Bachelor Nursing NRSG366 Case Study: Obesity, Hypertension, and Care

This case study, prepared for a Bachelor of Nursing course (NRSG366), analyzes the case of a 30-year-old divorced man named Peter, who is facing morbid obesity, poorly controlled type 2 diabetes, and hypertension. The assignment focuses on identifying two priorities of care: obesity and hypertension management, utilizing the clinical reasoning cycle. The solution details the process of collecting cues, processing information, identifying problems, establishing goals, taking actions, and evaluating outcomes. The primary healthcare nurse's role involves assessing patient information, conducting physical assessments, and implementing interventions such as diet plans, medication administration (metoprolol and lisinopril), and monitoring vital signs. The evaluation phase assesses the effectiveness of interventions by monitoring changes in weight, blood pressure, and the patient's attitude. The study emphasizes the importance of clinical reasoning and its impact on patient outcomes, highlighting the nurse's role in promoting health and addressing health disparities.

Running head: BACHELOR NURSING ASSIGNMENT
NRSG366 Semester One 2018
Assessment Task One: Case Study One
Name of the Student
Name of the University
Author Note

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Primary health care nurses are found to work in a plethora of healthcare settings that
share characteristics, which are focused on forming a primary contact with the healthcare system.
Thus, the role of a primary healthcare nurse encompasses maintaining a patient state of complete
mental, social and physical wellbeing. Clinical reasoning refers to the process by which nursing
professionals collect cues and process relevant clinical information, while treating a patient
(Salminen et al., 2014). The basic nursing duty also encompasses protection and promotion of
health, in addition to including reduction of health disparities and social exclusion (Marcum,
2012). The essay will identify two priorities of care and will use the clinical reasoning cycle to
provide a justification for the same, with regards to the case study.
Setting priorities in nursing is an essential skills demonstrated by primary healthcare
nurses. This priority setting facilitates better time management due to the fact that all nursing
actions are found to have relative importance for nurses. Patient load management also depends
largely on priority setting (Wielenga et al., 2015). According to research evidences, nurses are
expected to demonstrate their clinical knowledge and skills while establishing their priorities for
improving the overall health outcomes and satisfaction of their clients (Dalton, Gee & Levett-
Jones, 2015). They are expected to apply their knowledge related to pathophysiology of a
particular disease while establishing priorities for setting interventions. Prioritization also
includes delivering best care services and evaluating the plan of care for multiple patients, and
revising the plan as and when required (Morley et al., 2014). The two priorities of care in this
case scenario include management of obesity and hypertension.
The patient situation- In the above case scenario, Peter is an unemployed divorcee, aged
30 years, who lives separate from his wife and two sons. He is socially isolated and finds it
difficult to performing daily activities due to his obese condition. The patient Peter is found to

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suffer from morbid obesity that is considered as a serious health condition. It can be attributed to
the fact that the patient the patient has a higher BMI than the normal range of 35. This condition
in the patient is characterized by the extreme deposition of excess body fat in the body (Sturm &
Hattori, 2013). Furthermore, the patient is also found to suffer from poorly controlled type 2
diabetes. This indicates presence of insulin resistance in his body. Presence of obesity ventilation
in the patient can be also associated to his overweight that makes it difficult for him to breathe
rapidly or deeply, thereby resulting in low amount of blood oxygen and high carbon dioxide
levels (Carrillo et al., 2012). Vital signs measurements indicate that the patient suffers from
hypertension. The heart rate and respiratory rate are within the normal levels. Further reports
from the case study also indicate that obesity presents itself as a significant problem for the
patient.
Collecting cues or information- The role of a nursing professional should encompass
reviewing the patient information, gathering new data from by monitoring the patient and
collecting essential cures from the present scenario. The patient was admitted to the hospital after
presenting symptoms of diaphoresis, shakiness, increased hunger, high blood glucose levels, and
breathing problems. His medical history indicates that Peter had also consulted a dietician and
commenced on an LEHP diet for weight reduction. Evidences have established importance of
this diet in weight loss (Wadden et al., 2013). Moreover, it is evident from the available
information that presence of morbid obesity makes it difficult for Peter to perform a range of
tasks. Research evidences suggest that morbid obesity, health and social isolation are closely
associated and present considerable challenges to a person, in the form of discrimination and bias
(Pantell et al., 2013). Conduction of a physical assessment helped in confirming presence of
hypertension and obesity in the patient. 50mg BD metoprolol and 10mg lisinopril administration

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is also accurate as they will help in lowering the persistent high blood pressure, thereby
preventing further risks of cardiovascular and renal complications (Liu et al., 2013).
Information processing- Nursing process refers to the scientific method that is used by
all nurses for ensuring the quality of care being delivered to all patients. This nursing approach
often encompasses five different steps of processing of information, namely, assessment,
diagnosis, planning, implementation and evaluation. During the assessment phase the primary
healthcare nurse is responsible for gathering relevant physiological, psychological, spiritual, and
sociological status. This data collection depends on physical examinations, and reference to the
patient history. In this case scenario, the diagnosing step would also encompass the fact that
nurses will confirm whether the patient Peter is at an increased risk of developing health
complications due to his problems. Several risk factors are associated with the symptoms
presented by Peter that makes him more susceptible to develop cardiovascular disorders.
According to research evidences, gender differences play a major role in development of
cardiovascular diseases. These diseases are found to contribute more to death of men on a global
scale (EUGenMed et al., 2015). Presence of depressive symptoms in the patient can be not only
attributed to his isolation from the family members, but also to obesity. Patients suffering from
morbid obesity are about 25% more likely to suffer from mood disorder such as, depression
(Preiss, Brennan & Clarke, 2013). This is correlated to low self-esteem, poor self-image, and
social isolation (Witherspoon et al., 2013). This helps in establishing links between depression
and obesity in the patient. Moreover, obesity is also strongly correlated with hypertension and
cardiovascular disease. High arterial pressure maintained during obesity contributes to
hypertension (Nguyen & Lau, 2012). The patient is also found to suffer from sleep apnea, the

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most common cause of which is obesity and excess weight. This obstructive sleep apnea may
also adversely affect multiple organ systems in his body.
Problem identification- The diagnosing phase involves making education judgments
about actual or potential health problems pertaining to the patient. The health problems and
issues will be identified by synthesizing relevant facts and drawing conclusions from the same.
An analysis of the case study indicates that the two major priorities are related to obesity and
hypertension management. Peter was initially of 105 kgs. However, following insulin
administration and losing his job, he was found to gain significant weight, which in turn is
resulting in fatigue and uncomfortable feelings. Hypertension and obesity is also making it
difficult for Peter to perform the daily activities that confirms that management of hypertension
and morbid obesity should be the major nursing priorities.
Establishing goals and taking actions- Following an agreement on the diagnosis, a plan
of action will be developed. In this case, there are a range of diagnosis related to obesity, and
hypertension needs to be addressed. Thus, the nurse will be responsible for prioritizing each
assessment and devoting time to all symptoms. The implementation phase involves following
through the proposed plan of action, which focuses on achievable outcomes. Primary healthcare
nurses responsible for administering interventions that will help the patient lose weight, and
lower the arterial pressure, thereby facilitating his quality of life. Nursing goals for obesity
management include identification of the risk factors and inappropriate behaviour that have
contributed to the problem. The nurse will also be responsible for preparing a diet plan and
determining the nutritional knowledge for treating the same (Sargent, Forrest & Parker, 2012).
This is mainly due to the fact that obese patients have been found to have lower health-related
QoL, across their health and physical perceptions, when compared to non-obese people (Black et

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al., 2013). The nursing intervention will include reviewing the patient history and conducting a
review of the daily calorie intake, eating habits and food amounts. The nurse will also explore
and discuss all events and emotions related to the eating pattern. An effective diet plan will also
be formulated using available knowledge regarding the height, age, body build, gender and
nutrient requirements of the patient (Milagro et al., 2013). Further goals include establishing the
importance of avoiding fat-rich diet and weighing periodically to obtain appropriate body
measurements (Hu, 2013). The nursing priority regarding obesity management will also include
development of an appetite reduction plan and administration of appetite-suppressant drugs such
as, mazindol, and diethylpropion (Kim & Park, 2012).
Goals for hypertension management focus on maintaining blood pressure within the
normal ranges, demonstration of a stable cardiac rhythm, and reduction of cardiac workload.
Major nursing actions will focus on reviewing the risk factors that might contribute to cardiac
stress, and checking of the laboratory data and monitoring the BP. The patient will be subjected
to auscultation for breath sounds and heart rates. Presence of peripheral and central pulses will be
noted, in addition to observing the skin colour, temperature, capillary refill time and moisture
(Carter, Bosworth & Green, 2012). Evidences of extreme fatigue, sudden weight gain, extremity
swelling and shortness of breath will also help in determining impending cardiac failure or poor
ventricular function. Comfort measures will be provided, followed by maintainance of activity
restriction (Joffres et al., 2013). Response of the patient to the administered medications will also
be noted for controlling the blood pressure levels (Radhakrishnan, 2012). These medications are
commonly beta-blockers that help in lowering the arterial blood pressure.
Evaluation of outcomes and reflection- A complete evaluation will be done to determine
whether the goals of enhancing patient wellness have been met. The outcomes of the

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aforementioned interventions should be evaluated and reflected by the nursing professionals for
enhancing their clinical expertise. Outcome evaluation will assist the nurse to identify whether
the patient is eating to satisfy an emotional or physiological need. A good reducing diet will also
result in low fat intake and prevent loss of lean muscle mass. It will also result in eliminating
metabolic imbalances that might contribute to weakness, fatigue and ketosis. Determining
activity levels and monitoring effects of a progressive exercise program will help in adherence to
the plan and normalizing the BMI. Obesity evaluation measures will encompass an assessment of
the changes in the weight of the patient, changes in associated health condition such as, BP and
weakness. Assessing changes in Peter’s attitude and knowledge about morbid obesity will help in
measuring outcomes (Baig et al., 2015). Using a tool for evaluating blood pressure levels,
determining the health risk appraisal and effectiveness of diagnostic procedures in reducing BP
will help in its evaluation (Castera, Pinzani & Bosch,2012). In addition to assessing awareness of
the patient regarding behaviours that might reduce hypertension risks, the BP must be measured
in both arms and thighs, thrice while the patient is at rest, sitting or standing (Schapira et al.,
2012). Use of an accurate technique and proper cuff size also plays a major role. The primary
healthcare nurse will then be involved in contemplating the nursing process and identifying the
nursing areas that can be done differently in future practice.
To conclude, it can be stated that the clinical reasoning cycle is greatly dependent on
critical thinking disposition of an nursing professional and is influenced by the philosophical
perspective, attitude and preconception of the clients. Effective clinical reasoning skills are
therefore useful in exerting positive impacts on patient outcomes. The case study analysis helps
in confirming that nursing job is not just restricted to eliminating any infirmity or disease. Thus,
nurses also work with the aim of reaffirming health as a basic human right. The clinical

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reasoning cycle helped in identifying major health disorders presented by Peter and the nursing
interventions that should have been taken.

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