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Social and Medical History of Peter Mitchell

This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions.

Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification.

Peter Mitchell is a 52-year-old male with type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping. Peter has been a smoker for approximately 30 years and smokes approximately 20 cigarettes per day.

On his previous admission, Peter was seen by a dietician and commenced on low energy, high protein diet (LEHP) to assist with weight reduction. His GP had previously discussed weight loss with Peter, however, he had never wanted to do anything about it as it seemed ‘too hard’. Peter was also reviewed by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.

Peter has been discharged home with a referral to you as the community nurse for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities.

Social History

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

Consequently, because of his weight issues, Peter has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is a divorcee who lives alone, his two sons live in the same state but live in different cities and rarely visit him. He has increasingly become socially isolated as he is embarrassed by his size. Peter is also finding it increasingly difficult to perform activities of daily living (ADLs). Peter realises that he is in the prime of his middle age life and is motivated to lose weight and quit smoking but isn’t sure where to start.

Medical History

Obesity - weight 145kgs

Type 2 diabetes (Diagnosed 9 years ago)

Hypertension

Sleep apnoea

Gastro oesophageal disease reflux disease

Current Medications

insulin Novomix 30 B D (34 units mane & 28 units nocte)

metformin 1000mg BD

lisinopril 10mg daily

Nexium 20mg daily

metoprolol 50mg BD

pregabalin 50mg nocte

Social and Medical History of Peter Mitchell

As per the given scenario, Peter Mitchell is a patient who is suffering from type 2 diabetes and he is a 52 year old person. He was admitted into the hospital with poorly controlled diabetes, obesity and other health related issues. It is observed that Peter has been a smoker for around 30 years and he smokes 20 cigarettes in a day due to which he is suffering from the type 2 diabetes and another health disease. The aim of this essay is to analyse the situation of Peter and identify key factors that increase the problem of type 2 diabetes and obesity in peter. This essay also focuses on the priorities of care and the clinical reasoning cycle in order to improve the health of peter and reduce chronic situations.

According to the case study, peter was admitted in the hospital for reducing the impact of type 2 diabetes and doctors suggested high protein diet in ord3er to reduce weight and his GP has discussed weight loos with peter. After four weeks the peter was admitted into the medical ward for controlling and managing their weight. Mainly, peter is an unemployed person that receives government benefits and he lost his job three years ago. According to the peter statement he has always been a biggish person with his normal weight sitting at almost 145kg which is very high and it is one of the common key factors that increase the problem of obesity in peter (Czech, 2017). During medical treatment doctors provided numbers of medicines to peter for reducing the issue of type 2 diabetes and overweight for example, insulin novomis 30 B D, metformin 1000mg BD, Lisinopril 10mg daily, pregablin 50mg and many more.

From the given scenario, it is identified that peter is suffering from various kinds of health diseases, for example, obesity, type 2 diabetes, hypertension, sleep apnoea and gastro oesophageal disorder. He is a smoker which is another key element that increases the rate of chronic conditions and he does not follow any exercise plan due to which their weight crosses the 145kg. According to body mass index if any person has more than 105kg weight then he/she can suffer from overweight or obesity related problems (Rubino, et al., 2016). Moreover, Peter does not eat healthy foods and take a high level of sugar that increase the problem of type 2 diabetes and he is diagnosed with type 2 diabetes and obesity health issues.

Factors Contributing to Peter's Chronic Conditions


According to the world health organization, the term obesity is defined as the chronic condition which affects the functions of the human body (Yassour, et al., 2016). Such kind of problem occurs due to major two factors, for example, lack of physical activities and poor diets. Peter is diabetes and obesity patient that faces both these disorders because of improper treatments. Santos, & Lima, (2016) identified that smoking can increase the weight of an individual and it also affects the lungs and other parts of the body. Cancer is one of the best examples that occur due to smoking and peter smokes more than 20 cigarettes in a day due to which he is diagnosed with obesity and reflux disease.

The problem of type 2 diabetes also increases other health issues in patients such as cardiovascular, COPD, obesity and blood cancer (Zaccardi, Webb, Yates, & Davies, 2016). High blood pressure is also a very important factor for increasing the rate of type 2 diabetes in peter and it can be reduced by using physical activities and exercise. Moreover, it is suggested that the family members of Peter should motivate him for doing exercise and physical activities on a regular basis for managing their weight and disorders. As per the given case, peter is also finding it increasingly difficult for performing activities of daily living and he realises that he is in the prime of his middle age life.

Due to lack of motivation and experience peter is not able to reduce their weight and in previous treatment, doctors provided enough information about chronic disorders. In order to control and manage the issue of obesity and type 2 diabetes, there are many priorities of care available which can be adopted by the peter. It is observed that principles of care and priorities of care provide a platform to the patient for controlling and managing the health related disorder in an effective manner (Chávez-Talavera, Tailleux, Lefebvre, & Staels, 2017).

For the given scenarios there are major two kinds of priorities of care can be used, for example, peter’s views of the significance of the issue for their lives and the specialist’s views of the significance of the issue for peter’s care. Or in other words, the first priority of care is to follow healthy food and physical activities and the second priority of care is to communicate with doctors and take proper treatment or therapies. In the first priority care, peter can follow the proper dietary plan and exercise plan in order to reduce their weight. Currently, the weight of peter is around 145kg that lead to the issue of obesity and he should take only healthy foods and fruits for reducing their weight.

Priorities of Care for Peter Mitchell

According to Reeves, Zaki, & Day, (2016) if any person takes proper exercise and dietary plans and follows on regular basis then he can increase their health and reduce chronic diseases by 50%. However, family members or nurses can motivate peter for taking the proper dietary plan and eating only healthy foods in order to reduce their weight. Peter should reduce smoking because it also plays a major role in the development of diabetes. The second priority of care is to communicate with a specialist and take proper treatment and therapies in order to maintain their health and reduce the level of chronic disorders.  


It is observed that many doctors suggest healthy foods and physical activities and they also provide some medicine for reducing their weight (Hunter, & Arthur, 2016). So, peter can follow the proper guidance and take medicine on a regular basis that can improve their health in an effective manner. Moreover, nurses and doctors can collect the views of peter and analyse their health issues by understanding their situation. it is observed that peter is suffering from numbers of health disorders and doctors can suggest some key factors that increased the rate of chronic disorder in peter. They can deliver a large level of treatment and therapies for managing the level of obesity or type 2 diabetes.

It is identified that the functions of the specialists in health communities contain several elements such as health promotion, detection of health issues in patients and implementation of the treatment processes. It is suggested that the development and implementation of the priorities of care should include a few steps, for example, facilities, techniques, nursing care for promoting healthy diets and exercise plans and many more.

After analysing and understanding the situation of peter the clinical reasoning cycle can be used and applied in order to reduce the problem of type 2 diabetes and obesity. With the help of clinical reasoning cycle, the issues and chronic diseases faced by peter can be controlled and monitored. There are major eights stages involved in the clinical reasoning cycle for understanding and evaluating the patient’s disorders such as consider the patient problem, collect information, process information, identify issues, establish goals and targets, take action, evaluate results and reflect on the process (Delany, & Golding, 2014).


At the time of initial stage of clinical reasoning cycle, the nurse and doctor begins to contain the first impression of the patient and determine silent features of the situation (Forsberg, Ziegert, Hult, & Fors, 2016). For peter, nurses can apply this step and identify the silent features of Peter's problems. In the second stage, the nurses and doctors can collect relevant facts and information about the peter’s disease and collect viewpoints of the peter. After collecting information, nurses can process information and data and evaluate the issues faced by peter. With the help of this step, nurses can understand chronic disease faced by peter and analyse key factors that increase the problem of diabetes and obesity in peter.

Application of Clinical Reasoning Cycle to Manage Peter's Chronic Conditions

The fourth stage is to identify the problem where nurse and specialist can identify the issues faced by peter and synthesise information and inference to make a definitive nursing diagnosis. In the next stage, the nurse can establish goals and targets for implementing treatments and therapies on peter in order to reduce the impact of chronic disease from the body. Such kind of process helps nurse for describing what they want to implement and process for implementing strategies on peter. In the next step, the nurse can identify and select a course of action between the various alternative available (Gummesson, Sundén, & Fex, 2018).  Moreover, they can select an appropriate technique for reducing the problems and diseases faced by peter.


Evaluate outcomes is another stage of clinical reasoning cycle where a nurse can re-examine aims and subjective data in order to evaluate the processes used by nurses during treatment. By using this stage, the nurse can evaluate the outcomes and results after implementing strategies on peter. The last stage of the clinical reasoning cycle is reflecting on the process which can be used by nurses in order to review their practice with a view to refinement. By using this step, nurses can compare the health of peter and reduce peter’s disorder more effectively.

This essay focused on peter’s chronic condition and identified the key factors that increased the problem of type 2 diabetes and obesity in peter. It has been concluded that healthy foods and physical activities play a major role in the reduction of diabetes and obesity. This essay also identified two priorities of care for improving the health of peter in an effective manner and applied the clinical reasoning cycle to reduce chronic disorders and problems. It has been suggested that peter should take the proper dietary plan and follow physical activities which can help them for improving their health more effectively.

References

Chávez-Talavera, O., Tailleux, A., Lefebvre, P., & Staels, B. (2017). Bile acid control of metabolism and inflammation in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease. Gastroenterology, 152(7), 1679-1694.

Czech, M. P. (2017). Insulin action and resistance in obesity and type 2 diabetes. Nature medicine, 23(7), 804.

Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC medical education, 14(1), 20.

Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing the progression of clinical reasoning through virtual patients: An exploratory study. Nurse education in practice, 16(1), 97-103.

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 29-34.

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions. Nurse education in practice, 18, 73-79.

Reeves, H. L., Zaki, M. Y., & Day, C. P. (2016). Hepatocellular carcinoma in obesity, type 2 diabetes, and NAFLD. Digestive diseases and sciences, 61(5), 1234-1245.

Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti, K. G. M., Zimmet, P. Z., ... & Amiel, S. A. (2016). Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Surgery for Obesity and Related Diseases, 12(6), 1144-1162.

Santos, R. M. M., & Lima, D. R. A. (2016). Coffee consumption, obesity and type 2 diabetes: A mini-review. European journal of nutrition, 55(4), 1345-1358.

Yassour, M., Lim, M. Y., Yun, H. S., Tickle, T. L., Sung, J., Song, Y. M., ... & Lander, E. S. (2016). Sub-clinical detection of gut microbial biomarkers of obesity and type 2 diabetes. Genome medicine, 8(1), 17.

Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. The postgraduate medical journal, 92(1084), 63-69.

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