Clinical Reasoning Cycle Application in a Diabetes Patient Case Study

This report presents a case study of a 70-year-old diabetic patient, Marcel, and analyzes his care through the lens of the clinical reasoning cycle. It examines his medical history, including hypertension and family history of diabetes, and details his medication regimen, starting with Metformin and progressing to a combination of Metformin/Glibenclamide and Lantus insulin. The report explores the patient's symptoms of fatigue, obesity, and hyperglycaemia, alongside the side effects of his medication. The report highlights the importance of lifestyle modifications, including diet, exercise, and smoking cessation, in managing diabetes and preventing complications. It also discusses the need for psychosocial support to manage stress and emotional disturbances. The analysis emphasizes the significance of the clinical reasoning cycle in providing a structured approach to nursing care, integrating pharmacological knowledge with psychosocial considerations to achieve optimal health outcomes. The report concludes that the clinical reasoning cycle is a valuable tool for nurses in understanding the disease's pathophysiology and applying their knowledge systematically.

Chronic care

INTRODUCTION
Clinical reasoning cycle consist of using knowledge, intuition and thinking for analysing
the patient's situation and to take decision as per the clinical circumstances of the patient
(Koivisto & et.al., 2016). The report will analyse the decision making through clinical reasoning
for the given case study of a diabetic patient.
MAIN BODY
Marcel is 70 years old and was fatigued recently. The age related factors and past medical
history of hypertension are also important element in correct identification of the problem.
Considering the present situation of the patient though extreme critical situations are not
observed but the lack of suitable intervention and diagnosis can lead to serious implications
which are often neglected with age factor. Marcel was commenced Metformin and after 3
months his medication was changed to combination of Metformin/GLibenclamide. Further, for
controlling his BGL Lantus 10 units was given until his BGL was within normal range. For the
insulin control Marcel uses insulin pen.
On collecting various cues it is observed that Marcel is obese and also has family history
of type 1 and type 2 diabetes. Thus, there is high risk that patient may have diabetes. In old
people most of the time fatigue is assumed to be associated with hypertension, however it can be
also be the result of diabetes. Further, Marcel has been a heavy smoker. Thus, it is also required
to consider this aspect. From the lab findings it has been found that patient has hyperglycaemia.
After retirement sedentary life style and excessive weight gain due to sub-nutritional diet has
caused insulin imbalance in the body. Due to the enormity of diet and life style routine Marcel is
concerned about its diagnosis and thus needs proper understanding of diabetes management.
The hyperglycaemia events occurs as HBA1C level of patient was more than 7%.
However, the dosage of metformin/Glibenclamid resulted in side effects in the form of diarrhoea.
Thus, it can be interpreted that Marcel may need insulin addition. The patient also informed that
due to stiffness of hands he will prefer insulin pens for the regulation of insulin. The patients face
difficulty in vision thus there eye vision, blood pressure, skin integrity must also be checked
regularly.
The life style and weight management is one of the key concern and thus insulin dosage
are important for maintaining the sugar level of patient (Turpin & Higgs, 2017). Marcel is the
only member of family who drives and thus for avoiding hyperglycaemia events during driving
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he must know his BGL prior to driving. The hypos and skin infections can be common effects of
the medication and disease. Thus, he must be informed about the diabetes management. Marcel
must also be provided knowledge about pathophysiology of disease and hyperglycaemia events
so that when he feels or expect fall events he can balance himself or can take necessary actions.
The primary goal for the nursing care of Marcel is to control his insulin dosage and BGL.
For this purpose proper diet plan and weight management goals must be developed. The weight
reduction goals must be decided for the patient. For avoiding the critical complications of
diabetes such as skin infections, myocardial infarction and blindness hypertension, smoking and
alcohol consumption must be controlled and regulated (Forsberg & et.al., 2016). For achieving
these goals Marcel can enhance his physical activities. For instance he can go for morning and
evening walks. For the low distance destinations he can walk instead of using vehicle. The
hypertension or increased blood pressure can also cause imbalance in sugar level. Thus Marcel
must also be given psychological counselling for managing stress and other emotional
disturbances.
The weight management techniques and proper administration of the medications will
help to control the insulin levels in the body. The avoidance to alcohol, smoking and other
hazardous practices can increase the risk of diabetes complications and events of hypoglycaemic
or hyperglycaemic events. Thus, the suggested actions will also help to control the emotional and
social elements which triggers the hypertension or hormonal imbalance.
The use of clinical reasoning cycle provides the better nursing diagnosis and
interventions of the clinical issues. By implementing this cycle it has been also learned that along
with the medications psychosocial factors are also equally important in achieving desired health
outcomes (Hunter & Arthur, 2016).
CONCLUSION
It can be concluded from the report that that by using clinical reasoning cycle nurses can
not only help to understand the pathophysiological base of the disease but also allows nurses to
properly apply their knowledge of pharmacology and psychosocial elements in systematic way.
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REFERENCES
Books and Journals
Forsberg, E. & et.al., (2016). Assessing progression of clinical reasoning through virtual
patients: An exploratory study. Nurse education in practice. 16(1). 97-103.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice. 18. 73-79.
Koivisto, J. M. & et.al., (2016). Learning by playing: A cross-sectional descriptive study of
nursing students' experiences of learning clinical reasoning. Nurse education today. 45.
22-28.
Turpin, M., & Higgs, J. (2017). Clinical reasoning and evidence-based practice. Evidence-based
practice: Across the health professions. 364-383.
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