NRSG366 : Nursing Case Study Assessment - Clinical Reasoning Cycle

Nursing Case Study Assessment

Case Scenario/ Task

Multiple factors influence the care of patients with chronic conditions. As a PrimaryHealth Care nurse, it is important that care given is prioritised based on bothclinical and patient needs. Prioritisation of the patient needs for care is integral todaily nursing practice. This requires integrating and collaborating different aspects ofpatient needs in order to maximise care activities and the effectiveness of nursinginterventions.

This case study is designed to demonstrate the integration of various principles ofmanaging care of patients with chronic conditions. Students will be expected toidentify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycleto these as a means of justification. Please refer to the subject outline and markingrubric when answering this question.

Case scenario

Peter Mitchell is a 52 year old male with morbid obesity and type 2 diabetes whowas admitted to the medical ward with poorly controlled diabetes, obesity ventilationsyndrome and sleep apnoea. Peter was referred by his GP after he presented withsymptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficultybreathing whilst sleeping. Peter has been a smoker for approximately 30 years andsmokes approximately 20 cigarettes per day.

On his previous admission, Peter was seen by a dietician and commenced on lowenergy, high protein diet (LEHP) to assist with weight reduction. His GP hadpreviously discussed weight loss with Peter however he had never wanted to doanything about it as it seemed ‘too hard’. Peter was also reviewed by thephysiotherapist and was commenced on light exercises which he was to continue athome on discharge.

Peter has been discharged home, with referral to community care unit for ongoingsupport and follow up, after four weeks in the medical ward to manage his weightand clinical comorbidities.

Past medical history

• Obesity (weight 145kgs with a BMI of 50.2m2).
• Type 2 diabetes (Diagnosed 9 years ago)
• Hypertension
• Depression (Diagnosed three months ago by GP).
• Sleep apnoea
• Gastro oesophageal disease reflux disease

Social History

Peter is an unemployed male who receives government benefits. Peter lost his jobthree years ago as a fork lift driver at the Moranbah coal mine in far NorthQueensland. Peter states that he has always been a ’biggish guy’ with his ‘normalweight’ sitting at around 105kg but since starting insulin and losing his job he hasgained a significant amount of weight.

Consequently, because of his weight issues Peter has difficulty finding workdue to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is adivorcee who lives alone, his two sons live in the same state but live in differentcities and rarely visit him. He is socially isolated because he isembarrassed by his size and he rarely goes out. Peter is also finding itincreasingly difficult to perform activities of daily living (ADLs). Peter realises thathe is in the prime of his middle age life and is motivated to lose weight and quitsmoking but isn’t sure where to start.

Current Medication

• Insulin Novomix 30 B D (34units mane & 28units nocte)
• Metformin 500mg BD
• Lisinopril 10mg daily
• Nexium 20mg daily
• Metoprolol 50mg BD
• Pregabalin (Lyrica) 50mg nocte

Last observations on discharge

• Weight 145kgs
• Height 170cms
• BP 180/92mmHg
• RR 23 Bpm
• HR 102 Bpm
• Sp02 95% on RA

The current study deals with the case study of an individual who have been suffering from type 2 diabetes. The person is a morbid obese individual who have been recently admitted in a hospital with issues like uncontrolled diabetes, syndrome of obesity ventilation and sleep apnoea. Peter has been discharged from t6he respective hospital suggesting him to take the help of community care unit so that there can be continuous monitoring of his heath issues. He also has been asked to follow up after 4 weeks so that then doctors would be able to keep a check on the weight and the clinical issues that he had been suffering from. Care of Peter had to be taking with focus so that he could recover from the symptoms that have shown even after treatment. Moreover, he had been living alone so there had been no one to take care of him. He had been socially isolated with his sons living far away from him.

Discussion

The two priorities of care that have been considered for the case person Peter are Availability and Coordination. The two priorities that have been selected have been done according to the situation that we can receive from the case study. Being a lonely person, the individual had always been lacking motivation to work hard for the reduction of the right which has been causing health issues (Diabetes Prevention Program Research Group, 2015). Therefore, coordination and availability would be the priority of Peter in case of receiving care from the caregiver. This would help him to recover from the issues that he had been suffering from. With the availability of the care giver and coordination, Peter would be able to get the best of the recovery that was expected from the treatment.

The clinical reasoning cycle would be effective in justifying the use of the two priorities of care for the betterment of the individual in the case study (Dunkley et al. 2014). The cycle has 8 steps which would be effective in explaining or justifying the selection of the priority for peter. The very first step involves the consideration of the case of Peter. The very first thing that the care giver has to know is the case history of the patient. This would be easy for the individual to handle if there is regular meeting with the patient. This would help the nurse to gather information with experience (American Diabetes Association, 2015). With the availability of the nurse in the premises of the Peter, it would be easy to understand the medical history of Peter. Also, it would be easy to understand the psychological aspect of the Peter better when there is better communication with the individual. Therefore, selection of this priority would help Peter in communicating and opening up with the regularly visiting nurse. Peter has been living alone since he is a divorcee and his sons live far away in distant cities. Therefore, with the visiting nurse, it would be easy intervention to know the detail about Peter and establish a better relationship with him. With the third stage, the nurse would be effective in interpreting the medical case along with the data collected as well as develop a bond between the two easily. Since the nurse would be available most if the time every day, it would be easy for the nurse to identify the exact health issue of Peter and deal with the symptoms. Therefore, it would be easy for the nurse to instruct the patient to take the necessary step. In the fifth stage, it would be easy for the nurse to decide on the goal to as in treatment for Peter for a specific time so that effective result can be gained (Scheen & Van Gaal, 2014). This setting up of the goal can be easily done as the nurse would be available regularly for to the patient and would be able to monitor the improvements that have occurred due to the medication that has been selected. After setting up of the goal, it would be easy for the nurse to select the suitable method through which the treatment would be provided to Mr. Peter. After the selection of the suitable method, this would be easy for the nurse to apply to Peter as it would be easy to monitor. Even Peter would be motivated to follow all the medications and work on the issues that he has because of the presence of the nurse (Evert et al. 2014). He had been demotivated due to the loss of job and family. With the regular visiting, it would be easy for the nurse to keep an eye on the actions or the results of the treatment that have been given to Peter. Also, it would be easy for the nurse to reflect on the evaluation of the treatment that has been meted out to Peter. This would be learning process for the nurse and would be able to develop the service that would be provided to the next case patient. This would again lead to the considering the case of Peter and the manner in which the treatment was provided to him. Therefore, this cycle continues and the nurse is able to enrich the learning process.

Professional role of the nurse to provide coordination to Peter would help him to get rid off from the situation (Brown et al. 2016). Along with the obesity, Peter is facing some mental problem as he has lost his job and family. This would create another problem in the mind of the patients. Coordinating attitude of the nurse is needed in order to improve physical and mental welling of Peter. Strict diet must be followed by the patient of diabetics. As the nurse is involved with food and medicine of Peter therefore, it is would be necessary for nurse to maintain strict diet chart of Peter. The clinical factor and health associated factor of a patient can be managed through the active collaboration of nurse. Therefore, the nurse would be very strict to maintain her responsibility to maintain health and safety of Peter. Nurse’s role is included in support about the health and nutrition of the patients (Hollis et al. 2014). In this way Peter should be provided that food that is high in nutritious value but less contain of fat. Peter is chain smokers that indicate the possibility of his asthmas in future (Hockenberry et al. 2016). Therefore, the nurse should provide diet to Peter that can not contain allergenic substance. Apart from this , it can be said that weight measurement related information must b known by be nurse that help her to maintain strict diet chart of Peter. Among other coordination, make Peter motivated to think positive about his life is the major role of the nurse. Excessive is the major part in maintaining good health. In this way the nurse should take initiative motivate Peter to do some free hand exercise (Jensen et al. 2014). This process has positive impact on the health and safety of Peter. Nursing is the practice that involved with the process of providing support to the patients. In this way the coordination of support should be given to Peter in order to make him happy. In this way, Peter should not be blamed for his past that has created this situation. Peter is mentally weak due to the loss of job and family. With the regular coordination, it would be easy for the nurse to keep an eye on the actions or the results of the treatment that have been given to Peter. The nurse should be very much concern about the stigma of the patient as he is very frustrated for his overweight and the deed that he has done in future (Yacoub et al. 2014). Furthermore, it can be said that Peter should given friendly attitude from the nurse in order to deal with the health and wellbeing of the patient. Apart from this, it can be said that the process of medical facility that has positive impact in the process of managing of health and safety of the patient (Garber et al. 2017). Apart from this it has been said that the process of managing health and safety of the patient. The most significant factor that comes under the role and responsibility of the patients is that is provide scope to Peter get rid off from the situation. Weight management is considered as one of the most duty that the nurse has to play in order to maintain health and safety of the patient. Apart from this, it can be said that the nurse is involved to maintain diet chart of Peter to make him normal.

Conclusion

The clinical reasoning cycle has become an effective tool for the nurses in making the best decision in the decision making process. This is considered to be significant for the healthcare professionals as they are able to communicate with the patient and get the best reflection that they can have from the implementation of the treatment process on them. For the specific case study, the patient has been given the priority of coordination with the nurse along with availability so that it becomes easy for the patient and the nurse to communicate with each other. This way it would be effective for both of them to make the best of the efforts. Peter would benefit from the service of the nurse since the nurse would be available regularly for the effective service. This would also give effective learning process for the nurse. With the utilizing of different priorities of care, it becomes easy for the nurses to take care of the patients and help them recover.