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Introduction to Clinical Reasoning Cycle

Question:

Discuss About The European Guidelines Management In Adults?

Clinical reasoning cycle can be described as the procedure by which healthcare professionals are able to collect cues from the patient’s situation, process the information and thereby come to an understanding about the patients’ situation. This cycle then helps to plan and implement various types of interventions and evaluate the outcomes of the interventions (Yumuk et al., 2015). The nursing professionals would then reflect on the experience and develop learning and knowledge from the entire cycle to enhance their skills. In the present assignment, the clinical reasoning cycle would be used to assess the situation of the patient named Peter and develop ideas about his health requirements. Depending upon them, two health priorities would be identified and managed accordingly. This would provide opportunities to Peter to lead better quality lives.

The patient’s name is Peter Mitchell who is 52 years old and lives alone. He is divorcee and his two sons live in different cities and visit him rarely. He is obese and has poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. He is a chain smoker and takes approximately 20 cigarettes per day. He is suffering from depression and is feels embarrassed about his weight. He has socially isolated himself. The patient is suffering from the chronic conditions of obesity with a BMI of 50 that indicates his obsess condition. He is suffering from type-2 diabetes for 9 years.


His weight and diabetes need to be maintained and this is the first priority. In case of Peter, his ill-managed condition of obesity had made him develop type-2 diabetes. Even after occurrence of diabetes, he did not control his diet efficiently, which had made him exposed to various risks. He had developed obesity hypoventilation syndrome also called the Pickwickian syndrome. In case of peter, severe weight gain had resulted him to fail miserably in breathing rapidly or even deeply enough (Patel et al., 2015). This had resulted in low blood oxygen levels and high blood carbon-dioxide levels. Such cases also resulted him to suffer from sleep apnoea where he suffered from short breathing sessions where individuals stop breathing altogether for short times during sleeping (Villablanca et al., 2015). This puts pressure on the heart and therefore Peter is highly vulnerable to develop heart disorders. Researchers are of the opinion that abdominal fact causes fat cell to release a specific chemical called the “pro-inflammatory chemical. This can make the body less sensitive to the action of the insulin that the body produced to control blood sugar level (Uerlik et al., 2016). This mainly takes place due to disruption of the function of the insulin responsive cells of the body by the pro-inflammatory chemical released by fat cells. Therefore, although insulin is present in the system, the cells show insulin resistance thereby resulting in occurrence of type 2 diabetes. Researchers also give theories where they state that being overweight stresses the membranous network inside the cells known as the endoplasmic reticulum (Ross et al., 2015). When these networks have more nutrients for processing than they can successfully handle, these networks start sending alarming signal telling the cells to slow down or dampen the insulin receptors of the cells present on the surface. Because of this, the cells become resistant to insulin as blood sugar level increases.

Case Study: Health Priorities for Peter


From the entire discussion in the previous step, one can conclude that his weight and calorie intake needs to be managed to successfully control is chronic disorder or obesity and diabetes. Health literacy would be his main care plan. He should be well educated about both weight and diabetes management for ensuring healthy life. Peter should be properly educated about the disorders he has. The nurse should develop health literacy about the pathophysiology of obesity and diabetes in Peter. Both these chronic situations are poorly controlled which had resulted in the present strenuous situations of obesity ventilation syndrome as well as sleep apnoea. He has not been able to manage proper diet as well as insulin medication administration successfully and therefore his symptoms have aggravated and his weight had continued to increase at a rapid rate. He is severely depressed now as he is being immensely depressed of his “huge size”. Huge weight of the body had resulted him in now suffering from obesity hypoventilation syndrome as well as sleep apnoea. In the present, he has poor management of diet. He also does no not have proper ideas of diabetes management. Moreover, he is still smoking at an alarming rate that might have dangerous heart and lung disorders excessively increasing chances of hypertension symptoms. All these need to be managed properly so that Peter can develop better quality lives. The healthcare professionals should also ensure that Peter develop self-motivation and self-alignment with the interventions. She would need to empower Peter so that he tends to follow the programs successfully. The nurse should develop weight-loss maintenance program. There should be five important segments of the program. This should be self-monitoring of the weight on a regular basis. The second component would be consumption of low fat diet and the third would be to uptake daily physical activity for approximately sixty minutes (Reges et al., 2018). The fourth would be minimal sedentary “screen time” and the fifth would be consumption of home cooked meals only. The nurse should keep in mind that Peter has very low self-determination and confidence. However, he understands the need for the program to develop his social bonding. Therefore, proper counseling needs to be done for Peter where his self-determination would be ensured. Peter should be set with easy goals first and then gradually, his activities should intensify. This would help him to follow the program and align with the components accordingly. Proper diabetes educator would be assigned to him. She would develop his literacy and would evaluate his practical skills in assessing is blood sugar levels, taking of medication of proper time and in proper ways (Bray et al., 2018).

Another priority area is his symptoms of hypertensions. The vital signs show that he has blood pressure of about 180/92mmHg. This blood pressure is far higher than the normal blood pressure of individuals that should be 120/80mmHg. Therefore, he has severe risks for heart attacks, stroke and many others. Therefore, his blood pressure should be kept under control. However, Peter has a habit of smoking excessively high levels of cigarette that is the biggest risk factor for his high blood pressure symptoms (Cusman et al., 2016). Researchers are of the opinion that nicotine in cigarettes is the main contributor of the disorder. They have high contribution in raising blood pressure and heart rate. Nicotine mainly causes narrowing of the arteries that hardens the wall of the arteries. This situation results in making the blood undergo clotting which stresses the heart and exposes individuals for heart attack and stroke. Researchers are of the opinion that smokings as well as secondhand smoking both increase the risk for building up of fatty substances called plaque inside the arteries (Falachetti et al., 2014). This situation is called the arthrosclerosis (Kumar et al., 2015). Hence, in order to protect Peter, the second priority area would be controlling his smoking habits and maintaining his blood pressure level. His smoking habit is affecting his health by increasing the blood pressure. This would make him vulnerable to heart disorders. Therefore, smoking habits and blood pressure needs to be controlled.

Weight and Diabetes Management


For managing his hypertension, a proper checklist would be prepared for him along with educating him to take proper initiatives to keep the blood pressure under control. Besides, taking medications in regular manner, he should be instructed to lose his extra weights, exercising regularly, eating a healthy diet and reducing sodium in his diet (Jafar et al., 2016). Stopping on the intake of caffeine and reducing stress are the other initiatives that he should take. He should be taught about how to check his blood pressure level so that he can understand his status effectively. Quitting to smoking is the most important intervention that he should uptake to reduce his levels of blood pressure. Proper counseling should be done by substance abuse counselors who would first make it sure that he is himself self-determined to leave smoking for his health (Gamfi et al., 2017). Proper counseling would help him to develop self-motivation, determination and enthusiasm.  He should be advised to take up nicotine replacement therapy. This therapy contains strategies like reducing general withdrawal symptoms, reducing the reinforcing effects of tobacco-delivered nicotine (De et al., 2014). It would also help to exert some psychological effects on his mood and attention states. Nicotine replacement products can also be ensured like Nicotine inhaler, Nicotine lozenge, Sublingual nicotine tablet, Nicotine nasal spray and others. After Peter has undertaken the initiatives, he would be advised to visit the healthcare centers where further evaluation would be done. This would ensure whether the initiatives are working or he needs modification of the initiatives or better outcomes (Omboni & Ferrari, 2015). Following this, the healthcare professionals may reflect upon the practices that would help them to learn from the events and thereby enhance their skills and knowledge. Moreover, he should involve fish in his diet and he sold have meals which are low on salt. These would help reducing his blood pressure. Moreover, he should also perform swimming, jogging and brisk walking so that he could control his Bp. Moreover, he should be taught how to measure bp so that he can monitor his own BP and notify if the level is found beyond normal limit.


From the entire discussion, it becomes clear that Peter has two priority areas. One of them is their ill-managed weight and diabetes that had made him vulnerable to life threatening situations. Moreover, his hypertension is also another priority area and his excessive smoking habit has aggravated the risk of him suffering from heart disorders. Therefore, this is another priority area that needs to be attended. Therefore proper weight management programs and hypertension management programs should be introduced to the patients. Nicotine replacement therapy is another initiative. All these would ensure better quality life of Peter.

References:

Bray, G. A., Heisel, W. E., Afshin, A., Jensen, M. D., Dietz, W. H., Long, M., ... & Hu, F. B. (2018). The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocrine Reviews.

Cushman, W. C., Whelton, P. K., Fine, L. J., Wright, J. T., Reboussin, D. M., Johnson, K. C., & Oparil, S. (2016). SPRINT trial results: latest news in hypertension management. Hypertension, 67(2), 263-265.

De, S. G., Ruppar, T., Berben, L., Schönfeld, S., & Hill, M. N. (2014). Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 9(9), 1102-1109.

Falaschetti, E., Mindell, J., Knott, C., & Poulter, N. (2014). Hypertension management in England: a serial cross-sectional study from 1994 to 2011. The Lancet, 383(9932), 1912-1919.

Gyamfi, J., Plange-Rhule, J., Iwelunmor, J., Lee, D., Blackstone, S. R., Mitchell, A., ... & Cooper, R. (2017). Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study. BMC health services research, 17(1), 104.

Jafar, T. H., Allen, J. C., Jehan, I., Hameed, A., Saffari, S. E., Ebrahim, S., ... & Chaturvedi, N. (2016). Health education and general practitioner training in hypertension management: long-term effects on kidney function. Clinical journal of the American Society of Nephrology, CJN-05300515.

Kumar, N., Khunger, M., Gupta, A., & Garg, N. (2015). A content analysis of smartphone–based applications for hypertension management. Journal of the American Society of Hypertension, 9(2), 130-136.

Omboni, S., & Ferrari, R. (2015). The role of telemedicine in hypertension management: focus on blood pressure telemonitoring. Current hypertension reports, 17(4), 21.

Patel, D. (2015). Pharmacotherapy for the management of obesity. Metabolism-Clinical and Experimental, 64(11), 1376-1385.

Reges, O., Greenland, P., Dicker, D., Leibowitz, M., Hoshen, M., Gofer, I., ... & Balicer, R. D. (2018). Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality. Jama, 319(3), 279-290.

Ross, R., Blair, S., de Lannoy, L., Després, J. P., & Lavie, C. J. (2015). Changing the endpoints for determining effective obesity management. Progress in cardiovascular diseases, 57(4), 330-336.

Uerlich, M. F., Yumuk, V., Finer, N., Basdevant, A., & Visscher, T. L. (2016). Obesity management in Europe: current status and objectives for the future. Obesity facts, 9(4), 273-283.

Villablanca, P. A., Alegria, J. R., Mookadam, F., Holmes, D. R., Wright, R. S., & Levine, J. A. (2015, April). Nonexercise activity thermogenesis in obesity management. In Mayo Clinic Proceedings (Vol. 90, No. 4, pp. 509-519). Elsevier.

Yumuk, V., Tsigos, C., Fried, M., Schindler, K., Busetto, L., Micic, D., ... & Obesity Management Task Force of the European Association for the Study of Obesity. (2015). European guidelines for obesity management in adults. Obesity facts, 8(6), 402-424.

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