Community Nursing Case Study: Peter's Diabetes and Related Issues

This case study analyzes the scenario of Peter, a 52-year-old male with type 2 diabetes, and the role of a community nurse in his care. Peter suffers from multiple comorbidities including sleep apnea, obesity, hypertension, and depression, significantly impacting his life. The paper emphasizes the application of the Levett-Jones clinical reasoning cycle to identify and prioritize two key areas of care: managing diabetes and addressing obesity. It details the nurse's initial assessment, considering Peter's social and financial situation, as well as his motivation and self-esteem. The study outlines interventions such as medication management, education on diet and lifestyle changes, and strategies to combat depression and promote patient independence. The importance of therapeutic communication, collaboration with other healthcare professionals, and setting achievable goals are also discussed. The case study highlights the nurse's crucial role in supporting Peter through his complex health issues, promoting a healthier lifestyle, and improving his overall quality of life by focusing on both clinical and patient needs.

Running Head: NURSING
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This paper will emphasize the effects of level 2 diabetes on Peter who is suffering from
the disease and also the role of primary health care nurses in treating him. Due to his level 2
diabetes (T2DM) he is also suffering from other effects of the disease such as sleep apnea
(OSA), obesity (OHS), hypertension as well as depression which is having a serious impact on
his life. The paper will analyze Peter’s scenario and discuss the needs and ways to primarily
control his diabetes, eliminate obesity, and help in weight loss, management of hypertension and
sleep apnea and also controlling his depression. Apart from these the needs of medication,
knowledge of balanced diet and nutrition, knowledge about lifestyle and daily needs of exercises
in order to control the obesity will also be discussed. Hunter & Arthur (2016) mentioned the
Levett Jones clinical reasoning cycle (CRC) has to be applied in order to manage the priorities of
caring patient in terms of urgency and also provide rationale for the care. By following the CRC,
two main priorities are going to be identified by CN and explain the process of providing care to
Peter.
While visiting the patient initially, the community nurse (CN) is expected to focus on
situation and difficulties faced by Peter and run a diagnostic of his whole body to provide holistic
care accordingly. On the first visit, it is seen that Peter stays alone and there is no one to take
care of him. He has been divorced with his wife and two of his sons lives by themselves and
hardly visits their father. Moreover, he is unemployed and gets government funds for his daily
living which can result in financial strains for his medical expenditure or other health care
equipment (Deane, 2016). He has cut off all his contact and prefers living in solitude which is
having a negative impact on his psychology. Here it is observed that he has gained almost 40 kg
of weight after his insulin has started and as a result suffering from morbid obesity. Moreover, he
has also developed sleep apnea along with his obesity which is impacting his daily activities.
Although he is motivated to lose his weight and stop smoking he is not confident enough that
how he will do it (Foschino Barbaro, 2018). He has been drowning in depression which has
eroded his self-esteem and as a result, he has totally cut off his communication with the outside
society and has been discouraging himself for doing the work out which is very much important
in controlling his diabetes. Therefore the CN needs to support him morally and treat him with
respect. Reed, Pengo & Steier (2016) mentioned that to uplift his self-esteem the CN needs to
show empathy and be nonjudgmental. The medical condition has broken down his morale and
they have to make him believe in himself once again. It is also advised not to use medical terms

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or labels and diagnose his problem with therapeutic communication. Nair, Nicolae & Dreyfus
(2018) opined in this type of condition therapeutic communication will encourage Peter to
engage in communication with the nurse and express what is going on inside his head. The CN
needs to be patient and be an active listener to understand the physiological turmoil he is going
through (Welbourn et al. 2016). This will also allow the nurse to build a therapeutic and
collaborative relationship with him that will help him to communicate and can be considered the
first step in treatment.
The first priority identified to be taken care of is managing his level 2 diabetes (T2DM).
Ismail et al. (2016) stated that the CN has to go through his old medical history and reports
which will help the nurse to collect vital information about his medical condition. He needs to
analyze from the past medical history and then he can determine what the present condition of
his health is. The next plan of action can be accessed by further studying his medical information
that can be accessed from his GP, his previous medical reports from his dieticians, psychologist
and psychotherapist about his health condition (Levy et al. 2015). It is also noted that Peter has a
high level of BGL and T2DM which is very poorly controlled signifies his lack of knowledge on
medication management and glycaemia control (Stevens & Stern, 2019). According to Nair,
Nicolae & Dreyfus (2018), in the next phrase of CRC, the CN needs to identify all the medicines
and care needed and plan in accordance treat his diabetes. He has been suffering from a complex
health problem that demands constant motivation in order to maintain the changes in his lifestyle
and adhere to the treatment regime. In order to take proper care managing his depression is the
greatest priority (Stevens & Stern, 2019). Depression will lead to very low self-esteem and that
will discourage Peter to follow his treatment plans and worsen his condition. It might also lead
Peter to feel worthless, functional impairment and also losing interest in his daily activities.
The CN needs to establish achievable goals in collaboration with Peter. It will help in the
diabetic interventions which will help Peter to live a healthier life. The CN should motivate and
involve Peter in psychotherapy, dieticians, pharmacists and other health care professionals which
will help him to understand his condition in a better way and will encourage him to join the
diabetic interventions courses that will lead to a healthier lifestyle (Welbourn et al. 2016).
Instead of forcing decisions the CN needs to respect the decisions of Peter and involve him to
activities of his preference. This will also help Peter gain confidence in himself and make him

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responsible for the decisions that will help to change his own life. It is also important to
investigate and find out reasons why Peter finds it difficult to start working out which is very
crucial for diabetic interventions.
The second priority is found to be managing the obesity and weight gain that are
adversely affecting his health. It is noticed that due to his complex health condition Peter finds it
difficult to maintain his normal life and perform his day to day activities. It becomes important
for the CN to acknowledge Peter’s depression, OSA, OHS and also T2DM (Gungor, 2017).
Obesity cause stress in the respiratory system resulting in improper exhalation of CO2 which
leads Peter to improper sleep. It is also observed that T2DM leads to peripheral neuropathy that
leads to high risk of ulcers in the foot, amputation and difficulty in mobility with growing age.
The CN needs to educate Peter to take care of his hygiene and maintain his skin integrity
(Newmarch, Weiler & Casserly, 2019). As Peter stays alone so the CN needs to habituate Peter
in self-monitoring of proper medication and prepare his own balanced diet suggested by the
dieticians. This will help Peter to be aware of his own food habits and take care of himself.
Proper diet and regular exercise will help to curb down his excess weight and then it will help
Peter to do his daily activities at ease (Reed, Pengo, & Steier, 2016). Evaluation and reflection is
an effective diabetic intervention and helps Peter in achieving his goals. Self-motivation and
awareness will help Peter to identify his own strengths and weaknesses. The CN can give
occasional visits and check how Peter is performing and check his health.
The previous medical reports suggest that he has been provided with numerous resources
explaining to him how he can control his weight but due to his lack of interest he has not been
following anything. His past medical reports also suggest that he has visited a dietitian and has
been instructed to have low energy but high protein sources of food which will give him the
energy to do his works and also help to regulate his weight gain. Weight loss is considered to be
the most efficient method of diabetic intervention. Even the psychotherapist has instructed in
light exercise and daily morning walk which will help him to be fit and reduce his weight gain
(Deane, 2016). It adheres that Peter is not following any of his medical instructions mainly
because of his depression and there can be several factors that might lead to his depression such
as dissolving of a marriage, living in solitude, his unemployment resulting in financial crisis and
also his health condition. He is also suffering from morbid obesity which is the root cause of

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other health problems such as sleep apnea, hypertension and depression which is resulting in him
to be careless about his health treatment plans. His quality of life is deteriorating because of his
obesity, sleep apnea, depression and hypertension. These are also having a huge impact not only
his physical well-being but also his mental and spiritual health.
Shaw et al. (2016) stated that it is a very common phenomenon that medication for anti-
depressants can lead to weight gain too so the CN needs to find ways so that Peter can reduce
these medications. In order to do that Peter needs to be socially active and cannot confine
himself in his house. He needs to go out and talk to people which will help him to fight with his
depression and bring in confidence in himself. Sleep apnea and obesity have got several
symptoms such as lethargy, breathlessness, feeling sleepy during the day, headache and also
depression (Shenoy, Seixas & Grandner, 2019). It is the duty of CN to primarily improve the
OHS or OSA condition of Peter and then only he can be motivated in working out and reducing
his body weight. According to Kanellakos & Brodsky (2019), short term goals are considered to
be one of the effective ways in intervening diabetic patients and once Peter can achieve these
short term goals then he can opt for alternative medications or treatments for weight gain,
depression and insomnia. Peter can also enroll in social groups that will not only help him to take
care of his health but also help him to communicate with other people. This will promote active
social life for Peter and keep him motivated to take care of his health. These small goals will
boost confidence in him and with time can help him to improve his connections with his family.
To conclude this paper has discussed deeply the causes, effects and interventions of stage
2 diabetes such as sleep apnea, obesity, depression, hypertension and others. The study has
elaborated how CN can actually help these diabetic patients, Peter, in this case, to justify and
take care of two complex medical issues that are diabetes and weight gain. Community Nurse
has a very important role in taking care of the patients and bringing them back to a healthier
lifestyle where they can take care of themselves.

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