Prioritizing Care for Peter: An Evidence-Based Nursing Research Essay

This essay presents a case study of a 52-year-old patient named Peter Mitchell with a complex medical history including obesity, type 2 diabetes, hypertension, and other conditions. The essay employs the Levett Jones clinical reasoning cycle to prioritize Peter's care, identifying weight reduction and blood glucose control as the primary areas of focus. It explores the interplay of physical, psychological, and medication-related factors contributing to Peter's health issues, emphasizing the impact of obesity on his other conditions, such as breathing problems and sleep apnea. The essay highlights the need for integrated interventions, including nutritional, medical, social, psychological, and behavioral approaches, and stresses the importance of nurse coordination with other healthcare professionals. It concludes by emphasizing the nurse's role in implementing the clinical reasoning cycle and promoting patient adherence to medication and lifestyle modifications to manage chronic conditions effectively.

Evidence Based Nursing Research
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Nurses can provide prioritised care the patients by using clinical reasoning cycle. Levett
Jones clinical reasoning cycle is a step wise approach for providing nursing intervention. It
incorporates multiple sequential steps like collection of patient information, processing of
information, planning and implementing interventions, evaluating outcomes and reflecting on
and learning from the process. Levett Jones clinical reasoning cycle gives opportunity for the
nurse to think critically and helps nurse to understand patient’s condition and plan
intervention accordingly. In this essay, clinical reasoning cycle is being followed to prioritise
care for Peter. First prioritised care identified for Peter is reduction in body weight and
second prioritised care is reduction in blood glucose level.
In this case scenario, case of 52 yr old Peter Mitchell is being discussed. Peter is having past
medical history of obesity, type 2 diabetes, hypertension, depression, sleep apnoea and gastro
oesophageal disease reflux disease. Data indicates that his pat body weight was 145 kgs and
BMI was 50.2 m2. Moreover, due to administration of insulin, he was gaining significant
amount of body weight. Hence, first prioritised to be provided to Peter is weight reduction
and keeping body weight in control. Along with medical intervention, dietician and
physiotherapist intervention also required for his body weight control. Dietician
recommended him to consume low energy and high protein diet. Low energy and high
protein content diet can be helpful to reduce energy reserve and reducing body weight.
Physiotherapist asked him to perform light exercise which can result in more energy
expenditure as compared to the energy consumption. Increase in body weight is associated
with other several co-morbid conditions diabetes, hypertension and depression. These
conditions can be effectively controlled by control in the body weight. It is evident that obese
people can have breathing problem also. All these conditions are evident in Peter. His blood
pressure is 180/92 mmHg which is higher as compared to the normal blood pressure which is
120/80 mmHg. His respiratory rate is 23 Bpm which is higher as compared to the normal
respiratory rate which should be between 12 – 20 Bpm. Higher respiratory rate is indication
of the breathing insuffiecncy. His heart rate is 102 Bpm which is slightly higher as compared
to the normal heart rate. There can be multiple risk factors for the occurrence of obesity like
physical, physiological, psychological and genetic, environmental responsible for the
occurrence of obesity (Ahima, & Lazar, 2013).
Diet and medication related factors are also responsible for the occurrence of obesity in the
people. In case of Peter physical, psychological and medication related factors are responsible
for increase in body weight in Peter. Peter is unemployed hence he is not doing much
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physical work, he is having psychological feeling of fatigue and insulin administration are the
physical, psychological and medication related factors respectively are responsible for
obesity in Peter. As compared to obesity, BMI is the important indicator for obesity (Zeng et
al., 2014). BMI more than 40 m2 can be considered as the severe obesity condition. In case of
Peter, BMI is 50.2 m2, which indicates he is severe case of obesity.
It is evident that life-expectancy can be drastically reduced in obesity and it co-morbid
conditions. Due to all these co-morbid conditions, Peter need to take different medications
like insulin and metformin for reducing blood glucose level, lisinopril and metoprolol for
hypertension and pregabalin for pain. Since, all these medications need to take
simultaneously. Hence, these medications can affect efficacy of another medication. Hence,
obesity need to be controlled to control other co-morbid conditions and to prevent medication
interactions. Obesity is also responsible for the narrow opening of the respiratory tract; hence
Peter is experiencing breathing problem and sleep apnea (Hamilton, &Naughton, 2013).
Social support is necessary for the control of body weight. However, Peter is experiencing
social isolation due to sustained increase in body weight and failure to secure job. Social
involvement can be helpful in augmenting his physical activity and also to reduce stress and
depression. Stress and depression are responsible for exaggerating obesity. In obese patients,
valve at the top can be overloaded which lead to secretion of acid in the stomach. This
secretion of acid results in the gastro-intestinal reflux in obese patient like Peter. Different
interventions like nutritional, medial, social, psychological and behavioural need to be
implemented in case of Peter. Since, obesity is a multifactorial disease, it cannot be
controlled by single intervention. Implementation of multiple interventions at the same time
can be helpful in reducing body weight in severe body obese patients like Peter. By
controlling weight of Peter, other co-morbid conditions can be effectively controlled (Haire-
Joshu and Tabak, 2016).
Second identified priority for Peter is to control blood glucose level. Nurse need to control
blood glucose level to control other conditions like obesity ventilation syndrome and sleep
apnoea. Control in the blood can be useful in controlling symptoms like shakiness,
diaphoresis and increased hunger. Since, 9 years he is having diabetes and it resulted in other
conditions like obesity and hypertension. It is evident that diabetes can sustain after age of
50. In diabetes, in response to increase in the blood sugar level body can produce more
amount of insulin. However, due to destruction of beta cells insulin lose its sensitivity to
control blood sugar level. Hence, diabetes patient become resistant to insulin. This insulin
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dependent diabetes is called as type-2-diabetes (Kahn et al., 2014). Obese people are more
prone to type-2-diabetes due to unhealthy eating habits and lack of physical exercise. On the
other side, insulin consumption for management of diabetes can increase body weight. In
case of Peter also, intake of insulin exaggerated increase in body weight. In the studies, it is
evident that people with BMI more than 30 are prone develop type-2-diabetes (Li et al.,
2014).
It is evident that there is correlation between diabetes and sleep apnea. In insulin dependent
diabetes, there are chances of development of diaphoresis. He is having long history of
diabetes and he is taking insulin and metformin for the control of blood glucose level. In case
of diabetes, blood glucose need to be checked prior to and after meal. Based on the glucose
level, insulin dose need to be changed. If insulin is being administered without checking
blood glucose level, there can be possibility of hypoglycaemic condition. This
hypoglycaemic condition can occur, if glucose level is in control at the time of insulin
administration. Diaphoresis is the symptom of hypoglycaemia and it is evident in Peter.
Hence, nurse should perform accurate assessment prior to administration of the medication.
Nutritional, physical and psychological factors are responsible for the increase in blood
glucose level. Hence, multiple interventions like insulin administration, oral antidiabetic drug
administration, diet control, exercise and relaxation should be implemented for Peter. It is
evident that integrated interventions can be helpful in more effective control of glucose level.
Nurse should educate patient to consume medication on time and desired amount of
medication need to be consumed. Diabetes medication need to be consumed for the longer
duration of time. Moreover, diabetes is mostly present in the older people like Peter along
with other co-morbidities. Hence, there are chances of non-adherence to medication
consumption in case of Peter. Nurse should encourage him to adhere to medication
consumption because irregular consumption of medication can lead to alteration in blood
glucose level (Clark et al., 2014).
It can lead to uncontrolled glucose levels which can lead to diabetic complications. Renal
disorders and retinopathy are the prominent diabetic complications. Diabetic complications
can affect multiple organs and lead to deterioration of Peter.
Conclusion:
Weight control and blood sugar level control were the two priority areas identified for Peter.
These priority areas were identified based on the Levett Jones clinical reasoning cycle.
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Identification of these priority areas helped in effective nursing intervention for Peter.
Multiple factors like physical, physiological, psychological and social factors were
considered for providing nursing intervention for Peter. Diet, exercise and medication
administration should be incorporated in addressing these two priority areas in Peter. Nurse
should coordinate effectively with different professionals like dietician and physiotherapist to
implement effective nursing intervention in Peter. As both obesity and diabetes are chronic
condition, nurse should encourage him to adhere to medication consumption. Nurse should
monitor effectively medication administration because Peter is consuming multiple
medications simultaneously. Nurse should collect all the data for all the co-morbid conditions
prior to medication administration. In conclusion, nurse should play prominent role to
implement Levett Jones clinical reasoning cycle in Peter.
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References :
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benefits program targeting generic antihyperlipidemic and antidiabetic medications.
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Hamilton, G., and Naughton, M. (2013). Impact of obstructive sleep apnoea on diabetes and
cardiovascular disease. The Medical Journal Of Australia, 199(8), 27-30.
Haire-Joshu, D., and Tabak, R. (2016). Preventing Obesity Across Generations: Evidence for
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