Dsicuss about the Assessment and Management of the Clinical Problems.
Clinical reasoning cycle can be defined as the procedure through which the healthcare professionals use their inductive as well as deductive cognitive skills to make clinical decisions for providing safe care to patients. Researchers are of the opinion that clinical reasoning can be considered as the approach that involves scientific knowledge that may be sometimes in the form of scientific reasoning (Wills & Kelly, 2018). In clinical reasoning cycle, critical thinking is considered inherent in clinical reasoning which thereby helps professionals to take decisions that result in best outcomes for the patients (Tate et al., 2016). The professionals then need to evaluate the outcomes of the initiatives taken and reflect on and learn from the procedures. This assignment will exhibit how a professional can use the CRC cycle to sequentially proceed through the case of Peter and help him with interventions so that he can develop a better quality life.
Peter Mitchell is seen to be a 52 years old man who is currently divorced and has two sons. Sons do not have very close relationships with their father and rarely visits him as they live in other towns. He is seen to suffer from diabetes and even does not know how to properly control the disorder for better life. He is also suffering from obesity and smokes about 20 cigarettes in a particular day. He is also seen to be in the preliminary stage of depression and has isolated himself socially. H e is quite embarrassed by his huge weight that may be another reason for his depression.
His disorder of obesity is the first priority of nursing professionals. Two important connections are found between the chronic situations of obesity as well as diabetes. His ill controlled obesity symptoms have been the main reason for which his diabetes could not come under control. Researchers have stated that when individuals exhibit overweight conditions, it creates a stress on the endoplasmic reticulum which are membranous networks found inside the cells (Brown et al., 2017). When these organelles have more the amount of nutrients that they can carry successfully, the networks begin sending alarming signals. These signals tell the cells of the body to slow down or dampen the receptors of insulin in the cells that are present on the surface. Therefore, the cells of the body become resistant to insulin for which sugar level in the blood increases. Researchers have also stated another important theory that links obesity with diabetes. Abdominal fat mainly causes the fat cells to release a particular type of chemicals that are called the pro-inflammatory chemicals. These chemicals become successful in making the body less sensitive to action of the insulin. Therefore, the cells of the body become less responsive when the pro-inflammatory chemicals are present in the body (Cook eta l., 2018). Obesity hyperventilation syndrome has mainly taken place because of ill-managed obesity. Here, the patients feel to breathe rapidly as well as deeply. As a result, it leads to high blood carbon dioxide as well as low oxygen concentration sin the blood. This may expose him to lung disorders in future.
Nursing professionals can conclude that as Peter has poorly managed diet system and no proper health literacy to maintain obesity as well as diabetes. He has developed serious syndromes of sleep apnoea, obesity hyperventilation syndrome, increased hunger and high basal glucose level. If both the disorders are treated properly, he will develop better quality lives. From the case study, it becomes quite clear that Peter suffers from lack of determination and confidence to adapt to different interventions to lose weight although he understand the necessity of the interventions in his life. Proper health literacy would be ensured for Peter where he should be first taught about how his obese situation had been the reason of his poorly controlled diabetes and how they are threatening his life. The first initiative of the nurse would be to counsel him in ways by which they can assure peter’s self-inclination and determination to follow the strategies proposed by them (Lewis et al., 2016). Once they are confirmed that Peter is determined to follow their advice, they should develop a diet plan for Peter. Peter should be advised to undertake light physical exercises that would help him burn down her extra calories should follow this. He should begin with easier exercise for less than 10 minutes that would be followed by longer periods of exercises in the later days. He should be also advised to be sure that he has less sedentary time and should involve himself in different light activities (Teixeira et al., 2015). Diabetes educator can be assigned to him so that he can learn how to measure blood glucose levels, check them regularly, administer medications effectively and keep his BGL level in check.
Another priority area that the nursing professionals should provide importance to is the controlling of blood pressure of the patient and thereby maintaining the symptoms of hypertension. The normal blood pressure of patient is usually 120/80mmHG. However, in case of the patient, it is seen that he has very high pressure that is about 180/92 mmHg. This makes the patient vulnerable to stroke, heart attacks and many others. Therefore, the professionals should take initiatives by which his blood pressure should be kept in check so that he remains safe from stroke, heart attack and many others (Hunter, 2012). Peter’s habit that makes it most vulnerable to high level of blood pressure is his smoking behavior where he smokes for about 20 cigarettes per day.
Smoking of nicotine is one of the most important reason for which this disorder may take place as nicotine results in increasing of heart rate and blood pressure (Butcher et al., 2018). Researchers are of the opinion that nicotine is responsible for narrowing the arteries called vasoconstrictions as well as hardening of the walls of the arteries. This often exposes the blood to undergo clotting which thereby puts stress on the heart (Brown et al., 2017). For this reason, individuals are exposed to stroke and heart attacks. Fatty substances called plaques may also build up in the arteries affecting the smooth flow of blood and therefore blood pressure increases (Boddenheimer & Baul, 2016). Therefore, nursing professionals should help Peter to control his smoking behavior so that his blood pressure remains under control. In order to help him to leave his smoking habit, substance abuse counselor can be arranged for him who would help him to be self-determined, motivated and enthusiastic to live his smoking habit and start afresh. Nicotine replacement therapy can be proposed for him as it helps individuals to overcome their habits and urges to smoke nicotine (Martinez et al., 2014). Moreover, nicotine replacement products should also be proposed to him like Nicotine nasal spray, Nicotine inhaler, Sublingual nicotine tablet, Nicotine lozenge and others (Con et al., 2015). He should be also taught to measure his blood pressure level so that he can understand whether his blood pressure levels are stable or requires consulting health professionals. Besides, the smoking cessation therapy, the nursing professional should also inculcate a teaching session where she should be describing Peter about the importance of nutritional therapy, drug therapy, physical activity, home monitoring of BP as well as tobacco cessation. The professional would also encourage Peter about lifestyle modification were the first initiate would be weight reduction of the patient. Dietary approach would mainly involve eating several servings of fishes each week. He should also eat plenty of vegetables and fruits. Moreover, he should also take lot of fibers in is diet and drink lot of water. He may also follow the DASH diet that is highly beneficial in lowering of blood pressure. He should be also instructed to lessen dietary intake of sodium and not adding salt in his food. Moreover, regular physical activities as swimming, jogging, brisk walking and others help in maintaining the weight and keeps lowered blood pressure. Stress also has huge contribution in the increase of blood pressure and therefore it is important for the nursing professional to make him introduce to relaxation therapy. This relaxation therapy along with guided imagery and biofeedback also help in decreasing blood pressure. Moreover, the nursing professionals should assess effectiveness of the coping strategies by closely observing the behaviors of Peter. She should see how well, peter is able to verbalize concerns, feelings, and his willingness to participate in the treatment plan. This will help the nurses to understand how well he would be self-motivated to follow the care plans. If peter is not showing self-determination, he should be counseled before beginning care interventions.
From the entire discussion, it is seen that clinical reasoning cycle has helped the professionals to reflect each of the aspects of Peter’s health and also helped them to sequentially develop a plan where two health priorities of Peter was established. Proper interventions had be proposed for Peter so that he can overcome his ill health, develop health literacy about his conditions, feels empowered and thereby can lead a proper quality life free from any life threats.
References:
Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role for nurses. New England Journal of Medicine, 375(11), 1015-1017.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2018). Nursing Interventions classification (NIC)-E-Book. Elsevier Health Sciences.
Conn, V. S., Ruppar, T. M., Chase, J. A. D., Enriquez, M., & Cooper, P. S. (2015). Interventions to improve medication adherence in hypertensive patients: systematic review and meta-analysis. Current hypertension reports, 17(12), 94.
Cook, D. (2018). Adult obesity 2: treatment and management options for weight loss and maintenance. Nursing, 9, 57.
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters Kluwer/Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson
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Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.
Martínez-González, N. A., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing, M., & Rosemann, T. (2014). Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC health services research, 14(1), 214.
Tate, D. F., Lytle, L. A., Sherwood, N. E., Haire-Joshu, D., Matheson, D., Moore, S. M., … & Michie, S. (2016). Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions. Translational behavioral medicine, 6(2), 236-243.
Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I., … & Brug, J. (2015). Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.
Wills, J. D., & Kelly, M. (2018). Systematic review: What works to address obesity in nurses. Occupational Medicine.
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