Applying the Clinical Reasoning Cycle to a Type 2 Diabetes Case Study

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Contents
INTRODUCTION...........................................................................................................................................1
PRIORITIES FOR MARCEL.............................................................................................................................1
NOTES OF CURRENT MEDICATION..............................................................................................................1
CLINICAL REASONING CYCLE.......................................................................................................................2
PATIENT CONSIDERATION.......................................................................................................................3
INFORMATION AND CUES.......................................................................................................................3
PROCESS INFORMATION:-.......................................................................................................................4
IDENTIFY ISSUES......................................................................................................................................4
GOALS AND OBJECTIVES..........................................................................................................................4
ACTION, EVALUATION AND REFLECTION.................................................................................................5
CONCLUSION...............................................................................................................................................5
REFERENCES................................................................................................................................................6
INTRODUCTION
This assignment is focusing on writing a essay based on clinical reasoning cycle concept while
applying the case study of Marcel who is a diabetic patient under treatment. In this assignment
the information provided in the case study would be used to apply the clinical reasoning cycle
and best available evidence to support marcel and his medication management. All parts of this
case study will be analyzed and supported with current literature evidence (Standards of
Medical care in Diabetes, 2016).
PRIORITIES FOR MARCEL
Mr. Marcel has a history of hypertension and heavy smoker and had a family medical history of
type 1 and type 2 diabetes. He is currently obese with 35.6 body mass index and suffering from

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more tiredness or fatigue. Obesity, hypertension and smoking are some factors that relates to
diabetes (Chang & Johnson, 2018).
As a patient of diabetes type 2 , higher BMI, heavy smoker the priorities of Marcel is to reduce
the blood glucose level, modification of diet and reduce intake of calories and carbohydrates,
develop an active life style, behaviour modification, cessation of smoking and ensuring proper
administration of medication etc.
NOTES OF CURRENT MEDICATION
1. First medication marcel is commenced on is Metformin for first 3 months but it was not
able to control the BGL properly. After 3 months he was prescribed a combination of
Metformin/Glibenclamide and Marcel was assessed regularly after that.
2. Even after combination of oral agents Marcel was showing a HBA1AC > 7 % which is a
sign of continued hyperglycemias. Due to growing tolerance and side effects it was
decided to add insulin in his medication.
3. Lantus 10 units were prescribed in a 3 day titration format until the pre breakfast BGL
level reaches < 7 mmols
4. Metformin 500 mg BD were to be continued as it is for Marcel.
CLINICAL REASONING CYCLE
According to Levett Jones, et al. (2010) clinical reasoning cycle can be described as the process
of collecting information, processing it and coming to a conclusion about a patient’s problem
and situation and developing an optimal solution of care. It includes planning and
implementation of interventions, reflecting upon results and learning from the process and
making changes where needed.

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CLINICAL REASONING CYCLE
PATIENT CONSIDERATION
The patient named Mr. Marcel who is 70 years old lives with his wife and diagnosed with Type
2 Diabetes which is caused by inadequate production and utilization of insulin by the body
(Parrish, 2017).
INFORMATION AND CUES
MR. Marcel has a family history of hypertension and diabetes. He is overwhelmed with the
changes in his life style which is demanded by current medical situation and its management.
He is also confused regarding his diagnosis and he believes using insulin as an agent means his
diabetes has shifted from type 2 to type 1 which is a very serious development. He is a 70 year
old retired person with a sedentary life style. He is required to monitor his BGL and for that he

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is being trained for self medication and monitoring. The pathophysiology of Hyperglycemia can
vary from one to another but the main reasons can be such as: Decreased Incretin Effect by
GUT, Increased Lipolysis by fat cells, Increased Reabsorption by kidneys, Decreased Glucose
Uptake by muscles, Neurotransmitter Dysfunction by brain, Increased Hepatic Glucose
Production by liver, Increased Glucagon Secretion by pancreatic alpha cells and Decreased
Insulin Secretion, Decreased Amylin Secretion by pancreatic beta cells (Craft & Gordon, 2019).
PROCESS INFORMATION:-
Mr Marcel is not yet able to modify his life style and bring changes in his habits which can
enable him to live a healthier life style. Impact of chronic diabetes is also visible on other organ
systems like his vision is getting weaker, his hands are stiff and eventually if not managed
properly it will impact the neaphrological and neurological systems as well. The nursing
intervention of Mr. Marcel includes the health education, nutritional education and lifestyle
changes. As the Mr. Marcel has stiffness in his hands so nurse will provide education that he
can use the flash blood glucose monitor which can be easily used by touching to skin as it has
sensors and about the accuracy of BGL monitoring before meal (Deravin-Malone and Anderson,
2016).
IDENTIFY ISSUES
Primary issue with Mr Marcel is to make him realise that his condition is reversible and he
needs to have a strong will power and cope up with the changes needed in his life style. It
appears from case study that psychologically he has accepted the situation and not trying very
hard to make changes in it.
GOALS AND OBJECTIVES
1. To develop diet plan according to the Australian dietary guidelines and ensure that Mr
Marcel follows it properly.
2. A reduction in 10 percent of weight and reducing the BMI to less than <35 in a period of
6 months.
3. Smoking cessation to 0, at least 30 minutes of physical exercise 5-6 days a week.

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4. Alcohol consumption reduced to 20g a day.
5. Reaching BGL level of 6-8 mmol/L and 8-10 mmol/L fasting and post pardian
respectively.
6. To educate patient about his disease, possible complications, impact on health and
importance of intervention. To educate about self medication and self monitoring and
encourage towards a healthier life style (International Diabetes Federation, 2017).
ACTION, EVALUATION AND REFLECTION
Once the goals are clear for both patient and his nurse then this part is initiated where actions
would be taken and after a fixed time all parameters will be evaluated and if it is found that the
current parameters are not meeting the goals then entire process will be reflected upon and
necessary changes will be made in the intervention and their implementation (Lewis, et al.
2016).
CONCLUSION
In conclusion it can be stated that Mr. Marcel is an immediate need of proper intervention for
his disease as it risk of leading towards both acute and chronic complications. Nurses are
required to collect all the possible information, share it with Mr. Marcel to enhance his
understanding and then develop a nursing intervention plan which is optimal in nature. It
should include his diet management as well as physical exercise, cessation of habits and indulge
in a hobby which will keep him physically as well as mentally healthy. Australian guidelines of
dietary management, medication and diabetes management would be very important in
developing these interventions (Hendrickx, et al. 2016).

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REFERENCES Chang, E., & Johnson, A., (2018) Living with a Chronic illness and disability principles for
nursing practice. Elsevier, Chatswood Australia (p. 462) Craft, J. & Gordon, C., (2019) Understanding pathophysiology 3rd ed. Chatswood, N.S.W.
Elsevier Australia (p.1107) Deravin-Malone L and Anderson J (2016) Chronic Care Nursing: A Framework for
Practice , Cambridge University Press Hendrickx, C., Halliday, JA., Beeney, LJ. & Speight, J., (2016) Diabetes and emotional
health: a handbook for health professional supporting adults with type 1 or type 2
diabetes. Canberra National Diabetes Service Scheme,
 International Diabetes Federation (2017) IDF Diabetes Atlas, 8th edn. Brussels, Belgium:
International Diabetes Federation, (2017). Retrieved 13 April 2019 from
http://www.diabetesatlas.org
 Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., Hagler, D., Harding, M. M.,
Kwong, J., & Roberts, D. (2016). Clinical companion to medical-surgical nursing.
Retrieved from https://ebookcentral.proquest.com
 Parrish, T. (2017). Nursing care of people with diabetes mellitus. In Lemone, P., et al.
(2017), Medical Surgical Nursing Critical Thinking in Person-Centred Care, (3rd ed).
Melbourne: Pearson. pp. 563-566. Standards of Medical care in Diabetes (2016) American Diabetes Association. Strategies
for improving care Diabetes care Vol 39 Supp 1 Copyright © 2017 Pearson Australia (a
division of Pearson Australia Group Pty Ltd) 9781488611759, LeMone, Medical–Surgical
Nursing 3e p.12-14 Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S.Y.S., Noble, D., Norton, C.A., Roche, J.
and Hickey, N., 2010. The ‘five rights’ of clinical reasoning: An educational model to
enhance nursing students’ ability to identify and manage clinically ‘at risk’patients.
Nurse education today, 30(6), pp.515-520.