Task

This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions.

Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification.

Scenario One: Peter Mitchell

Peter Mitchell is a 52-year-old male with type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping. Peter has been a smoker for approximately 30 years and smokes approximately 20 cigarettes per day.

On his previous admission, Peter was seen by a dietician and commenced on low energy, high protein diet (LEHP) to assist with weight reduction. His GP had previously discussed weight loss with Peter, however, he had never wanted to do anything about it as it seemed ‘too hard’. Peter was also reviewed by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.

Peter has been discharged home with a referral to you as the community nurse for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities.

Social History

Peter is an unemployed male who receives government benefits. Peter lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland. Peter states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 105kg but since starting insulin and losing his job he has gained a significant amount of weight.

Consequently, because of his weight issues, Peter has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is a divorcee who lives alone, his two sons live in the same state but live in different cities and rarely visit him. He has increasingly become socially isolated as he is embarrassed by his size. Peter is also finding it increasingly difficult to perform activities of daily living (ADLs). Peter realises that he is in the prime of his middle age life and is motivated to lose weight and quit smoking but isn’t sure where to start.

Medical History

Obesity – weight 145kgs

Type 2 diabetes (Diagnosed 9 years ago)

Hypertension

Sleep apnoea

Gastro oesophageal disease reflux disease

Current Medications

insulin Novomix 30 B D (34 units mane & 28 units nocte)

metformin 1000mg BD

lisinopril 10mg daily

Nexium 20mg daily

metoprolol 50mg BD

pregabalin 50mg nocte