NRSG366 Case Study: Type 2 Diabetes, Priorities of Care & Management

This case study focuses on the management of a 52-year-old male patient, Peter Mitchell, with a 9-year history of type 2 diabetes, obesity, ventilation syndrome, and sleep apnea. The study identifies and discusses two primary priorities of care: dietary management and physical exercise, utilizing the clinical reasoning cycle to justify these priorities. It emphasizes the importance of patient education, stress management, and lifestyle modifications, including smoking cessation and avoiding spicy foods. The study also addresses the patient's medication regimen, including insulin and metformin, and the importance of self-monitoring blood glucose levels. The conclusion highlights the increasing prevalence of type 2 diabetes and the crucial role of nurses in patient education and management, advocating for a healthy lifestyle to combat the disease. This assignment solution is available on Desklib, a platform offering a wide range of study resources for students.

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Introduction
Type2 diabetes is a recurring condition that affects the way a body of person generates sugar
level which is an essential source of energy for one’s body. With type-2 diabetes, the body can either
accept or reject the effect of insulin which is the hormone that helps in regulation of sugar movement
within the body cells or sometimes the sugar is not produced enough within the body. Type 2diabetes
usually affects adult and middle age people but in recent past also children have been reported to have
obesity. This is probably due to the change of lifestyle where you find that most children are diagnosed
with obesity due to lack of exercise and taking the diet directed by a dietician.
Case study
Peter Mitchell is a 52-year-old man living with a 9 –year’s history of type 2 diabetes, in previous
admission Peter Mitchell had symptoms of hyperglycemia before diagnosis, he had fast blood glucose
records which indicated about 117-128 which was described as indicative borderline diabetes, this was
brought due to the mode of type of food he takes he admitted that he had been taking spicy food and
was advised by dietician to change the kind of food. He was supposed to take low energy, and a high
protein diet to assist with weight reduction.
Peter Mitchell was referred by his GP to the diabetes specialist clinic; Peter was admitted with
poorly controlled diabetes, obesity ventilation syndrome and sleep apnea. He was presented with
symptoms of shakiness, diaphoresis, increased hunger, high blood pressure level, and difficulty in
breathing while sleeping. Peter had issues with being addicted to a smoking cigarette for the last twenty
years and admitted to be a smoker for the last 20 years.
Peter Mitchell leaves alone since divorcing with his wife; they have two sons together but
rarely pay him a visit. Regarding on his financial status he is currently unemployed after losing three
years as forklift in Moranbah coal mine and only depends on government benefits, and this explains the
reason for weight gain since he has been staying at home without working (American Diabetes
Association., 2018).
Discussion
Peter Mitchell presented with uncontrolled type 2 diabetes and a complex that required
treatment. The immediate action for the nurse practitioner assigned to provide care was to address the
most pressing concern about is a health issue and put it in the priority. Furthermore, the main priority
for Peter Mitchell was to lose weight and was the primary objective for him to seek diabetes specialist
care, his blood pressure level and sleeping apnea needed to be addressed.

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The first priority for Peter Mitchell was to be referred to a dietician. He accepted that he had
v very minimum dietary information to assist in making the achieve weight loss because he felt that his
current weight was embarrassing and sometimes he lacked the self-confidence to go out and look for
jobs. He acknowledges that his glucose control was widely affected by significant portion of taking spicy
food like bread and pasta. He accepted to start improving the diet control by reducing the part of his
meal by one-third during the first weeks before dietary consultation because he knew to lose would as
important in reducing blood pressure.
The second major priority was for him to engage in a physical exercise he realized since
losing him three years ago he hardly engages in an exercise activity after much discussion he realized
that many months have been passing without him participating in any physical exercise and he rarely
engages in even seasonal practice. He agreed that every morning would take a walk after breakfast; the
walk will take about 15-20 minutes each day.
The treatment approach of diabetes type 2 should always engage the patient by considering all
the factors the patient should continue during diabetes management. Well, communication between
the nurse and the patient will ensure the patient is well knowledgeable of the decision about their care
(Simonson, Halperin, Foster, Vernon, & Goldfine, 2018). It is always required that care designated to the
patient should educate the patient about the review and the reinforcement required this will include
that patient should check his dietary on the food he is supposed to take and the food he has to has it
helps the patient to manage his weight.
The patient should integrate other social activity like doing light exercise each day, morning and
evening. It should be noted that people with obesity face a lot of stigmatization and many cases lack
support from family member to encourage them to control their diet and engage in many exercises. In
the case of Peter Mitchell, ever since he got a divorce with his wife (Bethel et al., 2018). He has been
separated from his sons who would have helped him by providing emotional support for their father.
But due to lack of their visit, it looks like he has been in distress for a long period and has to turn into the
addiction of smoking cigarette which has encouraged the growth of difficulty in breathing in especially
whenever he is asleep (Wiviott et al., 2019).
Stress management plays major role in reducing blood sugar level and prevent high blood
pressure if the stress is not managed it will be hard for the patient to control the blood pressure (Lean et
al., 2018). The patient should be advised to use a relaxation technique to help in getting away the stress,
for example, the patient should engage in listening to chill music and participate in yoga also sometime
the patient can engage in meditation (Wanner et al., 2018). Stress relief ensures the patient sleeps

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better and also wakes up in good health. According to studies conducted it shows that lack of enough
sleep will worsen the increase of type 2 diabetes.
One way that can ensure that a patient like Peter Mitchell gets enough sleep is by encouraging
the patient to leave a drug free life by avoiding alcohol and cigarette (Zheng, Ley, & Hu, 2018). The use
of spicy food during the night I encourage the body to gain more weight which led to an increase in high
blood pressure. Peter Mitchell should avoid food spicy food or reduce instead he is supposed to take
food that has high protein.
Doing of exercise daily is recommended for Peter Mitchell especially light exercise ensures that
there is constant blood flow across all the organs of the body(Pratley et al., 2018). Even if one does not
lose any pounds daily it encourages the prevention of diabetes. For instance when Peter Mitchell will
indulge in physical activity such walking the muscles contraction helps to push glucose out of the blood
into your cells for Peter Mitchell will have to start doing light physical exercise, for example, aerobic and
walking little distance each day for the startup (Garber et al., 2018). When his body adapts to the
physical exercise he is supposed to start on weight lifting sessions which are the most f effective way of
keeping blood sugar level down.
The issue of a lot of people who are overweight and diagnosed with type 2 diabetes experiences
sleeping apnea which essentially the patient experience breathing problem while asleep(Wiviott
al.,2019). This is a high risking concerning with the health of Peter Mitchell where it was reported that
he was experiencing sleeping apnea he studies the high risk of death due of breathing (Tuttle,
Lakshmanan, Rayner, Busch, Zimmermann, Woodward, & Botros, 2018). If the issue about Peter
Mitchell is severe he may need to consider surgery also he can use a special device while sleeping. In
most cases this issue can be solved by the loss of weight.
Peter Mitchell was reported also suffering from gastroesophageal reflux which is a diseases
that causes stomach acid to repeatedly flow back into the esophagus which can initially irritate the
walls of esophagus this kind of diseases is not strange to him considering that he had obesity and he
Was an addict to smoking cigarette(Packer et al., 2018). In order to prevent inflammations of the
esophagus, the patient is recommended to quit smoking of cigarette and also he has to ensure he check
on his weight. He will have to also provide the type of food he consumes is less of fast food and avoid
eating large meal especially late at night.
On medication Peter Mitchell is supposed to take insulin novomix 30BD which will be given as
monotheraphy it is also taken with combination with oral antidiabetic medicinal product it helps to
reduce the sugar level of the patient is supposed to take about 34 unit in the morning and 28 unit in the

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evening(Moţăţăianu, Maier, Bajko, Voidazan, Bălaşa, & Stoian, 2018). After exercise, Peter Mitchell was
to take metformin about 1000mg BD for four weeks, and he was supposed to be on a diet has required
this will ensure his blood pressure level will reduce.
During the visit by personal Nurse care Peter Mitchell was able to learn to use a glucose meter
which had two steps procedure which was good step forward for him cause he was able to administer
for himself twice a day in the morning after breakfast and in evening during dinner time(Davies et al.,
2018). Able to learn glucose reading was important because it would guide the patient on the choice of
medication and also he can evaluate the effects brought by dietary changes.
Conclusion
Type 2 diabetes has been an emerging issue within our society in the recent past. Considering
the aging people and the number of people with diabetes will undoubtedly increase shortly if the
lifestyle does not change and start to do more exercise. Nurses who are assigned to a patient usually
play an important role in educating and management of people with diabetes. The integration of clinical
skill and expertise ensures that there is a delivery of quality service to the patient and ensuring that the
community is aware of fighting diabetes by living a healthy life.

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References
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