Clinical Reasoning Cycle - Nursing Assignment Sample

Subject Name : Nursing

TITLE CLINICAL REASONING CYCLE

Clinical reasoning cycle (CRC) has a significant role in developing safe and effective practice in nursing. The nurses use the clinical reasoning cycle as a basic component of clinical nursing and it also helps them to maintain professional accountability. The basic nature of the CRC facilitates the nurses to get engaged in the critical thinking process and enhance their decision making. The studies have indicated that the nurses who apply CRC while caring for their patient have a positive impact on the health outcome of the patient. Moreover, in the nursing practice, the community services nurses specifically focus on developing and implementing short and long term goals while providing care for the patient. Moreover, the multiple numbers of the complication has a greater impact on providing of patients care and improving the chronic condition. In this case study, Peter Mitchell is a geriatric patient who is suffering from various medical issues like type 2 diabetes mellitus (T2DM), and overweight for which he has been referred to care home of community services for managing his health condition and other associated co-morbid factors. Moreover, patient prioritization while providing care to the patient is an essential part of the nursing practice. Thus this study will further discuss the application of CRC specifically in case of the patient and design the care based on two nursing priorities.
According to the case study, Peter Mitchell, 52-year-old, male, admitted to hospital due to several problems like sleep apnoea, T2DM, and obesity ventilation syndrome. Currently, he is unemployed and thus receives various government benefits. Before three years he worked as a forklift driver for at Moranbah coal mine in the Northern Queensland. He was also reported to be a chain smoker for the last 30 years and use to smoke 20 cigarettes every day. He was also divorced and stayed alone. He had two sons but they stayed in different cities. Previously, he was assessed by the physician for managing his problem of overweight and T2DM. The physiotherapist also instructed that he must do physical exercise daily but he did not follow it. The medical condition of the patient clearly indicates that he requires losing weight and needs to control his unchecked diabetic condition. His further care was to be taken by a nurse at the community center who will also provide him adequate support, and routine follow-up at home. At present, the patient is also self-motivating for giving up his habit of smoking and losing weight. However, he finds it difficult for initiating the process of his own.
Peter has a history of T2DM from last nine years. He is also facing the problem of obesity and has a weight of 145kg. Moreover, the patient has a medical history of hypertension, sleep apnoea, gastro-oesophagal reflux disease (NYU Langone Health, 2019). His current medical assessment also indicated that he had the problem of shakiness, increase in hunger, high blood glucose level, difficulty in breathing while sleeping, and diaphoresis. The current medication prescribed to the patient includes Novomix, Metformin, Nexium, Metoprolol, Lisinopril, and Pregabalin. Moreover, for combat with the problem of heavyweight he was suggested to be on low energy high protein diet (LEHP). As he stays alone he also feels isolated and is very uncomfortable about his size. His history showed that he has been lethargic and always remained biggish guy with an approx weight of 105 kg. This was also the reason for quitting his previous job. He also felt that he have gained weight significantly since he started taking insulin for controlling his T2DM. However, the decreased use of insulin leads to an increase in his blood glucose level. The study also indicates that insulin therapy aids in decreasing microvascular complication. However, the problem of weight gain due to insulin intake here adversely affects the diabetic condition and cardiovascular mortality and co-morbidity condition (Brown et al., 2017). Moreover, the patient suffering from the metabolic complications likes T2DM often tend to have other complications like overweight which make managing the problem quite challenging nature. Moreover, the appearance of such complication also restricts the patient from performing day to day activities (ADLs). The problem of obstructive sleep apnoea has been found to be associated with the problem of increased insulin resistance condition in the body. Additionally, the obesity ventilation syndrome is associated with the complex interaction of various pathological conditions which also include respiratory difficulties, functional impairment, diminished breathing, sleep-related breathing complication, etc.
After processing of all the information related to clients past history, social life, medical history, and medication, this was found that his problem of obesity and smoking was the reason which made him more prone to the poorly controlled diabetic condition. This was analysed that the client requires assistance related to loosing weight on a priority basis. This will require doing regular exercise and giving up the habit of smoking. Thus his increased weight and uncontrolled blood sugar level was the area which requires monitoring on a priority basis. Moreover, during the medical examination, other deteriorated health conditions were due to the intake of prescribed medication. The intake of metformin has known to cause the sleeping related problem in the patient which includes sleep apnoea and insomnia. Moreover, the studies have indicated that sleep apnoea is affected by the glucose metabolism which is also known to cause inhibition in metformins function that acts as weight decreasing agent (Kabir et al., 2011). Moreover, the appearance of all of these conditions is a clear indication that the quality life of the patient is widely compromised due to which nurse will require to apply critical thinking for providing the provision of care. The isolated condition and unemployment is the additional reason which causes stress in the case of Peter. Moreover, stress is directly associated with adverse health outcome among individuals (Mhlisen et al., 2017). The habit of smoking is also related to the increased problem of smoking. Moreover, heavy smoking is associated with the problem of sleeplessness, increased shakiness, and hunger. Both smoking and obesity is also related to the development of gastro-oesophageal reflux disease condition. Thus it is very necessary to consider all of these factors so that patient can lose weight and control his blood sugar level. Moreover, quitting smoking will be also important aspects of the well-being of the patient. The studies have also shown that overweight is one of the signification factors that is responsible for causing hypertension among the patient (Hall et al., 2015).
Therefore, the two main problems or issues identified in case of Peter after his discharge from hospital will be to manage his problem of obesity and quit smoking which is the major cause of the poorly controlled diabetic condition.
The two nursing priorities established for improving the health status of the client will include modification in the lifestyle of the client that can be achieved by helping the client to lose weight. The second priority will be to help the client to quit smoking so that the client can efficiently manage the symptoms of T2DM and other associated problems like restlessness and sleeping issues (Nagrebetsky et al., 2014). Here in this case study, Peter is suffering from high blood sugar level from a longer period of time so management of the weight is quite difficult in this case. Thus the weight management will take several immediate measures modification in nutritional intake of the client, in cooperation of regular exercise and motivating the client to practice it on a daily basis. As client has been mentioned light exercises, he will now need to incorporate it in his daily life so that it could be effective for the purpose of weight loss. Moreover, regular physical activity will aid in the burning of the significant amount of the calorie as it also improves the metabolic rate which will help the client to lose excess weight. Moreover, insulin resistance syndrome has restricted the client from losing weight. This problem could also be resolved by the administration of daily exercise, appropriate nutritional intake and smoking cessation (Han amp Lean, 2016). Additionally, smoking cessation has been studied to have a significant positive impact on the management of the diabetic condition. This also helps in managing insulin resistance syndrome (Katyal amp Bollu, 2018). Some of the behavioral intervention to be introduced in case of the client will include patient education, counseling from time to time which can motivate patient from achieving the established goal (Berra, Rippe, amp Manson, 2015). Moreover, special counseling related to smoking cessation will be required which could be provided through the setting of specific routine.
The evaluation of all of the nursing intervention will also have a crucial role in managing Peters condition. The evaluation will primarily focus on the reduction of the weight, the decrease in blood glucose level, and cessation of smoking. Moreover, the impact of every counseling session also needs to be monitored. Participation in regular physical activity will enable the client to lower the lethargicness and will allow him to maintain fitness (NIH, n.d). This will also empower the client to perform his day-to-day life activity himself. The cessation of smoking will also improve the circulation level of the patient which will decrease the problem of shortness of breath and cholesterol level (ADA, 2015).
Before the beginning of this study, I was quite unsure about the exact method that could be implemented to improve the clients condition. However, at the last of the study, I was able to support the patient for maintaining his optimal health condition. Moreover, I was able to make him agree that he will perform regular exercise and strictly follow the prescribed nutrition every day. I was also able to convince the client to quit smoking and motivate him by taking multiple counseling session. Therefore, through following CRC I was able to manage multiple chronic health condition of the client efficiently.

References
American Diabetes Association. (2015). 4. Foundations of care education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization.Diabetes Care,38(Supplement 1), S20-S30.
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Mhlisen, M. H., Pasgaard, A. A., Curtis, T., Overgaard, C., Torp-Pedersen, C., amp Bggild, H. (2017). Unemployment as a consequence of high levels of perceived stress and interaction by socioeconomic status A historical cohort study. InKongres for Medicinsk Studenterforskning, 3132.
Nagrebetsky, A., Brettell, R., Roberts, N., amp Farmer, A. (2014). Smoking cessation in adults with diabetes a systematic review and meta-analysis of data from randomised controlled trials.BMJ open,4(3), e004107.
NIH. (n.d.). Benefits of Quitting. Retrieved from https//smokefree.gov/quit-smoking/why-you-should-quit/benefits-of-quitting
NYU Langone Health. (2019). Lifestyle Modifications for Obesity. Retrieved from https//nyulangone.org/conditions/obesity-in-adults/treatments/lifestyle-modifications-for-obesity