Clinical Reasoning Cycle for Long-Term Patient with Type II Diabetes

Long-term patient condition (Type II diabetes) Figure: Phases of clinical reasoning cycle Patient introduction • John Smith is a 63 years old retired individual who lives alone since the death of his wife due to road accident. • He is currently experiencing a delay in his wound healing process (in left ankle) and went to GP recently and he prescribed him some clinical assessments which he has not done yet.. • Some other symptoms were headache, fatigue, frequent urination, anxiety and confusion. • All the current vital signs of the patient are: Heart rate: 84 bpm, respiratory rate: 18 bpm, SpO2: 96, Blood pressure: 144/70, Body temperature: 98.2 F. • The patient was diagnosed with type II diabetes 3 years before. Patient’s background • Since the death of his wife, Mr. Smith becomes completely alone and he needs to do all his regular activities by himself. • In order to cope with anxiety and stress he smokes 7-10 cigarettes each day and consume alcohol. • As he can not cook daily, he needs to depend on a maid who cook for him regularly. • He has not habit of physical exercise and he lost all his social connections since after demise of his wife. • His father was died due to sudden heart attack. He had a comorbidity of type II diabetes. • Physical: Current physiological complications including headache, confusion, fatigue and frequent urination. • Social: He has no such social connection and depends on a maid. • Psychological: Confusion and mild- deorientation . • Cultural: He has no cultural activities, participation and interest. • Spiritual: The person is spiritual and has belief in god. • Economic: The patient has financial stability and belong from good economic background. • Family: No family members Cues and information Process information and problems identification • All the current clinical and physical symptoms of the patient indicates the worsening of diabetic conditions. . • Since the demise of his wife, he has not followed any pharmacological and non-pharmacological suggestions given by his general practitioner. • On-going stress and social-detachment have negative impact on the progression of blood sugar. The current condition hence, may be responsible for physiological deterioration. • Delay in wound healing process also indicates the progression of type II diabetes. • Therefore, the further assessments and nursing care plan will be based on the given patient report and information obtained from the patient in interview. Specific goal for the patient • The first goal is to assist John Smith for self-monitoring blood glucose level as it is an evidence-based approach, suggested to the patients suffering from diabetes to monitor their blood sugar level on a regular basis. • The second goal is to assist the patient for behaviour change approach; as according to evidence, behaviour change intervention is considerably effective in managing blood glucose level. • The third goal is to monitor signs of hyperglycaemia, as uncontrolled blood glucose level and irregular lifestyle in the patients who are already suffering from type II diabetes, often increase the risk of hyperglycaemia and associated complications. Action against the goal • Proper education is to be given to Mr. Smith on the utilization of blood sugar measuring device. • The patient is to be encouraged for participating in group activities and social events to increase his socialization; as socialization has a positive impact on emotional stability. It also reduces stress and anxiety. Therefore, it would be beneficial for reducing the progression of the illness. • Mr. Smith is to be encouraged for participating in physical activity and physical exercise program as mild to moderate physical exercise has a significant benefit on blood sugar management. • Proper education is to be provided to Mr. Smith on healthy diet and the significance of it on the management of type II diabetes. Dietary intervention is an evidence-based non-pharmacological therapeutic approach of type II diabetes. • The risk and/or the occurrence of hyperglycemia can be addressed by monitoring the HbA1c range in blood. Urine blood glucose analysis can also provide significant data in identifying the condition. Reflection • I came to learn following the scenario of John Smith that type II diabetes is a long-term condition that affects a person in different terms including physically, mentally, socially and economically. • Irregular lifestyle and improper follow-up of physician’s suggestion and pharmacological and non-pharmacological interventions can worsen the situation even more. • Diagnosing a long-term condition in right time and taking appropriate clinical decision to manage the progression of the condition is very essential. • By doing this assessment, I newly learnt about non-pharmacological interventions which are considered very effective in reducing the progression of the illness. Reference Kalra, S., Jena, B. N., & Yeravdekar , R. (2018). Emotional and Psychological Needs of People with Diabetes. 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