NRSG366 Case Study: Chronic Conditions Management of Peter Mitchell

This case study examines the case of Peter Mitchell, a 52-year-old patient with type 2 diabetes, obesity, and a history of smoking. The essay identifies key factors contributing to Peter's condition, including poor diet, lack of exercise, and smoking habits. It prioritizes care strategies such as adopting a healthy diet and exercise plan, as well as seeking consistent medical treatment and therapies. The clinical reasoning cycle is applied to analyze Peter's situation, focusing on problem identification, information gathering, goal setting, action implementation, and outcome evaluation. The analysis emphasizes the importance of healthy lifestyle changes and continuous medical management to improve Peter's health and reduce the impact of his chronic conditions. Desklib offers a variety of study tools and resources to help students understand complex topics.

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Individual case study

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Scenario One: Peter Mitchell
As per the given scenario, Peter Mitchell is a patient who is suffering from type 2
diabetes and he is a 52 year old person. He was admitted into the hospital with poorly
controlled diabetes, obesity and other health related issues. It is observed that Peter has
been a smoker for around 30 years and he smokes 20 cigarettes in a day due to which he is
suffering from the type 2 diabetes and another health disease. The aim of this essay is to
analyse the situation of Peter and identify key factors that increase the problem of type 2
diabetes and obesity in peter. This essay also focuses on the priorities of care and the
clinical reasoning cycle in order to improve the health of peter and reduce chronic situations.
According to the case study, peter was admitted in the hospital for reducing the
impact of type 2 diabetes and doctors suggested high protein diet in ord3er to reduce weight
and his GP has discussed weight loos with peter. After four weeks the peter was admitted
into the medical ward for controlling and managing their weight. Mainly, peter is an
unemployed person that receives government benefits and he lost his job three years ago.
According to the peter statement he has always been a biggish person with his normal
weight sitting at almost 145kg which is very high and it is one of the common key factors that
increase the problem of obesity in peter (Czech, 2017). During medical treatment doctors
provided numbers of medicines to peter for reducing the issue of type 2 diabetes and
overweight for example, insulin novomis 30 B D, metformin 1000mg BD, Lisinopril 10mg
daily, pregablin 50mg and many more.
From the given scenario, it is identified that peter is suffering from various kinds of
health diseases, for example, obesity, type 2 diabetes, hypertension, sleep apnoea and
gastro oesophageal disorder. He is a smoker which is another key element that increases
the rate of chronic conditions and he does not follow any exercise plan due to which their
weight crosses the 145kg. According to body mass index if any person has more than 105kg
weight then he/she can suffer from overweight or obesity related problems (Rubino, et al.,
2016). Moreover, Peter does not eat healthy foods and take a high level of sugar that
increase the problem of type 2 diabetes and he is diagnosed with type 2 diabetes and
obesity health issues.
According to the world health organization, the term obesity is defined as the chronic
condition which affects the functions of the human body (Yassour, et al., 2016). Such kind of
problem occurs due to major two factors, for example, lack of physical activities and poor
diets. Peter is diabetes and obesity patient that faces both these disorders because of
improper treatments. Santos, & Lima, (2016) identified that smoking can increase the weight

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of an individual and it also affects the lungs and other parts of the body. Cancer is one of the
best examples that occur due to smoking and peter smokes more than 20 cigarettes in a day
due to which he is diagnosed with obesity and reflux disease.
The problem of type 2 diabetes also increases other health issues in patients such as
cardiovascular, COPD, obesity and blood cancer (Zaccardi, Webb, Yates, & Davies, 2016).
High blood pressure is also a very important factor for increasing the rate of type 2 diabetes
in peter and it can be reduced by using physical activities and exercise. Moreover, it is
suggested that the family members of Peter should motivate him for doing exercise and
physical activities on a regular basis for managing their weight and disorders. As per the
given case, peter is also finding it increasingly difficult for performing activities of daily living
and he realises that he is in the prime of his middle age life.
Due to lack of motivation and experience peter is not able to reduce their weight and
in previous treatment, doctors provided enough information about chronic disorders. In order
to control and manage the issue of obesity and type 2 diabetes, there are many priorities of
care available which can be adopted by the peter. It is observed that principles of care and
priorities of care provide a platform to the patient for controlling and managing the health
related disorder in an effective manner (Chávez-Talavera, Tailleux, Lefebvre, & Staels,
2017).
For the given scenarios there are major two kinds of priorities of care can be used,
for example, peter’s views of the significance of the issue for their lives and the specialist’s
views of the significance of the issue for peter’s care. Or in other words, the first priority of
care is to follow healthy food and physical activities and the second priority of care is to
communicate with doctors and take proper treatment or therapies. In the first priority care,
peter can follow the proper dietary plan and exercise plan in order to reduce their weight.
Currently, the weight of peter is around 145kg that lead to the issue of obesity and he should
take only healthy foods and fruits for reducing their weight.
According to Reeves, Zaki, & Day, (2016) if any person takes proper exercise and
dietary plans and follows on regular basis then he can increase their health and reduce
chronic diseases by 50%. However, family members or nurses can motivate peter for taking
the proper dietary plan and eating only healthy foods in order to reduce their weight. Peter
should reduce smoking because it also plays a major role in the development of diabetes.
The second priority of care is to communicate with a specialist and take proper treatment
and therapies in order to maintain their health and reduce the level of chronic disorders.

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It is observed that many doctors suggest healthy foods and physical activities and
they also provide some medicine for reducing their weight (Hunter, & Arthur, 2016). So,
peter can follow the proper guidance and take medicine on a regular basis that can improve
their health in an effective manner. Moreover, nurses and doctors can collect the views of
peter and analyse their health issues by understanding their situation. it is observed that
peter is suffering from numbers of health disorders and doctors can suggest some key
factors that increased the rate of chronic disorder in peter. They can deliver a large level of
treatment and therapies for managing the level of obesity or type 2 diabetes.
It is identified that the functions of the specialists in health communities contain
several elements such as health promotion, detection of health issues in patients and
implementation of the treatment processes. It is suggested that the development and
implementation of the priorities of care should include a few steps, for example, facilities,
techniques, nursing care for promoting healthy diets and exercise plans and many more.
After analysing and understanding the situation of peter the clinical reasoning cycle
can be used and applied in order to reduce the problem of type 2 diabetes and obesity. With
the help of clinical reasoning cycle, the issues and chronic diseases faced by peter can be
controlled and monitored. There are major eights stages involved in the clinical reasoning
cycle for understanding and evaluating the patient’s disorders such as consider the patient
problem, collect information, process information, identify issues, establish goals and
targets, take action, evaluate results and reflect on the process (Delany, & Golding, 2014).
At the time of initial stage of clinical reasoning cycle, the nurse and doctor begins to
contain the first impression of the patient and determine silent features of the situation
(Forsberg, Ziegert, Hult, & Fors, 2016). For peter, nurses can apply this step and identify the
silent features of Peter's problems. In the second stage, the nurses and doctors can collect
relevant facts and information about the peter’s disease and collect viewpoints of the peter.
After collecting information, nurses can process information and data and evaluate the
issues faced by peter. With the help of this step, nurses can understand chronic disease
faced by peter and analyse key factors that increase the problem of diabetes and obesity in
peter.
The fourth stage is to identify the problem where nurse and specialist can identify the
issues faced by peter and synthesise information and inference to make a definitive nursing
diagnosis. In the next stage, the nurse can establish goals and targets for implementing
treatments and therapies on peter in order to reduce the impact of chronic disease from the
body. Such kind of process helps nurse for describing what they want to implement and

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process for implementing strategies on peter. In the next step, the nurse can identify and
select a course of action between the various alternative available (Gummesson, Sundén, &
Fex, 2018). Moreover, they can select an appropriate technique for reducing the problems
and diseases faced by peter.
Evaluate outcomes is another stage of clinical reasoning cycle where a nurse can re-
examine aims and subjective data in order to evaluate the processes used by nurses during
treatment. By using this stage, the nurse can evaluate the outcomes and results after
implementing strategies on peter. The last stage of the clinical reasoning cycle is reflecting
on the process which can be used by nurses in order to review their practice with a view to
refinement. By using this step, nurses can compare the health of peter and reduce peter’s
disorder more effectively.
This essay focused on peter’s chronic condition and identified the key factors that
increased the problem of type 2 diabetes and obesity in peter. It has been concluded that
healthy foods and physical activities play a major role in the reduction of diabetes and
obesity. This essay also identified two priorities of care for improving the health of peter in an
effective manner and applied the clinical reasoning cycle to reduce chronic disorders and
problems. It has been suggested that peter should take the proper dietary plan and follow
physical activities which can help them for improving their health more effectively.

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References
Chávez-Talavera, O., Tailleux, A., Lefebvre, P., & Staels, B. (2017). Bile acid control of
metabolism and inflammation in obesity, type 2 diabetes, dyslipidemia, and
nonalcoholic fatty liver disease. Gastroenterology, 152(7), 1679-1694.
Czech, M. P. (2017). Insulin action and resistance in obesity and type 2 diabetes. Nature
medicine, 23(7), 804.
Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an
action research project with allied health clinical educators. BMC medical
education, 14(1), 20.
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing the progression of clinical
reasoning through virtual patients: An exploratory study. Nurse education in
practice, 16(1), 97-103.
Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual
framework for interprofessional learning: a literature review and a case
study. Physical Therapy Reviews, 23(1), 29-34.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Reeves, H. L., Zaki, M. Y., & Day, C. P. (2016). Hepatocellular carcinoma in obesity, type 2
diabetes, and NAFLD. Digestive diseases and sciences, 61(5), 1234-1245.
Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti, K. G. M., Zimmet, P. Z., ... &
Amiel, S. A. (2016). Metabolic surgery in the treatment algorithm for type 2 diabetes:
a joint statement by international diabetes organizations. Surgery for Obesity and
Related Diseases, 12(6), 1144-1162.
Santos, R. M. M., & Lima, D. R. A. (2016). Coffee consumption, obesity and type 2 diabetes:
A mini-review. European journal of nutrition, 55(4), 1345-1358.
Yassour, M., Lim, M. Y., Yun, H. S., Tickle, T. L., Sung, J., Song, Y. M., ... & Lander, E. S.
(2016). Sub-clinical detection of gut microbial biomarkers of obesity and type 2
diabetes. Genome medicine, 8(1), 17.

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Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and
type 2 diabetes mellitus: a 90-year perspective. The postgraduate medical
journal, 92(1084), 63-69.