Nursing Case Study: Type 2 Diabetes Mellitus Management & Care Plan

This assignment presents a case study analysis of Peter Mitchell, a 52-year-old patient with poorly managed type 2 diabetes mellitus and obesity, leading to sleep apnea, hypertension, and social isolation. The analysis utilizes Levett-Jones' clinical reasoning cycle to assess Peter's condition, collect relevant cues, and process information to determine nursing priorities. The primary concerns identified include the need for patient education and healthcare literacy to improve diabetes management, as well as interventions to address excessive body weight through physical exercise and activities. Goals are established to enhance Peter's understanding of diabetes care, promote responsible diet and nutrition, and manage his weight through exercise. Action plans involve providing healthcare education sessions to improve health literacy and implementing physical activities to control obesity and improve overall health. The evaluation process involves constant monitoring of Peter's physical and mental health, assessing blood glucose levels, basal metabolic rate, diet regime, and social participation to determine the effectiveness of the interventions.

Running head: NURSING ASSIGNMENT
CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

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Development of care plan is an important aspect for patients who are suffering from
chronic healthcare condition as the care plan is developed depending on several physical,
mental and environmental factors (Kieft et al., 2014). While developing the care plan for such
patients, nursing professionals prioritize the care process and depending on the priority of care,
apply interventions in the care process so that improved outcome for the patient could be
obtained (Elwyn et al., 2014). As per Eaton, Roberts and Turner (2015), hence while applying
the nursing priority in the care process, the care professionals should implement patients needs
and requirements so that the care process could be aligned with the patients healthcare
requirements. In this aspect, clinical reasoning cycle by Levett- Jones helps the nursing
professionals to assess the need of the patient as it helps to align the patient’s complications
with the patients need and well-being to provide them care depending on their health priority
(Kieft et al., 2014). The clinical reasoning cycle discusses about patients current situation,
current cues, and then processes then so that the nursing priority could be determined and
interventions could be implemented in the care process (Eaton, Roberts & Turner, 2015).
This assignment would discuss about the case study of Peter Mitchell (52) and would
discuss about his improper handling of type 2 diabetes mellitus and associated obesity due to
which he developed conditions such as sleep apnea, hyper tension and started isolating himself
from the society.
As per the first step of clinical reasoning cycle, the healthcare condition of the patient
would be considered. In case of Peter, the primary concern for his healthcare condition is his
poorly managed type 2 diabetes mellitus, his excess body weight, sleep apnea which increases
the occurrence of secondary health conditions such as diaphoresis, shakiness, high level of
blood glucose concentration, increased hunger and hypertension. He is suffering from type 2
diabetes mellitus from 9 years and due to his improper management of diabetes, he is suffering
from distress, mental trauma and depression. As per Halter et al. (2014), prolonged period of
diabetes mellitus in patients above the age of 45 could lead to cardio- vascular disease. Hence,
his uncontrolled healthcare condition would be used for the determination of health priority.
Further, it is also seen in the case study that Peter weighs around 145 kg and as per Phelan et
al. (2015), patients with high weight and associated diabetes could affect the healthcare
condition of the patient due to his chronic risk factors. Further, it was seen through the
researches of Bastien et al. (2014) that overweight patients with increased blood sugar level has
higher risk associated with their organs health as the organs suffer from excessive weight and
pressure. Hence this information would be included in the cue. Further, while collecting the

2NURSING ASSIGNMENT
healthcare information, patients smoking habit would be collected so that while assessing the
impact of his body weight and diabetes, this habit and associated negative effect could be
collected.
After collecting the healthcare information of Peter Mitchell, all the cues from his case
study would be collected and then connected with one another so that the assessment of the
priority could be done. The first cue of his health condition is Peter’s uncontrolled type 2
diabetes that led peter to quit his job. he quit the job so that he could take insulin therapy
however, in those three years his weight increased from 105 kg to 145 kg, that decreased the
self- confidence and self- esteemed by making him conscious about his health. Further, it was
seen that the patient had prolonged diabetes condition, due to which he become depressed as
lost his hope for health improvement. Besides, due to his excessive body weight, he was unable
to connect to the society and isolated himself in his home. It was also seen in case of peter that
his hypertension and increased blood pressure affected the health outcome and made his
hunger uncontrolled. As per Raymond and Lovell (2014), patients with diabetes, obesity and
depression are always associated with overeating or malnutrition as they lose their health
improvement related hope and suffer from uncontrolled hunger. Further depression and stress
is also associated to shakiness in hands and legs with over- eating symptoms. Moreover, due to
prolonged disease condition, it is evident that patient becomes unable to maintain the diet and
nutritional balance and associate themselves with addictive habits which was also evident in the
case study of Peter Mitchell (Kristeller, Wolever & Sheets, 2014). Hence, these were the cues
that collected from the patient’s case study and hence, these would be used for the processing
information.
After the collection of cues, these cues would be processed from the above- mentioned
case study of Peter Mitchell. It is evident from collection of cues that one condition of his health
aspect is completely related to another healthcare condition. It is seen that the patient is
suffering from diabetes since 9 years due to which his risk factor associated to cardio- vascular
disease has increased. Further as per Lavie et al. (2014), the average body weight of 52 year
old healthy male is 72 kg with normal blood pressure, whereas the patient was observed with
145 kg of body weight. Therefore, the gap which was identified in the care process was his diet,
nutrition and his knowledge about his health complication, due to which stress and depression
condition also increased (American Diabetes Association, 2016).

3NURSING ASSIGNMENT
Hence, the primary concerns which would be selected for nursing priority for peter would
be providing him with healthcare interventions related to patient education and healthcare
literacy sessions so that his knowledge about diabetes care and management could be
increased. Further, for his excessive body weight, the patient would be provided with physical
exercise and activities so that thorough exercise and diet control, his overweight could be
controlled easily and he could be provided with hope and confidence to overcome his health
complication (American Diabetes Association, 2016).
The goals that would be established for Peter Mitchell and his associated health
complications would be divided in two sections, the first goal for patient care would be providing
him with educational sessions so that while undergoing the process, he could understand the
effectiveness of management and intervention for his diabetes and could responsibly take care
of his diet and nutritional aspects (Powers et al., 2017). This would further help him to maintain
his blood glucose levels and maintain his basal metabolic index in a controlled state. The
second goal for the patient would be managing his excess body weight through the application
of exercise and activities such as gardening, jogging, and climbing stairs and so on. This would
help to manage the exceeding weighting of the patient and he would be able to improve his
active lifestyle through the mentioned activities (Phelan et al., 2015). Further a psychotherapist
would also be included in the case scenario.
Action plan would be prepared for Peter Mitchell would be based on the two goals
developed in the previous step for the Levett-Jones clinical reasoning cycle. In this purpose, as
per the first goal, the patient would be provided with healthcare educational sessions so that his
health literacy could be improved. As per Lloyd (2014), inclusion of health literacy in the care
process helps to the patient to understand his ailment and through the educational sessions he
would be able to comply with the interventions and would follow the instructions of the
healthcare professionals to improve his health condition. Further as per Mossialos et al. (2015),
inclusion of patient education would help him to monitor his diet, nutrition, is increasing blood
glucose level and self- awareness level of the patient would increase. Further, educational and
psychotherapy sessions would help the patient to overcome his fears and stigma related to his
overweight due to which he limited his social engagements. Therefore, this action plan would
target his social isolation, his knowledge about his illness and improving his confidence level to
combat health complications.

4NURSING ASSIGNMENT
The second action plan would target his activity level by implementing exercise, activities
like jogging, walking and gardening so that through constructive activities. Patient could be
involved in physical work that would help him to control his obesity. As per Colberg et al. (2014),
including physical activities is an appropriate intervention for people with obesity and diabetes
as it would help them to increase their activity level so that they could control their increasing
BGL level. Further Kalyani, Corriere and Ferrucci (2014) also mentioned that to overcome
cumulative result of diabetes and obesity, exercise is an effective intervention that helps to
improve both the conditions. Besides that, Layous, Chancellor and Lyubomirsky (2014)
mentioned that and inclusion of this Peter would help him to develop positive thoughts so that
he could develop exercise helps people, with positive thoughts positive thoughts regarding his
health condition. This would develop his self- esteem and confidence so that he could overcome
both of these ailments, control his smoking habits and overcome his food and hunger episodes.
Therefore, through the application of these two action plan, the above- mentioned goal for Peter
Mitchell would be achieved (American Diabetes Association, 2016).
The evaluation of the process would be done through the constant monitoring and
observing Peter’s physical and mental health. The effectiveness of patient educational sessions
and exercise would be done by assessing the blood glucose level and the basal metabolic rate
of the patient. The effectiveness of his diet and nutritional literacy would be done through
assessing his diet regime so that his ability to overcome his shakiness and smoking and hunger
habits. The mental stress and depression of the patient would be assessed by the healthcare
physicians by his communication and social skills as well as using his social participation.
These complete analyses of Peter Mitchell’s case study helped me to understand that
depression, stress, diabetes and overweight complications are associated to each other and
occurrence of it leads to several complication for the patient. Further, my interventions of patient
education and physical exercise is not only associated to patient’s primary health complication,
but also helped him to overcome his secondary ailments as well.

5NURSING ASSIGNMENT
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