Evidence Based Nursing Research for Reasoning - myassignmenthelp

Question: Discuss about theEvidence Based Nursing Research for Clinical Reasoning. Answer: Nurses can provide prioritised care the patients by using clinical reasoning cycle. Levett Jones clinical reasoning cycle is a step wise approach for providing nursing intervention. It incorporates multiple sequential steps like collection of patient information, processing of information, planning and implementing interventions, evaluating outcomes and reflecting on and learning from the process. Levett Jones clinical reasoning cycle gives opportunity for the nurse to think critically and helps nurse to understand patients condition and plan intervention accordingly. In this essay, clinical reasoning cycle is being followed to prioritise care for Peter. First prioritised care identified for Peter is reduction in body weight and second prioritised care is reduction in blood glucose level. In this case scenario, case of 52 yr old Peter Mitchell is being discussed. Peter is having past medical history of obesity, type 2 diabetes, hypertension, depression, sleep apnoea and gastro oesophageal disease reflux disease. Data indicates that his pat body weight was 145 kgs and BMI was 50.2 m2. Moreover, due to administration of insulin, he was gaining significant amount of body weight. Hence, first prioritised to be provided to Peter is weight reduction and keeping body weight in control. Along with medical intervention, dietician and physiotherapist intervention also required for his body weight control. Dietician recommended him to consume low energy and high protein diet. Low energy and high protein content diet can be helpful to reduce energy reserve and reducing body weight. Physiotherapist asked him to perform light exercise which can result in more energy expenditure as compared to the energy consumption. Increase in body weight is associated with other several co-morbid conditions diabetes, hypertension and depression. These conditions can be effectively controlled by control in the body weight. It is evident that obese people can have breathing problem also. All these conditions are evident in Peter. His blood pressure is 180/92 mmHg which is higher as compared to the normal blood pressure which is 120/80 mmHg. His respiratory rate is 23 Bpm which is higher as compared to the normal respiratory rate which should be between 12 20 Bpm. Higher respiratory rate is indication of the breathing insuffiecncy. His heart rate is 102 Bpm which is slightly higher as compared to the normal heart rate. There can be multiple risk factors for the occurrence of obesity like physical, physiological, psychological and genetic, environmental responsible for the occurrence of obesity (Ahima, Lazar, 2013). Diet and medication related factors are also responsible for the occurrence of obesity in the people. In case of Peter physical, psychological and medication related factors are responsible for increase in body weight in Peter. Peter is unemployed hence he is not doing much physical work, he is having psychological feeling of fatigue and insulin administration are the physical, psychological and medication related factors respectively are responsible for obesity in Peter. As compared to obesity, BMI is the important indicator for obesity (Zeng et al., 2014). BMI more than 40 m2 can be considered as the severe obesity condition. In case of Peter, BMI is 50.2 m2, which indicates he is severe case of obesity. It is evident that life-expectancy can be drastically reduced in obesity and it co-morbid conditions. Due to all these co-morbid conditions, Peter need to take different medications like insulin and metformin for reducing blood glucose level, lisinopril and metoprolol for hypertension and pregabalin for pain. Since, all these medications need to take simultaneously. Hence, these medications can affect efficacy of another medication. Hence, obesity need to be controlled to control other co-morbid conditions and to prevent medication interactions. Obesity is also responsible for the narrow opening of the respiratory tract; hence Peter is experiencing breathing problem and sleep apnea (Hamilton, Naughton, 2013). Social support is necessary for the control of body weight. However, Peter is experiencing social isolation due to sustained increase in body weight and failure to secure job. Social involvement can be helpful in augmenting his physical activity and also to reduce stress and dep ression. Stress and depression are responsible for exaggerating obesity. In obese patients, valve at the top can be overloaded which lead to secretion of acid in the stomach. This secretion of acid results in the gastro-intestinal reflux in obese patient like Peter. Different interventions like nutritional, medial, social, psychological and behavioural need to be implemented in case of Peter. Since, obesity is a multifactorial disease, it cannot be controlled by single intervention. Implementation of multiple interventions at the same time can be helpful in reducing body weight in severe body obese patients like Peter. By controlling weight of Peter, other co-morbid conditions can be effectively controlled (Haire-Joshu and Tabak, 2016). Second identified priority for Peter is to control blood glucose level. Nurse need to control blood glucose level to control other conditions like obesity ventilation syndrome and sleep apnoea. Control in the blood can be useful in controlling symptoms like shakiness, diaphoresis and increased hunger. Since, 9 years he is having diabetes and it resulted in other conditions like obesity and hypertension. It is evident that diabetes can sustain after age of 50. In diabetes, in response to increase in the blood sugar level body can produce more amount of insulin. However, due to destruction of beta cells insulin lose its sensitivity to control blood sugar level. Hence, diabetes patient become resistant to insulin. This insulin dependent diabetes is called as type-2-diabetes (Kahn et al., 2014). Obese people are more prone to type-2-diabetes due to unhealthy eating habits and lack of physical exercise. On the other side, insulin consumption for management of diabetes can increase body we ight. In case of Peter also, intake of insulin exaggerated increase in body weight. In the studies, it is evident that people with BMI more than 30 are prone develop type-2-diabetes (Li et al., 2014). It is evident that there is correlation between diabetes and sleep apnea. In insulin dependent diabetes, there are chances of development of diaphoresis. He is having long history of diabetes and he is taking insulin and metformin for the control of blood glucose level. In case of diabetes, blood glucose need to be checked prior to and after meal. Based on the glucose level, insulin dose need to be changed. If insulin is being administered without checking blood glucose level, there can be possibility of hypoglycaemic condition. This hypoglycaemic condition can occur, if glucose level is in control at the time of insulin administration. Diaphoresis is the symptom of hypoglycaemia and it is evident in Peter. Hence, nurse should perform accurate assessment prior to administration of the medication. Nutritional, physical and psychological factors are responsible for the increase in blood glucose level. Hence, multiple interventions like insulin administration, oral antidiabetic drug adm inistration, diet control, exercise and relaxation should be implemented for Peter. It is evident that integrated interventions can be helpful in more effective control of glucose level. Nurse should educate patient to consume medication on time and desired amount of medication need to be consumed. Diabetes medication need to be consumed for the longer duration of time. Moreover, diabetes is mostly present in the older people like Peter along with other co-morbidities. Hence, there are chances of non-adherence to medication consumption in case of Peter. Nurse should encourage him to adhere to medication consumption because irregular consumption of medication can lead to alteration in blood glucose level (Clark et al., 2014). It can lead to uncontrolled glucose levels which can lead to diabetic complications. Renal disorders and retinopathy are the prominent diabetic complications. Diabetic complications can affect multiple organs and lead to deterioration of Peter. Conclusion: Weight control and blood sugar level control were the two priority areas identified for Peter. These priority areas were identified based on the Levett Jones clinical reasoning cycle. Identification of these priority areas helped in effective nursing intervention for Peter. Multiple factors like physical, physiological, psychological and social factors were considered for providing nursing intervention for Peter. Diet, exercise and medication administration should be incorporated in addressing these two priority areas in Peter. Nurse should coordinate effectively with different professionals like dietician and physiotherapist to implement effective nursing intervention in Peter. As both obesity and diabetes are chronic condition, nurse should encourage him to adhere to medication consumption. Nurse should monitor effectively medication administration because Peter is consuming multiple medications simultaneously. Nurse should collect all the data for all the co-morbid conditions prio r to medication administration. In conclusion, nurse should play prominent role to implement Levett Jones clinical reasoning cycle in Peter. References : Ahima, R., and Lazar, M. (2013). The Health Risk of Obesity--Better Metrics Imperative. Science, 341(6148), 856-858. Clark, B., DuChane, J., Hou, J., Rubinstein, E., McMurray, J., and Duncan, I. (2014). Evaluation of increased adherence and cost savings of an employer value-based benefits program targeting generic antihyperlipidemic and antidiabetic medications. Journal of Managed Care Pharmacy, 20(2), 141-50. Hamilton, G., and Naughton, M. (2013). Impact of obstructive sleep apnoea on diabetes and cardiovascular disease. The Medical Journal Of Australia, 199(8), 27-30. Haire-Joshu, D., and Tabak, R. (2016). Preventing Obesity Across Generations: Evidence for Early Life Intervention. Annual Review of Public Health, ;37, 253-71. Kahn, S., Cooper, M., and Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083. Li, W., Katzmarzyk, P., Horswell, R., Zhang, Y., Zhao, W., and Wang, Y. et al. (2014). Body Mass Index and Stroke Risk Among Patients With Type 2 Diabetes Mellitus. Stroke, 46(1), 164-169. Zeng, Q., He, Y., Dong, S., ..Wang, Y. (2014). Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults. British Journal of Nutrition, 112(10), 1735-44.