Levett-Jones Clinical Reasoning Cycle Application: Peter Mitchell Case

This report presents an analysis of the case study of Peter Mitchell, a patient with type-2 diabetes, obesity, sleep apnea, and other health complications. It applies the Levett-Jones Clinical Reasoning Cycle, a framework for structuring clinical care, to assess the patient's situation, collect and process information, identify care priorities (overweight condition and uncontrolled diabetes), establish goals (weight loss and lifestyle changes), and take actions to achieve these goals. The report details nursing interventions such as lifestyle modifications, dietary adjustments, exercise programs, and patient education. It also outlines an evaluation process to measure outcomes, including weight change, diabetes control, and mental status. The report concludes by reflecting on the effectiveness of the clinical reasoning cycle in managing this complex case and highlights its systematic approach to clinical scenarios. The report provides a comprehensive plan for managing the patient's health issues, emphasizing the importance of lifestyle changes and patient involvement.

PARTNERSHIP IN CHRONICITY

Introduction
Levett-Jones Clinical Reasoning Cycle is a process that reflects the importance
of personalization and prioritization of patient’s needs. This reasoning cycle is used to
structure clinical care by healthcare professionals (Herdman, 2011). This clinical
reasoning cycle helps to deliver patient-centered nursing care based on the critical
thinking, clinical analysis, clinical reasoning and reflective practice performed by
professional healthcare nurse (Alfaro-LeFevre, 2012). This essay is one such patient-
centered nursing care structure developed by using Levett-Jones Clinical Reasoning
Cycle. The study involves identification of two care priorities and managing care
process by a primary health care nurse for the provided case study, which is
performed by implementing reasoning cycle steps.
Clinical reasoning cycle
1. Considering patient situation
In the present case study, patient name Peter Mitchell is a middle aged male
(52 Years) admitted to the medical ward as per reference from his General Physician.
He was facing symptoms of shakiness, increased hunger, high blood glucose,
diaphoresis and breathing difficulties while sleeping. As he is a sufferer of type-2
diabetes and obesity, these symptoms highlight high alert of these two conditions.
Peter is already overweight, diabetic suffering depression. Peter is a serious smoker
from age of 30years, smoking 20 cigarettes per day. Adding on to this situation, Peter
suffers other critical situations as well, that involves hypertension; sleep apnoea and
gastro oesophageal reflux. Peter is taking proper medication for his health issues but
still, he is facing these critical and life-threatening symptoms due to mismanaged
lifestyle habits.
2. Collecting cues and information about the case
Review current information
As per case information Mr. Peter on his previous admission to medical ward

dietician recommended him to lose weight. However, Peter had no interest to make
any effort related to his weight resulting in present critical condition. Further, he was
also commenced with light exercises by the physiotherapist and was advised to
continue them at home. But the increased weight and BMI show his carelessness
towards his physical condition.
He is 145kgs with BMI 50.2m2 (very high) and height 170cms. His last
observed blood pressure is 180/92mmHg (high), respiratory rate 23Bpm (high), heart
rate 102bpm (little high) and SpO2 (peripheral capillary oxygen saturation) is 95%
(normal). Peter is on current medication involving insulin metformin for diabetes,
Lisinopril for hypertension, Nexium for reflux, metoprolol for high blood pressure
and Pregabalin (Lyrica) for neuropathic pain in diabetes. Further, Peter is unemployed
and struggling to get work reason being his weight issues. He is divorced, living
alone, socially isolated, living without any family attention and care. Peter also faces
difficulty to perform daily living activities.
Gather new information
The present admission of Mr. Peter Mitchell to the medical ward was due to
poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was
detected with the symptom of high blood glucose level instead of the fact that his
medication involves Insulin (34units mane & 28units nocte). Audetat et al. (2013)
indicated that if a patient confronts high blood glucose levels despite the fact that
insulin is included in medication process indicates mismanagement in medication
(insulin) process. According to Selvin et al. (2014) studies improper intake of insulin
leading to high blood glucose level also persists symptom of increased hunger. This
confirms that high blood glucose level is leading to increased hunger symptom in
Peter’s case and he is mismanaging his medication process.
Further, shaking and diaphoresis is due to obesity ventilation syndrome.
Cunningham, Kramer & Narayan (2014) indicated that obesity ventilation syndrome
leads to sleep apnoea identified by difficulty breathing while asleep interrupted sleep
and daytime sleepiness. In the present case, Peter is facing cessation of breathing
while asleep confirms presence sleep apnoea due to obesity syndrome.
Recall knowledge
In the present case of Mr. Peter Mitchell, three identified critical diseases that
are type-2 diabetes, obesity ventilation syndrome and sleep apnoea are either directly

or indirectly linked to each other. Olsson et al. (2013) indicated that mismanagement
in the lifestyle of diabetic patient leads to deposition of fat in the body that lead to a
highly obese body as a major defect. Audetat et al. (2013) studied that if the blood
glucose level of diabetic people remains abnormally high this then leads to the
stoppage of blood glucose entering body cells. Therefore, the body becomes incapable
to convert food to energy leading increased hunger and increase in obesity. Further,
American Diabetes Association (2015) paper highlights that high blood sugar leads to
deposition in form of fat in the body.
Further, Cunningham, Kramer & Narayan (2014) studied that deposition of
adipose tissue in the state of obesity restrict the normal movement of chest muscles
and diaphragm creating difficulty in breathing by respiratory muscles. Hence, obese
people find it difficult to breathe creating obesity ventilation syndrome that causes
shortness of breathing while asleep which is a major symptom of sleep apnoea.
3. Process information
Interpret
As per present case study data, Mr. Peter Mitchell is a seriously heading
towards a critical stage of diabetes and obesity only at middle age period of life. He
certainly needs a proper care plan to get a control over this critical health issues
basically lifestyle modification because symptoms like shortness of breathe, high BPL
level and diaphoresis are really dangerous and abnormal conditions.
Discriminate
All the information provided in the case study is relevant and shows some link
to understand the critical state of Peter’s health. However, not much attention is made
on the impact of other health issues like hypertension, reflux and depression on the
health of Peter considering it as a gap in case information.
Relate
As per nursing professional knowledge, mental health issue like depression
can be considered as a major cause of the lifestyle mismanagement in Mr. Peter’s life.
His careless attitude towards his health (obesity), social isolation, joblessness and
unwillingness to improve his health can be considered as outcomes of mental
disturbance (depression) (Herdman, 2011).

Infer
As per the study conducted of case data till now it is clear that nursing care
goals should completely be based on managing the lifestyle habits and controlling
obesity in case of Peter. This lifestyle management will also involve objective to
manage the critical situation of diabetes harnessing his health.
Match
The present case of Mr. Peter Mitchell suffering critical obesity and diabetes is
a common phenomenon. It is a common disease for which care providers carry a good
experience to handle these situations because the control over these issues mainly
depends on the lifestyle, eating, activities and mental strength of the patient (Doenges,
Moorhouse & Murr, 2014).
Predict
The condition of Mr. Peter Mitchell is really critical as the body weight is
145Kg with BMI above 50. It is tough to manage his obesity issues yet proper goal
setting could help to get a control over critical symptoms leading to medical
emergencies.
4. Identification problems/issues
The two major care priorities in case of Mr. Mitchell are his overweight
condition and uncontrolled diabetes type 2. Peter is not even ready to pay any
concentration or control his growing complication related to obesity and diabetes
(Moorhead et al. 2014).
5. Establishing goals
The two care priority issues are obesity and mismanagement of diabetes in Mr.
Peter’s care. The nursing goals are: -
Decreasing body weight by 10% within 6months of therapy (1/2 lb/week)
Establishing and practising appropriate lifestyle behaviour change for controlling
diabetes

6. Taking actions
For the fulfilment of nursing goal regarding weight loss of 10% in 6 months
involves certain specific interventions. Yang & Zhang (2014) studied some specific
nursing actions that provide effective weight loss which is considered best for Peter’s
case as well. Implement rewarding and reinforcing short-term goals for patient
followed by negotiations regarding patient’s aspects of diet that require modifications.
Balance the dairy and animal protein intake in the diet as well as provide diet as per
measurements. Advise and encourage water intake as well as long-term exercise
programs like walking that is best for a diabetic patient (Stellefson, Dipnarine &
Stopka, 2013). Further, keep a proper monitoring of patient weekly weight changes
and modify diet as per requirement. Lastly, educate the patient about healthy eating
habits like short meals 5-6times/day, high intake of fibre, regular exercise, relaxation
techniques and maximised water intake.
As per provider case study data of Peter, the best lifestyle behaviour change in
his case involves practices to quit smoking, practising relaxation, social liberation and
replacing the unhealthy behaviour with substitutes (Cygan et al. 2014). According to
Thom et al. (2013) studies self-rewarding, communication with the patient,
motivational counselling and interviewing ate some of the best processes to
implement lifestyle changes. Lastly, providing education regarding diabetes and its
control can also help Peter to overcome his issues related to depression (Doenges,
Moorhouse & Murr, 2014).
7. Evaluate Outcomes
The evaluation process will involve determining the weight change and
achievement of determined weight loss goal by detecting weight after 6 months of
therapy. Further, lifestyle behaviour change can be evaluated by determining the
control over health issue diabetes and obesity. Lastly, mental status examination
(MSE) can be performed to evaluate the mental strength after the nursing process
(Kalyani, Corriere & Ferrucci, 2014).
8. Reflecting on the process and new learning
The clinical reasoning cycle process can be considered as most systematic,
manageable and comfortable approach to deal with any clinical scenario in nursing

professional practice. As a professional, implementing such process to resolve an
issue or case can benefit to gather smart, workable and manageable outcomes. Using
clinical reasoning cycle made its easy to deal with this complicated health
management case.
Conclusion
A proper nursing plan to manage the case study patient Mr. Peter Mitchell was
developed using clinical reasoning cycle. This involved analysis of patient situation
followed by collection and processing information to detect health priority issues.
Further, establishing nursing goals and taking actions to achieve these goals handled
these health priority issues. Lastly, the process to evaluate care outcomes is also
provided in the study to further establish better processes for effective care.

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