ACU NRSG366 Assessment: Prioritizing Care for Chronic Conditions

This case study analyzes the healthcare needs of a 52-year-old patient, Peter, with Type 2 diabetes, obesity, sleep apnea, and other chronic conditions, admitted to a medical ward. The essay explores the importance of prioritizing patient care based on clinical and individual needs, focusing on the role of a community health nurse. It identifies dietary assessment and self-care education as two crucial priorities of care, supported by nursing concepts and evidence. The assignment emphasizes the application of the clinical reasoning cycle, including assessment, planning, implementation, and evaluation, to ensure effective management of chronic conditions. The document provides a comprehensive overview of the patient's medical history, medications, and lifestyle factors, highlighting the impact of these factors on his health and wellbeing, while emphasizing the importance of nurse support and education in promoting self-management and improving health outcomes. References from American Diabetes Association, Colberg, Scott, and others are included to support the discussion.

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Nursing
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The essay brings about the discussion on the analysis of healthcare needs of the
patients or individuals under the chronic conditions in context to the nursing. The basic need
of any patient may include psychological need, protective need, spiritual need, and the need
of effective care and treatment provided by the health professionals. Therefore, it states about
the objectives of primary care of any health delivery system, to ensure effective health
services to the patients (Coppell et al., 2017). The discussion of the patient care needs will be
carried out based on the given case study, enlisting specifically two priorities of care with the
application of appropriate nursing concepts and evidences. Thus, essay will enlist some major
principles of managing care of the chronic patients, for improvement in their health and
wellbeing.
The case represents about a 52-year old patient, Peter living with Type 2 diabetes
admitted to the medical ward, suffering through the uncontrolled poor health due to few other
health problems, such as obesity ventilation syndrome and sleep apnoea. A wide range of
signs or symptoms affected the patient, and his employment issue or financial instability has
one reason behind increased weight. Observing the medical history of the patient, Peter
several aspects has identified as obesity, Type 2 diabetes, and hypertension, sleep disorders,
and Gastro oesophageal disease reflux disease (Pinto et al., 2016).
However, peter was currently on the medications such as insulin Novomix 30 B D (34
units mane & 28 units nocte) metformin 1000mg BD lisinopril 10mg daily. Furthermore, the
increased body weight of Peter leads him towards further problems making it difficult to find
for the work, and affects his social relationships with the people. This is evident from the
case, as it has found that Peter felt isolated and he faced difficulties performing the daily life
activities. Thus, it describes the factors influencing the care of chronic health patients, as the
case stated the issues of unemployment, and increased weight, which may affect the care of
the patients. Hence, it is essential to understand the implications of poor health and
recommend two priorities of care to ensure positive change in the health condition (Srisawat
et al., 2017).
The role of nurse is crucial to ensure support to the patients living with the Type 2
diabetes, and other chronic health illness. In a healthcare setting, there is a crucial role of the
community or diabetes specialist nurse in providing good patient care, along with promoting
self-care of patient (Mosadeghrad, 2015). Thus, it is essential for the nurse to take care of the
patient’s health and provide support through effectively communicating with them, and

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educating towards the medications, or Intake of the food (American Diabetes Association,
2016). Therefore, two main aspects of the priorities of care enlisted below:
First priority of care for the patient of the diabetes, as in this case refer to dietary
assessment as per the illness or disease. Being a community nurse it becomes a responsibility
to keep a check on the patient’s diet and ensure that proper and healthy food is being
consumed (Freund et al., 2015).
There are some of the basic principles that a nurse educates to the patients or give
information to the Type 2 diabetics, regarding food to be taken. Nurse will provide the
information to the patient, here in the case i.e. Peter as he is also facing the problem of
obesity. The patient need to follow healthy diet, and must eat carbohydrates from fruits,
vegetables, whole grains, low fat, or non-fat milk, so the person must choose healthy
carbohydrates. Moreover, the nurse will need to make sure about the calorie intake of the
person, i.e. patients with the Type 2 diabetes, generally put on a 1500 to 1800 calorie diet per
day to promote the aspect of weight loss (Scott et al., 2016).
As this has been evident through the case that peter need to focus on the reduction of
his weight, as this led to the chronic health condition. This is because with the help of
exercise, and dietary assessment or nutrition as one priority of care, Peter will be able to work
effectively and attain positive health outcomes, and it also states about the foods to avoid
such as fruits, orange, melon, apples, bananas, and grapes, and vegetables includes carrots,
greens, and others. Therefore, there are number of different ways the patient must involve, in
self-care towards making change in diet will facilitate in prevent, or delay the diabetes
(Colberg et al., 2016).
Self-care education and counselling is another priority of care through the aspect of
nursing in context to the diabetes, and other chronic health illness. A nurse makes the plan
with the GP, through the perspective of patient, for encouraging the patient, Peter into self-
care to effectively manage the issue of diabetes, and other chronic health problems. The plan
for the self-care or management states that the Peter must self-monitor the blood glucose on
daily basis, both pre-prandial and post-prandial. In addition, he must consider adjusting the
insulin dose, and the food intake. Thus, it is the primary role of nurse to care for patients with

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the chronic illness, educating them about the self-management of the disease, and lead them
towards the development of health (Pinto et al., 2016).
Self-care behaviours include healthy eating habits, being active, monitoring, taking
medications, and other aspects, which lead to improvement in diabetes. Therefore, in context
to the case nurse play a vital role in encouraging the patient towards motivating the person
towards adopting healthy eating habits. As Peter in the case has found that increased weight
has been a major reason behind the diabetes, and other health problems so this states about
engaging self-management for improvement in health. Self-behaviour indicates involve in the
clinical reasoning cycle has been described as the process by which nurses obtains the
information, regarding the health of individuals, interventions, and leading to positive
outcomes of the patients (Gray, 2015).
The clinical reasoning cycle include aspects such as, collect, process, decide, plan,
act, evaluate, and reflect the nursing process to ensure the achievement of the goal for health
of the patient. In respect to the case, the nurse will contribute by analysing the medical
history of the patient, and other issues of the health condition. Then, through building
therapeutic alliance, they will attain effectiveness in bringing a change in the health of the
patient. Nurse in the healthcare will undertake the assessment of the patient, and discussing
the plan with GP. GP or general practitioners or other health experts or diabetes specialist
will facilitate determining the suitable course of action or treatment plan. Hence, it has been
understood that the aspects of self-care or management, in context to any chronic disease or
illness play a vital role towards improving the health of the individuals (Powers et al., 2017).
To conclude the above discussion it has been analysed that diabetes is one of the
major health issue amongst the individuals or adults in the later years of life. The above case
has represented well the aspect of health and illness, with the illustration of many factors such
as obesity, influencing the diabetic patients. Moreover, the essay has described well two
priorities of care undertaken by the health professionals and role of nurse ensuring care to the
patient. These were the two aspects, which will further lead to an improvement in the health
and overall wellness of the Peter, patient as given in the case study.

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References
American Diabetes Association. (2016). Standards of medical care in diabetes—2016
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 34(1), 3.
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ...
& Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of
the American Diabetes Association. Diabetes care, 39(11), 2065-2079.
Coppell, K. J., Abel, S. L., Freer, T., Gray, A., Sharp, K., Norton, J. K. & Whitehead, L. C.
(2017). The effectiveness of a primary care nursing-led dietary intervention for
prediabetes: a mixed methods pilot study. BMC family practice, 18(1), 106.
Freund, T., Everett, C., Griffiths, P., Hudon, C., Naccarella, L. & Laurant, M. (2015). Skill
mix, roles and remuneration in the primary care workforce: who are the healthcare
professionals in the primary care teams across the world?. International journal of
nursing studies, 52(3), 727-743.
Gray, A. (2015). Nutritional recommendations for individuals with diabetes. In Endotext
[Internet]. MDText. com, Inc..
Mosadeghrad, A. M. (2015). Developing and validating a total quality management model for
healthcare organisations. The TQM Journal, 27(5), 544-564.
Pinto, J. A., Ribeiro, D. K., da Silva Cavallini, A. F., Duarte, C., & Freitas, G. S. (2016).
Comorbidities associated with obstructive sleep apnea: a retrospective
study. International archives of otorhinolaryngology, 20(02), 145-150.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H. & Vivian,
E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint
position statement of the American Diabetes Association, the American Association
of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes
Educator, 43(1), 40-53.
Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M.
& Kawakami, N. (2016). Association of mental disorders with subsequent chronic

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physical conditions: world mental health surveys from 17 countries. JAMA
psychiatry, 73(2), 150-158.
Srisawat, K., Shepherd, S., Lisboa, P. & Burniston, J. (2017). A systematic review and meta-
analysis of proteomics literature on the response of human skeletal muscle to
obesity/type 2 diabetes mellitus (T2DM) versus exercise training. Proteomes, 5(4),
30.