Priorities of care in the nursing profession case study answers

Subject Name : Nursing

Case Study

The establishment of priorities of care in the nursing profession requires an in-depth understanding of the patient’s medical conditions, medical history, and medication interventions. Nursing care requires an efficient approach to maintain accountability in the profession (Butcher, 2018).

Thus, the adaptation of adequate nursing interventions requires taking note of the patient’s medical history and current status, analysis of the case, designing appropriate goals, implementation of interventions, evaluation of outcomes, and overall reflection of the process. In this study, the case of Peter Mitchell will be described on the above basis, followed by a self-reflection section based on the nursing perspective.

Peter Mitchell, a 52-year-old male, was admitted to hospital due to Type 2 Diabetes Mellitus (T2DM), obesity ventilation syndrome (weight 145 kg), sleep apnea, hypertension, and gastroesophageal disease. Peter was referred to his GP due to symptoms such as shakiness, diaphoresis, increased hunger, high blood glucose levels, and insomnia.

Peter’s medical history shows he has been a smoker for approximately the last 30 years, consuming 30 cigarettes daily (heavy smoker). Previously, he had been admitted for medical assistance and was commenced on a low energy high protein (LEHP) diet for weight loss. His GP also discussed weight loss with him, but he never followed these instructions as he found them difficult to manage. He had also been reviewed by a physiotherapist who commenced a few light exercises for weight loss, which he was asked to continue post-discharge.

Peter is currently unemployed and receiving government support. He lost his job three years ago due to his weight problem, which led to repeated incidents of fatigue and discomfort. He lives alone and has become socially isolated, finding difficulty performing his daily living activities (ADLs). These problems have motivated him to lose weight. His current medications include insulin Novomix 30 BD, 1000 mg BD metformin, lisinopril 10 mg daily, Nexium 20 mg daily, metoprolol 50 mg BD, and pregabalin 50 mg nocte.

Obesity and T2DM are interrelated health issues that substantially decrease life expectancy, reduce quality of life, and increase healthcare costs. Diabetes is a metabolic disorder characterized by high blood sugar levels due to insulin deficiency (American Diabetes Association, 2018). Body mass index (BMI) strongly correlates with blood sugar levels and insulin resistance. In obese individuals, non-esterified fatty acids, hormones, glycerols, proinflammatory markers, and other components increase. Reduced insulin production from pancreatic beta cells elevates plasma fatty acids, restricting glucose entry into muscle cells (Tangvarasittichai, 2015). These conditions lead to both obesity and T2DM.

Adequate nursing interventions for Peter address social isolation, T2DM, overweight, and insomnia. His overweight contributed to job loss, and living alone after divorce with two separate children has lowered his self-esteem. Comorbid conditions exacerbate both physical and psychological effects.

Interventions include lowering blood glucose levels, resolving overweight, managing insomnia, diaphoresis, increased hunger, and social isolation. Nursing interventions are based on developing SMART objectives to enable improvement within a specific timeframe. Low self-esteem, related to reduced motivation, can be improved by establishing a healthy patient-nurse relationship for sharing concerns. This fosters trust, allows the nurse to motivate the patient, and informs the patient about improving health (Marso, 2016).

The second goal is reducing overweight within six months to improve ADLs. The third goal is maintaining blood sugar levels immediately and continuously. Managing blood sugar levels helps control sleeplessness, diaphoresis, increased hunger, and insomnia. Both obesity and T2DM are interrelated, increasing heart disease risk (Jayanthi, 2017).

Management of T2DM involves regular blood sugar monitoring (optimal range: 70–180 mg/dL) (Swiger, 2016), enabling physicians to provide appropriate medication. Nurses educate the patient on using a glucometer and keeping records for self-monitoring post-discharge (Ellis, 2019).

Peter is administered insulin and metformin for controlling T2DM. Nurses must administer insulin per physician instructions, emphasizing medication inspection (expiry date, color) and proper injection sites (Butcher, 2018). Nutritional intake should be monitored and guided by a nutritionist. Blood glucose should be checked upon waking, before meals, and before bed, and increased water intake helps control symptoms. Daily blood pressure monitoring is essential. Nurses also educate patients on foot care to prevent neuropathy, including daily inspection, toenail cleaning, and scrubbing (Hartstra, 2015).

Overweight can be managed through daily exercise, which also lowers blood glucose. Regular walking and passive exercises help improve his condition (Tai, 2015).

Development of SMART goals and an action plan improves health conditions. Regular blood glucose monitoring allows physicians to adjust medication doses appropriately. Improved knowledge enables self-management post-discharge. Adequate nutrition and exercise aid in managing T2DM and obesity, supporting timely achievement of set goals.

Initially, my knowledge of caring for patients with T2DM and obesity was confined to theory. This study provided practical experience, helping me face contemporary challenges. I learned to deal respectfully with patients, educate them about their health, and establish healthy patient-nurse relationships. I also learned to treat patients as individuals rather than just as sick people, enhancing my practical nursing skills.

The case study clarified maintaining the condition of patients with T2DM and obesity. In-depth study helped identify specific issues, set SMART goals, and take necessary actions. Self-reflection improved self-awareness and understanding of strengths and areas for improvement, allowing me to correlate theoretical knowledge with practical practice.

References

American Diabetes Association. (2018). 4. Lifestyle management standards of medical care in diabetes 2018. Diabetes Care, 41(Supplement 1), S38-S50.
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2018). Nursing Interventions Classification (NIC)-E-Book. Elsevier Health Sciences.
Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.
Hartstra, A. V., Bouter, K. E., Bäckhed, F., & Nieuwdorp, M. (2015). Insights into the role of the microbiome in obesity and type 2 diabetes. Diabetes Care, 38(1), 159-165.
Jayanthi, R., Srinivasan, A. R., Hanifah, M., & Maran, A. L. (2017). Associations among insulin resistance, triacylglycerol/high density lipoprotein (TAG/HDL ratio), and thyroid hormone levels: A study on type 2 diabetes mellitus in obese and overweight subjects. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11, S121-S126.
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., & Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 375(4), 311-322.
Swiger, P. A., Vance, D. E., & Patrician, P. A. (2016). Nursing workload in the acute-care setting: A concept analysis. Nursing Outlook, 64(3), 244-254.
Tai, N., Wong, F. S., & Wen, L. (2015). The role of gut microbiota in the development of type 1, type 2 diabetes mellitus and obesity. Reviews in Endocrine and Metabolic Disorders, 16(1), 55-65.
Tangvarasittichai, S. (2015). Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World Journal of Diabetes, 6(3), 456.