NRSG366 Semester 1: Nursing Care Plan for Complex Patient Case

This assignment provides a comprehensive nursing management plan for a 52-year-old patient, Peter Mitchell, suffering from type 2 diabetes, morbid obesity, sleep apnea, and depression. The care plan is structured around the clinical reasoning cycle, addressing Peter's co-morbid conditions and the challenges they pose to his daily life. The assignment details medication management, lifestyle interventions, and counseling strategies aimed at improving Peter's physical and mental well-being. It also discusses the importance of monitoring blood glucose levels, promoting healthy dietary habits, encouraging physical activity, and fostering a positive self-image. The assignment emphasizes the complexities of managing multiple health issues simultaneously and highlights the role of therapeutic communication and social support in patient care. The reflection focuses on the importance of knowledge regarding insulin administration and the application of therapeutic communication skills.

Running head: NURSING CARE
Nursing Care
Name of the student
University name
Author’s note

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Table of Contents
Introduction................................................................................................................................2
Discussion of type 2 diabetes nursing care using clinical reasoning cycle................................2
Discussion of depression using clinical reasoning cycle...........................................................5
Conclusion..................................................................................................................................6
References..................................................................................................................................8

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Introduction
The current assignment focuses upon nursing care and management for a patient
suffering from con-morbid conditions. Here, the patient named Peter Mitchell is a 52 years
old man and was suffering from a number of co-morbid conditions such as – type 2 diabetes,
morbid obesity, sleep apnoea, depression. Since peter was suffering from co-morbid
conditions managing his daily life activities became difficult for him. Additionally, the huge
body weight made conducting his daily job of a fork lift driver at the coal mine difficult for
him. He also secluded himself from the society owing to his abnormally huge body size
which resulted in sleep apnoea and depression. Therefore, he has put on a series of
medications including metformin, Metoprolol etc. In this assignment a nursing management
plan has been designed for Peter Mitchell with respect to the different attributes of the
clinical reasoning cycle. The activities and limitations of the care management programs at
each step have been discussed in detail.
Discussion of type 2 diabetes nursing care using clinical reasoning cycle
In order to design an effective care plan for the patient the nurse needs to follow an
effective cycle. Here, peter was a 52 year old man who was suffering from type 2 diabetes
diagnosed 9 years ago. Peter had been referred by his GP on showing a number of symptoms
such as shakiness, diaphoresis, increased hunger, high blood glucose levels and difficulty
during sleeping. The sudden trauma experienced by the patient over here could be attributed
to rise in blood glucose level.
On gathering of further information it was understood that the patient had been
suffering from a number of co-morbid health conditions and was prescribed a huge lot of
medications such as insulin Novomix 30 BD, Metfromin 500 mg BD, Lisinopril 10 mg daily,

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Nexium 20 mg daily, Metroprolol 50 mg BD, Pregabalin 50 mg nocte. The Metfromin was
introduced to reduce the glucose tolerance in patients with type 2 diabetes. It was
administered to peter to decrease hepatic glucose production along with improving insulin
sensitivity. The Nexium 20 mg was administered to reduce the effect of GERD in the patient.
The patient was also a suggested to take pregabalin 50 mg nocte. This was administered to
reduce the incidents of depression and low mood disorder in the patient.
Obesity could be linked to the development of the type 2 diabetes. In this respect, the
patient was depressed and had feelings of increased hunger. Thus, increased hunger could
often be related to low mood which triggers binge eating (Brown, Edwards, Seaton &
Buckley, 2017). The binge eating has been seen to trigger the conditions of obesity further in
the patient. As mentioned by Munshi et al. (2016), difficulty in maintaining the energy
balance between stored energy to that of energy expenditure can result in unnecessary weigh
gain in the patient. As mentioned by Brown, Edwards, Seaton & Buckley (2017), high levels
of fatty acids in blood serum has been seen to down regulate the production of insulin. Thus,
he was suggested low energy high protein diet (LEHP) by the doctor. Obesity triggers
negative image about self within the patient. Hence, people with large amount of visceral fat
often suffers from obstructive sleep apnoea, which can further worsen the condition of type 2
diabetes by releasing stress hormones which in turn increases the concentration of blood
glucose level (Davies et al., 2015). Peter was also a chain smoker which could have resulted
in narrowing of trachea further aggravating symptoms of sleep apnoea.
Here, the patient has been suffering from type 2 diabetes, which is been marked by
high levels of blood glucose. Peter was further recommended by his GP to the acute care unit
owing to display of a number of health symptoms such as increased sweating, shakiness and
difficulty in breathing during sleep. The sudden uneasiness in the patient could be attributed
to excessive high levels of blood glucose level (Snoek, Bremmer & Hermanns, 2015).

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Therefore, it was required to put the patient under immediate care and support services. As
reported by Abrams, Nathanson, Silver, Ramirez, Toner & Teresi (2017), leaving a
hyperglycaemic patient unattended could often lead to lethal outcomes such as diabetic
coma.
Therefore, as a nursing professional looking after the care concerns of Peter Mitchell
it was required that blood glucose level of the patient is effectively monitored. The entire
process would be divided into 3-months cycle. The nurse will be taking data for
improvements brought about in the overall health condition of the patient at an interval of
every three months.
Therefore, some of the ways in which it can be done is by closely monitoring the
medication pattern of the patient along with managing his daily activities. Peter had been
often prescribed light to heavy exercises by his consultant physician. Additionally,
counselling sessions could be undertaken by the patient to improve his self image regarding
body weight (Valkanova, Ebmeier & Allan, 2013).
The outcome of the nursing plan implemented for the care and management of the
patient could be evaluated using a number of clinical assessment procedures. The nurse will
be taking a note of the recovery of the patient on a regular basis. A time limit will be set up
by the nurse such as six months for reducing the effects of hyperglycaemia in the patient
along with reducing the impact of the co-morbid conditions. The nursing plan would focus
upon implementation of exercises along with healthy diet for maintaining the blood glucose
level and agility in the patient. The results would be evaluated through clinical assessments
such as blood glucose tests and urine analysis along. The sleep improvement patterns in the
patient would also be monitored.

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During the process of dealing with Peter I have felt that developing knowledge
regarding the interval time periods which needs to be maintained during the administration of
two consecutive insulin doses is important. Thus, repeating the medicine doses within a small
interval of time can disrupt the normal metabolic process of the patient alongside leading to
more fatal consequences (Palmer, Vorderstrasse, Weil, Colford & Dolan‐Soto, 2015).
Discussion of depression using clinical reasoning cycle
In this respect, Peter Mitchell was a 52 years old divorcee and used to live on his
own. His deteriorating health and morbidly obese condition had made continuing work
difficult for him. Additionally, he felt that his large body size had made him socially
unacceptable. Therefore, he secluded himself socially which further contributed towards the
development of depression in the patient. The patient was also no having sufficient family
support as he was a divorcee who used to live alone. Additionally, his sons used to stay away
from him providing him with little or no help amidst his physical ill health.
Peter was suggested nexium 20 mg daily by the doctor. It was suggested for the
lowering of the feelings of depression in the patient. However, excessive intake of nexium
could trigger weight increase in the patient (Yim, Stapleton, Guardino, Hahn-Holbrook &
Schetter, 2015). This could further complicate the situation as the patient was morbidly
obese. Nexium was suggested to reduce mood disorders in the patient was suffering from
clinical depression where he had little or no wish to intermix with the society. However,
administration of nexium would have severely affected the adrenal secretions in the long run
worsening the condition of sleep apnoea in the patient.
In the current scenario, depression developed in the patient under a range of
circumstances such as unemployment, number of health issues, social isolation and negative
self image due to obesity. Due to overweight the patient was unable to manage his daily tasks

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which further developed frustration in the patient (Davies et al., 2015). Thus, fear about
negative social image further resulted in psychosocial complications in the patient (Kok,
Williams & Zhao, 2015).
Peter feels uncomfortable about his size, which has resulted in enhancing the thoughts
of depression in the patient. As peter feels uncomfortable about his size he rarely goes out or
feels like participating in exercises. Therefore, in the lack of sufficient support from the
patient it becomes difficult for the nursing professional to provide the patient with sufficient
support programs (Esser, Legrand-Poels, Piette, Scheen & Paquot, 2014). The morbid obesity
in the patient makes depression management difficult, as the administration of steroid
derivatives for controlling mood disorder could have negative consequences on the overall
health of the patient.
The nursing professional needs to adopt effective counselling process which will help
the patient in reducing negative self image (Valkanova, V., Ebmeier, K. P., & Allan, 2013).
Additionally, setting up of social support channels for the patient where he will be a
part of a larger community. As commented by Moreno-Indias, Cardona, Tinahones &
Queipo-Ortuno (2014), taking part in community based healthcare programs can also help in
developing increased self motivation and social acceptance in the patient.
The effect of the counselling sessions can be measured in the form of positive
behaviour changes in the patient such as greater participation, less social inclusion
(Birkenfeld & Shulman, 2014).
I think in order to deal effectively with the condition of peter I could have used
therapeutic communication skills. Therefore, using such skills would have helped me in
communicating with the patient better, as well as understand the emotional complexities in
the patient.

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Conclusion
In this assignment, the nursing management strategies for a patient suffering from a
number of health co-morbidities have been discussed. One of the biggest issues faced by the
nursing professional was management of both obesity and type 2 diabetes in the patient. This
is because one is related to the other and alteration in one parameter could produce drastic
effects over the other. Obesity symptoms can down regulate insulin production in the body.
On the contrary overdoses of insulin can promote weight gain in the patient. Therefore,
lifestyle management along with effective health education programs can help in managing
the overall health of the patient. The assignment discusses the different nursing interventions
in steps which help in effectively evaluating the condition of the patient.

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References
Abrams, R. C., Nathanson, M., Silver, S., Ramirez, M., Toner, J. A., & Teresi, J. A. (2017).
A training program to enhance recognition of depression in nursing homes, assisted
living, and other long-term care settings: Description and evaluation. Gerontology &
geriatrics education, 38(3), 325-345.
Birkenfeld, A. L., & Shulman, G. I. (2014). Nonalcoholic fatty liver disease, hepatic insulin
resistance, and type 2 diabetes. Hepatology, 59(2), 713-723.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical
Nursing: Assessment and Management of Clinical Problems. London: Elsevier Health
Sciences, 55-75.
Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skjøth, T. V., ... &
DeFronzo, R. A. (2015). Efficacy of liraglutide for weight loss among patients with
type 2 diabetes: the SCALE diabetes randomized clinical trial. Jama, 314(7), 687-
699.
Esser, N., Legrand-Poels, S., Piette, J., Scheen, A. J., & Paquot, N. (2014). Inflammation as a
link between obesity, metabolic syndrome and type 2 diabetes. Diabetes research and
clinical practice, 105(2), 141-150.
Kok, J. L. A., Williams, A., & Zhao, L. (2015). Psychosocial interventions for people with
diabetes and co-morbid depression. A systematic review. International journal of
nursing studies, 52(10), 1625-1639.

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Moreno-Indias, I., Cardona, F., Tinahones, F. J., & Queipo-Ortuño, M. I. (2014). Impact of
the gut microbiota on the development of obesity and type 2 diabetes
mellitus. Frontiers in microbiology, 5, 190.
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., ...
& Haas, L. B. (2016). Management of diabetes in long-term care and skilled nursing
facilities: a position statement of the American Diabetes Association. Diabetes
care, 39(2), 308-318.
Palmer, C., Vorderstrasse, A., Weil, A., Colford, C., & Dolan‐Soto, D. (2015). Evaluation of
a depression screening and treatment program in primary care for patients with
diabetes mellitus: insights and future directions. Journal of the American Association
of Nurse Practitioners, 27(3), 131-136.
Snoek, F. J., Bremmer, M. A., & Hermanns, N. (2015). Constructs of depression and distress
in diabetes: time for an appraisal. The Lancet Diabetes & Endocrinology, 3(6), 450-
460.
Valkanova, V., Ebmeier, K. P., & Allan, C. L. (2013). CRP, IL-6 and depression: a
systematic review and meta-analysis of longitudinal studies. Journal of affective
disorders, 150(3), 736-744.
Yim, I. S., Stapleton, L. R. T., Guardino, C. M., Hahn-Holbrook, J., & Schetter, C. D. (2015).
Biological and psychosocial predictors of postpartum depression: systematic review
and call for integration. Annual review of clinical psychology, 11, 101-125.