Primary Healthcare Nursing: Identifying Priorities In Care And Utilizing Clinical Reasoning Cycle

The role of primary healthcare nurses in maintaining patient wellbeing

Discuss about the Prevalence of obesity hypertension among University.

Primary health care nurses are found to work in a plethora of healthcare settings that share characteristics, which are focused on forming a primary contact with the healthcare system. Thus, the role of a primary healthcare nurse encompasses maintaining a patient state of complete mental, social and physical wellbeing. Clinical reasoning refers to the process by which nursing professionals collect cues and process relevant clinical information, while treating a patient (Salminen et al., 2014). The basic nursing duty also encompasses protection and promotion of health, in addition to including reduction of health disparities and social exclusion (Marcum, 2012). The essay will identify two priorities of care and will use the clinical reasoning cycle to provide a justification for the same, with regards to the case study.

Setting priorities in nursing is an essential skills demonstrated by primary healthcare nurses. This priority setting facilitates better time management due to the fact that all nursing actions are found to have relative importance for nurses. Patient load management also depends largely on priority setting (Wielenga et al., 2015). According to research evidences, nurses are expected to demonstrate their clinical knowledge and skills while establishing their priorities for improving the overall health outcomes and satisfaction of their clients (Dalton, Gee & Levett-Jones, 2015). They are expected to apply their knowledge related to pathophysiology of a particular disease while establishing priorities for setting interventions. Prioritization also includes delivering best care services and evaluating the plan of care for multiple patients, and revising the plan as and when required (Morley et al., 2014). The two priorities of care in this case scenario include management of obesity and hypertension.

The patient situation- In the above case scenario, Peter is an unemployed divorcee, aged 30 years, who lives separate from his wife and two sons. He is socially isolated and finds it difficult to performing daily activities due to his obese condition. The patient Peter is found to suffer from morbid obesity that is considered as a serious health condition. It can be attributed to the fact that the patient the patient has a higher BMI than the normal range of 35. This condition in the patient is characterized by the extreme deposition of excess body fat in the body (Sturm & Hattori, 2013). Furthermore, the patient is also found to suffer from poorly controlled type 2 diabetes. This indicates presence of insulin resistance in his body. Presence of obesity ventilation in the patient can be also associated to his overweight that makes it difficult for him to breathe rapidly or deeply, thereby resulting in low amount of blood oxygen and high carbon dioxide levels (Carrillo et al., 2012). Vital signs measurements indicate that the patient suffers from hypertension. The heart rate and respiratory rate are within the normal levels. Further reports from the case study also indicate that obesity presents itself as a significant problem for the patient.

Setting priorities in nursing for better outcomes

Collecting cues or information- The role of a nursing professional should encompass reviewing the patient information, gathering new data from by monitoring the patient and collecting essential cures from the present scenario. The patient was admitted to the hospital after presenting symptoms of diaphoresis, shakiness, increased hunger, high blood glucose levels, and breathing problems. His medical history indicates that Peter had also consulted a dietician and commenced on an LEHP diet for weight reduction. Evidences have established importance of this diet in weight loss (Wadden et al., 2013). Moreover, it is evident from the available information that presence of morbid obesity makes it difficult for Peter to perform a range of tasks. Research evidences suggest that morbid obesity, health and social isolation are closely associated and present considerable challenges to a person, in the form of discrimination and bias (Pantell et al., 2013). Conduction of a physical assessment helped in confirming presence of hypertension and obesity in the patient. 50mg BD metoprolol and 10mg lisinopril administration is also accurate as they will help in lowering the persistent high blood pressure, thereby preventing further risks of cardiovascular and renal complications (Liu et al., 2013).

Information processing- Nursing process refers to the scientific method that is used by all nurses for ensuring the quality of care being delivered to all patients. This nursing approach often encompasses five different steps of processing of information, namely, assessment, diagnosis, planning, implementation and evaluation.  During the assessment phase the primary healthcare nurse is responsible for gathering relevant physiological, psychological, spiritual, and sociological status. This data collection depends on physical examinations, and reference to the patient history. In this case scenario, the diagnosing step would also encompass the fact that nurses will confirm whether the patient Peter is at an increased risk of developing health complications due to his problems. Several risk factors are associated with the symptoms presented by Peter that makes him more susceptible to develop cardiovascular disorders. According to research evidences, gender differences play a major role in development of cardiovascular diseases. These diseases are found to contribute more to death of men on a global scale (EUGenMed et al., 2015). Presence of depressive symptoms in the patient can be not only attributed to his isolation from the family members, but also to obesity. Patients suffering from morbid obesity are about 25% more likely to suffer from mood disorder such as, depression (Preiss, Brennan & Clarke, 2013). This is correlated to low self-esteem, poor self-image, and social isolation (Witherspoon et al., 2013). This helps in establishing links between depression and obesity in the patient. Moreover, obesity is also strongly correlated with hypertension and cardiovascular disease. High arterial pressure maintained during obesity contributes to hypertension (Nguyen & Lau, 2012). The patient is also found to suffer from sleep apnea, the most common cause of which is obesity and excess weight. This obstructive sleep apnea may also adversely affect multiple organ systems in his body.

Using clinical reasoning cycle

Problem identification- The diagnosing phase involves making education judgments about actual or potential health problems pertaining to the patient. The health problems and issues will be identified by synthesizing relevant facts and drawing conclusions from the same. An analysis of the case study indicates that the two major priorities are related to obesity and hypertension management. Peter was initially of 105 kgs. However, following insulin administration and losing his job, he was found to gain significant weight, which in turn is resulting in fatigue and uncomfortable feelings. Hypertension and obesity is also making it difficult for Peter to perform the daily activities that confirms that management of hypertension and morbid obesity should be the major nursing priorities.

Establishing goals and taking actions- Following an agreement on the diagnosis, a plan of action will be developed. In this case, there are a range of diagnosis related to obesity, and hypertension needs to be addressed. Thus, the nurse will be responsible for prioritizing each assessment and devoting time to all symptoms. The implementation phase involves following through the proposed plan of action, which focuses on achievable outcomes. Primary healthcare nurses responsible for administering interventions that will help the patient lose weight, and lower the arterial pressure, thereby facilitating his quality of life. Nursing goals for obesity management include identification of the risk factors and inappropriate behaviour that have contributed to the problem. The nurse will also be responsible for preparing a diet plan and determining the nutritional knowledge for treating the same (Sargent, Forrest & Parker, 2012). This is mainly due to the fact that obese patients have been found to have lower health-related QoL, across their health and physical perceptions, when compared to non-obese people (Black et al., 2013). The nursing intervention will include reviewing the patient history and conducting a review of the daily calorie intake, eating habits and food amounts. The nurse will also explore and discuss all events and emotions related to the eating pattern. An effective diet plan will also be formulated using available knowledge regarding the height, age, body build, gender and nutrient requirements of the patient (Milagro et al., 2013). Further goals include establishing the importance of avoiding fat-rich diet and weighing periodically to obtain appropriate body measurements (Hu, 2013). The nursing priority regarding obesity management will also include development of an appetite reduction plan and administration of appetite-suppressant drugs such as, mazindol, and diethylpropion (Kim & Park, 2012).

Identifying priorities of care for the case study

Goals for hypertension management focus on maintaining blood pressure within the normal ranges, demonstration of a stable cardiac rhythm, and reduction of cardiac workload. Major nursing actions will focus on reviewing the risk factors that might contribute to cardiac stress, and checking of the laboratory data and monitoring the BP. The patient will be subjected to auscultation for breath sounds and heart rates. Presence of peripheral and central pulses will be noted, in addition to observing the skin colour, temperature, capillary refill time and moisture (Carter, Bosworth & Green, 2012). Evidences of extreme fatigue, sudden weight gain, extremity swelling and shortness of breath will also help in determining impending cardiac failure or poor ventricular function. Comfort measures will be provided, followed by maintainance of activity restriction (Joffres et al., 2013). Response of the patient to the administered medications will also be noted for controlling the blood pressure levels (Radhakrishnan, 2012). These medications are commonly beta-blockers that help in lowering the arterial blood pressure.

Evaluation of outcomes and reflection- A complete evaluation will be done to determine whether the goals of enhancing patient wellness have been met. The outcomes of the aforementioned interventions should be evaluated and reflected by the nursing professionals for enhancing their clinical expertise. Outcome evaluation will assist the nurse to identify whether the patient is eating to satisfy an emotional or physiological need. A good reducing diet will also result in low fat intake and prevent loss of lean muscle mass. It will also result in eliminating metabolic imbalances that might contribute to weakness, fatigue and ketosis. Determining activity levels and monitoring effects of a progressive exercise program will help in adherence to the plan and normalizing the BMI. Obesity evaluation measures will encompass an assessment of the changes in the weight of the patient, changes in associated health condition such as, BP and weakness. Assessing changes in Peter’s attitude and knowledge about morbid obesity will help in measuring outcomes (Baig et al., 2015). Using a tool for evaluating blood pressure levels, determining the health risk appraisal and effectiveness of diagnostic procedures in reducing BP will help in its evaluation (Castera, Pinzani & Bosch,2012). In addition to assessing awareness of the patient regarding behaviours that might reduce hypertension risks, the BP must be measured in both arms and thighs, thrice while the patient is at rest, sitting or standing (Schapira et al., 2012). Use of an accurate technique and proper cuff size also plays a major role. The primary healthcare nurse will then be involved in contemplating the nursing process and identifying the nursing areas that can be done differently in future practice.

Addressing the problem of obesity and hypertension

To conclude, it can be stated that the clinical reasoning cycle is greatly dependent on critical thinking disposition of an nursing professional and is influenced by the philosophical perspective, attitude and preconception of the clients. Effective clinical reasoning skills are therefore useful in exerting positive impacts on patient outcomes. The case study analysis helps in confirming that nursing job is not just restricted to eliminating any infirmity or disease. Thus, nurses also work with the aim of reaffirming health as a basic human right. The clinical reasoning cycle helped in identifying major health disorders presented by Peter and the nursing interventions that should have been taken.

References

Baig, M., Gazzaz, Z. J., Gari, M. A., Al-Attallah, H. G., Al-Jedaani, K. S., Mesawa, A. T., & Al-Hazmi, A. A. (2015). Prevalence of obesity and hypertension among University students’ and their knowledge and attitude towards risk factors of Cardiovascular Disease (CVD) in Jeddah, Saudi Arabia. Pakistan journal of medical sciences, 31(4), 816.

Black, D. W., Shaw, M., McCormick, B., & Allen, J. (2013). Pathological gambling: relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life. Comprehensive psychiatry, 54(2), 97-104.

Carrillo, A., Ferrer, M., Gonzalez-Diaz, G., Lopez-Martinez, A., Llamas, N., Alcazar, M., … & Torres, A. (2012). Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 186(12), 1279-1285.

Carter, B. L., Bosworth, H. B., & Green, B. B. (2012). The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. The Journal of Clinical Hypertension, 14(1), 51-65.

Castera, L., Pinzani, M., & Bosch, J. (2012). Non invasive evaluation of portal hypertension using transient elastography. Journal of hepatology, 56(3), 696-703.

Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to’flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29.

EUGenMed, Cardiovascular Clinical Study Group, Regitz-Zagrosek, V., Oertelt-Prigione, S., Prescott, E., Franconi, F., … & Knappe-Wegner, D. (2015). Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. European heart journal, 37(1), 24-34.

Hu, F. B. (2013). Resolved: there is sufficient scientific evidence that decreasing sugar?sweetened beverage consumption will reduce the prevalence of obesity and obesity?related diseases. Obesity reviews, 14(8), 606-619.

Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., … & Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ open, 3(8), e003423.

Nursing interventions for managing obesity

Kim, K. S., & Park, S. W. (2012). Drug therapy for obesity. The Korean Journal of Obesity, 21(4), 197-202.

Liu, H., Xing, X., Huang, L., Huang, Z., & Yuan, H. (2013). The expression level of myocardial β1-adrenergic receptor affects metoprolol antihypertensive effects: a novel mechanism for interindividual difference. Medical hypotheses, 81(1), 71-72.

Marcum, J. A. (2012). An integrated model of clinical reasoning: dual?process theory of cognition and metacognition. Journal of evaluation in clinical practice, 18(5), 954-961.

Milagro, F. I., Mansego, M. L., De Miguel, C., & Martinez, J. A. (2013). Dietary factors, epigenetic modifications and obesity outcomes: progresses and perspectives. Molecular aspects of medicine, 34(4), 782-812.

Morley, J. E., Caplan, G., Cesari, M., Dong, B., Flaherty, J. H., Grossberg, G. T., … & Martin, F. (2014). International survey of nursing home research priorities. Journal of the American Medical Directors Association, 15(5), 309-312.

Nguyen, T., & Lau, D. C. (2012). The obesity epidemic and its impact on hypertension. Canadian Journal of Cardiology, 28(3), 326-333.

Pantell, M., Rehkopf, D., Jutte, D., Syme, S. L., Balmes, J., & Adler, N. (2013). Social isolation: a predictor of mortality comparable to traditional clinical risk factors. American journal of public health, 103(11), 2056-2062.

Preiss, K., Brennan, L., & Clarke, D. (2013). A systematic review of variables associated with the relationship between obesity and depression. Obesity Reviews, 14(11), 906-918.

Radhakrishnan, K. (2012). The efficacy of tailored interventions for self?management outcomes of type 2 diabetes, hypertension or heart disease: a systematic review. Journal of advanced nursing, 68(3), 496-510.

Salminen, H., Zary, N., Björklund, K., Toth-Pal, E., & Leanderson, C. (2014). Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning. Journal of medical Internet research, 16(1).

Sargent, G. M., Forrest, L. E., & Parker, R. M. (2012). Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. obesity reviews, 13(12), 1148-1171.

Schapira, M. M., Fletcher, K. E., Hayes, A., Eastwood, D., Patterson, L., Ertl, K., & Whittle, J. (2012). The development and validation of the hypertension evaluation of lifestyle and management knowledge scale. The Journal of Clinical Hypertension, 14(7), 461-466.

Sturm, R., & Hattori, A. (2013). Morbid obesity rates continue to rise rapidly in the United States. International journal of obesity, 37(6), 889.

Wadden, T. A., Hollander, P., Klein, S., Niswender, K., Woo, V., Hale, P. M., & Aronne, L. (2013). Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. International journal of obesity, 37(11), 1443.

Wielenga, J. M., Tume, L. N., Latour, J. M., & van den Hoogen, A. (2015). European neonatal intensive care nursing research priorities: an e-Delphi study. Archives of Disease in Childhood-Fetal and Neonatal Edition, 100(1), F66-F71.

Witherspoon, D., Latta, L., Wang, Y., & Black, M. M. (2013). Do depression, self-esteem, body-esteem, and eating attitudes vary by BMI among African American adolescents?. Journal of pediatric psychology, 38(10), 1112-1120.