in the initial stage; he was just suffering from the
diabetes and having the insulin therapy. But as the time goes on his social isolation, obesity has
worsened his condition. As peter has no family support, there is no one to motivate him for his
health and support in the treatment. Due to his obesity and smoking habit, his diabetic condition
become chronic and have effect on the functioning of other organs also such as problem of
hypertension, sleep aponea, depression and gastro-oesophageal reflux disease. Thus, with time,
his condition became chronic.
So, from the study of the condition, cues and collection of information of the Peter, and
processing of the information, it is clear to the health professional nurse that the top two
priorities of the care for the peter Mitchell is Diabetic control and Obesity (Wilkin, 2011).
After that, the primary health care nurse should identify the problems and issues that he or she
will face during the care management. The nurse should follow the chronic health care principles
for the management of the issues and problems that will faced during the primary chronic care by
nurse and the Peter. In the case, Peter has no supportive system and motivation. The primary

care nurse should follow the principle of the self-management, linkage with the support and
resources of the community. The nurse should use the written documentation for the monitoring
and reminding of the Peter and assured the Peter that there will be continued care.
In the peter case, by following the clinical reasoning cycle first four steps, the health care nurse
will be cleared about the top two priorities of care and issues that will be faced by peter and
nurse during the care. After that, the nurse has to design the health care plan by the establishment
of the care goals (Elding Larsson, 2016). As in the case of peter, the two priorities are diabetes
and obesity, so the nurse has to make care plan accordingly by considering the issues and
problems that will interfere in overcoming the goals of the care plan (Sosenko, Skyler, Herold &
Palmer, 2012). As in the case of peter, care plan could consider the issues and problems such as
motivation for high protein and low calorie diet, treatment to reducing smoking and social care.
After the consideration of above all concerns the primary health care should make plan to
provide the priority care on diabetic and obesity. As in the case of peter, the nurse care plan
should include the consultation the dietician for making the diet plan, motivation of the peter for
weight management through little exercise and smoking habit reduction, his linkage with society
and community and proper following of the treatment plan (Cleland, 2017).
After the development of the care plan, the primary health care nurse should implement the plan
and do the regular check in that either plan is followed properly or not. (Sosenko, Skyler, Herold
& Palmer, 2012).
There is evaluation of the outcomes of the care plan, after following the care plan properly; the
nurse should do the evaluation of the outcomes that is done by evaluating the two priorities that
was chosen. If, in the Peter case, evaluation suggest that there is some improvement in his

diabetic condition and he has reduce some weight then it means that care plan is effective and
successful. If it will not happen then it means the care plan is not appropriate and requires
changes (Cleland, 2017).
By the following the Levett-Jones clinical reasoning cycle, it is concluded that in case of the
Peter if his diabetic and obesity will be controlled and rest of the disease condition can easy to
recover.

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