Case Study on Chronic Kidney Disease and type 2 diabetes mellitus
The prioritised nursing care needs of the patient will be described using Levitt-Jones’ Clinical Reasoning Cycle in this case study. The 8 steps of cycle; patient situation consideration, cues collection, processing information, issue identification, goal establishment, acting, evaluating result and reflecting on progression and learning will be described respectively (Levett-Jones, 2013).
Mr George aged 51 years; an aboriginal man visited a general practitioner (GP) for his annual health examination recently. Upon presentation, various health problems were identified. He has a Chronic Kidney Disease (CKD) stage four, type 2 diabetes with foot ulcer, macroalbuminuria resultant to diabetes nephropathy, obesity. About his family history, he has a wife and three kids. Both the husband and wife receive a pension for disability and carer payment respectively for two years. He has a history of Stroke 2 years back. There is a history of dialysis in his extended family members. George is a former smoker. He is under furosemide, metformin, atorvastatin, vitamin D and sodium bicarbonate. However, George is unaware of the importance of prescribed medications and is unsure if they are good to him.
When Mr George arrived at the clinic, he had foot ulcer , weight gain, elevated cholesterol and gradually deteriorating kidney function. The vital status was BP- 153/93 mm of Hg (targeted BP is 130/80 mm of Hg), weight 104kg (10kg more in 2 years), urine albumin level- 30mg/mmol, GFR 27ml/min/1.73m2, serum creatinine- 237mmol/L, HbA1c- 78mmol/mol (higher than the targeted value i.e. 53mmol/mol). Regular monitoring of foot ulcer, blood glucose level, kidney function test, weight control should be done to prevent further complication. Moreover, George has eyesight sight and found oedematous on physical assessment.