NRSG366 Semester One 2018
Assessment Task One: Case Study One
Multiple factors influence the care of patients with chronic conditions. As a Primary Heath Care nurse, it is important that care given is prioritised based on both clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating and collaborating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions.
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. Please refer to the subject outline and marking rubric when answering this question.
Case scenario
Peter Mitchell is a 52 year old male with morbid obesity and 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 referral to community care unit for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities.
Past medical history
• Obesity (weight 145kgs with a BMI of 50.2m2).
• Type 2 diabetes (Diagnosed 9 years ago)
• Hypertension
• Depression (Diagnosed three months ago by GP).
• Sleep apnoea
• Gastro oesophageal disease reflux disease
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 is socially isolated because he is embarrassed by his size and he rarely goes out. 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.
Current Medication
• Insulin Novamix 30 B D (34units mane & 28units nocte)
• Metformin 500mg BD
• Lisinopril 10mg daily
• Nexium 20mg daily
• Metoprolol 50mg BD
• Pregabalin (Lyrica) 50mg nocte
Last observations on discharge
• Weight 145kgs
• Height 170cms
• BP 180/92mmHg
• RR 23 Bpm
• HR 102 Bpm
• Sp02 95% on RA