NRSG366 Case Study: Clinical Reasoning & Diabetes Care Priorities

This case study analyzes the care of Peter Mitchell, a patient with type 2 diabetes and several comorbidities including obesity, hypertension, and sleep apnea. The study identifies two primary care priorities: managing comorbid conditions and smoking cessation. It discusses the impact of comorbidities on diabetes management and quality of life, emphasizing the need for a balanced approach to treating both diabetes and related conditions. The case study also addresses the risks associated with smoking and proposes interventions such as nicotine replacement therapy and psychotherapy to help the patient quit. The importance of considering the patient's socioeconomic status and individual characteristics in developing a personalized care plan is highlighted. The paper concludes by emphasizing the need for further research on the management of comorbidities and smoking cessation in diabetic patients, with the aim of improving their overall health and quality of life. Desklib is a great platform for students to find similar case studies and solved assignments.

Running head: DIABETES word count: 1583
Student name
Student No.
Unit
Title: Care for Type 2 Diabetes Patient

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There are different factors that influence the delivery of quality health care to
patients with chronic health infections. There is therefore need for health care
professionals to offer their care services depending on the patient and the clinical
needs. The nurses have to incorporate the patient’s needs so as to come up with
sufficient and effective medical intervention and also to deliver a quality care. This
makes the patient’s need an integral part in care delivery. This paper looks into how
to integrate the patient’s needs in the care delivery process. It would present a
detailed discussion, justify and analyse some care priorities while applying the
clinical reasoning cycle. Peter Mitchell, a patient admitted for type 2 diabetes is said
to show signs of shakiness, diaphoresis, increased hunger, high levels of BLG and
experienced breathing complications especially when asleep. Peter has been
smoking for over 30 years, consuming an approximate of 20 cigarettes a day. His
medical history showed that he was obese (145 kg), had hypertension, sleep
apnoea, gastro oesophageal disease and diabetes mellitus which had been
diagnosed about 9 years ago. The paper will come up with identify the patient’s
problems, two care priorities, identify goals of on how to address these priorities then
evaluate the effectiveness of the are priorities.
Diabetes mellitus is a chronic disease constituting of a serious health issue
due to the increase in its prevalence (Moser, Van der Bruggen, Widdershoven and
Spreeuwenberg, 2008). Diabetes mellitus is caused by the inability of the body to
normally use the insulin secreted in the body. Insulin is a hormone secreted by the
pancreas and it controls the body sugar level. Type 2 diabetes is a result of insulin
not controlling the sugar levels in the body and therefore the glucose levels shoot.
Peter being a type 2 diabetes patient, it is important to deal with the comorbid
infection that come along with diabetes mellitus. These include obesity,

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hypertension, gastro oesophageal disease and sleep apnoea. According to Luijks et
al. (2015), the best way to attain control over any type of diabetes is preventing any
diabetes related infections and the CVDs. However, a patient with many comorbidity
would not benefit much from blood glucose control as some research shows that it
reduces 5 years of cardiovascular events (Greenfield et al., 2009).
Some researcher such as Voorham et al. (2012) reported contradicting
findings concerning the effect of comorbidity on type 2 diabetes. They claim that
comorbidity has benefits on diabetes mellitus and no negative effects are linked to
these comorbid diseases as far as type 2 diabetes is concerned. However, their
study was faced with a couple of limitations including, their study time was little,
about 6 months, their selection of the comorbid infections was unclear and their
study samples did not reflect the general population. Adriaanse, Drewes, Van der
Heide, Struijs and Baan (2015) argue that comorbid infection and complications are
the primary determinants of the quality of life a type 2 diabetes patient can live.
Sometime the patients suffer from non-diabetes related comorbid but their effect is
less as compared to the diabetes related comorbid (Laiteeropong et al. 2011).
Comorbidities affect the patient’s ability to undertake their self-care and also creates
barriers to their lifestyle. According to the International Diabetes Federation (2013),
the study on the relationship between comorbidity and their effect on type 2 diabetes
patient is limited. Laiteerapong, Haung and Chin (2011) call for more research on the
comorbid infections due to the prevalence of diabetes patients with comorbid
infections.
Struijs, Baan, Schellevis, Westert and van den Bos (2006) think that comorbid
conditions are associated with a lot of health care consequences among diabetes
patients. Comorbid infections increase the health care cost as well as making health

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care utilization intense. For a type 2 diabetes patient with comorbid conditions, they
should be prescribed with constant care. As the nurse in charge of Peter I have to
visit him almost every day to check on his progress. Reducing and preventing further
comorbidity would be my priority in caring for this patient, as this would improve the
quality of his life regardless of the type 2 diabetes. I would also come up with a
patient management scheme that balances the diabetes mellitus care and the
comorbid conditions treatment. For anyone to do this, there is need to understand
the pathophysiology, how these diseases affect one another, risks of their treatment
and the effect of their treatment on the quality of life of the patient. This therefore call
for massive research on these comorbidities. I would also come up with a more
comprehensive care tool to help manage and coordinate the care for these
infections. I would also involve the patient as much as possible in the care process
(Versnel, Welschen, Baan, Nijpels and Schellevis, 2011).
As the nurse in charge of Peter, finding a way for him to quit smoking is
important, smoking would worsen his condition. Smoking is a risk factor to many
chronic infections. The Korean Diabetes Association recommended stopping
smoking as among the most crucial steps in curbing the effect of CVDs effects on
diabetes (Ko et al. 2011). Although it is claimed that smoking reduces body weight, is
linked with central obesity. It also affects oxidative stress and increasing body
inflammation of the body, damaging the normal functioning of β cells and impairing
the functions of the endothelium (Chang, 2012). In Korea, 50 percent of men are
smokers which has been associated diabetes cases in the region. According to a
study by Cho et al. (2009), cigarette smokers are at a higher risk of contracting type
2 diabetes mellitus, with this risk being proportional to the number of cigarettes one
smokes in a day. For the case of Peter, he would smoke around 20 cigarettes a day,

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which could be the cause of the type 2 diabetes. For individuals smoking 20 or more
cigarettes a day are even at a higher risk of type two diabetes according to Jee,
Foong, Hur and Samet (2010). There is no much research done on why smoking is a
risk factor of diabetes and how it affects glucose homeostasis but some evidence
claim that there is an increased resistance on insulin action for smokers (Seet et al.,
2012). Smoking is thought to suppress glucose uptake by about 40 percent. Away
from resistance of insulin action, smokers having type 2 diabetes are prone to
atherosclerosis and also showed low levels of high density lipoprotein cholesterol
(Xie, Liu, Wu and Wakui, 2009).
Smoking increases the risk for CVDs in both diabetic and non-diabetic
individuals. In fact smoking is an independent risk factor for cardiovascular
infections. Smoking also increases the chances of stroke in diabetic people though it
is not as much as for cardiovascular diseases. (Prasad and Cucullo, 2015).
Therefore, smoking is not a safe practice for Peter. Since there is no a safer way to
smoke, the only way to lower the risks of smoking on Peter is by quitting the
behaviour (Torre, 2013). Stein et al. (2014) also think that quitting smoking is the
best reduce the effects of comorbid infection for diabetic patients. Aubin et al. (2012)
claim that quitting smoking leads to weight gain. Some researchers including Yeh at
al. (2010) say that this could be a reason to discourage from quitting smoking as it
benefits could less that the effects that would come along with quitting this habit.
Some studies claim that quitting smoking could worsen glucose metabolism, though
this remains a field for more research. Being his nurse I plan to help him quit. This
could start by cutting on the number of cigarettes he consumes in a day. Smoking
being a chemical and a behavioural activity, replacing it a healthier habit could help. I
would encourage him to do more exercises which would help in the glucose

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metabolism and reduce obesity. Though it does not work for all smokers, Peter will
try the nicotine replacement therapy (Stein et al., 2014). I will also recommend him to
a psychotherapist. Psychotherapy would help Peter understand why he smoke and
why he should quit it (Mogensen, 2013). It would also give him emotional support on
the challenges associated with quitting smoking.
According to the description on Peter, he is living in poverty. He had lost his
job some time ago and he depends on government help. To add on this he lives
alone, though he has two sons. This makes him difficult to even carry out his daily
activities. Peters, Huxley and Woodward (2014) claim that knowledge of the patient’s
characteristics such as their socio-economic status, sex and BMI (Souto-Gallardo,
Bacardi-Gascon and Jimenez-Cruz, 2011) are crucial in diabetes prognosis. These
characteristics help up with an individualized care plan.
Being Peter’s nurse I choose to deal with comorbid diseases and smoking.
Comorbidity is associated with most of the consequences that occur to type 2
diabetic patients. Since comorbidity not only worsens the patient’s health but also
makes the patient unable to manage self-care and also adhere to treatments,
dealing with them would much improve the health conditions of the patient. Smoking
on the other hand is a risk factor of most of these comorbid diseases and also the
diabetes mellitus itself. Dealing with these two would improve Peter’s quality of life.
This would make him live a better life regardless of him living alone. The effect of
smoking and comorbid diseases are not well dealt with and therefore more research
on these fields would be crucial.

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