Prioritizing Nursing Care: Case Study of Peter Mitchell's Needs

This nursing case study focuses on Peter Mitchell, a 52-year-old male patient admitted with morbid obesity, type 2 diabetes, and related complications. The assignment analyzes his medical history, including hypertension, sleep apnea, and smoking, to prioritize his care needs. Utilizing the clinical reasoning cycle, the essay identifies and discusses two key priorities: weight reduction and blood glucose control. The solution details a comprehensive nursing care plan, including dietary interventions, exercise recommendations, and medication management, alongside patient education and psychosocial support. The effectiveness of interventions is evaluated, with a reflection on the care process to identify challenges and guide future actions. The case study highlights the interconnectedness of the patient's health issues and emphasizes the importance of evidence-based nursing practice in achieving positive patient outcomes.

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Case Study One-Peter Mitchell
Chronic health conditions are multifactorial in nature and the care process by nurse must
involve the clinical and patient needs. The treatment outcomes are affected by multiple factors
and the nurse must be aware of different factors affecting the patient’s health (Helgeson &
Zajdel, 2017). The essay deals with the case study of Peter Mitchell are a 52 year old male with
morbid obesity and type 2 diabetes. The aim of the essay is to prioritize the patient needs for care
integrating the different aspects of patient needs. Prioritization refers to use of clinical reasoning
and decision making skills to design care process that can avoid adverse outcomes (Urden, Stacy
& Lough, 2015). In reference to the chronic condition presented in the case study, the essay will
identify and discuss two priorities of care while applying the clinical reasoning cycle by Levett-
Jones. It is a non-linear process to analyse the series of contributing and predisposing factors. It helps
develop goal driven patient care (Dalton, Gee & Levett-Jones, 2015).
The clinical reasoning cycle involves eight stages, where the first stage is “consideration of
patient’s situation” (Dalton, Gee & Levett-Jones, 2015). In the given case study Peter, 52 year old
male is admitted to the medical ward with morbid obesity and type 2 diabetes. The patient is
presented with the poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. The
second stage of the clinical reasoning cycle is “collection of cues and information”. In this stage the
patient’s current information is reviewed using case history, previous assessment and new
information is collected through further assessment (Dalton, Gee & Levett-Jones, 2015). The
patient history shows obesity and type 2 diabetes, hypertension, sleep apnoea and depression. The
patient also has history of gastro oeasophageal disease reflux and smoking (for 30 years). The
patient was previously on high protein diet to reduce weight. Peter had difficulty coping with the

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weight loss. He was instructed for light exercises by his physiotherapist. As per the patient social
history, he lost his job due to insulin therapy. His weight gain, obesity and diabetes interfered with
his occupations and that added to his fatigue and other health issues. Overweight is also interfering
with his activities of daily living, and may have increased risk of apnoea. It added to socially
isolation. He lives alone and lacks emotional support, which may also be the cause of stress and poor
health. However, the patient is motivated to quit smoking and lose weight with appropriate
supervision. The patient’s assessment results showed BP 180/92mmHg, height 170cms, Weight
145kgs, HR 102 Bpm, Sp02 95% on RA, RR 23 Bpm. The handover informs different medications
for abnormal vital signs and diabetes. The untreated condition may increase the risk of cardiovascular
problems and other comorbidities (Koolhaas et al., 2017).
An important part of clinical reasoning cycle refers to “processing of information”. It
involves interpreting the information, relating with the clinical knowledge to prioritize care (Dalton,
Gee & Levett-Jones, 2015). It will better help to prioritize the care. The weight and height of the
patient indicates a BMI of 50.2, which much greater than the normal range of 30, indicating
obesity (Mark & Somers, 2016). Obesity is associated with ventilation syndrome and sleep
apnoea. It may be the cause of upper airway obstruction that is causing the episodes of shallow
breathing, when sleeping. Smoking also results in airway obstruction and apnoea (Krishnan et
al., 2014). The patent may be immediately provided with oxygen. It may increase the risk of
further health deterioration. Hypertension may be due to high blood pressure and increased heart
rate. If untreated it may worsen diabetes as the patient is obese, which also influences blood
pressure (Heymsfield & Wadden, 2017). Increase in respiratory rate, blood pressure, high
glucose level may increase the risk of heart failure or collapsibility of pharyngeal tract. Excess
adipose tissue restricts the movement of diaphragm and that of chest muscles (Mark & Somers,

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2016). Altogether it may affect the inhalation, exhalation as well as heart rate. It is essential to
reduce weight of the patient as fatty tissue in excess amount may increase vascular resistance.
Diabetes also increases blood pressure and hypertension by predisposing arteries to
arthrosclerosis. It may increase the risk of kidney failure, stroke and other health issues (Cheung
& Li, 2012). Social isolation and smoking may further increase the risk of anxiety and
depression (Choi & DiNitto, 2014).
The main problem or health issue of the patient can be identified by synthesizing facts and
inferences (Dalton, Gee & Levett-Jones, 2015). The main health issue of the patient, from the
above analysis, is clearly obesity and diabetes as they are linked with all the other presenting sign
and symptoms. The adverse symptoms such as hypertension, high blood glucose level, diaphoresis,
or abnormal seating are common in obesity and uncontrolled diabetes. Obesity increases insulin
production for compensating high glucose level. It increases the type 2 diabetes and sequentially
appetite, weight gain. Diabetes is also associated with shakiness and diaphoresis. Unusual sweating
or diaphoresis is common symptom in overweight and obese individual. Hypertension is also
observed in both obesity and diabetes people but the later has greater influence on the hypertension
(Heymsfield & Wadden, 2017). Therefore, the signs and symptoms are common in both diseases
like a cyclical pathway. Intervention is immediately required to decrease obesity and control
diabetes. It will consequently improve his activities of daily living and social life.
Applying clinical reasoning cycle, establishment of goals that will yield desired health
outcomes in the patient is important part of care process (Dalton, Gee & Levett-Jones, 2015). The
two priorities for nursing care is reduction in weight and control the blood glucose level. I will do
this by developing comprehensive nursing care plan that is patient centered and evidenced based.

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Taking action based on evidence will ensure positive health outcomes as per clinical
reasoning cycle (Dalton, Gee & Levett-Jones, 2015). To fulfill the first priority of reducing the
weight of Peter, a realistic weight reduction plan will be formulated, along with appetite reduction
and diet plan. It will be initiated on collaboration with dietician. Peter will be given a weekly
weight loss protocol. The diet plan will include high protein and low fat consumption. The
patient will be monitored for ignoring the signals of hunger or track any distortion. The rational
for this lifestyle intervention is decrease in hypertension and cholesterol with protein intake. A
weight loss by ten kg may have positive impact on the cholesterol and blood pressure as per
Nanditha et al., (2016). Further physical activity is essential for overweight individual. It will
help reduce weight every month and enhance the metabolic rate. The patient may be
recommended for aerobics as it puts lest pressure on joints. Swimming is also considered better
than jogging and walking. Involving in physical activity for 30 minutes for five days in a week
will help the body mange sugar level by improving sensitivity to insulin (Koolhaas et al., 2017).
The patient will be supported with education to encourage him to lose weight. Peter will
be educated about healthy diet and need of high protein consumption in present condition. To
patient may be administered with the anti-obesity medication. Orlistat is another affective
medicine for BMI greater than 30 kg/m2 in decreasing the absorption of dietary fat by 30%. It
will help reduce weight and associated complications. It may include glycosidase inhibitors,
metaformin or insulin therapy (Bedhiafi et al., 2018). The pharmacological interventions will be
initiated by collaborating with the general physician attending Peter.
To control the glucose level, which is the second nursing priority metaformin may be
continued as it was previously administered. Further blood pressure can be controlled by
administering metaprolol (Yang et al., 2018). Medication will be administered as per the

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instructed dosage. Patient education is also important to self monitor glucose and for self-
management of complications due to obesity and diabetes. The patient will be educated to cope
up with the mental health concerns associated with weight loss program. The patient may be
encouraged to stop smoking as it elevates blood sugar in diabetes patients. Referring to cognitive
behavioural therapist may be effective to help Peter manage stress due to lifestyle interventions
specially Smoking cessation. Further, the effect of smoking on his respiratory efficiency and
Heart rate will be explained. It will relive him of fatigue (Lycett et al., 2015). The rationale for
educational intervention is to encourage client in adopting healthy behaviour.
The effectiveness of the outcomes must be evaluated as per the knowledge of clinical
reasoning cycle (Dalton, Gee & Levett-Jones, 2015). The patient’s weight will be monitored daily.
It is important to assess his understanding of the illness and treatment procedure to ensure
compliance. The patient’s vital signs will be assessd to rule of any side effects of medications and
modified diet. The patient will be monitored for deviations in exercise, nutrition and diet
recommendations. The client is expected to demonstrate reducing weight as per plan and healthy
eating. The patient is expected to self monitor glucose and show high self esteem in coping with
complications. It is also important to assess for hyperglycemia condition (American Diabetes
Association, 2015).
Reflection on the care process is the last stage of the clinical reasoning cycle that involves
contemplating on the caring and learning process (Dalton, Gee & Levett-Jones, 2015). It may be
difficult for client to adhere to dietary recommendations in initial phase of treatment as he lacks
emotional support. The patient also has low self esteem due to poor body image. To address the
challenges I will engage client in motivational therapy and group discussions to promote social
connectedness (Harvey, 2015). Further, challenges will be identified to prioritize future action.

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The essay helped learn ways to identify patient health issue and prioritize care for Peter using
clinical reasoning cycle. Identification of health issues assisted in prioritizing care. The tool helped in
collecting and analyzing the clinical information. Analysis facilitated the understanding of factors
underlying the Peter’s health’s complications. Prioritizing the care guided the development of
adequate nursing interventions. The interventions to reduce weight and control glucose level in
patient are based on evidence. It will help to address the priority issues and promote the patient
health.

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References
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